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How Witnessing Domestic Violence Affects Children

Short and Long-Term Effects of Witnessing Domestic Violence as a Child

Elizabeth is a freelance health and wellness writer. She helps brands craft factual, yet relatable content that resonates with diverse audiences.

Ann-Louise T. Lockhart, PsyD, ABPP, is a board-certified pediatric psychologist, parent coach, author, speaker, and owner of A New Day Pediatric Psychology, PLLC.

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Short-Term Effects of Witnessing Domestic Violence as a Child

• Long-Term Consequences

Protecting Children from Domestic Abuse

For victims of domestic violence —the physical attacks, emotional maltreatment, and other abuse endured are certain to take a toll on well-being. 

However, while the horrors of abuse are apparent in primary victims—children who witness the abuse of their mothers, fathers, or other family members, are impacted.

This article will look into the lasting psychological and physical effects of a child’s exposure to domestic violence . To reduce the risk of these effects, it is also important to highlight ways that children can be protected from harm’s way.

If you or a loved one are a victim of domestic violence, contact the National Domestic Violence Hotline at 1-800-799-7233 for confidential assistance from trained advocates.

For more mental health resources, see our National Helpline Database .

As an all-too-common occurrence across the country, domestic violence is an uncomfortable feature of many American homes. An estimated 10 million people are affected by incidents of domestic abuse annually, a number that widens when silent victims, like children, are considered.

In 2010, 1 in 15 children were exposed to cases of intimate partner violence, with a worrying 1 in 3 children also experiencing acts of violence.

The effects of domestic abuse on children may be apparent within a short period of time, while other damages may be noticed in the long run. Some of the immediate effects that children experience after witnessing domestic violence are discussed below.

Children are likely to remain on edge if they are always surrounded by the abuse of one parent by the other. These children will live in bated breath for the next time physical or verbal assault might take place in their home. This can breed a state of perpetual anxiety .

For pre-schoolers who witness this, it isn’t uncommon to revert to the habits of younger children. Thumb sucking, bedwetting , increased crying, and whining may result from observing abuse.

School-aged children can develop anti-social traits and may struggle with guilt over the abuse witnessed. These children typically take on the blame for the abuse their parent deals with, a belief that can strongly bruise their self-esteem .

Post-Traumatic Stress Disorder

One of the most devastating effects of domestic violence is its ability to cause post-traumatic stress disorder in children that are raised around it.

Despite being spared from physical abuse, the trauma of domestic violence is enough to cause dangerous changes in the developing brains of children. These changes may cause nightmares , changes in sleep patterns , anger, irritability, difficulty concentrating, and children may sometimes have the ability to re-enact aspects of the traumatizing abuse observed.

Physical Challenges

Mental health strains are a common result of witnessing the abuse of a parent. However, these consequences may sometimes be apparent in their physical well-being.

School-aged children may report headaches and stomach pains which are traceable to the tense situation back home. In infants, there is a higher risk of experiencing physical injury following the constant stream of abuse on a parent.

Aggressive Behavior

When teenagers witness domestic abuse, they tend to act out in reaction to the situation . They may fight, skip school, engage in risky sexual activities, or dabble in drugs and alcohol. These teenagers are also very likely to get in trouble with the law.

Physical Abuse

In many instances, children that live in abusive households are also likely to fall victim to this treatment themselves.

An abusive partner can very easily become an abusive parent or guardian—physically, verbally, and emotionally harming their children.

Long-Term Effects of Witnessing Domestic Violence as a Child

As helpful as distance might be, simply moving away from domestic violence isn’t enough to undo the damage caused by witnessing it.

Children that grew up watching a parent experience abuse are likely to deal with effects that last well into adulthood. Some of the long-term effects that children experience after witnessing domestic violence are addressed below.

The anxious child raised in a toxic, abusive environment may grow to become a depressed adult . The trauma of routinely witnessing domestic violence places children at a high risk of developing depression, sadness, concentration issues, and other symptoms of depression into adulthood.

Health Problems

A poor diet or environmental risks may not always be the primary causes of conditions like heart disease, obesity, and diabetes in adulthood.

In some cases, these illnesses have direct links to the physical, emotional, and verbal abuse a child witnesses or is subjected to.

Repeating Abusive Patterns

While abusive behavior can be repetitive, it's important to note that abuse does not always occur in a cyclical pattern. In fact, assuming that violence occurs in cycles can lead to victim-blaming. Abuse can be unpredictable and is it never OK.

Feeling the pain and anguish of witnessing violence doesn’t always guarantee that children will toe a different path. In some cases, early exposure to abuse simply sets the stage for children to walk that same line in adulthood.

In these cases, male children might physically abuse their partners after watching their fathers do the same. Likewise, women from homes that witness domestic violence are more likely to be sexually assaulted by their partners in adulthood.  

Knowing that domestic violence can have lasting effects on the physical, mental, and later life of children—it's important to properly shield them from abuse. The following are ways to protect a child from domestic abuse.

Make Safety a Priority

One of the best ways to protect the interest and well-being of a child is for victims to receive the necessary support they need to leave the abusive environment.

By doing this, children are spared further exposure to violence and are given a chance to grow up within healthier structures. 

Teach Children Healthy Relationship Dynamics

With a skewed view about romantic dynamics, talking to children about healthier interactions between partners can help to manage the damage caused after witnessing domestic violence.

Children should be taught healthy ways to resolve disputes in friendships. It's important that they learn wholesome ways that partners can relate with each other, taking care to share why violence has no place in relationships.

Educating Children About Boundaries

An effective way to manage the damage, and prevent a cycle of domestic violence is to teach children healthy boundaries.

Teaching children about autonomy (that no one has a right to touch their bodies or vice-versa) is a step in the right direction. Children should also be taught to always tell a trusted adult if another person is making them uncomfortable in any way.

A Word From Verywell

Domestic violence has the potential to leave lasting marks on direct and indirect victims. With psychological challenges like anxiety and depression likely to develop from domestic violence— receiving appropriate care from a mental health professional can help to manage these effects in children. Therapy can also help with navigating the emotional strain and trauma of living in a toxic environment.

National Coalition Against Domestic Violence. Domestic Violence and Children .

Office on Women’s Health. Effects of Domestic Violence on Children’s Health .

Tsavoussis A, Stawicki SP, Stoicea N, Papadimos TJ. Child-witnessed domestic violence and its adverse effects on brain development: a call for societal self-examination and awareness . Front Public Health . 2014;2:178. Published 2014 Oct 10. doi:10.3389/fpubh.2014.00178

Stiles MM. Witnessing Domestic Violence: The Effect on Children . Am Fam Physician . 2002;66(11):2052-2067.

Moylan CA, Herrenkohl TI, Sousa C, Tajima EA, Herrenkohl RC, Russo MJ. The Effects of Child Abuse and Exposure to Domestic Violence on Adolescent Internalizing and Externalizing Behavior Problems .  J Fam Violence . 2010;25(1):53-63. doi:10.1007/s10896-009-9269-9

Monnat SM, Chandler RF. Long Term Physical Health Consequences of Adverse Childhood Experiences . Sociol Q . 2015;56(4):723-752. doi:10.1111/tsq.12107

By Elizabeth Plumptre Elizabeth is a freelance health and wellness writer. She helps brands craft factual, yet relatable content that resonates with diverse audiences.

