3
Causes and Consequences of Violence Against Women

Causes

A vital part of understanding a social problem, and a precursor to preventing it, is an understanding of what causes it. Research on the causes of violence against women has consisted of two lines of inquiry: examination of the characteristics that influence the behavior of offenders and consideration of whether some women have a heightened vulnerability to victimization. Research has sought causal factors at various levels of analysis, including individual, dyadic, institutional, and social. Studies of offending and victimization remain conceptually distinct except in sociocultural analysis in which joint consideration is often given to two complementary processes: those that influence men to be aggressive and channel their expressions of violence toward women and those that position women for receipt of violence and operate to silence them afterwards. Many theorists and researchers have sought to answer the question, "Why does this particular man batter or sexually assault?" by looking at single classes of influences. Among them have been biologic factors such as androgenic hormonal influences; evolutionary theo-



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--> 3 Causes and Consequences of Violence Against Women Causes A vital part of understanding a social problem, and a precursor to preventing it, is an understanding of what causes it. Research on the causes of violence against women has consisted of two lines of inquiry: examination of the characteristics that influence the behavior of offenders and consideration of whether some women have a heightened vulnerability to victimization. Research has sought causal factors at various levels of analysis, including individual, dyadic, institutional, and social. Studies of offending and victimization remain conceptually distinct except in sociocultural analysis in which joint consideration is often given to two complementary processes: those that influence men to be aggressive and channel their expressions of violence toward women and those that position women for receipt of violence and operate to silence them afterwards. Many theorists and researchers have sought to answer the question, "Why does this particular man batter or sexually assault?" by looking at single classes of influences. Among them have been biologic factors such as androgenic hormonal influences; evolutionary theo-

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--> ries; intrapsychic explanations focused on mental disorder or personality traits and profiles; social learning models that highlight the socialization experiences that shape individual men to be violent; social information processing theory concerning the cognitive processes that offenders engage in before, during, and after violence; sociocultural analyses aimed at understanding the structural features of society at the level of the dyad, family, peer group, school, religion, media, and state that encourage male violence and maintain women as a vulnerable class of potential victims; and feminist explanations stressing the gendered nature of violence against women and its roots in patriarchal social systems. Recently, researchers armed with multivariate statistical analysis have tested complex models of violence with multiple factors to explain battering (McKenry et al., 1995) and to model the common roots of verbal, physical, and sexual coercion toward women (Malamuth et al., 1995). Also new are integrative metatheories of intimate violence that consider the impact of historical, sociocultural, and social factors on people, including the processes whereby social influences are transmitted to and represented within individual psychological functioning, including cognition and motivation (White, in press). Many of the theories about the causes of perpetrating violence against women are drawn from the literature on aggression and general violence. Both the research on general violence and that on violence against women suggest that violence arises from interactions among individual biological and psychosocial factors and social processes (e.g., Reiss and Roth, 1993), but it is not known how much overlap there is in the development of violent behavior against women and other violent behavior. Studies of male batterers have found that some batterers confine their violent behavior to their intimates but others are violent in general (Fagan et al., 1983; Cadsky and Crawford, 1988; Shields et al., 1988; Saunders, 1992; Holtzworth-Munroe and Stuart, 1994). The research suggests that, at least in some cases, there may be differences in the factors that cause violence against women and those

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--> that cause other violent behavior. Much more work is needed in order to understand in what ways violence against women differs from other violent behavior. Such understanding will be particularly important for developing preventive interventions. Although current understanding suggests that violent behavior is not caused by any single factor, much of the research has focused on single causes. Therefore, in the following sections several salient findings emerging from each single-factor domain are highlighted to illustrate how each contributes something to the causal nexus of perpetration of violence. They are followed by a brief review of efforts to build multifactor models. Theories of Violent Offending Individual Determinants Evolution From an evolutionary perspective, the goal of sexual behavior is to maximize the likelihood of passing on one's genes. This goal involves maximizing the chances that one will have offspring who themselves will survive to reproduce. In ancestral environments, optimum male and female strategies for successfully passing on one's genes often did not coincide because the amount of parental investment required by males is smaller than that required by females. Males were best served by mating with as many fertile females as possible to increase their chance of impregnating one of them; females, who have the tasks of pregnancy and nurturing the young, are often better served by pair bonding. Sex differences in current human mating strategies may be explained as having been shaped by the strategies that created reproductive success among human ancestors. A number of studies have shown that young adult males are more interested in partner variety, less interested in committed long-term relationships, and more willing to engage in impersonal sex than are young adult females (Clark and Hatfield, 1989; Symons

