RISK FACTORS AND LETHALITY

Categories of Risk Factors for Abusers

The CDC identifies four risk factor categories for abusers: individual, relationship, community, and societal. Not everyone who experiences these risk factors becomes an abuser. Identification and understanding of risk factors can lead to prevention.

INDIVIDUAL RISK FACTORS

• Low self-esteem
• Low income
• Low academic achievement
• Low verbal communication ability
• Young age
• Aggressive or delinquent behavior as a youth
• Heavy alcohol and drug use
• Depression and suicide attempts
• Anger and hostility
• Lack of nonviolent social problem-solving skills
• Antisocial personality traits and conduct problems
• Poor behavioral control/impulsiveness
• Borderline personality traits
• Prior history of being physically abusive
• Having few friends and being isolated from other people
• Unemployment
• Emotional dependence and insecurity
• Belief in strict gender roles (e.g., male dominance and aggression in relationships)
• Desire for power and control in relationships
• Hostility toward women
• Attitudes accepting or justifying IPV
• Being a victim of physical or psychological abuse (consistently one of the strongest predictors of perpetration)
• Witnessing IPV between parents as a child
• History of experiencing poor parenting as a child
• History of experiencing physical discipline as a child
• Unplanned pregnancy

RELATIONSHIP RISK FACTORS

• Marital conflict/fights, tension, other struggles
• Jealousy, possessiveness, negative emotions within an intimate relationship
• Marital instability, divorces, separations
• Dominance and control of the relationship by one partner over the other
• Economic stress
• Unhealthy family relationships and interactions
• Association with antisocial and aggressive peers
• Parents with less than a high school education
• Social isolation/lack of social support

COMMUNITY RISK FACTORS

• Poverty and associated factors (e.g., overcrowding, high unemployment rates)
• Low social capital; lack of institutions, relationships, and norms that shape a community’s social interactions
• Poor neighborhood support and cohesion
• Weak community sanctions against IPV (e.g., unwillingness of neighbors to intervene in situations where they witness violence)
• High alcohol outlet density

SOCIETAL RISK FACTORS

• Traditional gender norms and gender inequality (e.g., belief that women should stay at home, not enter workforce, and be submissive; belief that men should support the family and make the decisions)
• Cultural norms that support aggression toward others
• Societal income inequality
• Weak health, educational, economic, and social policies/laws
  (CDC, 2021)

Common Risk Factors

POVERTY

Although domestic violence is found in all walks of life, those who live in poverty face additional challenges. The CDC (2021) lists poverty as a risk factor for intimate partner violence. Poverty damages health and well-being in countless ways; exposure to domestic violence is just one. When violence and poverty intersect, they limit coping options. Both poverty and violence lead to stress, feelings of powerlessness, and social isolation, which combine to produce posttraumatic stress disorder, depression, and other emotional difficulties.

Victims who are experiencing poverty face risks that are related to poverty as well as risks from their abuser.

• Risks from the abuser include physical injury; threats and loss of security, housing, and income; and potential loss of their children.
• Risks from poverty include food insecurity, lack of access to health insurance and healthcare, possible racism, unsafe neighborhoods, and poor schools for their children.

The double jeopardy of poverty and violence challenges victims and the healthcare and social service professionals responsible for protecting them. Intervening to stop the violence is only the first step. Issues of income, housing, and healthcare—both mental and physical—must also be addressed. For example, in 2022, 11% of all homeless service system beds (emergency shelter, transitional housing, and safe haven) in the United States were aimed at survivors and families of domestic violence (NAEH, 2023).

FAMILY/CAREGIVER STRESS

Families stressed by illness, unemployment, alcohol, and/or drug use are more likely to experience violence. This is particularly true with elder abuse, especially if the older person is frail or mentally impaired, the caregiver is poorly prepared for the task, or needed resources are unavailable. Adult children who abuse their parents frequently suffer from mental and emotional disorders, alcoholism, drug addiction, and/or financial problems that make them dependent on the parents for support. These families may respond to tension or conflict with violence because they have not learned any other way to respond.

DISABILITY/IMPAIRMENT

People with disabilities are especially vulnerable and are more likely to experience abuse than those without disabilities. Approximately 70% of people with disabilities experience some form of abuse, and they are three times more likely to be sexually assaulted. Eighty percent of women with disabilities have been sexually assaulted and experience IPV at a 40% higher rate than do women who do not have a disability. In addition to a higher prevalence, the frequency and severity of the acts are also elevated.

It is estimated that between 70%–97% of cases are not reported, and only 5% of reported cases are prosecuted as compared to 70% of comparable cases against people without disabilities. Survivors with disabilities must contend with barriers to help-seeking, such as need for transportation, fear of being institutionalized, lack of communication devices, and many other reasons. In addition, if a survivor is able to leave an abusive household, many domestic violence shelters cannot accommodate their specific needs.

In almost 100% of cases, survivors with disabilities are abused by a trusted person. This person is usually a family member, intimate partner, or caregiver (Sanctuary for Families, 2022).

In addition to physical and psychological abuse, unwanted sexual contact, and intimidation, people with disabilities may also experience the following types of abuse:

• Neglect
• Minimizing a disability
• Withholding medications
• Refusing help for necessary activities of daily living
• Preventing access to healthcare or resources
• Isolating victims
• Harming or threatening to harm a service animal
• Depriving victims of necessary physical accommodations
• Withholding or destroying assistive devices such as wheelchairs
• Financial exploitation
• Using the disability to shame, humiliate, or justify the abuse
• Threat of abandonment
• Deliberately ignoring personal care and hygiene

Risk of Lethality

Femicide continues to be a serious problem in the United States, and among women who are killed, around 40% of their deaths were perpetrated by their intimate partners compared to only 4% of men who are killed by their intimate partners.

