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Integrated treatment options for male perpetrators of intimate partner violence

The information and resources listed here can be easily adapted to other groups and settings. It is vital for all staff employed by health, behavioral health, and integrated care organizations to understand the nature and impact of trauma and how to use principles and practices that can promote recovery and healing: Trauma-Informed Approaches. In addition to information and resources on IPV, this page provides links to resources on Trauma and Trauma-Informed Approaches , as well as Suicide Prevention , that we encourage you to explore. This type of violence can occur among heterosexual or same-sex couples and does not require sexual intimacy. IPV affects millions of people in the U.

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Intimate Partner Violence - domestic abuse programmes

Intimate partner violence IPV against women is associated with a wide range of adverse outcomes. Although mental disorders have been linked to an increased risk of perpetrating IPV against women, the direction and magnitude of the association remain uncertain. In a longitudinal design, we examined the association between mental disorders and IPV perpetrated by men towards women in a population-based sample and used sibling comparisons to control for factors shared by siblings, such as genetic and early family environmental factors.

Using Swedish nationwide registries, we identified men from 9 diagnostic groups over —, with sample sizes ranging from 9, with autism to 88, with depressive disorder. We matched individuals by age and sex to general population controls ranging from , to 1,, controls , and calculated the hazard ratios of IPV against women.

We also estimated the hazard ratios of IPV against women in unaffected full siblings ranging from 4, to 37, individuals compared with the population controls. Afterwards, we compared the hazard ratios for individuals with psychiatric diagnoses with those for siblings using the ratio of hazard ratios RHR.

In sensitivity analyses, we examined the contribution of previous IPV against women and common psychiatric comorbidities, substance use disorders and personality disorders. The average follow-up time across diagnoses ranged from 3. In comparison to general population controls, all psychiatric diagnoses studied except autism were associated with an increased risk of IPV against women in men, with hazard ratios ranging from 1. In sibling analyses, we found that men with depressive disorder, anxiety disorder, alcohol use disorder, drug use disorder, attention deficit hyperactivity disorder, and personality disorders had a higher risk of IPV against women than their unaffected siblings, with RHR values ranging from 1.

Sensitivity analyses showed higher risk of IPV against women in men when comorbid substance use disorders and personality disorders were present, compared to risk when these comorbidities were absent. The absolute rates of IPV against women ranged from 0. Individuals with alcohol use disorders 1. Our analyses were restricted to IPV leading to arrest, suggesting that the applicability of our results may be limited to more severe forms of IPV perpetration.

Our results indicate that most of the studied mental disorders are associated with an increased risk of perpetrating IPV towards women, and that substance use disorders, as principal or comorbid diagnoses, have the highest absolute and relative risks. The findings support the development of IPV risk identification and prevention services among men with substance use disorders as an approach to reduce the prevalence of IPV.

PLoS Med 16 12 : e This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Researchers who are interested in replicating our work can apply for individual level data from: Statistics Sweden mikrodata scb. The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Competing interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: AJNH is funded by Johnson and Johnson and received funds from Ono Pharma in HL has served as a speaker for Evolan Pharma and Shire and has received research grants from Shire; all outside the submitted work.

Intimate partner violence IPV against women is a major public health problem. It is the most common form of violence experienced by women and includes physical, sexual, and emotional abuse and controlling behaviors by an intimate partner [ 1 ]. Estimates of the prevalence of IPV against women vary widely depending on the definitions. IPV is associated with a wide range of serious health consequences in victims, such as physical injuries, pregnancy termination, sexually transmitted diseases, post-traumatic stress disorder, depression, and suicidality [ 3 — 7 ].

In addition, children exposed to IPV often develop a wide range of physical health, mental health, and social adjustment problems [ 8 ]. One potential risk factor for perpetrating IPV against women is mental illness, and etiological links may differ between different disorders.

Common deficits associated with mental disorders, such as poor interpersonal skills and emotional dysregulation [ 9 , 10 ], and specific core symptoms of certain disorders—such as impulsivity manifested in individuals with attention deficit hyperactivity disorder ADHD and substance use disorders [ 11 , 12 ] and hostility exhibited in some people with mood disorders and antisocial personality disorder [ 13 — 15 ]—have been linked to IPV against women [ 15 , 16 ].