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--> and Ellis, 1989; Clark, 1990; Landolt et al., 1995). This finding is consistent with the optimum evolutionary strategy for males of mating with as many fertile females as possible. It is theorized that males who have difficulty obtaining partners are more likely to resort to sexual coercion or rape. Extensive evidence of forced mating among animals has been documented (Ellis, 1989). Evolutionary theory also has been used to explain aspects of intimate partner violence. It is theorized that male sexual jealousy developed as a means of assuring the paternity of their offspring (Quinsey and Lalumière, 1995). Case histories from battered women often mention the extreme sexual jealousy displayed by their batterers (Walker, 1979; Browne, 1987), and extreme sexual jealousy is a common motive of men who kill their wives (Daly and Wilson, 1988). There is much debate over how much influence evolutionary factors have on modern human beings. Even those who favor evolutionary explanations acknowledge that additional factors are necessary to explain sexual assault and intimate partner violence. For example, Quinsey and Lalumière (1995) suggest that rape and other sexual coercion may be explained by the evolutionary approach that is modified by specific attitudes toward women or by psychopathy, coupled with an erotic interest in coercive sexual behavior. Evolutionary explanations of rape are also criticized as not explaining the proportion of rapes lacking reproductive consequences because they involve oral or anal penetration or victims who are prepubescent or male. Physiology and Neurophysiology The physiological or neurophysiological correlates of violence and aggression that have received particular attention are the functioning of steroid hormones such as testosterone; the functioning of neurotransmitters such as serotonin, dopamine, norepinephrine, acetylcholine, and gamma-aminobutyric acid (GABA); neuroanatomical abnormalities; neurophysiological abnormalities; and brain dysfunctions that interfere with cognition or

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--> language processing. This literature has been well reviewed in other sources (e.g., Fishbein, 1990; Reiss and Roth, 1993; Brain, 1994; Miczek et al., 1994a,b; Mirsky and Siegel, 1994); this section highlights the overall findings and notes studies that have specifically looked at violence against women. In considering this literature, it should be remembered that much of the evidence comes from animal studies and that generalizing from animals to humans is not straightforward. The evidence that comes from studies of human subjects only shows correlations, so any causal interpretations are tenuous. Furthermore, changes in hormonal, neurotransmitter, and neurophysiological processes may be consequences of violent behavior or victimization, as well as being causes of those behaviors (Reiss and Roth, 1993; van der Kolk, 1994). A recent comprehensive literature review (Archer, 1991) concluded that the majority of studies showed that high testosterone levels tend to covary with high probabilities of aggressive behaviors, dominance status, and pathological forms of aggression in nonhuman mammals, but that the picture for humans is not as clear. In humans, there appears to be a correlation between testosterone levels and aggression, but it is not clear whether testosterone levels influence aggressive behavior or vary as a result of aggressive behavior. Similarly, the results of human studies of neurotransmitters are not conclusive. For example, low levels of serotonin, the most heavily studied of the neurotransmitters, have been found to be correlated with aggressive behavior, impulsivity, and suicidal behavior (Asberg et al., 1976; Brown et al., 1979; Linnoila et al., 1983; Lidberg et al., 1985; Mann, 1987; Coccaro et al., 1989). More recent studies have found a complex interaction among serotonin, alcoholism, and monoamine metabolism and these behaviors (Linnoila et al., 1989; Virkkunen et al., 1989a,b). Further evidence of the role of neurotransmitters comes from the fact that drugs that act on serotonin receptors or on monoamine oxidase may reduce aggressiveness. Animal and human studies have found trauma and violence to