Without any sort of intervention, abuse tends to escalate. While not all abusers kill, and there are no perfect predictors of time and place, research has revealed some patterns of escalation in domestic violence. The use of risk assessment tools by multidisciplinary parties such as law enforcement and medical workers who are in contact with survivors is recommended to protect vulnerable survivors of IPV from homicidal injury (Williams et al., 2022).

Numerous studies have been conducted to identify behaviors that increase the risk of femicide by an intimate partner. Of all of the risk factors, a history of nonfatal strangulation is the highest predictor of future attempted or completed homicide.

Risk factors for domestic violence homicide by a male perpetrator include:

• Previous nonfatal strangulation (seven times more likely to occur)
• Access to a firearm (five times more likely to occur)
• Previous threats with a weapon
• Previous rape of the victim
• Previous threats to harm the victim
• Previous stalking of the victim
  (Spencer, 2020)

HOMICIDE-SUICIDE

IPV has been identified as a precipitating factor for 4.5% of suicides in the United States. Another 6.1% of suicides occur when a family member kills a domestic partner or other family member and then dies by suicide. Homicide followed by suicide events almost always involve male perpetrators (95%–97%) (Kafka et al., 2022).

INTIMATE PARTNER VIOLENCE AND GUNS

Nearly one million women currently living have either been shot or shot at by an intimate partner, and over 4.5 million have reported being threatened with a gun by an intimate partner. Guns in the hands of an abuser may physically injure or kill survivors and as a threat inflict emotional abuse (Everytown for Gun Safety, 2023).

Research has shown that gun safety laws that restrict access to firearms by people with a history of domestic violence and abuse lead to a reduction in intimate partner homicides.

According to longstanding federal laws, people who have been convicted in any court of a misdemeanor crime of domestic violence and/or who are subject to certain domestic violence protective orders are prohibited from purchasing and possessing firearms and ammunition. Being convicted for a misdemeanor crime of domestic violence is the third most frequent reason for the denial of an application to purchase a firearm by the FBI.

According to the newer 2022 Bipartisan Safer Communities Act, people convicted of a misdemeanor crime of domestic violence against a victim with whom they have or had a current or recent former dating relationship are also prohibited from purchasing and possessing firearms for five years. If the person is convicted more than once for domestic violence against a person with whom they have or had a dating relationship, the prohibition on gun purchases and possession lasts indefinitely.

Many states have adopted laws that fill gaps in federal law by more comprehensively restricting access to firearms and ammunition by domestic abusers. Examples of state laws include:

• Prohibiting domestic violence misdemeanants not covered by federal law from buying or possessing guns and/or ammunition
• Authorizing or requiring courts to order people convicted of domestic violence misdemeanors to relinquish their guns and/or ammunition
• Requiring officials to submit records regarding domestic violence offenses to databases used for firearm purchaser background checks
• Prohibiting purchase and possession of firearms by people convicted of a misdemeanor crime of stalking
• Allowing law enforcement officers to remove firearms when they arrive at the scene of a domestic violence incident
  (Giffords Law Center, 2023)

Understanding Perpetrators and Victims

People outside of abusive relationships often wonder both why a perpetrator abuses and why a victim of abuse remains in such a relationship.

WHY PERPETRATORS ABUSE

Typically, abusers want power and control, and their various behaviors are intended to achieve that end.

Although an abuser’s behavior may also arise from or be exacerbated by a mental illness, that is not usually the case; however, abusive behaviors may be complicated by substance abuse problems. Health professionals should be alert to any signs of these complicating factors when assessing high-risk individuals.

WHY VICTIMS STAY

Victims who stay with an abuser are often judged negatively by others who do not understand the complex problems these victims may face. To better understand these challenges, domestic violence researchers evaluated hundreds of posts from victims on social media and identified common reasons that victims stay in abusive relationships. The researchers also concluded that victims fear being judged by others and are more likely to respond positively to concern and compassion than to criticism and pressure.

• Distorted thoughts: Victims who are controlled and hurt become traumatized, resulting in confusion and self-blame.
• Damaged self-worth: Victims believe that they are worthless and deserve the abuse as a result of being treated badly.
• Fear: The threat of physical or emotional harm is traumatic and debilitating.
• Danger: In fact, leaving the relationship is the most dangerous time for a victim who is being abused.
• Wanting to be a “savior”: Some victims want to help their partners, continue to love them, and hope that they will change for the better.
• Children: Some victims sacrifice themselves to keep their children safe or express that they do not want their children to grow up without the other parent.
• Expectations and experience: Past experiences can distort the victim’s opinion of themselves or healthy relationships. Others feel pressured to remain in the relationship because of family values or religious beliefs. Cultural and social barriers may also preclude victims of thinking about leaving.
• Financial constraints: Many victims report an inability to provide for their children alone and that they cannot maintain employment because of abuse. Others suffer from financial abuse.
• Immigration status: Lacking legal status to remain in the country may be an impediment to those who are concerned about being deported.
• Lack of institutional support: Responses, such as from clergy or police, may not be helpful to stop the violence.
• Isolation: Abusers can separate victims from family and friends either physically or through emotional abuse.

Leaving an abusive situation is a process, and research shows it may take seven attempts to leave and return before a survivor leaves permanently (Cravens et al., 2015; Women Against Abuse, 2023).