Effects of Domestic Violence on Children’s Social and Emotional Development Essay

Children between the ages of zero and six year are continuously learning and developing socially and emotionally. For an appropriate development, a child needs love and care from both parents. In the case of families experiencing domestic violence, the social and emotional development of children brought put in such families is affected negatively. Psychological wellness of the child is affected at early age and later in life.

Introduction

Domestic violence has been an issue in many societies in the world but considered as a family matter, it’s only of late that legal proceedings can be taken on an offender. Since women movements in 1970s, domestic violence has become a legal matter calling for police, courts and judicial process intervention.

When one is talking of domestic violence, what comes in mind is wife or husband violence; in most case women are on the receiving end, they are subjected to physical, psychological and emotional violence. However the scope of domestic violence extend far beyond this believe to include child abuse and the effects that such abuse have on a child.

Family violence is a term that can be used to describe the various forms of violence that happen within a family set up. A family is a sociological unit which includes parents and children. The most common types of violence within the family are wife abuse and child abuse. Violence in this sense may include slaps, pushes, sexual abuse, battering, and use of abusive words. A research conducted by in United States of America, shown that each year over 3.3 children suffer from domestic violence.

The recognition of this is affected by lack of data that can be used for the analysis. The effect is mostly psychological, emotional and sometimes physical. The most noted one is physical and thus emotional and psychological remains not recorded (Shaffer, 2009). This paper discusses how children social and emotional development is affected by exposure to domestic violence. It will focus on children below the age of six years.

Child emotional and social development and domestic violence

Between the ages of Zero years to six years, a child is constantly learning and developing emotional and social health/character. At this age, he has no much choice on what and who to believe. Parents have the burden of developing a healthy emotional and social need of the child. The environment that a child grows in affects his social and emotional development.

Socialisation factors dominate in his character building as well as personality. The family is the first socialisation stage that a child gets. What the child observes is registered in its mind and goes a long way in forming attitude, behaviours and feeling about a certain issues at hand. If the family is undergoing domestic violence, the child mind will be exposed to violence and will form perception and attitudes towards such.

For example if a child is brought up in a family that the husband dominated and when he battles the wife it is generally accepted; a male child from such a home will develop a believe that women are inferior than men and thus they should be bitten. At this tender age a child is not able to differentiate what is good and what is wrong but learns from what surrounds him or her.

Impact of domestic volence on the emotional regulation of children

Rigterink, Fainsilber , and Hessler in the Journal of interpersonal violence, observe that early exposure of children to domestic violence influences their emotion regulation abilities. To evaluate the effect, the trio used baseline vagal tone (VT) method as the measuring parameter/unit.

They observed that the effects have a long-lasting effect in a child’s life and affects its social and emotional health. The research by the trio went further and evaluated other effects that domestic violence has on trajectory of children’s physiological regulatory abilities; they observed that in preschool and lower classes, children who come from families experiencing domestic violence have low concentration in class and are more likely to be violent in class (Zerk, Mertin & Proeve, 2009).

Expressing ones emotions is an important aspect in human growth and development. In domestically violent homes, violence may sometime erupt when one of the parents has expressed his/her emotions. The child is learning all this and has seen where the problem came from. His mind will convince him/her that violence is as a result of someone expressing his feeling. In the future the child decides not to air out their views and feelings. This results to children who are emotionally troubled.

They don’t know when to express their feeling and fear if they do, they might be subjected to violence. Good communication is an element of how well a person can express himself. If the child at tender age fears expressing his feeling, the same will affect him in the future. A research done by Joseph, Govender & Bhagwanjee, in 2006 showed that in episodes of violence children are left to wonder which side they should take.

It said that girls cried openly in the presence of the parents but boys cried secretly when they reflect on what was happening to their parents. This is a retaliatory reaction; the children in the research said they felt like hitting the abusing parent but instead ended up in this form of retaliatory response. From a different angle, this is grudge that the child has created with one parent which affects their relationship in the future (Zerk, Mertin & Proeve, 2009)

In extreme conditions, children from these homes shows similar characteristics like those seen in children living in areas of total war. Their condition can be termed as post-traumatic stress.

In the case of wife-husband violence, always, one parent will be the offender and the other one the victim; in an ideal situation, a child needs the love of a both parents. In this case he will lack either because the offender feels that he is not obligated to love the child. His/her mind is occupied with what they are going through with the spouse and not the care of the child. He/she is not able to provide the needed emotional support to his/her child.

The other parent heart is troubled and cannot give care to the child. Eventually the child suffers. Since the brain of a child is young and willing to learn, the child looks for love in other places like television; which may not give him/her the right moral teaching. The agony of the child goes further since shelters available for battled women or men do not take care of children. The child is left hanging on the balance not to know whether to stay or move with the offended parent.

At this moment, the child psychological, social and emotional stability is affected. The child is exposed to making lifetime decisions at an age below six years. Training to domestic violence care givers overlook the effect the violence might have hand on children and thus they end up healing the family but leaving scars and unsolved questions in children. This emotionally and socially disturbs a child in such homes (Linda and Alison 2009).

Impact on social development with peers and other adults

A family is expected to be a unit of peace where a child gets emotional care and benefits from the parents. It forms the background of human socialisation. The child is taught on basic interaction strategies at home. When a child is brought up in family that do not respect children rights but goes ahead and abuses the child; the child development is influenced by such actions.

All forms of child abuse have long lasting effects on a child. It may be physical or emotional. Emotional violence is registered in a child life for a long period of time and keeps haunting them in one way or another. This influences how he interacts with other peers.

When parents are fighting in the presence of the children, the child out of fear starts to cry. He/she does not know what to do, who to support, who call help from. The child gets emotionally troubled (Anderson & Aviles, 2006). “We are what we were socialized to be”, this statement observes that if a child has been socialised in a violent family, chances are high that it will develop certain attitude towards violence and may end up being violent also.

It is appreciated that there might not be much statistical data regarding the number and age of effect, the truth stands that children are affected by domestic violence. Infants , preschool going children as well as children are affected and portray different responses which stems from the family background that they have come from. Young children exposed to family violence at tender age show an increased irritation, sleep disturbances and excessive aggression; this stems from what they see in life.

Being aggressive and not able to control ones anger is a show of a person/child who is emotionally disturbed,. When this happens it does not end at childhood age but goes to affect the child till adulthood. Children tend to practice what they see in television, homes and in the society they are living in. This explains the aggressiveness and anger that those from families undergoing domestic violence. The emotional difficulty can be seen at ages below the age of six years (Anderson & Aviles, 2006).

John Bowlby’s theory of internal working models

The theory states that for health social and emotional development, a child requires the care and emotional attachment of their parents. This lack in the case of domestic violence a child emotional development is drastically affected. At this tender age, a child has not interacted much with the outside world. He gets comfort and safety in its parents. His/her mind is opened to learn from the surrounding. In the case the family has had violence, the child experiences lack of trust in either parent.

He is not sure of who to trust. Parents are the most reliable people that a child can expect care, love and emotional needs satisfaction. In the case that the family is in constant violence, the child is not given attention and it’s emotional and safety needs are not met. These results to children do not trust their parents . this has a long effect in the child’s life. In later years trusting even one’s spouse will be a problem (Anderson & Aviles, 2006).

In most/all cases, in the case of violence, there is always an exchange of harsh words among the spouse or to a child. These things register in the mind of the child and in the future he may take them and believe that is the situation. For example if in violence the mother of a child refers his husband as useless, the child is likely to believe that his father is useless. This believes may haunt him in the future where in case his father does something out of the ordinary the child thinks he is doing that out of being useless.

