Childhood family violence history and women’s risk for intimate partner violence and poor health

Abstract

Background

There is growing evidence for associations between generations in family violence and between family violence in both childhood and adulthood and women’s health. Most studies focus on a subset of family violence (child abuse, witnessing intimate partner violence [IPV] as a child, and/or adult IPV), and few examine possible differences associated with the nature of abusive experiences, such as physical versus sexual abuse.

Methods

A population-based telephone survey, the 1999 and 2001 Washington State Behavioral Risk Factor Surveillance System, asked a representative sample of 3527 English-speaking, non-institutionalized adult women whether they had been physically or sexually assaulted or witnessed interparental violence in childhood, and whether they had experienced physical assault or emotional abuse from an intimate partner in the past year. The survey also asked about current general health and mental distress in the past month.

Results

The risks associated with childhood family violence experiences varied depending on the nature of those experiences. Women reporting childhood physical abuse or witnessing interparental violence were at a four- to six-fold increase in risk of physical IPV, and women reporting any of the experiences measured were at three- to four-fold increase in risk of partner emotional abuse. In contrast, women reporting childhood sexual abuse only were not at increased risk of physical IPV. Women reporting childhood physical abuse were at increased risk of poor physical health, and women reporting any type of childhood family violence were at increased risk of frequent mental distress. Approximately one third of women reporting poor general health and half of women reporting frequent mental distress also reported at least one of the childhood experiences measured.

Conclusions

These findings underscore the role of childhood experiences of abuse and of witnessing family violence in women’s current risk for IPV, poor physical health, and frequent mental distress.

Introduction

T he role of family violence as an important factor in women’s health is becoming increasingly well recognized. Both a history of childhood abuse1, 2 and adult intimate partner violence (IPV)3, 4 have been linked with poor physical and mental health. Dose–response relationships have also been identified between the number of adverse childhood experiences and the presence of a number of adult diseases.5

A history of childhood abuse or of witnessing IPV may also increase risk for adult IPV, although not all studies find these associations. Hotaling and Sugarman6 identified four reviews of a possible association between women experiencing violence from parents during childhood and husband-to-wife violence in adulthood. Two of these reviews found such an association and two did not. Hotaling and Sugarman6 also reported that they found no such association in a national survey, after controlling for other risk factors including the woman’s self-esteem and marital conflict. However, if childhood abuse is associated with IPV because of its effects on factors such as self-esteem or later marital conflict, statistically controlling for these factors may obscure a real association. More recently, in a study of over 1200 women, those who reported receiving repeated severe beatings as children had more than three times the risk of being the victim of domestic violence as adults compared to non-abused women.7

Childhood experiences of witnessing interparental violence may also be associated with adult victimization. A well-controlled study of the association between childhood witnessing of abuse and adult IPV among 1443 women seeking medical care showed a four-fold increase in risk of partner physical and sexual abuse, and a three-fold risk of physical abuse only, among those women who reported that their fathers were physically abusive to their mothers.8 However, childhood abuse was not measured, and the high rates of violence in this sample may not be typical of the general population. Over one third (37.6%) of the sample reported ever experiencing physical IPV, compared to 22.1% in the National Violence Against Women Survey.9

These studies provide growing evidence for interlocking patterns of associations between the various types of family violence, and between family violence (both in childhood and adulthood) and women’s health. However, most studies focus on some subset of family violence (child abuse, witnessing IPV as a child, and/or adult IPV), and few examine possible differences associated with the nature of abusive experiences, such as physical versus sexual abuse. The nature of abuse experiences may be important; for example, a history of early and chronic sexual abuse was associated with more than a seven-fold increase in women’s HIV-risk behaviors, while physical abuse was not significantly associated with these risk behaviors.10 Also, the majority of the studies have been based on samples drawn from healthcare facilities, which may not be generalizable to the general population.

This study used a general population survey to examine the associations between women’s childhood experiences of physical and sexual abuse and witnessing interparental violence, on the one hand, and adult intimate partner physical violence and emotional abuse, physical health, and emotional distress, on the other hand, after controlling for age and income. The focus was on women because IPV is more injurious to women than men.11