Preliminary evidence suggests that individuals with mental illness have increased risk of perpetrating IPV against women [ 17 , 18 ].

Systematic reviews have reported an increased risk of IPV perpetration among individuals with a range of mental disorders including depression, anxiety disorders, panic disorders, substance use disorders, and personality disorders, particularly antisocial personality disorder and borderline personality disorder [ 19 — 22 ]. However, the majority of existing empirical studies have been conducted with small sample sizes, have been based on selected samples, have relied on self-report of risk factors and outcomes, and, most importantly, have lacked adequate adjustment of confounders such as familial factors.

There is considerable imprecision in previous work, partly due to different methodologies and samples. For instance, the hazard ratio of physical violence against a partner by men has ranged from 1. Most of the evidence to date suggests some associations between mental disorders and IPV against women, but these associations might reflect underlying confounders or reverse direction of effects.

Thus, the magnitude and direction of the links between mental disorders and IPV perpetration need clarification. In addition, the evidence for some disorders is very limited, particularly for specific psychiatric disorders, including schizophrenia-spectrum disorders, and developmental disorders such as ADHD and autism. For instance, autism, which is characterized by abnormal development of communication and social interaction [ 23 ], has been proposed to be associated with IPV as a result of impaired theory of mind, poor emotional regulation, and problems with moral reasoning [ 24 ].

Furthermore, the role of common psychiatric comorbidities, such as substance use disorders and personality disorders, is unclear. Clarifying these associations can assist in developing more effective prevention and intervention programs [ 25 ]. To date, many such programs targeting perpetrators of IPV typically have limited effectiveness [ 26 ], and this may be partly related to the lack of modifiable factors in these programs.

To this end, we investigated risk of IPV against women among men with mental disorders in a population-based longitudinal cohort. As familial factors, such as genetic predisposition and shared childhood adversity, are associated with both mental disorders and IPV perpetration [ 27 ], we conducted sibling comparisons to control for familial confounders, and we also conducted a range of sensitivity analyses to identify potential moderators.

To our knowledge, this is the largest epidemiological study of IPV perpetrators to date and the first to use sibling comparisons.

We selected a cohort of individuals born between 1 January and 31 December , who were followed from 1 January to the end of follow-up on 31 December In this study, we focused only on IPV perpetrated by men towards women, which is recorded as a separate category of crime in the crime register.

We could not examine IPV perpetrated by women towards men as current data in the Swedish registers do not separate this type of crime from general domestic violence in women. Arrests for male-to-female IPV were retrieved from the National Crime Register using a distinct crime code , which is a unique advantage over crime data from many other countries where such a code is absent.

We studied 9 psychiatric disorders diagnosed in either an inpatient or outpatient setting between and schizophrenia-spectrum disorders, bipolar disorder, depressive disorder, anxiety disorder, alcohol use disorder, drug use disorder, ADHD, autism, and personality disorders.

We adopted a hierarchical approach to the following diagnoses: schizophrenia-spectrum disorders, bipolar disorder, depressive disorder, and anxiety disorder, as research has shown that some diagnoses change over time to a more stable one.

For instance, depression and anxiety can be precursors of schizophrenia-spectrum disorders [ 30 , 31 ]. Thus, individuals with any diagnosis of bipolar disorder but not schizophrenia-spectrum disorder were regarded as having bipolar disorder. Individuals with any diagnosis of depressive disorder but neither schizophrenia-spectrum disorder nor bipolar disorder were regarded as having depressive disorder.

Individuals with any diagnosis of anxiety disorder but without schizophrenia-spectrum disorder, bipolar disorder, and depressive disorder were considered as having anxiety disorder. This approach is expected to increase the validity of the above-mentioned mental disorders but could risk potentially underestimating some comorbidities. Therefore, we included comorbidities for common disorders including substance use disorders and personality disorders in the sensitivity analyses see the statistical analyses section below.

For diagnoses of alcohol use disorder, drug use disorder, ADHD, autism, and personality disorders, no hierarchical approach was assigned. Therefore, these disorders included both primary and secondary diagnoses. Diagnoses identified before arrest for IPV during — were defined as the exposure in this study. Swedish register-based psychiatric diagnoses generally have moderate to high concordance rates with clinical diagnoses [ 29 ].