When a family is undergoing domestic violence, both the parents are psychologically, emotionally and socially unsettled. They are having lot of unresolved businesses between themselves in what can be said to be a competition to fight for children’s favour. In this situation the child is neglected.

Neglect is in the form of provide for a child’s basic and emotional need. The parents may become unable to provide physical and emotional care to their children’s. Neglected children are depressed and emotionally troubled. They feel they are not treated well by the same people they trust for this care.

Alcohol has been used as an escapist method by parents whose families do not have peace. On the other hand the drunken parent cannot take care of his children effectively financially and emotionally. This results to neglected children. In later years, adolescence, the children experience constant emotional pain which can be shown on competent face towards the outside world. The child is always fearful and suspicious of the world he/she is living in (Carretta, 2008)

Learning theory of development

The theory states that development is an individual is affected by the socialization environment that he is living in. Children under the age of six years are constantly learning and their character is developing. They need emotional and social support to make them better human beings in the future.

If they are brought up in families which have constant domestic violence, they lack the much needed care from their parents and end up emotionally troubled. When they are relating with other kids whether in school or at home, they are affected by the feeling that they are inferior; in class work, the children do not understand as fast as they are expected to be absorbing.

This is because their mind is not set. They do not have peace of mind. To them the world is not being fair. When it comes with interaction with other children in games and other social activities, these children may be outdrawn or when playing he portrays aggressiveness, this may lead to other kinds negative perception towards the child a move that make the victim child more emotionally troubled (Fantuzzo, Fusco, Mohr & Perry, 2007).

Implications for an early childhood educator

An early child educator is the one who is responsible of early teaching of a child in formal education; it is important for him to know the signs and symptoms of a child who comes from families with domestic violence. After doing so he will be able to handle the child professionally in class.

When children are continuously seeing their parents fight, they are always feeling that they should come to the rescue of the victim. However, they are incapable of. Boys are affected even higher, they feel their weaknesses are being utilised by the violent parent.

The children feel anxious and powerlessness. They have to look for a coping strategy which they result to denial. In these situations to cope with the feelings, they use denial as a coping strategy to traumatic situation. An example is when a child is used to seeing parents in constant fights, he may say “that’s normal” such an attitude results from denial. This denial cognitive strategy results to a person who accepts pain even when they are not legitimate (Zerk, Mertin & Proeve, 2009).

Abraham Maslow, in his theory of hierarchy of needs, quotes psychological need as one human need. Fear is an element of psychological need. When a child seeing his parents in constant battle, the child fears that the same may happen to him/her. A violent partner threatens a family and the child lives in constant fear.

The panic caused shapes the attitude and psychological needs of the child. He always feels that his life is threatened. In case there is only one parent who is violent, the child feels threatened by the parent; ambivalence, the child starts taking sides in the family. He may in the future respond differently to the two parents. He is not sure who he can trust and why. This affects the emotional health of the child (Carretta, 2008).

How can the effect of domestic violence be changed

The effect that domestic violence especially those not directly on a child have been ignored for a long period of time. The focus has been domestic violence which considers the case of parties concerned (husband and wife) and has left the effects that this violence has on children from such families.

Children issues are talked when direct child abuse is being considered. The bitter truth is that children are also affected by domestic violence. At infant and tender age, the effects can be seen in the way the child preserves life. He may have negative attitudes and cannot control his/her emotions. When parents are fighting, the child suffers in silence and this have an effect on its cognitive development. He feels that life is not favouring him; he results to denial.

Lack of data and adequate research in the area have made psychologist and persons concerned about the welfare of relations ignore the need to incorporate child counselling in the event of a domestic child. The child emotional and social life is challenged.

The societies have the burden of understanding and appreciating this effect and should devise measures to atop the trend. For instance, during courtship and marriage counselling’s, couples should be trained on how not to fight or resolve their issues in an arguing manner.

They may for example take the bedroom strategy where they will withdraw from the children when solving issues. In the case of violence, counsellors should appreciate that children are equally affected by the violence and should have a section with the child. They should build confidence and give the child emotional support to face life after that (Horton, 2008).

Between the ages of zero to six years, a child is constantly learning new things. His social and emotional characters are developing. The development of these characters is influenced by the exposure that he gets from his parents. When brought up in a family that experiences violence, the child social and emotional development is affected. Domestic violence has been in the society since people started living together. Having differences in family is healthy but how a couple resolves the differences is where the problem lies.

In case of domestic violence, it is not the couple alone which suffer but their children too are affected socially and emotionally. What the child observes is registered in its mind and goes a long way in forming attitude, behaviours and feeling about a certain issues at hand. If the family is undergoing domestic violence, the child mind will be exposed to violence and will form perception and attitudes towards such. When exposed to violence his attitude, personality, behaviour and cognitive development is affected.

Anderson, T., & Aviles, A. (2006). Diverse faces of domestic violence. ABNF Journal, 17 (4), 129-132. Retrieved from CINAHL Plus with Full Text database.

Carretta, C. (2008). Domestic violence: a worldwide exploration. Journal of Psychosocial Nursing & Mental Health Services, 46 (3), 26-35. Retrieved from CINAHL Plus with Full Text database.

Emery, R. (1989). Family violence. American Psychologist, 44 (2), 321-328. doi:10.1037/0003-066X.44.2.321.

Fantuzzo, J., Fusco, R., Mohr, W., & Perry, M. (2007). Domestic Violence and Children’s Presence: A Population-based Study of Law Enforcement Surveillance of Domestic Violence. Journal of Family Violence, 22 (6), 331-340. doi:10.1007/s10896-007-9080-4.

Fritz, G. (2000). Domestic violence hurts children as well as adults. Brown University Child & Adolescent Behavior Letter, 16 (7), 8. Retrieved from Professional Development Collection database.

Horton, A. (2008). Domestic violence: the untold story. Journal of Human Behavior in the Social Environment, 18 (1), 31-47. Retrieved from CINAHL Plus with Full Text database.

Linda B. and Alison C.(2009). Inter-Parental Violence: The Pre-Schooler’s Perspective and the Educator’s Role. EARLY CHILDHOOD EDUCATION JOURNAL . Volume 37, Number 3, 199-207, DOI: 10.1007/s10643-009-0342-z

Joseph, S., Govender, K., & Bhagwanjee, A. (2006). “I can’t see him hit her again, I just want to run away… hide and block my ears”: A Phenomenological Analysis of a Sample of Children’s Coping Responses to Exposure to Domestic Violence. Journal of Emotional Abuse, 6 (4), 23. Retrieved from MasterFILE Premier database.

Rigterink,T., Fainsilber L., and Hessler, D.(2010).“Domestic Violence and Longitudinal Associations With Children’s Physiological Regulation Abilities”. Journal of interpersonal violence . 25 (12)

Shaffer, D. (2009). Social and Personality Development (6th Ed). Belmont, CA: Belmont

Zerk, D., Mertin, P., & Proeve, M. (2009). Domestic Violence and Maternal Reports of Young Children’s Functioning. Journal of Family Violence, 24 (7), 423-432. doi:10.1007/s10896-009-9237-4.

