Over the last decade, the issue of domestic violence has been transformed from a position of ‘selective inattention’ to becoming a high-priority social and public health issue.⁽¹⁾ Although it is now recognized that experiences of domestic violence are associated with adverse mental as well as physical health outcomes for the victim, this has not always been the case. Early psychiatric writings tended to attribute responsibility for violent relationships, to the masochistic traits of women who are drawn to and then fail to separate, from abusive and violent partners. During the 1980s and 1990s, however, the perception of victims of domestic violence, or ‘battered women’ began to change, towards an understanding that the responsibility for domestic abuse lies with the wife beater, rather than the wife beater’s wife.

This change came about as a result of several factors; first, effective lobbying by the feminist movement which put the issue of domestic violence firmly on the political agenda; second, the influence of a number of researchers who began to conceptualize the psychological and behavioural problems seen in victims as the consequence, rather than the cause of, domestic violence, for example through the identification of a specific ‘Battered Woman Syndrome’,⁽²⁾ and finally the introduction of Posttraumatic Stress Disorder as a distinct psychiatric diagnosis in 1980 (APA, 1980).

Domestic violence is currently defined in the United Kingdom as ‘Any incident of threatening behaviour, violence or abuse (psychological, physical, sexual, financial or emotional) between adults who are, or have been in an intimate relationship’.⁽³⁾ Most cases of domestic violence involve the abuse of a woman by her male partner, however, domestic violence may also involve other family members, same sex partners, and the abuse of men by women partners.

The estimated prevalence of domestic violence varies, according to the definition being used and the population surveyed. Based on an analysis of 48 population-based studies from around the world, the prevalence of domestic violence is between 10 and 69 per cent over a lifetime and between 3 and 52 per cent in the past year.⁽⁴⁾ In the United Kingdom, around 16 million incidents of domestic violence are recorded annually, with a lifetime prevalence of 21 per cent lifetime and 4 per cent in the past year for women and 10 per cent lifetime and 2 per cent in the past year, for men.⁽⁵⁾ Women who report domestic abuse consistently report experiencing more incidents and more injuries and being more fearful of their partner, than male victims.⁽⁵⁾

Domestic violence arises out of a complex interplay of personal, situational, and socio-cultural factors. Poverty, alcohol use, low academic achievement, being single, separated or divorced, and witnessing or experiencing violence as a child are the most important individual risk factors for domestic violence.⁽⁴⁾ Poverty operates at an individual and societal level, in that it places increased stress on the individual and the family system and also acts as a marker for a number of other social conditions (e.g. low education, overcrowding) that combine to increase the risk of domestic violence. Alcohol use by the perpetrator also significantly increases the risk of domestic violence.^(4,5) Women appear to be at particularly high risk of domestic violence during pregnancy and the immediate post-partum period.⁽⁶⁾ Experiences of domestic abuse in childhood and adolescence are associated with an increased risk of perpetration, for men⁽⁴⁾ and re-victimization, for women⁽⁷⁾ in adult relationships. Inequality and a power imbalance within the relationship⁽⁸⁾ and in the wider society,⁽⁹⁾ also increases the risk of domestic violence. Higher rates are found in societies where men have economic and decision-making power in the household, where women do not have easy access to divorce, and where there is a high level of public acceptance of men’s right to discipline their wives.^(4,9)

Domestic violence is associated with a range of adverse physical and psychological health and social outcomes.^(1,4,5) In extreme cases, the violence results in the victim’s death. Between 40 and 70 per cent women victims of homicide are killed by a current or former spouse or partner, compared with between 4 per cent and 8 per cent male victims of homicide.⁽⁴⁾