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If We Consider A Comparatively Recent Study By Mirrlees-black (c 1999), We ...



If we consider a comparatively recent study by Mirrlees-Black (C 1999), we can point to a substantial evidence base that suggests that domestic violence in the sense of physical violence is more often than not perpetrated by a comparative stranger, the more subtle forms of psychological and financial abuse are more likely to be perpetrated by a significant other with a closer and more intimate relationship than overt violence.

If we accept all of these caveats and consider the aetiology of domestic violence in general terms, a number of different authorities point to a number of different factors which appear to be significant in the genesis and perpetuation of the abusive and violent situation. Boyle suggests that controlling behaviour in the perpetrator is significant and Dearwater (S R et al. 1998) suggests a crescendo scenario starting from verbal abuse stemming from a failure of respect on the part of the perpetrator, which can then escalate into one of the other forms of controlling behaviour patterns. Controlling behaviour can be considered as economic control as well as physical control.

For a definitive and considered general statement on the issue we can look to the World Health Organisation who has defined violence as:
...the intentional use of physical force or power, threatened or actual...that either results in, or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation (WHO 1996)

If we consult the literature for an appreciation of the incidence of domestic violence, we immediately face the problem (quite apart from that of actual definition cited above) of knowing the extent of domestic violence that is unreported. Clearly we can cite figures that reflect the number of cases that are reported to the police or are suspected at the A&E departments across the country, as these are figures that are routinely collected and are in the public domain. Abbott (J et al. 1995), in trying to understand the degree of the problem, undertook a large cross sectional study and commented on the reluctance of many victims to disclose significant information. Their study (albeit American based) suggested that 11.7% of women who attended the A&E Depts. included in their study, were attending because of either injuries or stress directly referable to domestic violence in one of its many forms. Of all the women seen in the A&E Depts., 2% were there as a direct result of physical trauma sustained directly from an abusive relationship, and this particular study suggests a staggering 54.2% lifetime prevalence rate for domestic violence in the populations of women who were seen in the A&E Depts. during the period of the study. This may well reflect the comments made in the opening paragraph of this review that the degree of domestic violence is as much a factor of the culture of the perpetrator and definition of the act as much as any other factors.

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