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IvyPanda. (2019, January 17). Effects of Domestic Violence on Children’s Social and Emotional Development. https://ivypanda.com/essays/effects-of-domestic-violence-on-childrens-social-and-emotional-development/

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1. IvyPanda . "Effects of Domestic Violence on Children’s Social and Emotional Development." January 17, 2019. https://ivypanda.com/essays/effects-of-domestic-violence-on-childrens-social-and-emotional-development/.

Bibliography

IvyPanda . "Effects of Domestic Violence on Children’s Social and Emotional Development." January 17, 2019. https://ivypanda.com/essays/effects-of-domestic-violence-on-childrens-social-and-emotional-development/.

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The impact of exposure to domestic violence on children and young people: a review of the literature

Affiliation.

• 1 Children's Research Centre, University of Dublin, Trinity College, Dublin, Ireland.
• PMID: 18752848
• DOI: 10.1016/j.chiabu.2008.02.004

Objective: This article reviews the literature concerning the impact of exposure to domestic violence on the health and developmental well-being of children and young people. Impact is explored across four separate yet inter-related domains (domestic violence exposure and child abuse; impact on parental capacity; impact on child and adolescent development; and exposure to additional adversities), with potential outcomes and key messages concerning best practice responses to children's needs highlighted.

Method: A comprehensive search of identified databases was conducted within an 11-year framework (1995-2006). This yielded a vast literature which was selectively organized and analyzed according to the four domains identified above.

Results: This review finds that children and adolescents living with domestic violence are at increased risk of experiencing emotional, physical and sexual abuse, of developing emotional and behavioral problems and of increased exposure to the presence of other adversities in their lives. It also highlights a range of protective factors that can mitigate against this impact, in particular a strong relationship with and attachment to a caring adult, usually the mother.

Conclusion: Children and young people may be significantly affected by living with domestic violence, and impact can endure even after measures have been taken to secure their safety. It also concludes that there is rarely a direct causal pathway leading to a particular outcome and that children are active in constructing their own social world. Implications for interventions suggest that timely, appropriate and individually tailored responses need to build on the resilient blocks in the child's life.

Practice implications: This study illustrate the links between exposure to domestic violence, various forms of child abuse and other related adversities, concluding that such exposure may have a differential yet potentially deleterious impact for children and young people. From a resilient perspective this review also highlights range of protective factors that influence the extent of the impact of exposure and the subsequent outcomes for the child. This review advocates for a holistic and child-centered approach to service delivery, derived from an informed assessment, designed to capture a picture of the individual child's experience, and responsive to their individual needs.

Publication types

• Comparative Study
• Research Support, Non-U.S. Gov't
• Adolescent Development
• Child Abuse / psychology*
• Child Abuse / statistics & numerical data
• Child Behavior Disorders / epidemiology
• Child Behavior Disorders / psychology
• Child Development
• Crime Victims / psychology
• Domestic Violence / psychology*
• Domestic Violence / statistics & numerical data
• Family Characteristics
• Health Status
• Life Change Events
• Resilience, Psychological
• Socioeconomic Factors
• Stress Disorders, Post-Traumatic / psychology
• Violence / psychology

• Open access
• Published: 26 May 2023

Psychological complications of the children exposed to domestic violence: a systematic review

• Alireza Doroudchi   ORCID: orcid.org/0000-0002-4251-972X 1 ,
• Mohammad Zarenezhad   ORCID: orcid.org/0000-0003-3407-8167 1 ,
• Homayoun Hosseininezhad   ORCID: orcid.org/0000-0002-1223-1768 1 ,
• Abdorrasoul Malekpour   ORCID: orcid.org/0000-0001-9230-448X 1 ,
• Zahra Ehsaei   ORCID: orcid.org/0000-0002-7270-6542 1 ,
• Reza Kaboodkhani   ORCID: orcid.org/0000-0002-2754-2884 2 &
• Maryam Valiei   ORCID: orcid.org/0009-0007-1565-1489 1  

Egyptian Journal of Forensic Sciences volume  13 , Article number:  26 ( 2023 ) Cite this article

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Domestic violence (DV) is one of the major concerning health problems worldwide, and individuals who experienced domestic violence, may suffer physical or psychological consequences.

Children as a major part of the family and society are usually involved in familial challenging events such as domestic violence, and suffer several major complications. This review aimed to explore the psychological consequences of child exposure to domestic violence. A systematic search in four databases yielded 18 peer-reviewed original studies that met the inclusion criteria. Selected studies highlighted the psychological consequences of domestic violence in witnessing and exposed children. The findings of the present study revealed that children exposed to DV suffer various psychological, mental, and behavioral complications which may be short and long-lasting, and moderate or severe. Children exposed to domestic violence may show declined educational performance and social abilities. Internalization problems, depression, post-traumatic stress disorders symptoms, and externalization symptoms such as aggressive behaviors and even lower levels of IQ are of most important reported complications of domestic violence in children. Educational programs for parents as well as trained school caregivers and health policy-makers can diminish and prevent the complications of domestic violence in children.

Considering the importance of children mental hygiene, health policymakers should consider facilities to screen and detect children with signs of maltreatment and exposed to domestic violence. In this regard, trained teachers or school counselors will be helpful, as social supports and therapies may be more effective by early detection affairs.

Domestic violence (DV) as a major worldwide health problem, has attracted the attention of social and health policymakers (Finley 2019 , Marchetti 2019 , Shayan et al. 2015 ). Family (domestic) violence lead to physical and psychological consequences affecting all family members, even relatives (Ferrari et al. 2016 , Noble‐Carr et al. 2019 ). DV includes various types of violence such as physical, sexual, and emotional; mainly referred to intimate partner violence, mostly occur between male and female partners. However, it can embrace child, elderly, or sibling abuse (Kourti et al. 2023 ). DV has been highlighted as a major health problem to children worldwide. For example, in the United States of America, about 3 million children have suffered DV consequences (Mastorakos and Scott 2019 ). Based on UNICEF reports, about 133–275 million children experience the exposure or witness DV (Unicef 2006 ). During COVID-19 pandemics, DV has also been highlighted as a critical and substantial public health issue (Wake and Kandula 2022 ). Repeated exposure to DV is believed to be associated with the onset, severity, and recurrence of mental health problems (Jouriles et al. 2018 , Münger and Markström 2018 , Zarenezhad et al. 2016 ) and individuals with mental disorders are at a higher risk of DV complications (Khalifeh and Dean 2010 , Vaziri et al. 2018 ). DV endanger the health and quality of life of the family members including/especially the children (Hester et al. 2015 , Ferrari et al. 2016 , Knight and Hester 2016 , Carneiro et al. 2017 , Jaffe et al. 2017 , David and Jaffe 2018 ). It is also believed that DV has more emotional and less physical manifestations (Callaghan et al. 2017 , Ali and McGarry 2020 ). Children as a major part of family and society are usually indirect victims of DV and may suffer severe and irreversible physical and mental impacts from DV, and are at an increased risk for major mental health problems (Ferrari et al. 2016 , Gomma et al. 2019 , Hall 2019 ). However, psychological effects of DV on children have not been explored systematically. Thus, the present systematic review aims to demonstrate the psychological impacts of DV on children.

Methodology

Medical subject headings were used to search related published studies in scientific databases including PubMed/MEDLINE, Thomson Reuters, Cochrane, and Google scholar. The search was conducted in the mentioned databases using Mesh keywords Domestic violence, Children (child), witness, exposed (Exposure), and psychological effects. Our search results included original research papers published in the English language from January 2000 until 2022, with their online abstracts. The study was conducted based on the inclusion criteria demonstrated in Table  1 . Although our literature search was based on the Mesh keywords, studies with no mentioned key words but which covered the main topics and subject related to our subject were also included.