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--> have effects on hormones, neurotransmitters, and brain function (e.g., van der Kolk, 1994). Studies have also looked at brain abnormalities and violent behavior. Neuropsychological deficits in memory, attention, and language, which sometimes follow limbic system damage, have been found to be common in children who exhibit violent or aggressive behavior (e.g., Miller, 1987; Lewis et al., 1988; Mungas, 1988). Differences in peripheral measures of nervous system activity, such as heart rate or skin conductance, have been found between control subjects and samples of criminals, psychopaths, delinquents, and conduct-disordered children (Siddle et al., 1973; Wadsworth, 1976; Raine and Venables, 1988; Kagan, 1989; Raine et al., 1990). Langevin (1990:112) found a "link between temporal lobe impairment and sexually anomalous behaviors" that was independent of nonsexual criminality and not explained by learning disabilities or alcohol abuse. Reduced impulse control and personality changes following head injury may lead to an increased risk of battering (Detre et al., 1975; Lewis et al., 1986, 1988). Likewise, studies have found that batterers are more likely to have had head injuries than nonbatterers (Rosenbaum and Hoge, 1989; Rosenbaum et al., 1996). There is increasing interest in the role played by biological factors in violent behavior; however, most researchers believe it is the interaction of biological, developmental, and environmental factors that is important (Fishbein, 1990). For example, Marshall and Barbaree (1990) speculate that biological factors may set the stage for learning, providing limits and possibilities rather than determining outcomes, and that developmental and environmental factors play the larger role. However, as suggested by a previous study (Reiss and Roth, 1993), preventing head injuries and environmental exposure to toxins, such as lead, that may damage brain functioning could be considered potential avenues for preventing violence. Alcohol Every category of aggressive act (except throwing objects) has a higher prevalence among people who have been

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--> drinking (Pernanen, 1976). Alcohol use has been reported in between 25 percent and 85 percent of incidents of battering and up to 75 percent of acquaintance rapes (Kantor and Straus, 1987; Muehlenhard and Linton, 1987; Koss et al., 1988). It is far more prevalent for men than their female victims. Considerable research links drinking and alcohol abuse to physical aggression, although adult consumption patterns are likewise associated with other variables related to violence (such as witnessing physical violence in one's home of origin; Kantor, 1993). The relationship of alcohol to intimate partner violence could be spurious, but the relationship of men's drinking to intimate partner violence remains even after statistically controlling for sociodemographic variables, hostility, and marital satisfaction (Leonard and Blane, 1992; Leonard, 1993). Men's drinking patterns, especially binge drinking, are associated with marital violence across all ethnic groups and social classes (Kantor, 1993). The relationship of alcohol to violence is a complex one, involving physiological, psychosocial, and sociocultural factors. The exact effects of alcohol on the central nervous system remain in question, but nonexperimental evidence indicates that alcohol may interact with neurotransmitters, such as serotonin, that have been associated with effects on aggression (Linnoila et al., 1983; Virkkunen et al., 1989a,b). Studies have found a genetic basis for alcohol abuse and alcoholism (Cloninger et al., 1978; Plomin, 1989) and for antisocial personality traits (Christiansen, 1977; Bohman et al., 1982; Mednick et al., 1984; Cloninger and Gottesman, 1987) that are often found among violent offenders. The fact that alcohol abuse and antisocial personality frequently occur together has led to the speculation of common genetic bases, but the evidence remains inconclusive (Reiss and Roth, 1993). Alcohol may interfere with cognitive processes, in particular, social cognitions. Recent studies suggest that men under the influence of alcohol are more likely to misperceive ambiguous or neutral cues as suggestive of sexual interest and to ignore or misinterpret cues that a woman is unwilling

