IPV leads to significant physical injury and health problems for women (e.g., Brownridge 2006). As regards physical health, the problems include injuries, immune disorders, difficulty sleeping, and gastrointestinal problems (Eby et al. 1995). In addition to physical injuries, IPV is also associated with health problems (e.g., Campbell et al. 2002). In addition, different types of IPV have disparate associations with negative physical health outcomes. For example, among college-aged women, it was psychological IPV, rather than physical IPV, that was predictive of poor health status, including women’s health perceptions and the extent to which their physical health impaired their daily activities (Straight et al. 2003). Sexual assault (sometimes perpetrated by an intimate partner) has been associated with physical health symptoms and somatization (Tansill et al. 2012). Additionally, there is some evidence that experiencing multiple forms of abuse, rather than any one type of abuse, puts a woman at greatest risk for physical injuries (e.g., Eshelman and Levendosky 2012).

Pregnant women are susceptible to these physical health problems as well as other problems. Recent research suggests that women experiencing IPV are more likely to experience contraceptive coercion (partners withholding contraception and forcing women to get pregnant) compared to women not experiencing IPV (e.g., Miller et al. 2010). Contraceptive control has also been associated with unplanned pregnancies (Miller et al. 2010). Once pregnant, women who experience IPV have an increased risk of hemorrhage prior to childbirth and a restriction in intrauterine growth (Janssen et al. 2003) as well as increased rates of sexually transmitted diseases (Campbell et al. 2002). Preterm labor, vaginal bleeding, severe nausea, vomiting or dehydration, and kidney infection or UTI are also associated with IPV during pregnancy (Silverman et al. 2006). Interestingly, in the Silverman et al.’s (2006) research, women who experienced IPV prior to (and/or during) pregnancy had more health problems than those who only experienced IPV during pregnancy. In addition, miscarriage rates and perinatal deaths are higher in this population (e.g., Janssen et al. 2003) for two reasons—the abuse itself and women’s lack of early prenatal care.

In the aftermath of many types of traumatic stressors, there is a high risk for depressive and post-traumatic stress symptoms (PTS) (e.g., Shih et al. 2010). The prevalence of depression among women experiencing IPV ranges from 35 to 75% (e.g., Nathanson et al. 2012), and the prevalence of PTS ranges from 45 to 84% (e.g., Jones et al. 2001). Comorbidity between PTS and depression is high (e.g., Nixon et al. 2004). Women exposed to IPV also have a higher risk for anxiety symptoms and diagnoses (e.g., Pico-Alfonso et al. 2006).

IPV varies in frequency, ranging from episodic to chronic (Martsolf et al. 2012). More frequent and severe IPV has been associated with more severe mental health symptoms. For example, sustained, chronic IPV is more likely to be associated with depressive, anxiety, and PTS symptoms (e.g., Bogat et al. 2003, 2004). Recency of IPV also affects mental health with more recent abuse associated with more negative mental health outcomes (e.g., Bogat et al. 2003). Termination of IPV often triggers a reduction in mental health symptoms (e.g., Bogat et al. 2004), but not always (see Anderson et al. 2003). It may be that some women are concerned that the abuse will begin again, and this sustains mental health problems. As with physical health problems, some research finds that specific types of IPV are associated with depressive and PTS symptoms. However, at least one study found that experiencing multiple types of IPV was more predictive of mental health problems than experiencing only one or two specific types (Eshelman and Levendosky 2012), suggesting the importance of examining multiple types of IPV.

In summary, IPV diminishes women’s psychological resources through its damaging effects on physical and mental health. For those women who are pregnant or parenting, this depletion of internal resources becomes problematic as they attempt to respond to the needs and demands of their pregnancy/children. In addition, their children’s needs may be higher than normal, if they, too, have experienced the trauma (see section below for summary of how IPV affects children’s psychosocial development). With reduced psychological resources, women’s developing IWMs related to the mother-child relationship are damaged (see Levendosky et al. 2012), and they are also likely to engage in problematic parenting behaviors. For example, warm, sensitive, and engaged parenting requires the ability to regulate one’s own affective responses as well as the capacity to identify and appropriately attend to a child’s emotional cues (e.g., Maccoby and Martin 1983); however, self-regulation diminishes under stress (Muraven and Baumeister 2000), such as IPV. Thus, it follows that attuned and sensitive parenting is hard to sustain in the context of IPV.

Parenting during infancy and early childhood is critical for the formation of a child’s self-worth and later relationship functioning as well as normative health and development (e.g., Maccoby and Martin 1983). Parenting behaviors can also influence trajectories of children’s adaptation in response to adversity (e.g., Fenning and Baker 2012). Parenting begins during the prenatal period when mothers develop thoughts and feelings about their infants and the mother-infant relationship (e.g., Stern 1995); thus, IPV may affect parenting as early as the prenatal period.