Data extraction and analysis

Data were extracted from the selected papers by two reviewers. Each article was evaluated separately and the results were merged. Discrepancies were resolved by referral back to the original papers. Extracted data included information about the authors of the studies, the year and country of the research, sample size, and the main findings of the studies. The results of the studies were merged in the discussion section considering other publications to respond to the questions: How do children suffer from domestic violence?

Do children suffer DV physically or psychologically?

What types of psychological disorders have children suffered because of domestic violence?

Does DV affect social activity or educational performance of the children?

Does DV affect Intelligence Quotient (IQ) or emotional intelligence (EQ) of the children?

Do children express delayed consequences of DV?

In our systematic review, the results were evaluated concerning the design and quality of the studies. The results of the studies were not combined due to the heterogeneity of the study types, populations, and outcomes. So, statistical analysis was not performed on the findings of selected studies.

Totally, 2740 potentially relevant articles were found in the first-round search in the mentioned databases. By screening titles of found articles; 2225 titles did not meet the criteria to be included in the study and were excluded. Five hundred fifteen articles potentially fulfilled the inclusion criteria and went forward for screening for duplicates in Endnote Software version X7. In this stage, 150 records were removed and 365 articles were evaluated by two reviewers independently concerning inclusion criteria. The abstract of selected papers was reviewed and papers were selected considering the subject and inclusion criteria of the study. In this stage, 284 papers were excluded and 81 articles were evaluated for full-text screening. Finally, 63 articles were excluded by screening the full-text body of articles and 18 articles were selected for the final systematic review. In the present systematic review, we included articles evaluating the psychological impacts of domestic violence on children that were published from 2000 to 2020.

Almost all studies indicated the negative impacts of domestic violence on children’s psychological status and their behavior. In the first study conducted by Levendosky and Bermann ( 2001 ), 120 women and their children residing in the community or domestic violence shelters were studied. Their findings indicated an ecological model for the impact of domestic violence on children and also the ecological framework and trauma theory exploring the effects of domestic violence on children.

Huth-Bocks et al. ( 2001 ) evaluated the direct and indirect effects of domestic violence on young children’s intellectual functioning. They included 100 women and their 3–5-year-old children (44 boys and 56 girls). They found that domestic violence has major impacts on verbal abilities and visual-spatial abilities by causing maternal depression and the intellectual quality of the home environment.

In another study, Levendosky et al. ( 2002 ) evaluated trauma symptoms in 62 preschool-age children exposed to domestic violence. The authors indicated that living with domestic violence is related to more aggressive behaviors and PTSD symptoms.

Children who witness DV may also suffer behavioral problems. For example, Spilsbury et al. ( 2008 ) studied 1019 children who were witnessing DV and they found that domestic violence caused symptoms of psychological maladjustment including externalizing and internalizing problems. Torteya et al. (2009) also reported that children exposed to DV showed significantly more internalizing or externalizing problems. They also found that chronic DV was associated with difficult child temperament and internalizing or externalizing symptoms.

Fusco and Fantuzzo ( 2009 ) evaluated the effects of direct exposure and the consequences of the involvement of DV on children. The children were involved as a part of the precipitating event, called for help. Almost, 75% of all children exposed to DV were directly involved in the violence, and were involved physically and mentally.

Rigterink et al. ( 2010 ) also evaluated the effects of DV on emotion regulation in children’s by measurement of vagal tone (VT). Almost, all children showed increased VT baseline, while DV-exposed children had less increase in baseline VT compared to non-exposed children. So, DV may sensitize children to stress and children continue to show increased stimulation to the stress, and their physiological resources become depleted as demonstrated by low baseline VT.

Fortin et al. ( 2011 ) conducted their study with 79 children exposed to DV. Indicators used for children’s appraisals of violence were attribution of blame and perceived threat. The levels of parentification and the degree of children’s faithfulness conflicts were assessed for children’s perceptions of family relationships. Their findings confirmed the influence of the mentioned variables and also showed the association between self-blame and children’s parentification. Mentioned variables may impact different dimensions of the children’s psychological features.

In other studies, DV had led to negative and overwhelming emotions as well as suppression effect for young children (Thornton 2014 ) and reduced psychological wellbeing and social support satisfaction (2017). Dargis and Koenigs ( 2017 ) found interpersonal and affective features of psychopathy as well as possible later psychopathic behaviors in children exposed to DV.

Later in 2018, Cho ( 2018 ) reported aggressive behavior, depression, anxiety, and juvenile delinquency for children who had been the witness of domestic violence in their families. In one study on 907 boys and girls exposed to DV, Forke et al. ( 2018 ) found higher perpetration for boys and higher combined victimization/perpetration for girls indicating major psychological adverse effects for children exposed to DV. Such psychological problems can alter behavioral developments and decline individuals’ life satisfaction.

Paul ( 2019 ) et al. reported post-traumatic stress symptoms in children witness of DV, and Hussain et al. ( 2019 ) reported mental depression, humiliation and public ridicule, negative effects on children’s cognitive growth. Cho ( 2019 ) reported depression and anxiety, delinquent behavior, affected academic performance, and sociality in South Korean children, and Fogarty et al. ( 2020 ) detected emotional-behavioral resilience in children exposed to DV. It can be expected that the future life of children exposed to DV can be influenced by possible effects and major consequences of DV. Mentioned mental and psychological consequences may be long-lasting and affect the children’s personal, social, and educational performance and their life quality (Table  2 ).

Domestic violence has been reported to be expressed in different forms of physical, psychological, and sexual (Shayan et al. 2016 , Dargis and Koenigs 2017 ). Various studies have revealed consequences of DV and concerns about the victims of DV have been being raised for health policymakers (Dargis and Koenigs 2017 , Gholamzadeh et al. 2018 , Maji 2018 ). Victims of DV may suffer various physical or mental health complications (Hegarty 2011 , Heron and Eisma 2021 ). Reported psychological complications are depression, anxiety, post-traumatic stress disorder (PTSD), lower self-esteem, increased risk of substance abuse, self-injury, and even suicide (Banerjee et al. 2019 , van Der Put et al. 2019 ). So far, most of the researches has focused on first and direct victims of DV which may be wives or husbands (Drijber et al. 2013 ). However, recent investigations have been conducted about the effects of DV on indirect victims of DV who are mainly children (Walters 2018 ). Domestic violence can cause various negative psychological, behavioral, cognitive, and emotional impacts on children (Callaghan et al. 2018 , Forke et al. 2019 ).

DV may cause direct impacts on victims such as homicide deaths and living with poor health and declined earnings (Rawlings and Siddique 2020 ). Empirical studies have studied the relationship between domestic violence experienced by mothers and health outcomes of their children, and it has been found that children may suffer negative early and delayed effects (Yount, et al. 2011 ).

Our systematic survey showed that most of the children who witness DV may display psychological symptoms such as internalizing, externalizing behaviors, and depression (Martinez‐Torteya et al. 2009 , Fortin et al. 2011 ). As the social activities of children are impacted by the mentioned mental and psychological problems, DV may cause decline in social activity of children who are victims or witnesses of DV (Howarth et al. 2019 , Wahyuni et al. 2019 ). Such children may have poor school and educational performance that may be due to affected verbal and intellectual abilities (Huth-Bocks et al. 2001 ). Trauma related symptoms are also common reactions in children who witness DV (Levendosky et al. 2002 ).

