Forensic Psychology

by Graham M Davies

  FIGURE 5.1 Conceptual model discriminating child-maltreating and non child-maltreating families (taken from Dixon, Browne, & Hamilton-Giachritsis, 2009)

  More recently, a longitudinal study of 1,000 young people identified as having a number of risk factors in adolescence, increased the likelihood of maltreating their own child as an adult (Thornberry et al., 2014). Risk was assessed over 10 domains (e.g. exposure to violence, family difficulties, education, peer relationships) and it was found that only 3% of those with no risk domains in adolescence were later investigated for maltreatment compared to 45% of those with risk in nine domains during their adolescence. However, it should be noted that 55% of those with risk in nine domains were not involved in child maltreatment. Thus, it is always important to remember that not all individuals who experience early child abuse and neglect go on to show negative outcomes.

  5.2.4 Resilience

  Childhood maltreatment has a variety of negative long-term outcomes, although some individuals show resilience and adaptive functioning. Current research is attempting to more clearly define the mechanisms through which different outcomes occur, moving from identifying key factors to the mechanisms through which they work and the implications for interventions (Masten & O’Dougherty Wright, 2010). Resilience is a difficult concept to define and, whilst originally taken as the absence of psychopathology over the lifespan, it is now more often seen as an individual who is able to show successful functioning over a number of different domains, such as personal relationships, employment and mental health (Luthar, 2003). Rates of resilience also differ according to the timeframe over which they are assessed and it is important to note that maltreated individuals may function well at some or many points in their lives, but have periods where they function less well (Hamilton-Giachritsis et al., in preparation). Arguably, being able to maintain good enough functioning in most domains of life (e.g. holding down employment, a positive relationship), even in the presence of mental health difficulties, shows at least a degree of resilience. The key message is that resilience has repeatedly been demonstrated by individuals, following both childhood and/or adulthood maltreatment.

  5.3 ADULTHOOD VICTIMISATION

  There are many crimes that occur within society that result in an adult becoming a victim of crime. This section will focus on two particular crimes: intimate partner violence, and rape and other forms of sexual victimisation. This section will deal with these separately; however, it is important to recognise that there is considerable overlap between the victims of these two groups. Victims of intimate partner violence are frequently victims of sexual violence and vice versa. Furthermore, there is often overlap between being abused as a child and subsequent victimisation as an adult (Abramsky et al., 2011). These overlaps should be kept in mind when reading this section. The section will examine in more depth the impact of victimisation, discussing both the physical and psychological effects on the victim. Females are most at risk of becoming victims of these crimes; however, it is important that male victims of these crimes are not ignored. Therefore, the experiences of both female and male victims of these types of violence will be assessed.

  5.3.1 Intimate Partner Violence

  This interpersonal violence can encompass many different types of abusive behaviours. Within England and Wales, this is recognised in the government definition of domestic abuse as “any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged 16 or over who are, or have been, intimate partners or family members regardless of gender or sexuality” (Home Office, 2013). The effects of physical abuse, psychological abuse, sexual abuse and power/control behaviours have all been shown to impact negatively upon the victim’s wellbeing (Coker et al., 2002; Jordan, Campbell, & Follingstad, 2010).

  5.3.1.1 Definitional/labelling issues

  In defining this crime, the violence that can occur within relationships has been described alternatively as intimate partner violence (IPV) or domestic violence, with the victims being described as battered men/women. Some preference has been expressed for the term IPV, as it may more clearly identify the violence as being experienced between partners (McCaw, Golding, Farley, & Minkoff, 2007). In this section, this is the term that will be used, as the violence that is discussed will relate solely to that which occurs between partners or ex-partners.

  5.3.1.2 Impact on physical health

  IPV victims sustain a range of physical injuries, most commonly to the face, neck and arms (Tjaden & Thoennes, 2000; Williamson, 2000). However, experiencing IPV can also affect the long-term physical health of the victim (see Table 5.6). Campbell (2002) suggests that many of these health issues (e.g. irritable bowel syndrome) are associated with stress, which may explain why these health problems are prevalent amongst victims of IPV.

  Table 5.6 Reported injuries and physical health complaints associated with IPV

  Injuries Physical health complaints

  Cuts

  Abrasions

  Bruising

  Fractures

  Sprains

  Broken teeth

  Bites

  Unconsciousness

  Chronic pain (including neck pain, headaches, migraines, pelvic pain)

  Central nervous system problems (fainting, seizures)

  Gastrointestinal symptoms (loss of appetite, nausea)

  Gastrointestinal disorders (irritable bowel syndrome)

  Cardiac symptoms (hypertension, chest pain)

  Urinary symptoms (pain, bladder/kidney infections)

  Sexual dysfunction

  (Adapted with permission from Campbell, 2002; Ellsberg, Jansen, Heise, Watts, & Garcia-Moreno, 2008; Williamson, 2000)

  5.3.1.3 Impact on mental health

  Victims of IPV are at an increased risk of suffering from mental health issues such as depression, post-traumatic stress disorder (PTSD), suicidality, and substance misuse (Golding, 1999 and Table 5.7). In addition, comorbidity, by which victims suffer from more than one mental health issue, is frequent (Nixon, Resick, & Nishith, 2004).