As a pregnant woman undergoes the physical transformation to parenthood, she also undergoes a mental transformation from care-seeker to caregiver (George and Solomon 2008; Stern 1995). This mental transformation is evident in changes to her IWMs, which guide her understanding of herself and others in her close relationships, including the relationship with her own child. The internal templates for the maternal role, called maternal representations, develop during pregnancy and are considered to be one of the earliest forms of parenting (e.g., Stern 1995). During this time, a woman begins to think about herself as a parent and develops hopes and expectations for her child, influenced by her own experiences in her attachment relationship(s) (e.g., Slade and Cohen 1996). When her child is born, these representations guide her parenting behaviors (e.g., Dayton et al. 2010). Ideally, they help her to perceive her own role and her child’s needs accurately and to respond consistently and sensitively toward her child. Maternal representations are intended to complement the attachment system, with both having the shared goal of the care and safety of the child (George and Solomon 1999). Therefore, by guiding maternal behaviors, maternal representations may play a critical role in the development of infant attachment security (e.g., Zeanah et al. 1994). Indeed, prenatal maternal representations significantly predict infant attachment classification at 1 year of age, suggesting that maternal representations may be a mechanism by which attachment relationships are transmitted from mother to child (Huth-Bocks et al. 2004a). For example, mothers with balanced (i.e., realistic, flexible, and rich in detail) representations are more likely to engage in sensitive parenting and have infants who develop a secure attachment style, whereas mothers with dismissive representations (i.e., downplay the importance of attachment needs from their infant and may show distant and harsh attitudes toward the baby) are more likely to show disengaged or hostile/intrusive parenting style, and their children are more likely to develop insecure attachment.

Maternal representations may be negatively affected by experiences that interfere with a mother’s shift from care-seeker to caregiver. IPV may impede this process by not only making a woman feel unsafe but also, relatedly, making her feel that she cannot ensure her child’s safety and care if her own safety and care are threatened (George and Solomon 2008). A person’s romantic partner, like the childhood primary caregiver, is also an attachment figure who typically provides a sense of safety. However, when her romantic partner is a source of fear and violence, a woman may engage in psychological defenses to protect herself. These defenses may ultimately lead to changes in her IWMs that have consequences for her maternal representations. Women who experience IPV during pregnancy may respond to the IPV by using defenses such as dissociation, withdrawal, and isolation, which may also result in emotional disengagement from the unborn child. Women may also identify with the unborn child (“My child is helpless like me”) or perceive their unborn child to be like their partner (“My child is violent like my partner”), either one hindering the shift from receiver to giver of care (Levendosky et al. 2012). Thus, women who experience IPV during pregnancy are more likely to develop distorted (e.g., unrealistic views of the infant) or disengaged representations (e.g., lack of attention or knowledge about the infant’s characteristics; Huth-Bocks et al. 2004b).

A brief case example illustrates how IPV may affect women’s developing maternal representations. Leslie was a 25-year-old first-time mother in her last month of pregnancy. She lived with her partner who was the baby’s father. They were both African-American and had graduated from high school. Leslie had also gone to beauty school but wasn’t working now—she planned to work soon after the baby was born. Her partner worked off and on and was currently doing some construction work. She hated being pregnant—she described being miserable due to her backaching during her pregnancy. She was abused by her partner and told us that she expected her baby to be a lot like her partner and was worried about this. When asked what she expected her child’s personality to be like when he or she was born, she responded immediately that she expected him to be a “pain in the butt” and to cry all the time and explained that her partner (baby’s father) is a “pain in the butt.” She imagined that the baby would cry all the time during the first year and that this would be very hard for her and that she would feel like she was going to go crazy when the baby cries a lot. When asked to describe her relationship with her baby during her pregnancy, she said that the baby was beating her up all the time. She felt that he was trying to break her ribs and that he was making her pregnancy worse than it had to be. She was hoping to have a son.

In Leslie’s story, there are clear signs of disturbance of these prenatal maternal representations. She attributes intentional violence to the fetus and also expects the baby to be very difficult (even violent) like his father. We do not know why she wants a boy, but perhaps it is to save the child from her own fate—both being hurt by a partner and being pregnant. Leslie appears to be ready for another violent male in her home, and this is presumably preferable to a female who is vulnerable. She is not focused on the needs of the baby, and her attributions of violence suggest that she is not really thinking about a baby but instead another violent male who can hurt her. Her concerns about her fetus/child and about her own mental health in response to normative infant behavior, e.g., crying, suggest a sense of profound vulnerability. All of this interferes with adequate development of the mother-child relationship.