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--> (Abbey et al., 1995). The impact of alcohol on behavior has also been linked to a person's expectations about alcohol's effects. For example, Lang et al. (1975) found individuals became more aggressive in laboratory experiments after drinking what they were told was alcohol, even though it was not. Similarly, laboratory studies of penile responses to pornographic stimuli decrease with actual ingestion of alcohol, but increase when participants believe they have drunk alcohol when they have actually received a placebo drink (Richardson and Hammock, 1991). It has also been suggested that alcohol may be used to excuse violent behavior (Coleman and Straus, 1983; Collins, 1986). These deviance disavowal theories ("I wouldn't have done it if I hadn't been drunk") have not been empirically tested, however (Kantor, 1993). There are methodological weaknesses in the studies of the links between alcohol and violence, including lack of clear definitions of excessive alcohol use and a reliance on clinical samples with an absence of control samples. (For a more complete review of the research and methodological weaknesses see Leonard and Jacob, 1988; Leonard, 1993.) Nonetheless, research has consistently found that heavy drinking patterns are related to aggressive behavior, in general, and to intimate partner and sexual violence. However, exactly how alcohol is related to violence remains unclear. Obviously, many battering incidents and sexual assaults occur in the absence of alcohol, and many people drink without engaging in violent behavior (Kantor and Straus, 1990). Psychopathology and Personality Traits A number of studies have found a high incidence of psychopathology and personality disorders, most frequently antisocial personality disorder, borderline personality organization, or posttraumatic stress syndrome, among men who assault their wives (Hamberger and Hastings, 1986, 1988, 1991; Hart et al., 1993; Dutton and Starzomski, 1993; Dutton, 1994, 1995; Dutton et al., 1994). A wide variety of psychiatric and personality disorders have also been diagnosed among sexual offenders, most

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--> frequently some type of antisocial personality disorder (Prentky, 1990). Distinctive personality profiles have been reported for rapists and sexually aggressive men (Groth and Birnbaum, 1979; Abel et al., 1986), and batterers (Geffner and Rosenbaum, 1990). However, personality testing of rapists has found no significant differences between sexual offenders and those incarcerated for nonsexual offenses (Quinsey et al., 1980; Langevin, 1983). Studies of the personalities of incarcerated rapists and court-referred batterers are problematic, these men are typically poorly educated and from low-status occupations. Thus the differences may say more about who gets reported, arrested, tried, convicted, and sentenced than it does about the personalities of violent men. Rape, for example, is one of the most underreported crimes (Bowker, 1979), and only a small proportion of reported rapes result in incarceration (Darke, 1990). Even within the restricted population found in studies of incarcerated sex offenders, most investigators have concluded that there is a great deal of heterogeneity among rapists and that sexual aggression is multiply determined (Prentky and Knight, 1991). Batterers also seem to be a heterogeneous group (Gondolf, 1988; Saunders, 1992). Because of this heterogeneity, much of the research on incarcerated rapists and known batterers has included attempts to develop typologies to represent subgroups of them. Typologies of batterers have generally used one, or a combination, of three dimensions to distinguish between subgroups: frequency and severity of physical violence and related sexual or psychological abuse; generality of the violence (i.e., violence only in the family or violence in general); and psychopathology or personality disorder (Holtzworth-Munroe and Stuart, 1994). Rapists have been categorized by motivational factors (sexual or aggressive), impulse control factors, and social competence. (For a detailed description of sexual offender taxonomies, see Knight and Prentky, 1990.)

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--> Because incarcerated sexual offenders and batterers in treatment are probably not representative of all sex offenders or batterers, another avenue of research has focused on normal population samples, comparing those who self-report physically or sexually aggressive behavior and those who do not. Sexually aggressive men are said to differ from other men in antisocial tendencies (Malamuth, 1986), nonconformity (Rapaport and Burkhart, 1984), impulsivity (Calhoun, 1990), and hypermasculinity (Mosher and Anderson, 1986). Batterers have been found to show lower socialization and responsibility (Barnett and Hamberger, 1992). It is important to remember, however, that there are potential biases in self-report data, and it is difficult to verify their accuracy other than through consistency of responses. Men may be reluctant to acknowledge that they have engaged in sexually or physically violent behavior or the men who report this behavior may be different from those who have engaged in the behavior but do not report it. Yet, because both intimate partner violence and sexual assault usually take place in private, self-reports play a central role in their study. Self-report measures on sensitive topics, including violent behaviors, have been found to be quite reliable (Straus, 1979; Hindelang et al., 1981; Bridges and Weis, 1989). Attitudes and Gender Schemas Cultural myths about violence, gender scripts and roles, sexual scripts and roles, and male entitlements are represented at the individual level as attitudes and gender schemas. These hypothetical entities are expectancies that give meaning to and may even bias interpretation of ongoing experience, as well as provide a structure for the range of possible responses. Acceptance of beliefs that have been shown to foster rape has been demonstrated among a variety of Americans, including typical citizens, police officers, and judges (Field, 1978; Burt, 1980; Mahoney et al., 1986). Once a violence-supportive schema about women has developed, men are more likely to misinterpret ambiguous evidence as confirming their beliefs (Abbey, 1991). Sexu-