Data for arrests for IPV between 1 January and 31 December were retrieved for all individuals in the cohort from the National Crime Register. This register includes crime data for all individuals aged 15 years the age of criminal responsibility and older. As a minority of IPV arrests result in conviction [ 32 ], we used first IPV arrest after diagnosis as our primary outcome.

IPV against women is defined as threats, violence, and sexual assaults where the victim is a woman and the current or ex-partner is the offender criminal code: In a sensitivity analysis, we included general domestic violence as the outcome, defined as violence against a person that the offender has or has had a close relationship to, including partners, children, parents, and siblings of the offender criminal codes: , , , , , , , , , and We collected information on the following covariates: family disposable income, single status, and immigrant status.

Family disposable income at the year of recorded diagnosis was used as a proxy for income and was treated as a dichotomous variable i. For the 2 developmental disorders ADHD and autism , as the patients were relatively young, with nearly half lacking income data, we used the disposable income data of their parents.

Single status was defined according to the year of diagnosis, and referred to individuals who were unmarried, divorced, or widowed. Immigrant status was defined as being born outside of Sweden. We designed the analytic strategy when the study was conceived including the exposures main psychiatric diagnoses , outcome arrests for IPV , and statistical approach Cox regression.

For each patient, up to 20 general population controls without the studied mental disorders were matched by age birth year and sex. We adopted Cox regression to control for time to event, and to account for the potential impact of death as a competing event for arrest for IPV.

In the current study, the rate of death during follow-up was higher among men with psychiatric diagnoses 1. Cox regression showed that, compared to general population controls, men with mental disorders were 3 to 11 times more likely to die during the follow-up.

We report results from the Cox regression, with mental disorders as the predictor, and IPV against women after the diagnosis of a mental disorder as the outcome. We included family disposable income, single status, and immigrant status as confounders. No other data were missing.

To account for possible confounding by familial factors, we conducted additional analyses with unaffected, sex-matched full siblings of patients as controls. Unaffected full siblings were siblings without a diagnosis of the examined disorder but not necessarily without other mental disorders. For instance, when investigating the link between depression and IPV, the sibling comparisons were siblings without a diagnosis of depression but with or without substance use disorders or other psychiatric disorders.

We compared unaffected full siblings of the patients with 20 age- and sex-matched general population controls with Cox regression. As in the models comparing patients and general population controls, we controlled for family disposable income, single status, and immigrant status and calculated hazard ratios of IPV against women for unaffected siblings of individuals with mental disorders.

Then, we compared the hazard ratios obtained in patient analyses to those obtained in sibling analyses using the ratio of hazard ratios RHR. The RHR provides one way of accounting for familial factors including genetic and early family environmental factors.

An RHR of 1 indicates that the risk of IPV against women in those with mental disorders is the same as the risk in their unaffected full siblings. That is, if there is an association between a mental disorder and IPV in the primary analysis, but the RHR is 1, then the association between the mental disorder and IPV is fully confounded by genetic and environmental factors shared by full siblings.

We conducted several additional sensitivity analyses. First, we compared the risk of arrest for IPV between psychiatric patients with and without comorbidity of alcohol use disorder, drug use disorder, or personality disorders, as these disorders are often comorbid with other psychiatric disorders and are associated with antisocial behaviors [ 34 — 37 ].

In addition, we conducted interaction analyses between mental disorders and comorbidity of these 3 disorders to further examine differences between groups in the Cox regression model. Second, to investigate confounding by substance use disorders, we adjusted associations between mental disorders and IPV for substance use disorders prior to the exposure.

Third, we performed subgroup analysis by inpatient and outpatient diagnosis to examine group differences. Fourth, we examined the association between mental disorders and arrest for general domestic violence to examine whether mental disorders were associated with IPV against women and with general domestic violence in a similar pattern in men.

Fifth, to mitigate against reverse causality because IPV might precipitate diagnoses of mental disorders , we ran separate analyses in a subgroup of individuals without a record of IPV before their diagnosis with a mental disorder. We used R statistical software in our analyses. We examined the risk of IPV against women by men in 9 diagnostic groups, with sample sizes ranging from 9, individuals with autism to 88, persons with depressive disorder.