The children witness DV may be less pleased to have participated in social activities. So, clinicians and school counselors are recommended to monitor and care about DV in children which may be presented by behavioral and emotional changes. The children exposed to DV also may show to have lower IQ levels (Koenen et al. 2003 ). Post-traumatic stress disorder (PTSD) was another reported consequences of DV in children witnesses of domestic violence (Rigterink et al. 2010 , Paul 2019 ). It seems that children experience a trauma like event when are witness or exposed to DV, wheather the exposure is direct or indirect. Besides, reduced psychological wellbeing and social support satisfaction, suppression effect are reported as health consequences of DV witnessing in children (Naughton et al. 2017 , Maji 2018 ).

Children exposed to DV may show anxiety, aggressive behavior, juvenile delinquency, interpersonal, and affective features of psychopathy as well as later psychopathic traits (Dargis and Koenigs 2017 , Cho 2018 , Maji 2018 ). Furthermore, the child witnessing domestic violence can reveal far-reaching consequences for children (Yakob 2018 ). Mental depression, humiliation, and public ridicule, negative effects on children’s cognitive growth (Ahmadzad-Asl et al. 2016 , Hussain et al. 2019 , Tonsing et al. 2020 ) as well as emotional-behavioral resilience (Fogarty et al. 2019 , Fogarty et al. 2020 ).

Children witness of DV have reported to be depressed fearful and inhibited. Besides, they may suffer internalizing and behavioral disorders, antisocial and aggressive behaviors (Gomma et al. 2019 ). Moreover, children exposed to DV may also suffer physical complications such as general pain and aches. Bedwetting, irritable and irregular bowel disease (IBD) and cold sores may be other complain of such children (Turhan 2022 ). Children may also become nervous with signs of fatigue. Such children may have poor personal hygiene and an increased desire to be involved in high-risk games, self-abuse, and suicide (Sureka and Kesarwani 2022 ).

Children exposed to DV suffer short‐ and long‐term behavioral and mental health impacts. As one of the main human resources of society, any maltreatment such as DV can cause major behavioral and antisocial consequences in growing and developing children. Several studies had paid to interventions for treatment and minimizing the psychological consequences of domestic violence in preschool, school, and young children, which were not included in our systematic review. Our study included studies in which the mental, behavioral, and psychological consequences of DV had been evaluated in witnessing children.

Strengths and limitations

In this systematic review, we tried to reduce bias on the available evidence of the psychological consequences of DV on witnessing children. A careful research design and comprehensive sampling procedures was applied for finding related literature. However, data collection method might lead to sampling bias, and we may have missed some studies that fulfill the inclusion criteria. Long term duration range of the studies involved in our systematic review was one of the strong points. Besides, we only included original research studies found by application of MeSH keywords and we did not evaluate the systematic reviews, narrative reviews nor meta-analysis studies. Moreover, we identified the relevant studies in an independently duplicated manner (Fig.  1 ).

The strategy of searching articles based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)

Conclusions

The findings of the present study reveal that children exposed to domestic violence suffer various psychological, mental, and behavioral complications which may be short and long-lasting. Children exposed to DV may deal with declined educational performance and social abilities. Psychological complications may be internalization problems, depression, post-traumatic stress disorders, and externalization symptoms such as aggressive behaviors and even lower levels of IQ. Educational programs for parents as well as trained school caregivers and health policymakers can diminish and prevent the complications of DV on witnessing children. Precise psychological investigations and standard psychological tests may be helpful for assessment of intellectual ability (or intelligence), academic skills (or achievement), cognitive functions such as memory, focus and attention, and visual-motor coordination, neurocognitive tests, personality tests, and brain dominance. Considering the importance of children mental hygiene, health policymakers should consider facilities to detect children with signs of maltreatment and exposed to domestic violence. In this regard, trained teachers or school counselors will be helpful for screening and early detection of such children. So, social supports and therapies may be more effective by early detection affairs.

Availability of data and materials

All data generated or analyzed during this study are included in this published article.

Abbreviations

• Domestic violence

Intelligence quotient

Post-traumatic stress disorder

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Alireza Doroudchi, Mohammad Zarenezhad, Homayoun Hosseininezhad, Abdorrasoul Malekpour, Zahra Ehsaei & Maryam Valiei

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Doroudchi, A., Zarenezhad, M., Hosseininezhad, H. et al. Psychological complications of the children exposed to domestic violence: a systematic review. Egypt J Forensic Sci 13 , 26 (2023). https://doi.org/10.1186/s41935-023-00343-4

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Intimate partner violence: A loop of abuse, depression and victimization

Marianna mazza.

Department of Neurosciences, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy. moc.liamtoh@azzamannairam

Giuseppe Marano

Department of Neurosciences, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy

Angela Gonsalez del Castillo

Service of Clinical Psychology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy

Daniela Chieffo

Laura monti, delfina janiri, lorenzo moccia, gabriele sani.

Corresponding author: Marianna Mazza, MD, PhD, Assistant Professor, Department of Neurosciences, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, Rome 00168, Italy. moc.liamtoh@azzamannairam

Intimate partner violence has been recognized as a serious public health issue. Exposure to violence contributes to the genesis of, and exacerbates, mental health conditions, and existing mental health problems increase vulnerability to partner violence, a loop that imprisons victims and perpetuates the abuse. A recently described phenomenon is when male violence against females occurs within intimate relationships during youth, and it is termed adolescent or teen dating violence. In this narrative review, factors associated with intimate partner violence and consequences of exposure of children to parental domestic violence are discussed, along with possible intensification of violence against women with the spread of coronavirus disease 2019 pandemic and subsequent lockdown. Intervention programs with a multicomponent approach involving many health care settings and research have a pivotal role in developing additional strategies for addressing violence and to provide tailored interventions to victims. Prevention policy with a particular attention on healthy child and adolescent development is mandatory in the struggle against all forms of violence.

Core Tip: Intimate partner violence represents a serious public health issue. Exposure to violence contributes to the genesis of, and exacerbates, mental health conditions, and existing mental health problems increase vulnerability to partner violence. A recently described phenomenon is when male violence against females occurs within intimate relationships during youth, and it is termed adolescent or teen dating violence. Coronavirus disease 2019 pandemic is causing a tremendous impact on women's possible exposure to violence. Possible interventions against violence are discussed.

INTRODUCTION

Intimate partner violence is described as physical violence, sexual violence, stalking, or psychological aggression by a current or former intimate partner. It represents a serious public health issue. It has been estimated that more than 30% of women in the United States have experienced intimate partner violence, and it represents the leading cause of homicide death for women. Prevalence is higher among young women (18 to 24 years of age), among racial and ethnic minority groups, and among people with mental and physical disabilities[ 1 ]. Psychological violence is estimated to be the most common subtype of intimate partner violence (compared to physical and sexual violence) in the United States and Europe[ 2 ].