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--> ally aggressive men more strongly endorse a set of attitudes that are supportive of rape than do nonaggressive men, including myths about rape and the use of interpersonal violence as a strategy for resolving conflict (e.g., Malamuth, 1986; Malamuth et al., 1991, 1995). Beliefs and myths about rape may serve as rationalizations for those who commit violent acts. For example, incarcerated rapists often rationalize that their victim either desired or deserved to experience forced sexual acts. Similarly, culturally sanctioned beliefs about the rights and privileges of husbands have historically legitimized a man's domination over his wife and warranted his use of violence to control her. Men, in general, are more accepting of men abusing women, and the most culturally traditional men are the most accepting (Greenblatt, 1985). Batterers' often excuse their violence by pointing to their wives' ''unwifely" behavior as their justification (Dobash and Dobash, 1979; Adams, 1988; Ptacek, 1988). Sex and Power Motives Violence against women is widely believed to be motivated by needs to dominate women. This view conjures the image of a powerful man who uses violence against women as a tool to maintain his superiority, but research suggests that the relationship is more complex. Power and control frequently underlie intimate partner violence, but the purpose of the violence may also be in response to a man's feelings of powerlessness and inability to accept rejection (Browne and Dutton, 1990). It also has been argued that rape, in particular, represents fulfillment of sexual needs through violence (Ellis, 1989), but research has found that motives of power and anger are more prominent in the rationalizations for sexual aggression than sexual desires (Lisak and Roth, 1990; Lisak, 1994). Attempts to resolve the debate about sex versus power have involved laboratory studies of men's sexual arousal to stimuli of depictions of pure violence, pure consensual sex, and nonconsensual sex plus violence. These studies have consistently shown that some "normal" males with no known history of rape may be aroused by rape stimuli involv-

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--> As early as 1974, Burgess and Holmstrom described what they termed "rape trauma syndrome" to describe the psychological aftermath of rape. Today, many assaulted women, like other victims of trauma receive diagnoses of PTSD. Among victims of intimate partner violence recruited from shelters and therapist referrals, 81 percent of those who had experienced physical attacks and 63 percent of those who had experienced verbal abuse were diagnosed with PTSD. Most rape victims (94 percent) who are evaluated at crisis centers and emergency rooms meet the criteria for PTSD within the first few weeks of the assault, and 46 percent still do so 3 months later (Rothbaum et al., 1992). Rape and physical assault are both more likely to lead to PTSD than other traumatic events affecting civilians, including robbery, the tragic death of close friends or family, and natural disaster (Norris, 1992). Although the concept was initially constructed to explain reaction patterns in survivors of natural disasters and combatants in war, it is not surprising to find a high prevalence of PTSD among survivors of intimate violence. The most common trauma suggested for PTSD in the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994:427) is "a serious threat to one's life or physical integrity; [or] a serious threat or harm to one's children …," experiences known to characterize the lives of women in relationships with violent mates. Factors most often associated with the development of PTSD include perception of life threat, threat of physical violence, physical injury, extreme fear or terror, and a sense of helplessness at the time of the incident (March, 1990; Herman, 1992; Davidson and Foa, 1993). Moreover, some researchers suggest that PTSD is most likely to develop when traumatic events occur in an environment previously deemed safe (Foa et al., 1989), another dimension clearly applicable to violence occurring in one's home. Many of the psychological aftereffects of violence against women can be understood as elements of a PTSD diagnosis