  Table 5.7 Prevalence of mental health problems in IPV victims

  Prevalence (%)

  Mean Range

  Depression 47.6 17.5–60.6

  Suicidality (include attempts and ideation) 17.9 4.6–77.0

  Post-traumatic stress disorder 63.8 31.0–84.4

  Alcohol dependence 18.5 6.6–44.0

  Drug dependence 8.9 7.0–25.0

  (Adapted with permission from Golding, 1999)

  Depression has been significantly associated with experiencing IPV (Wong et al., 2011), with prevalence levels in IPV victims significantly above national statistics of depression, even when the effects of other related factors, such as socio-economic deprivation, have been controlled for (e.g. Ouellet-Morin et al., 2015). Furthermore, women who have experienced both childhood abuse and IPV have been found to be twice as likely to suffer depressive symptoms compared to non-abused women (Fogarty, Fredman, Heeren, & Liebschutz, 2008).

  A smaller proportion of IPV victims also report substance misuse problems. Estimates of the number of victims that this includes suggest that approximately 10% report harmful alcohol or drug use (Coker et al., 2002; Gerlock, 1999). However, it is very difficult to establish the role of substance misuse problems in IPV as alcohol and drugs may be a cause or a consequence of the violence, for example to deal with the experience of IPV (i.e. “drinking to cope”; see Øverup, DiBello, Brunson, Acitelli, & Neighbors, 2015). Bennett and O’Brien (2007) propose a reciprocal relationship between IPV and substance misuse in which each factor increases the risk of experiencing the other. Therefore, women with substance misuse problems are at greater risk of suffering IPV and women who suffer IPV are at a greater risk of developing a substance misuse problem (Devries et al., 2014). However, these relationships are not simple, as comorbidity with other outcomes of IPV victimization (i.e. post-traumatic symptoms) have been found to affect these associations (e.g. Jaquier, Flanagan, &
Sullivan, 2015).

  5.3.1.4 Type of abuse

  As noted above, IPV can constitute a number of different behaviours, and victims frequently experience multiple forms of IPV (Fanslow & Robinson, 2011). Unsurprisingly, victims who experience severe multiple forms of IPV often report multiple mental health issues (i.e. comorbidity). Some studies have tried to differentiate between the types of IPV and the impact on mental health. In a systematic review of the literature, Lagdon, Armour, & Stronger (2014) found that depression was associated with all forms of IPV but that experiencing psychological abuse was more strongly associated with reporting depressive symptoms (see also Nathanson, Shorey, Tirone, & Rhatigan, 2012). This trend for psychological abuse having the strongest association with reported mental health issues was also apparent for PTSD and anxiety. This suggests that experiencing psychological IPV has the most severe impact on victims.

  5.3.1.5 Male victims of intimate partner violence

  One in five men will experience physical IPV during their lifetime (Desmarais, Reeves, Nicholls, Telford, & Fiebert, 2012). Physical injuries sustained by male victims are similar to those sustained by female victims with reports of being kicked, pushed, grabbed and punched, as well as more serious attacks involving choking (22.2%) and being stabbed (1.9%) (Coker et al., 2002). However, male victims have been found to be less likely to suffer physical injuries than female victims, potentially because of gender differences in physical size and strength (Holtzworth-Munroe, 2005).

  Given the similar experience of IPV for male victims compared to female victims, it is logical that the impact on physical and mental health is also very similar. Male victims report similar mental health issues to female victims including depression, post-traumatic symptoms, and suicidal ideation (Randle & Graham, 2011). In relation to post-traumatic symptoms, Hines (2007) found that, for men, the level of violence suffered within relationships was a significant predictor of post-traumatic stress symptoms. Affifi et al. (2009) demonstrated that amongst male victims, IPV was associated with a greater likelihood of suffering from psychiatric comorbidity (two or more psychiatric disorders), a disruptive disorder and a substance misuse problem.

  Coker et al. (2002) compared the victimisation of men and women and found that many of the negative effects on health occurred similarly in both male and female victims of IPV. However, Carbone-Lopez, Kruttschnitt, & MacMillan (2006) showed that although men and women experience IPV in a very similar pattern, women were more likely to experience poor physical and mental health as a result of victimisation. Similarly, Affifi et al. (2009) found that male victims experienced a narrower range of poor mental health outcomes compared to female victims of IPV. This meant that male victims had an increased likelihood of suffering only externalising disorders (e.g. disruptive behaviour disorders and substance misuse problems), whereas female victims were at an increased risk of suffering both internalising (e.g. anxiety disorders) and externalising disorders in addition to suicide ideation. This suggests that the effects of IPV may exhibit itself differently for male and female victims.

