Guest Written by Cornell Student, Paris Wu
Note: This blog is part of our Guest Blog Series, where we invite community members who are passionate about our topics to contribute written works relating to our issue areas. These pieces are not written by our staff, and encourage people across Tompkins County to bring awareness to specific topics they are interested in various creative formats.
Intimate partner violence (IPV) refers to a series of physical, sexual, and/or sexual abuses exercised over another individual during an intimate relationship. Survivors of IPV have reported cognitive deficits such as memory loss, mental fatigue, and confusion, difficulty following directions, difficulty retaining information, difficulty concentrating, inability to initiate self-directed behavior, and difficulty with abstract thinking in addition to depression, anxiety, irritability, and symptoms of post-traumatic stress disorder (PTSD). Definition of PTSD fluctuated throughout history, but may be broadly understood as “the response to an unexpected or overwhelming violent event or events that are not fully grasped as they occur, but return later in repeated flashbacks, nightmares, and other repetitive phenomena.”
According to the 2016/2017 Report on Intimate Partner Violence, 41.0% of women and 26.3% of men experienced contact sexual violence, physical violence, and/or stalking by an intimate partner during their lifetime and reported at least one intimate partner violence related impact. Among the female victims of intimate partner-perpetrated contact sexual violence, physical violence, and/or stalking, 71.3% reported PTSD symptoms, and their male counterparts reported 32.9%. What was interesting about this national report is that emotional or verbal abuse, harassment, non-physical sexual harassment, and other potentially traumatizing factors prevalent as elements of intimate partner violence was not emphasized. This was partially due to the hyponarrativity of the description of PTSD in the American Psychiatric Association (APA)’s latest edition of the Diagnostic and Statistical Manual of Disorder (DSM-5), which may be found on the National Library of Medicine’s website: https://www.ncbi.nlm.nih.gov/books/NBK207191/box/part1_ch3.box16/. Such a narrow definition of PTSD excluded many survivors of IPV, especially those who experience the psychological abuse subtype of IPV, from accessing diagnosis and treatment, marking a return to its historically exclusive nature.
In the late nineteenth century, neurologist Jean-Martin Charcot and psychologist Pierre Janet identified “traumatic hysteria” as results of shocking external events such as sexual abuse or violence, rather than the then conventional belief of “problems in the uterus.” However, when Sigmund Freud followed this framework by studying hysteria patients’ revisitation of traumatic events, he decided that the root of trauma was not their sexual victimization but rather women’s alleged rape fantasies. Such disconnect between psychoanalysis and women’s lived experiences resulted in a psychiatric theory that divulges more resources in studying the psychopathology of sex offenders and victim blaming. Nevertheless, Freud’s psychoanalysis became increasingly popular in the early twentieth century. His 1920 publication A General Introduction to Psychoanalysis might have even informed the original diagnosis criteria of PTSD in the APA’s third Diagnostic and Statistical Manual of Disorder (DSM-3) published in 1980, as it resembles the Freudian description of trauma.
As the creation of PTSD was a cultural continuation of science’s failure to “[hear] women with a devotion and respect” and established by the APA to meet Vietnam War veterans’ demands for diagnosing their post-war symptoms, its diagnosis criteria was limited to the gendered experiences of combat veterans. In response, feminists called for a more inclusive conceptualization of PTSD, since trauma arising from events such as intimate partner violence was also valid but stereotypically prevalent among women. This was a part of a larger feminist psychology movement beginning in the 1970s that aimed to “change the structure of the belief system of science to construct a psychology of human behavior.” By advocating for the elimination of gender biases in mental health research methodologies, and emphasizing the victim’s suffering rather than their culpability, feminists of the late twentieth century were able to include victims of IPV as PTSD patients, as well as creating the inclusive diagnostic criteria of “exposure trauma or stressful event” for PTSD in the DSM-4.