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--> (but see below). The PTSD construct has the advantage of providing a framework for recognizing the severe impact of events external to the individual (van der Kolk, 1987; Herman, 1992). However, for reactions to be seen as expectable responses to severe stressors, the trauma must be known. Unfortunately, in most mental health settings, routine screening for a history of family violence is almost never done; thus, serious or chronic psychological and physical conditions are treated without knowledge of the core trauma that may underlie current symptoms. Finally, PTSD sufferers can become aware of the potential links between the symptoms that plague them and the exposure to an extreme external stressor. Clinical researchers consistently note how abused women internalize the derogatory attributions and justifications of the violence against them (Walker, 1979, 1984; Pagelow, 1984; Browne, 1987). An enhanced understanding of the range of responses manifested by all types of people who are faced with physical or sexual danger or attack expands the interpretation of symptoms beyond internal or gender explanations and empowers both survivors and providers to proceed with focused goals of safety, symptom mastery, reintegration, and healing (Herman, 1992). Yet there are problems with the PTSD conceptualization. First, it doesn't account for many of the symptoms manifested by victims of violence. For example, thoughts of suicide and suicide attempts, substance abuse, and sexual problems are not among the PTSD criteria. Second, the diagnosis better captures the psychiatric consequences of a single victimization than the consequences of chronic abusive conditions (Herman, 1992). Third, the description of traumatic events as outside usual human experience is not accurate in describing women's experiences with intimate violence. Fourth, the diagnosis fails to acknowledge the cognitive effects of this kind of violence. People who have been untouched often maintain beliefs (or schema) about personal invulnerability, safety, trust, and intimacy, that are incom-

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--> patible with the experience of violence (McCann and Perlman, 1990; Norris and Kaniasty, 1991). In recent years, the notion of a battered woman syndrome has been used in a variety of legal proceedings, including criminal prosecutions of batterers, criminal prosecutions of women who have attacked their batterers, and divorce and child custody proceedings. The idea of the battered woman's syndrome developed as an attempt to explain the psychological effects of being in a battering relationship and has similarities with the PTSD conceptualization, but it is not a recognized psychiatric syndrome. Rather, it refers to the consequences of being battered as those consequences are represented in expert testimony in legal settings. The use of "battered woman syndrome" has been criticized for making those consequences of intimate partner violence for women a pathology and ignoring differences among battered women's responses to violence (e.g., Dutton, 1993, Schopp et al., 1994). Furthermore, because expert testimony about the experiences of battered women often encompasses more than just a discussion of psychological consequences, the term battered woman syndrome is misleading (Dutton, 1993). Consequences to Family and Friends Children in families in which the woman is battered are at risk of both physical (Walker, 1984; Straus and Gelles, 1990) and sexual abuse (Herman and Hirschman, 1981; Paveza, 1988). Even if children are not themselves abused, living in a family in which there is violence between their parents puts children at risk. These children have been found to exhibit high levels of aggressive and antisocial, as well as fearful and inhibited, behaviors (Jaffe et al., 1986a; Christopherpoulos et al., 1987). Other studies have shown that children who have experienced parental violence have more deficits in social competence (Jaffe et al., 1986b; Wolfe et al., 1986) and higher levels of depression, anxiety, and temperament problems than children in nonviolent homes (Jaffe et al., 1986b; Christopher-

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--> poulos et al., 1987; Holden and Ritchie, 1991). Jaffe et al. (1990) also found that children exposed to family violence see violence as an acceptable and useful means of resolving conflict. Interpreting these findings should be done with caution. Not only is there debate about what constitutes exposure to violence (e.g., actually seeing the violent acts or seeing the results of the violence), but some of the studies have methodological weaknesses. For example, samples are often drawn from among children residing in shelters for battered women. These children are under a lot of stress—beyond that of witnessing violence—related to dislocation and family crisis that may influence their behaviors and feelings. The source of the information may influence the findings; mothers report more behavior problems in children than children self-report (Sternberg et al., 1993). However, these studies suggest that children exposed to parental violence are at potential risk of emotional and behavioral difficulties that may be long lasting. Depression, developmental problems, acute and chronic physical and mental health problems, and aggressive or delinquent behavior are characteristic of children exposed to battering. An unknown number of the 3 million children exposed to battering each year (Jaffe et al., 1990) end up in foster care. Increased costs for schools, counseling, and juvenile justice programs have not been calculated. There are also unknown long-term costs associated with young boys who are learning how to be future batterers by modeling their fathers' behavior. Longitudinal investigations that are both labor intensive and expensive are an important way to investigate how witnessing violence between one's parents during childhood is related to violence in one's own intimate relationships during adulthood. Widely cited assertions of intergenerational relationships in intimate partner violence are based on cross-sectional studies, and the findings are open to multiple explanations, including biases inherent in self-report data. There