  5.3.1.6 Recovery and involvement with the criminal justice system

  Blasco-Ros, Sanchez-Lorente, & Martinez (2010) showed that IPV victims can recover from its effects although this recovery can be affected by the type of abuse suffered. Factors associated with recovery are social support and a cessation of abuse (Beeble, Bybee, Sullivan, & Adams, 2009). Interventions to help IPV victims have demonstrated some effects by treating post-traumatic symptoms (Johnson & Zlotnick, 2009), although evaluations of their long-term effectiveness are rare (Stover, Meadows, & Kaufman, 2009). Allen & Wozniak (2011) evaluated an intervention with a small sample of victims delivered over 10 weeks, which subsequently showed significant improvements in the post-traumatic symptomology of the victims following the intervention. The process of recovery was linked with several themes such as the victims’ creation of a safe living environment, establishing autonomy in their lives, taking pride in their appearance, reclamation of self, developing a more peaceful existence, and rejoining the community. However, victims can still experience mental health issues many years after experiencing IPV (Lindhorst & Beadnell, 2011).

  CASE STUDY 5.2 INTIMATE PARTNER VIOLENCE AND ITS EFFECTS

  Mary is a 36-year-old woman who has been married to her husband for five years. Mary has a previous history of being a victim of childhood physical and sexual abuse. She left school after college (aged 18 years) and has previously worked in full-time employment but has not worked for the last seven years and lists her occupation as housewife. She has one daughter who is 3 years old. During the last four years, Mary has been a victim of IPV carried out by her husband. Mary’s husband controls many aspects of Mary’s life, which means that Mary is not allowed to leave the house without her husband’s permission. This has meant that Mary has very few friends and no strong social support network. Mary’s husband has also physically assaulted her approximately seven times over the last year. These attacks have varied in severity. She has been left bruised by the attacks and once had to seek medical help for a cut on her face. In addition to the physical violence, her husband has raped her on several occasions. Mary has thought about suicide several times this year but does not want to leave her child in the care of her husband. She experiences flashbacks from these attacks, which lead her to have panic attacks. Mary has thought about calling the police but does not because she worries that her child will be taken away from her, that she would have nowhere to live, or no money to live upon. Mary has told nobody about the violence that she endures at home.

  As shown in Case Study 5.2, many IPV victims experience significant difficulties in help-seeking with obstacles such as personal and family safety, economic dependence, psychological factors such as attachment and commitment, sociocultural factors, and legal factors (Hien & Ruglass, 2009). Involvement with criminal justice systems offers IPV victims the opportunity to engage in help-seeking and access legal resources, which may potentially play an important role in their recovery (Bell, Perez, Goodman, & Dutton, 2011). In terms of accessing formal and informal support, Barrett and St. Pierre (2011) showed that two thirds of victims will access formal support and over 80% will access informal support. However, this leaves a significant number of IPV victims who do not access any support, with underreporting a significant issue (Bowen, 2011). Ansara and Hindin (2010) found that the police are often the key point of contact for IPV victims seeking formal help; however, this study still showed low levels of reporting with just over a quarter of the IPV victims reporting their victimisation to the police. Furthermore, even when a case is reported, there is a high level of case attrition throughout the criminal justice process, with Hester, Westmarland, Pearce, & Williamson (2008) showing that only 3% of cases resulted in a conviction.

  5.3.2 Rape and Sexual Victimisation

  This next section reviews the impact of victimisation in relation to rape, again assessing the impact on both physical and mental health. As with IPV, the focus of the majority of the literature is on female rape victims, but it is important that the occurrence of male rape is not neglected.

  5.3.2.1 Impact on physical health

  Although rape is a violent crime, a number of studies have demonstrated that approximately two-thirds of victims do not sustain physical injury requiring medical attention (Feist, Ashe, Lawrence, McPhee, & Wilson, 2007). This is not true for all studies as Kelly, Lovatt and Regan (2005) found that 70% of their sample was injured by the incident and there is evidence that the level of violence (and subsequent injury) may differ according to the level of relationship between the victim and perpetrator (Möller, Bäckström, Söndergaard, & Helström, 2012). Maguire, Goodall, & Moore (2009) found in a sample of 162 victims of sexual assault that 56% were bruised, 41% had abrasions, and 4% had lacerations. Baker and Sommers (2008) showed that 62.8% of their sample suffered genital injuries with a range of 1 to 24 different injuries in the genital area. However, victims are more likely to be injured non-gen
itally than genitally (Möller et al., 2012).

  In relation to the physical health of victims, being a victim of rape has been associated with a significant range of physiological conditions (see Table 5.8). In particular, sustaining injury from the rape has been associated with higher reports of pain, more days in bed due to disability, and more functional disability than victims who were not injured (Leserman, Li, Drossman, Toomey, Nachman, & Glogau, 1997). Unsurprisingly, these reports of physical health complaints are linked with rape victims having a significantly lower perception of their health (Goodman, Koss, & Russo, 1993).