However, a little less than two decades later, the diagnostic criteria of PTSD narrowed. The latest diagnostic manual, the DSM-5, limited PTSD’s primary stressor to physical trauma—“exposure to actual or threatened death, serious injury, or sexual violence.” This once again ignores and trivializes the needs for medical care among many IPV survivors. For example, research suggests that while psychological abuse is not recognized as a stressor for PTSD in the DSM-5, it is estimated to be the most common form of IPV in the USA and Europe (affecting between 25% and 49% people) that can independently cause PTSD.
Following Dokkedahl et al. (2019)’s protocol for analyzing the psychological subtype of intimate partner violence’s impact on mental health, this blog defines psychological abuse as “any act or behavior which causes psychological harm to the partner or former partner.” This includes coercion, defamation, belittling, constant humiliation, intimidation, threats of harm, threats to take away children, and more. Research between the 1990s and the publication of DSM-5 in 2013 has provided strong evidence demonstrating the impact of psychological abuse. That psychological abuse is implicated in the development of PTSD in IPV survivors even after controlling for the effects of physical victimization, that increased frequency of such abuse was associated with increased PTSD, and that women who experience IPV often rate psychological abuse as more damaging than physical abuse. Arguably, body shaming as a form of psychological abuse perpetrated by an intimate partner was associated with greater PTSD symptom severity even after the new diagnostic criteria for PTSD.
Weaver et al. (2019)’s research on IPV and body shame defined body image as “the subjective mental representations an individual develops regarding their body.” Since IPV is a “culturally embedded, body-focused, relationship violation,” it can negatively affect body image through degrading body-focused comments. In Humphreys et al. (2003)’s research on mental health and domestic violence, survivors of IPV with PTSD symptoms spoke of the undermining effects shame by their intimate partners had on themselves:
“I supposed he was like mentally abusing me in a way. I was just becoming some subservient little doormat of a wife for him… My confidence hit rock bottom when I was at home. I got to the point where I was no good at cooking, no good at basic things” (Sally).
“He made me hate everything… He used to hold my hair… in a mirror saying, ‘Look at you. Who is gonna want you—you are black. Who is gonna like you?” (Narelle).
“If you start believing that you are inferior to them, the more they make you believe it. I still believe that I’m fat and ugly. I’m working on it. But that’s what [they] do… they make you feel so small that you agree that everything is your fault” (Kim).
The belittling effect of body shaming highlighted how it fits the definition of psychological abuse, and corresponded with Holmes et al. (2023)’s research that discovered the significant associations between IPV, weight/shape concerns, and PTSD symptom severity through negative alterations in cognitions and mood (category D in DSM-5 PTSD symptom clusters). Indeed, psychological abuse in IPV through degrading body-focused comments mediated self-objectification, body surveillance and body shame, which fits the diagnostic criteria of “persistent and exaggerated negative beliefs or expectations about oneself, others, or the world” and “persistent negative emotional state (e.g., fear, horror, anger, guilt, shame)” for DSM-5 PTSD.
Yet such impact of psychological abuse as a part of intimate partner violence has continued to be doubted, trivialized, and ignored. Absence of attention of how psychological abuse negatively affects IPV survivors’ cognition, mood, or behavior in the fifth Diagnostic and Statistical Manual’s diagnosis criteria for post-traumatic stress disorder not only fails to deliver medical care to those in need, but further stigmatizes traumatized people who were historically treated as liars or culprits of their own victimization.
References
Albin, Rochelle Semmel. “Psychological Studies of Rape.” Signs 3, no. 2 (1977): 423–35. http://www.jstor.org/stable/3173293.
Britt, Lucy, and Wilson H. Hammett. “Trauma as Cultural Capital: A Critical Feminist Theory of Trauma Discourse.” Hypatia 39, no. 4 (2024): 916–33. https://doi.org/10.1017/hyp.2024.22.
Caruth, Cathay. Unclaimed Experience: Trauma, Narrative, and History. Baltimore: Johns Hopkins University Press, 2016.
Castro, Christian, Nathalia Quiroz Molinares, Elizabeth Verbel Saumeth, Claudia García de la Cadena, Geraldine Ruiz Avendaño, and Carlos José De los Reyes-Aragón. “Exploring the Relationship between Mental Health and Neuropsychological Functioning in Female Survivors of IPV.” Bethlehem University Journal 39 (2022): 139–52. https://www.jstor.org/stable/48811024.
Center for Substance Abuse Treatment (US). Trauma-Informed Care in Behavioral Health Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. (Treatment Improvement Protocol (TIP) Series, No. 57.) Exhibit 1.3-4, DSM-5 Diagnostic Criteria for PTSD. Available from: https://www.ncbi.nlm.nih.gov/books/NBK207191/box/part1_ch3.box16/.
Csabai, Marta, and Orsolya Papp-Zipernovszky. “Psycho-Politics and Illness Constructions in the Background of the Trauma-Concept of the DSM-5.” In Psychology and Politics: Intersections of Science and Ideology in the History of Psy-Sciences, edited by Anna Borgos, Ferenc Erős, and Júlia Gyimesi, 329–44. Central European University Press, 2019. http://www.jstor.org/stable/10.7829/j.ctvs1g9j3.23.
Dokkedahl, Sarah, Robin Niels Kok, Siobhan Murphy, Trine Rønde Kristensen, Ditte Bech-Hansen, and Ask Elklit. “The Psychological Subtype of Intimate Partner Violence and Its Effect on Mental Health: Protocol for a Systematic Review and Meta-Analysis.” Systematic Reviews 8 no. 1 (2019). https://doi.org/10.1186/s13643-019-1118-1.
Holmes, Samantha C et al. “Associations among Intimate Partner Violence, Posttraumatic Stress Disorder Symptoms, and Disordered Eating among Women Intimate Partner Violence Survivors Residing in Shelter.” Journal of interpersonal violence vol. 38, 1-2 (2023): NP2135-NP2158. doi:10.1177/08862605221098968.
Humphreys, Cathy, and Ravi Thiara. “Mental Health and Domestic Violence: ‘I Call It Symptoms of Abuse.’” The British Journal of Social Work 33, no. 2 (2003): 209–26. http://www.jstor.org/stable/23716826.
Leemis R.W., Friar N., Khatiwada S., Chen M.S., Kresnow M., Smith S.G., Caslin, S., & Basile, K.C.. (2022). The National Intimate Partner and Sexual Violence Survey: 2016/2017 Report on Intimate Partner Violence. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.
Nathanson, Alison M et al. “The Prevalence of Mental Health Disorders in a Community Sample of Female Victims of Intimate Partner Violence.” Partner abuse vol. 3,1 (2012): 59-75. doi:10.1891/1946-6560.3.1.59.
Raskin, Sarah A., Olivia DeJoie, Carolyn Edwards, Chloe Ouchida, Jocelyn Moran, Olivia White, Michelle Mordasiewicz, Dorothy Anika, and Blessing Njoku. 2023. “Traumatic Brain Injury Screening and Neuropsychological Functioning in Women Who Experience Intimate Partner Violence,” The Clinical Neuropsychologist 38 (2): doi:10.1080/13854046.2023.2215489.
Stewart, Abigail J., and Andrea L. Dottolo. “Feminist Psychology.” Signs 31, no. 2 (2006): 493–509. https://doi.org/10.1086/491683.
Tekin, Şerife, and Melissa Mosko. “HYPONARRATIVITY AND CONTEXT-SPECIFIC LIMITATIONS OF THE DSM-5.” Public Affairs Quarterly 29, no. 1 (2015): 109–34. http://www.jstor.org/stable/43574516.
Weaver, T. L., Elrod, N. M., & Kelton, K. (2019). Intimate Partner Violence and Body Shame: An Examination of the Associations Between Abuse Components and Body-Focused Processes. Violence Against Women 26 (12-13): 1538-1554. https://doi.org/10.1177/1077801219873434 (Original work published 2020).