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--> is evidence that longitudinal research following child victims may be needed to overcome possible problems with forgetting of childhood experiences (L. M. Williams, 1994). Physical and sexual assaults may also affect other family members and friends, making them into secondary victims. Davis and colleagues (1995) found that rape, attempted rape, and aggravated assault of women all had negative psychological consequences on their friends, family members, and romantic partners, regardless of the victim's level of distress. Female friends and family members were more affected than male friends and family members, particularly in regard to increased fear of violent crime. Some rape victims also experience sexual dysfunction and difficulties with interpersonal relationships, both of which can have negative effects on their family relationships. Sexual dysfunction may be long lasting: Burgess and Holmstrom (1979) found that 30 percent of rape victims reported that their sexual functioning had not returned to normal as long as 6 years after the assaults. Consequences to Society Fear of Crime Criminologists recognize that one social consequence of crime that affects many people beyond those who have been directly victimized is fear of crime (Hindelang et al., 1978; Skogan and Maxfield, 1981). The consequences of fear of crime are real, measurable, and potentially severe (Conklin, 1975; Skogan and Maxfield, 1981). Because women fear crime more than men (Warr, 1985; Gordon and Riger, 1989; Federal Bureau of Investigation, 1991), these consequences are disproportionately borne by women. Women's fear of crime seems to be driven primarily by their fear of rape (Warr, 1985; Gordon and Riger, 1989; Klodawsky and Lundy, 1994; Softas-Nall et al., 1995). Women perceive rape as a very serious crime—at least as serious, if not more so, than murder (Warr, 1985; Softas-Nall et al., 1995).

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--> The perceived risk of being raped is also high. Warr (1985) found young, urban women believed they were three times as likely to be raped as murdered and equally as likely to be raped as to suffer a less serious offense, such as theft of an auto. Similar ratings of seriousness and a high perceived risk of rape have been found in studies of women in Canada (Gomme, 1986), Great Britain (Smith, 1989), Germany (Kirchhoff and Kirchhoff, 1984), Holland (Van Dijk, 1978), and Greece (Softas-Nall et al., 1995). All these studies also found that women curtail their activities because of this fear: 42 percent of women in Warr's (1985) sample avoided going out alone (compared with only 8 percent of men), and 27 percent of women even refused to answer their door in response to fear. Economic Effects Existing data give some indication of the social consequences and attendant costs of violence. Straus (1986) estimated that intrafamilial homicide cost $1.7 billion annually; Meyer (1992) calculated the medical costs and lost work productivity of domestic violence at $5 to $10 billion per year; and the Bureau of National Affairs (1990) estimated the annual cost of domestic violence to employers for health care and lost productivity at $3 to $5 billion. Though alarming, the limited data available on women victims of violence and exclusion of sexual violence from these studies suggest that these figures may significantly underestimate the economic toll of violence. It is estimated that between 12 percent and 35 percent of women visiting emergency rooms with injuries are there because of battering (Randall, 1990; Abbott et al., 1995). Outside of emergency departments, there is practically no information on a myriad of other health costs related to battering and sexual assault, such as treatment for depression and PTSD, drug and alcohol abuse, prenatal complications, sui-

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--> cide attempts, and other chronic physical and psychological conditions. Estimates of the number of women who are homeless because of battering range from 27 percent (Knickman and Weitzman, 1989) to 41 percent (Bassuk and Rosenberg, 1988) to 63 percent of all homeless women (D'Ercole and Struening, 1990). In New York City, homeless shelters cost $125-130 per day per family; battered women's shelters with a variety of services cost more than $200 a day (Lucy Friedman, personal communication). But there is little information about other social service costs resulting from battering, such as the number of women and children on welfare because of abuse or the total costs of providing battered women with job training and placement, victim assistance services, and child care. Battering and sexual assault puts an enormous burden on the criminal justice system; a study in the District of Columbia found that 22 percent of 911 calls were from victims of battering (Baker et al., 1989). Yet the full extent of costs to the courts—civil and family, as well as criminal—and law enforcement generally have not been calculated. These include costs associated with getting and enforcing orders of protection; divorce, child custody, and support proceedings; and prosecutions for assault, sexual assault, stalking, trespassing, harassment, and murder, all of which involve personnel costs for prosecutors, judges, defense lawyers, court staff, and police, among others. In addition, anecdotal evidence suggests that some battered women may be forced into performing criminal acts by their batterers (Browne, 1987). Indirect Costs Researchers are just beginning to look at the indirect costs of battering and sexual assault—costs that result not from using services but from reduced productivity and changes in quality of life. For example, a study by Victim Services in New York City found that 56 percent of working battered women had lost a job as a direct result of the violence, and 75