In women of reproductive age, intimate partner violence has been linked with poor reproductive health and poor sexual health (unintended pregnancy and sexually transmitted infections) and heightened risks of obstetrical and gynecologic complications (pregnancy-associated death, preterm birth, low birth weight) and represents a risk factor for peripartum depression and substance abuse[ 1 ]. There are specific physical injuries in women that can be considered as indicators of intimate partner violence: Contusions, lacerations, and fractures (especially in the head, neck and face) and are frequently reported by patients as domestic accidents. Partner violence has been associated with many mental health consequences: Depression, anxiety, post-traumatic stress disorder, eating disorders, suicidal behavior, alcohol or drug abuse, sexual problems, problems with concentration, somatization, social, educational, or occupational difficulties, as well as feelings of blame and guilt or reproach. It is also linked to several and often disabling physical health problems (chronic pain, gastrointestinal problems, sexually transmitted infections, traumatic brain injury, cardiovascular diseases).

Exposure to violence can contribute on one side to the genesis of psychopathological conditions or can exacerbate mental health conditions, but on the other side existing mental health problems can increase vulnerability and predisposition to partner violence.

It has been estimated that emotional violence is the most common form of intimate partner violence across all continents worldwide[ 3 ]. Factors associated with intimate partner violence originate from multiple levels: Individual, relationship, community, and societal level[ 4 ]. Subjects who are at greater risk of experiencing intimate partner violence more likely come from a lower education background and poorer socio-economic status (with difficulty of access to resources and greater acceptance towards violence), have a history or a current substance abuse, and have been exposed to prior abuse or violence (with a history of abuse reinforcing the normative nature of violence and developing violence-condoning attitude). For example, many immigrant women have to cope with issues regarding their cultural integration into another society while at the same time concurrently feeling related and profoundly bounded by cultures and traditions from their countries of origin. Dependence on one’s partner, difficulties in language proficiency, financial problems, lack of social support, and uncertain legal status can leave these subjects feeling fragile and socially isolated and can prevent them from seeking assistance; besides, women linked to particular cultural backgrounds may refuse to acknowledge certain acts and behaviors as abusive due to beliefs and traditions regarding familial obligations and culturally prescribed gender roles[ 5 ].

People with mental illness may have a heightened risk of becoming victims of domestic violence and can be reluctant to disclose abuse. On the other hand, mental ill-health can also be a consequence of victimization and can involve post-traumatic stress disorder, depression, suicidality, and alcohol or substance misuse: Physical sequalae of abuse are added to psychological morbidity[ 6 ].

EXPOSURE OF CHILDREN TO PARENTAL DOMESTIC VIOLENCE

It has been outlined by recent research that the presence of intimate partner violence often compromises a child’s attachment to primary caregivers, which results in an additional risk factor for social, emotional, and psychological impairment[ 7 ]. A child can be exposed to domestic violence also through the awareness that violence occurs between parents, regardless of whether the child directly witnesses it. Infancy is a critical period of developing a secure attachment, and infants spend most of the time with caregivers, in a relationship of close proximity to them and high and obliged dependence from them; in addition, younger children have not completely strengthened the cognitive ability to discern between intimate partner violence as a threat to caregiver or to the self. As a consequence, the situation of violence in the household can indirectly impact on the child because it compromises the caregiving system in the parent. The presence of intimate partner violence increases a child’s risk of developing a wide variety of negative outcomes (internalizing symptoms, externalizing behaviors, problems with perceptual and cognitive functioning, academic difficulties, interpersonal difficulties). Possible consequences can be affected by the child’s age, relationships with other caregivers, and period of exposure to violence.

Violence against young girls causes physical and psychological effects, which can manifest as mild anxiety symptoms, apprehension, flashbacks, or feeling ashamed or worried to more severe anxiety signs, including a variety of sleep or eating disorders, post-traumatic symptoms, and even thoughts of self-harm and suicide. The inaction of a valid support system may further worsen this complex situation[ 8 ].

Children exposed to parental domestic violence are predisposed to physical and mental health disorders and are subjected to an increased risk of become a victim or a perpetrator of intimate partner violence in adolescence and adulthood[ 9 ]. Besides, adverse childhood experiences, such as child abuse, maltreatment, substance abuse in the household, incarceration of household members, and emotional or physical neglect, have long-term consequences with poorer physical, mental, individual behavioral, and social/interactional outcomes: The larger the number of adverse childhood experiences, the higher the odds of worst physical and mental health outcomes, including heart disease, stroke, asthma, diabetes, and mental distress[ 10 ]. Adolescence is a critical developmental period characterized by puberty, progressive autonomy from parents and family, changes in social relationships, and often the beginning of romantic relationships. Child sexual abuse, child physical abuse, witnessing parental intimate partner violence, exposure to school-related violence ( e.g. , bullying), and community violence ( e.g. , racism or discrimination) during childhood are potentially related to future intimate partner violence. Recently, it has been demonstrated that adverse childhood experiences in adolescence are predictive of interpersonal violence 15 years later[ 10 ].

Teen dating violence

When male violence against females occurs within intimate relationships during youth, it is termed adolescent or teen dating violence, occurring in individuals aged 10-24 years, including early, middle, and late adolescence, and described as physical, sexual, or psychological/emotional abuse, comprising threats, towards a dating partner. Six forms of teen dating violence have been assessed: Threatening behaviors, verbal/emotional abuse, relational abuse, physical abuse, sexual abuse, and stalking.

The cultivation of emotional relationships during adolescence are pivotal to the progressive growth of interpersonal communication skills, autonomy, and self-perceived competence, but together with affective and behavioral vulnerability experienced during adolescence, a variety of individual, social, and community risk factors may favor the emergence of adolescent dating violence[ 11 ]. Victims of teen dating violence may develop adverse health outcomes such as increased sexual risk behaviors, suicidality, unhealthy behaviors ( e.g. , lack of physical activity and negative weight-controlling behaviors), inauspicious mental health outcomes, substance use, injuries, victimization, and death. Additionally, it is common for adolescents who experience dating violence to struggle with their academics, drop out of school, or skip school to avoid seeing their partner.

Risk factors for perpetration of adolescent dating violence seem to be a history of experiencing, witnessing, and/or initiating abuse within the home, school, and community; childhood trauma in the form of physical and emotional abuse or neglect (due to personality anxiety traits formed during childhood, so that the individual feels a lack of security in the relationship and worries about being left by the partner); sexism and gender roles present in society; bullying; developing and formulating ineffective interpersonal communication and conflict resolutions skills during adolescence; alcohol or substance use during adolescence; attachment insecurities (anxiety and avoidance) expressed as anger, hostility, aggression, and emotional dysregulation[ 12 ]. Recent research suggests that there are multiple form of adolescent dating violence and that males may be victimized at similar rates as females[ 13 ]. Increasingly high rates of technology usage, as well as diffusion of apps and social media platforms, has created more opportunities for cyber teen violence dating (typically people who are no longer with their dating partner perpetrate this form of violence against an ex-partner).

Abusive behavior in adolescent dating relationships is associated with a risk of intimate partner violence later in adulthood[ 14 ].