The average age at the beginning of follow-up the year of receiving a diagnosis between and was 18 years for autism, 23 years for ADHD, and 30—34 years for the other mental disorders. Other characteristics are reported in Tables 1 and S1.

Cognitive behavioural therapy for men who physically abuse their female partner.

Skip to search form Skip to main content You are currently offline. Some features of the site may not work correctly. DOI: Expand Abstract. View on PubMed.

Intimate partner violence IPV is a serious public health concern affecting over 40 million individuals at least once during their lifetime. Among the various negative implications for partners and families are economic, emotional, physical, and social consequences.

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Evidence-Based Domestic Violence Perpetrator Treatment

Foreword International surveys have suggested that around one-third of all adult women will, at some point in their lifetime, experience abuse perpetrated by an intimate male partner. One way of doing this is to deliver programs that aim to reduce the risk of known perpetrators committing further offences. This paper describes the outcomes of a Gold Coast program delivered to men who perpetrate domestic violence and who are legally obliged to participate. The data show that this type of program can produce positive changes in participants. However, the extent to which such changes lead to direct behavioural change is less clear and further research and evaluation is required to develop the evidence base that is needed to ensure that programs for perpetrators produce significant and enduring improvements to community safety. Domestic violence is a term that is widely used to refer to the systematic abuse of power in an intimate relationship where one partner is controlling and other partner is intimidated and lives in fear. Forms of domestic violence include physical violence, emotional and psychological abuse, social abuse and isolation, financial abuse and spiritual abuse.

Integrated treatment options for male perpetrators of intimate partner violence

ISSUES: Male-to-female intimate partner violence remains a worldwide public health issue with adverse physical and psychological consequences for victims, perpetrators and children. Personality disorders, addiction, trauma and mood symptoms are established risk factors for intimate partner violence perpetration and factor prominently into a recovery-oriented treatment approach. Empirically based recommendations for intervention programs and the policies that guide intervention efforts are offered. KEY FINDINGS: Nascent research suggests that integrated treatment models utilising a holistic approach to account for psychological comorbidity and interventions that involve a motivational interviewing component appear promising in terms of significantly improving intimate partner violence treatment compliance and reducing subsequent acts of physical partner violence. Further, methodologically rigorous research is required to fully assess the benefits of traditional and integrated treatment options.

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Intimate partner violence IPV against women is associated with a wide range of adverse outcomes. Although mental disorders have been linked to an increased risk of perpetrating IPV against women, the direction and magnitude of the association remain uncertain. In a longitudinal design, we examined the association between mental disorders and IPV perpetrated by men towards women in a population-based sample and used sibling comparisons to control for factors shared by siblings, such as genetic and early family environmental factors.

Intimate Partner Violence

We'd like to understand how you use our websites in order to improve them. Register your interest. Epidemiological research suggests an interrelationship between mental health problems and the re occurrence of intimate partner violence IPV. However, little is known about the impact of mental health treatments on IPV victimization or perpetration, especially in low- and middle-income countries LMIC.

Intimate Partner Violence Addiction. Cognitive therapy and research 38 3 , , Journal of studies on alcohol and drugs 75 2 , , Journal of marital and family therapy 44 3 , , Journal of clinical psychology 70 3 , , Psychology of Addictive Behaviors 30 3 , ,

Integrated treatment options for male perpetrators of intimate partner violence.

Domestic violence, also known as partner violence PV , is a major social and public health problem in the United States. For the past three decades, individuals arrested for PV have been mandated to complete a course of treatment in accordance with the various standards in the states in which they were arrested. In California, these groups are facilitated by various mental health professionals, including marriage and family therapists, but also, and primarily, by non-licensed counselors with minimal training. Clearly, there is a need for further research on best practices for treating the PV offender population. Guides to evidence-based practice have been developed in the medical and some mental health fields e. The best available research can be ranked on a scale of most to least reliable e. Level I evidence derives from meta-analyses and RAC random assignment to conditions studies.

Feb 14, - Although treatment of mental ill health or substance abuse may Integrated treatment options for male perpetrators of intimate partner violence  by WA Tol - ‎ - ‎Cited by 6 - ‎Related articles.

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Comments: 2
  1. Shakataur

    There is nothing to tell - keep silent not to litter a theme.

  2. Shasar

    Has understood not all.

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