The negative effect of IPV on maternal representations may also be evident in postpartum parenting behaviors. As IPV undermines a woman’s representation of herself as worthwhile and as a capable parent who can protect her child (Ahlfs-Dunn and Huth-Bocks 2015), she may engage in parenting behaviors that undermine the mother-child relationship. For example, a woman who perceives herself and her child to be helpless against her partner may alternate between withdrawing and engaging in overly controlling parenting. She may feel overwhelmed and incapable of caring for or protecting her child, causing her to become emotionally dysregulated and withdrawn. In addition, she may feel that the child cannot take care of himself/herself and therefore treat the child as incapable, resulting in overly controlling parenting (see Levendosky et al. 2012). On the other hand, when a mother sees her child as another abuser, she may feel fearful of or hostile toward her child, causing her to respond with less warmth and engage in fewer positive caregiving behaviors (see Levendosky et al. 2012). Therefore, the way that a mother understands her relationship with her child may be negatively influenced by IPV, which may in turn have consequences for maternal parenting behaviors and ultimately for child attachment.

Turning now to parenting behaviors, we review the studies of early parenting in families with IPV. Beginning in pregnancy, women in IPV relationships are less likely to seek prenatal care (e.g., Huth-Bocks et al. 2002). These women may have partners who prevent them from obtaining prenatal care in an effort to assert control or out of concern that the abuse may be discovered (e.g., McFarlane et al. 1992). Thus, even the earliest parenting behaviors, such as that of seeking prenatal care, are negatively affected by IPV.

Research on the effects of IPV on parenting behaviors finds that mothers who experience IPV are less sensitive and warm (e.g., Dayton et al. 2016; Levendosky et al. 2006) and are more hostile, angry, and aggressive with their children (e.g., Graham et al. 2012; Gustafsson et al. 2015). In a rare longitudinal study of IPV and parenting, Letourneau et al. (2007) found that exposure to IPV prior to age 2 compared with later exposure to IPV or no exposure was associated with lower levels of maternal self-report of warmth/nurturance and positive discipline at both early and later assessments. However, there is evidence that some mothers may compensate for their experiences of IPV by employing effective and/or warm parenting (e.g., Letourneau et al. 2007). Mothers who compensate for IPV likely experience less psychological distress (e.g., fewer depressive symptoms, more adaptive ways of coping with the IPV, and more resilience). In addition, as Buchanan et al. (2014) note, based on findings from a small qualitative study, while harsh and insensitive caregiving behaviors may ultimately undermine the security of the mother-child relationship, some of these behaviors may be attempts to maximize the safety of the child in a detrimental environment. For example, they found that some mothers may appease their partners by withdrawing from the child and focusing on their partner’s demands to make the mother-child relationship feel less threatening. Other mothers may use overly controlling parenting with the child in an effort to ensure that the partner is not provoked by the child’s behavior. Therefore, the same parenting behavior that undermines the early mother-child relationship may also help a mother fulfill her role as a capable parent whose foremost goal is the safety of her child (Buchanan et al. 2014).

Importantly, IPV may not be the only factor negatively affecting mothers’ parenting behaviors. Mothers who experience IPV are also more likely to be from low-income families (e.g., Vest et al. 2002) and to have elevated depressive symptoms (e.g., Bogat et al. 2003) compared with women who are not in violent relationships. Both low family income and maternal depressive symptoms independently predict harsh parenting and parental coercion (e.g., Arditti et al. 2010). In families with multiple risk factors known to contribute to maternal parenting, the risk factors likely have both independent and interactive effects on maternal parenting behavior; however, these have not been adequately differentiated (e.g., Taylor et al. 2009).

Thus, women living in the context of IPV often suffer negative consequences to their physical and mental health, their internal working models of self as mother, and consequently their parenting behaviors. As a result of these negative repercussions of the violence, children in these families also frequently suffer negative consequences. As seen through an attachment lens, this is understood to happen intergenerationally through the damage to the IWMs of the mother in relation to her child.

IPV undermines the security of a child’s attachment by affecting the mother’s ability to provide a sense of safety and consistent care to her child (Carpenter and Stacks 2009). This may be especially problematic in early childhood when children are more dependent on their primary caregivers and may therefore be more likely to feel fearful and helpless if they see their mothers subjected to violence (Huth-Bocks et al. 2001). These feelings may alter children’s perceptions of self and other, which then influences how they respond affectively, behaviorally, and physiologically to future threats to their well-being.