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--> percent had been harassed while they were at work by their partners (Friedman and Couper, 1987). Resick et al. (1981) found women's work performance to suffer up to 8 months after rape. The costs of such reduced productivity or of constricted opportunity are unknown. How many women are prohibited from working by jealous partners or cannot concentrate at work because of battering or sexual assault? How many days are missed by women embarrassed to come to work with a black eye, afraid that the batterer will harass them at the office, or fearful of leaving their homes after being raped? Do partners or family members of rape victims lose time from work because of caring for injured victims or accompanying them to court? Diminished quality of life is another unexplored indirect cost. What are the costs associated with the isolation, fear, and lack of freedom that plague the lives of battered women and their children? How many activities and opportunities do women forsake out of fear of sexual assault? What are the long-term costs to society of batterers'—and victims'—inability to parent their children? Information on the direct and indirect costs of violence against women would provide a useful guideline for evaluating the cost-effectiveness of intervention programs. Conclusions And Recommendations Better understanding of the causes of violence against women will be useful in designing both prevention programs and interventions with offenders. Research has begun to identify childhood precursors to later violent aggressive behavior, and criminological research has studied the progression of criminal careers. Yet little research has considered the development of violence against women and whether pathways to violence against women are similar to the development of other violent behaviors. Nor is it known if physical and sexual violence against women develop in a similar manner and what the nature and extent of the relations among them

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--> are. Identifying precursors to violence against women may be important for early intervention and prevention efforts. Most of the information on violence against women comes from either clinical samples or general population surveys. Clinical samples are most likely not representative of either victims or perpetrators; in general population surveys, the numbers of ethnic, racial, cultural, and other subgroups are too small for analysis. Differences among subgroups in the causes of violence against women could have important implications for prevention and intervention strategies. Subgroups about which information is lacking include racial and ethnic minorities, lesbians, migrant workers, immigrants, the homeless, the disabled, and the elderly. Recommendation: Longitudinal research, with particular attention to developmental and life-span perspectives, should be undertaken to study the developmental trajectory of violence against women and whether and how it differs from the development of other violent behaviors. Particular attention should be paid to factors associated with the initial development of violent behavior, its maintenance, escalation, or diminution over time, and the influence of socioeconomic, cultural, and ethnic factors. Funding is encouraged for identification and analysis of existing data sets that include relevant information. In addition, research on the causes and consequences of violent behavior should include questions about violence against women. Although some of the direct effects of physical and sexual violence (and psychological abuse) on individual women have been fairly well documented, understanding indirect effects to victims, the consequences to women in general, and consequences to the society as a whole is only beginning. Research suggests that women who have been victims of violence seek physicians' care not directly related to the violence nearly twice as often as other women. Some preliminary data indicate that intimate partner violence may play a role in

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--> women's need to receive and remain on welfare. As mandatory arrest laws continue to be passed, and as more jurisdictions encourage filing charges in cases of sexual assault, the criminal justice system faces increased costs. Some research on rape has found reduced job performance for up to 8 months after an assault. There is very little information on lost productivity and reduced performance, on the job and at home, of victims of violence. Recommendation: Research is needed on the consequences of violence against women that includes intergenerational consequences and costs to society, including lost productivity and the use of the criminal justice, medical, and social service systems. Such research should address the effects of race and socioeconomic status on consequences of violence. Note 1.   In a national study of youths aged 10 to 16 years, more than one-third reported having been victims of sexual or physical assaults. This group revealed significantly more psychological distress including sadness and symptoms of posttraumatic stress disorder even after controlling for other variables that predict these outcomes (Boney-McCoy and Finkelhor, 1995). However, this study did not report outcomes separately for girls, who were far more likely to experience sexual assault, and boys, who experienced much more physical assaults by strangers. Nevertheless, the authors concluded that sexual assault in particular posed a very significant risk factor to the mental health of adolescents.

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