Violence during coronavirus disease 2019 pandemic

Coronavirus disease 2019 (COVID-19) has had a dreadful impact on the world’s economy, and women are forced to take on additional risks as they are already disadvantaged and vulnerable, especially in rural and remote settings[ 8 ]. Sexuality suffers because it has to deal with the arrogance of a death drive rekindled by the current pandemic condition. A life in which less libido is exchanged stably than one would like can become unbearable. But the libido, in the forms of stasis and engorgement, can turn, in the unconscious, into anguish and give rise to internal conflicts that inevitably end up resulting in the relationship with the other[ 15 ]. As the COVID-19 pandemic has intensified, its effects diversified by gender have begun to gain attention[ 16 ]. During the institutional lockdown, victims of domestic violence were required to remain closed with partners and without help or support: In such scenario there is a great chance that abusive situations can further aggravate, with a possible increase of domestic homicides or murder-suicides or deviant behaviors towards children. Increased concerns about domestic violence have been expressed in many countries. The reasons for this include social isolation, exposure to economic and psychological stressors, increase in negative coping mechanisms (such as alcohol or drugs misuse), and inability to access usual health and social services[ 6 ]. School closure due to lockdown can potentiate the risk for children to witness violence, exploitation, and abuse at home and away from help[ 8 ].

As the outbreak of COVID-19 has developed, referral rates to mental health and psychology services have declined, despite a likely increase in psychological distress, victimization, and mental illness. It is well-known that intimate partner violence has short-term and long-term effects on physical and mental-health of affected subjects and in particular might increase the risk of cardiovascular disease in women, by indirect (chronic inflammation or dysregulation of the hypothalamic pituitary axis as a consequence of chronic stress) and indirect pathways (coping strategies used by victims of abuse to deal with stress, such as smoking and overeating, and higher incidence of depressive disorders correlated to chronically elevated levels of cortisol, catecholamines, and inflammatory markers, all of which promote the development and progression of cardiovascular disease)[ 17 ].

Psychological distress linked with the pandemic itself, arising in response to fears about personal and familial infection as well as the sequelae of social distancing and quarantine measures, add worry about possible consequences of intimate partner violence during this global pandemic.

Particularly during the COVID-19 pandemic, programs are necessary to provide funding sources to guarantee telephone or remote counseling services or psychological assistance hotlines to manage and attempt to prevent crisis situations[ 18 , 19 ]. The use of mobile health and telemedicine to support safely subjects experiencing violence must be urgently improved, together with other strategies to reach women at risk in settings where access to mobile phones or the internet is limited or completely lacking. We must learn lessons from the past epidemics and also from the present about errors and defeats to recognize and address gender related effects of outbreaks[ 16 ].

Prevention and management of the violence against women of all ages should be expected and potentiated as a pivotal service in the COVID-19 response plan.

Possible interventions against violence

Lifetime and current intimate partner violence is common and unacceptably high. It has been outlined that approximately 1 in 4 women becomes a victim of violence at some point in their life regardless of their age, economic status, or ethnicity. Domestic violence against women is a well-recognized health concern and has serious negative impact on women’s lives. It is important to stress the fact that most of the factors associated with violence against women are preventable. Studies assessing screening and interventions practice in primary care services for women who experience intimate partner violence have demonstrated that clinical programs can mitigate the risk of subsequent violence[ 20 ]. In addition, interventional studies have stressed that gender-norms transformation through behavioral change and communication focused program can promote gender equality norm and avert domestic violence against women[ 21 ].

Intimate partner violence is often not obvious, and patients may present with nonspecific signs and symptoms. Clinicians must be aware of the red flags of domestic violence and incorporate the principles of trauma-informed care into their practice. This means asking about violence or risk of violence when it is safe and appropriate, in a private discussion and in a compassionate and nonjudgmental way, discussing needs, preferences, and immediate options. It is necessary to support the subject’s autonomy, provide emotional and practical support, and personalize responses and possible solutions to the individual patient[ 22 ].

For pregnant women suspected or known to be exposed to partner violence, it is mandatory to consider a pregnancy high-risk and to provide prenatal assessment and counseling for the mother and home-visitation programs in the child’s first years. Screening in primary care for mental health disorders such as depression or anxiety should reasonably include an inquiry about current and previous intimate partner violence. In parallel, current or past intimate partner violence should be appropriately included in the differential diagnosis of many medical and behavioral health conditions, particularly in women[ 1 ]. It should be taken into account the fact that violence victims may not disclose their experience immediately but in the context of multiple queries and a trusting relationship. It results important that a multicomponent approach involving many health care settings, training of staff, clinical specific tools of assessment (including multiple violence domains: Physical, sexual, emotional/psychological), established workflows, connection to follow-up social services, and legal services can be dedicated and promoted to improve the prevention and response and care to the problem of intimate partner violence and its serious consequences. It has been observed that women have the tendency to remain with violent partners due to a variety of reasons, including social norms, worry for children, and economic issues. Immigrant women require a specific culturally-tailored approach and may need specific advocacy and interventions that also focus on financial abuse and are finalized to economic empowerment, including individual mental health counseling (when the shame and stigma associated to intimate partner violence in many ethnic communities increase the reluctance to discuss in groups) and services provided in community member’s native language or in intervention delivery settings (shared community environments including churches, mosques, temples)[ 5 ].

Interventions integrating legal framework and programs that focus on transformation of traditional gender-norms are of great importance in order to prevent violence against women of all ages. There is an increasing need of intervention programs and techniques to reduce violence among offenders (group therapy or counseling aimed to work on impulsive and angry behavior or inability to control emotions) with a particular focus on trauma and substance abuse[ 23 ]. Since it has been observed that men with mental health problems (in particular depression, anxiety, alcohol or drug use disorder, attention deficit hyperactivity disorder, personality disorders) carry a higher probability to perpetrate domestic violence against women, treatment for any co-existing mental illness and in particular substance abuse or misuse should be prioritized to reduce risk[ 24 ].

Also, research has a pivotal role in developing additional strategies for addressing violence and to provide personalized interventions to victims. For example, qualitative studies exploring the emotional impacts of intimate partner sexual violence on women are scarce. Understanding should be deepened of the so-called invisible impacts of violence, described as the emotional repercussions (sense of powerlessness, helplessness, shame, ongoing fear of men) that are difficult to quantify and measure but may be a trigger for mental health outcomes, such as post-traumatic stress disorder, anxiety, and depression[ 25 ]. Research can guide attachment- and family-based interventions for families impacted by interpersonal violence. Besides, there is an urgent need for rigorous research to understand better which interventions are most effective and tailored for ethnic minority populations.

Last but not least, prevention is mandatory: Interventions focusing on community and domestic health and violence prevention and, focusing on high-risk and disadvantaged socio-economic groups (such as institutionalized children or adolescents), with a particular attention on healthy child and adolescent development, may greatly contribute to lower intimate partner violence victimization in adulthood by correcting attitudes on violence and improving help-seeking behavior (Table ​ (Table1). 1 ).

Proposed interventions against intimate partner violence

COVID-19: Coronavirus disease 2019.

Conflict-of-interest statement: Authors declare no conflict of interest.

Manuscript source: Invited manuscript

Peer-review started: December 31, 2020

First decision: April 21, 2021

Article in press: May 17, 2021

Specialty type: Psychiatry

Country/Territory of origin: Italy

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P-Reviewer: Zafrakas M S-Editor: Fan JR L-Editor: Filipodia P-Editor: Li JH

Contributor Information

Marianna Mazza, Department of Neurosciences, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy. moc.liamtoh@azzamannairam .

Giuseppe Marano, Department of Neurosciences, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy.

Angela Gonsalez del Castillo, Service of Clinical Psychology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy.

Daniela Chieffo, Service of Clinical Psychology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy.

Laura Monti, Service of Clinical Psychology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy.

Delfina Janiri, Department of Neurosciences, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy.

Lorenzo Moccia, Department of Neurosciences, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy.

Gabriele Sani, Department of Neurosciences, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy.