Domestic violence refers to violence among people in a domestic situation, which can include a spouse or partner, siblings, parents, aunts, uncles, grandparents, cousins, etc. The terms “domestic violence” and “intimate partner violence” are often used interchangeably although intimate partner violence is often used to describe violence perpetrated by a partner in a romantic or dating relationship. Until a more inclusive term emerges, both phrases are used when discussing relationship and partner violence (Women Against Abuse, 2023).

Intimate partner violence and domestic violence are preventable public health problems that affects millions of people in America and throughout the world. It occurs among both heterosexual or same-sex couples and does not require sexual intimacy. Its frequency and severity occur on a continuum, ranging from one episode to chronic, severe battering, aggression, financial abuse, and physical violence. It can be perpetrated against current or former romantic partners, children, extended family members, and pets.

Abusive behavior toward a domestic partner is about power and power imbalances. The perpetrator uses abuse to gain control over a partner, spouse, child, or older adult. Intimate partner violence often involves sexual or physical violence, psychological aggression, stalking, and economic abuse (Huecker et al., 2023). Unfortunately, in many societies and cultures, intimate partner violence is considered “normal.”

In the United States, domestic violence is a common problem, annually affecting an estimated 10 million people. Virtually all healthcare professionals will at some point evaluate or treat a patient who is a victim of domestic or family violence (Huecker et al., 2023).

In the United States (NNEDV, 2022, June):

• One in four women and 1 in 9 men are victims of domestic violence.
• Nearly 8 million women are raped, physically assaulted, and/or stalked by a current or former intimate partner each year.
• 1 in 5 women and 1 in 38 men have experienced rape in their lifetime.

An average of 3 women in the U.S. are killed by a current or former intimate partner every day and the percentage of women murdered by an intimate partner is 5 times higher than for men. Of the nearly 5,000 female victims of murder and nonnegligent manslaughter in 2021, one-third were killed by an intimate partner. By comparison, about 6% of the nearly 18,000 males murdered that year were victims of intimate partner homicide (Smith, 2022).

Globally as many as 38% of all murders of women are committed by intimate partners (WHO, 2021, March 9). For people of color and immigrants who are victims of partner violence, many face barriers accessing safety and services. Three out of four immigrant survivors fear accessing legal services related to their abuser (NNEDV, 2022, June).

1.1 Types of Intimate Partner Violence (IPV)

The Centers for Disease Control and Prevention (CDC) defines intimate partner violence as abuse or aggression that occurs in a romantic relationship. The definition includes both current and former spouses and dating partners.

There are four main types of intimate partner violence defined by CDC:

1. physical violence
2. contact sexual violence
3. stalking
4. psychological aggression (CDC, 2022, October 11)

1.1.1 Physical Violence

Physical violence is the intentional use of physical force with the potential for causing death, disability, injury, or harm. Physical violence includes, but is not limited to:

• Scratching, pushing, or shoving.
• Throwing, grabbing, or biting.
• Choking, shaking, aggressive hair pulling, slapping, punching, hitting, or burning.
• Use of a weapon.
• Use of restraints or one’s body, size, or strength against another person.
• Coercing other people to commit any of the above acts.

More than 30% of women and 25% of men experience severe physical violence during their lifetime. More than 40% of women and men in the U.S. report experiencing any physical violence by an intimate partner in their lifetime. This includes being slapped, pushed, or shoved, being hit with a fist or something hard, kicked, hurt by having hair pulled, slammed against something, hurt by choking or suffocating, beaten, burned on purpose, or had a knife or gun used on them (Leemis et al., 2022).

1.1.2 Contact Sexual Violence

Contact sexual violence is a combined measure that includes rape, being made to penetrate someone else (males only), sexual coercion, and/or unwanted sexual contact. All of these acts occur without the victim’s consent, including cases in which the victim is unable to consent due to being too intoxicated, incapacitated, experiencing a lack of consciousness, or lack of awareness through their voluntary or involuntary use of alcohol or drugs (Leemis et al., 2022).

Rape

Rape is any completed or attempted unwanted vaginal (for women), oral, or anal penetration through the use of physical force (such as being pinned or held down, or by the use of violence) or threats to physically harm, which includes times when the victim was too drunk, high, drugged, or passed out from alcohol or drugs and unable to consent (Leemis et al., 2022).

Rape is separated into three types:

1. completed forced penetration,
2. attempted forced penetration, and
3. completed alcohol- or drug-facilitated penetration.

Among women, rape includes vaginal, oral, or anal penetration by a male using his penis. It also includes vaginal or anal penetration by a male or female using their fingers or an object. Among men, rape includes oral or anal penetration by a male using his penis. It also includes anal penetration by a male or female using their fingers or an object (Leemis et al., 2022).

Being Made to Penetrate Someone Else (asked of males only)

This includes times when a victim is made to, or an attempt is made to make them sexually penetrate someone without the victim’s consent because the victim was physically forced (such as being pinned or held down, or by the use of violence) or threatened with physical harm, or when the victim was too drunk, high, drugged, or passed out from alcohol and drugs and unable to consent (Leemis et al., 2022).

Among men, being made to penetrate someone else can occurr in multiple ways: being made to vaginally penetrate a female using one’s own penis; being made to orally penetrate a female’s vagina or anus; being made to anally penetrate a male or female; or being made to receive oral sex from a male or female. It also includes male and female perpetrators attempting to force male victims to penetrate them, even if it did not happen (Leemis et al., 2022).

Sexual Coercion

Sexual coercion is unwanted sexual penetration that occurs after a person is pressured in a nonphysical way. In the National Intimate Partner and Sexual Violence Survey, sexual coercion refers to unwanted vaginal, oral, or anal sex after being pressured in ways that include being worn down by someone who repeatedly asks for sex or shows they are unhappy. Additionally, sexual coercion can include feeling pressured by being lied to, being told promises that are untrue, having someone threaten to end a relationship or spread rumors, and sexual pressure due to someone using their influence or authority (Leemis et al., 2022).

Unwanted Sexual Contact

Unwanted sexual contact is unwanted sexual experiences involving touch but not sexual penetration, such as being kissed in a sexual way or having sexual body parts fondled, groped, or grabbed (Leemis et al., 2022).

1.1.3 Stalking

Stalking involves a perpetrator’s use of a pattern of harassing or threatening tactics that are both unwanted and cause fear or safety concerns. A person is considered a stalking victim if they experienced any of stalking tactics on more than one occasion and by the same perpetrator and felt, fearful, threatened, or concerned for their own safety or the safety of others as a result of the perpetrator’s behavior (Leemis et al., 2022).

A relatively new category of stalking, cyberstalking has become increasingly common. Florida law (784.048) defines cyberstalking as "engag[ing] in a course of conduct to communicate, or to cause to be communicated, words, images, or language by or through the use of electronic mail or electronic communication, directed at a specific person, causing substantial emotional distress to that person and serving no legitimate purpose (Florida Legislature, 2023).

Examples of stalking include repeated unwanted phone calls, emails, or texts; leaving cards, letters, flowers, or other items when the victim does not want them; watching or following from a distance; spying; approaching or showing up in places when the victim does not want to see them; sneaking into the victim’s home or car; damaging the victim’s personal property; harming or threatening the victim’s pet; and making threats to physically harm the victim.

In the United States, more than 13% of women reported being stalked by an intimate partner in their lifetime, and 2.5% of women report being stalked by an intimate partner in the past 12 months. About 5% of men reported being stalked by an intimate partner in their lifetime and 1.2% report being stalked by an intimate partner in the 12 months (Leemis et al., 2022).

1.1.4 Psychological Aggression and Abuse

Psychological aggression and abuse in intimate relationships occur when a person is subjected to actions aimed at preventing or controlling their behavior, causing them emotional harm or fear. These behaviors are characterized by the intent to manipulate, control, isolate, or intimidate the person targeted by the psychological abuse (Cinquegrana et al., 2023).

Psychological intimate partner violence can occur in heterosexual as well as in same-sex intimate relationships and it can be perpetrated by men against women, as well as by women against men. Women are more likely to face psychological abuse at the hands of men they know, with one in five having experienced violence at the hands of an intimate partner (Cinquegrana et al., 2023).

Psychological aggression can include expressive aggression that can include name-calling, continual criticizing, disdain, and humiliation. It can also include coercive control such as limiting access to transportation, money, friends, and family and excessive monitoring of whereabouts.

Coercive control also includes threats of physical or sexual violence, control of reproductive or sexual health, exploitation of a vulnerable victim, and exploitation of a vulnerable victim with the intent of making them doubt their own memory or perception.

The abusive partner’s ability to control relies on the abused person’s belief that if she or he does not comply with the abusive partner’s demands, the victim, the victim’s children, or other persons or things the victim cares about will be harmed. Often, threats are alternated with acts of kindness from the perpetrator, making it difficult for the victim to break free of the cycle of violence.

Psychological abuse and aggression are often a precursor of other forms of violence, such as physical and sexual abuse. These behaviors may be quite subtle in nature, covered in pseudo-loving or quasi-humorous tones. This can minimize its severity, leading victims to consider the behaviors less serious than other forms of intimate partner violence. Subtle forms of psychological abuse—such as jealousy—are typically perceived as less coercive and less overtly violent than overt verbal abuse (Cinquegrana et al., 2023).

Many people feel that psychological abuse is less problematic than physical and sexual violence. For example, a study in English found that police officers are more likely to mention physical assaults and injuries rather than psychological abuse when they are asked to evaluate whether an episode of partner is “serious” or not. Another study involving 14 abused women found that they did not describe the psychologically abusive behavior of their partner as violent, and, consequently, not worthy of attention from professionals (Cinquegrana et al., 2023).

1.2 Violence Against Women

Violence against women is a major human rights violation and a global public health problem. An analysis of data from surveys and studies conducted between 2000 and 2018 report provides an estimate of two of the most common forms of violence against women (WHO, 2021):

• Violence by a husband or male intimate partner (physical, sexual, or psychological)—the most widespread form of violence against women globally.
• Sexual violence by perpetrators other than a current or former husband or partner—including male relatives, friends, acquaintances, or strangers—referred to as non-partner sexual violence.

Violence perpetrated against women by an intimate partner is usually accompanied by emotionally abusive and controlling behavior. The National Violence Against Women survey found that women whose partners were jealous, controlling, or verbally abusive were significantly more likely to report being raped, physically assaulted, or stalked by their partners.

Globally, an estimated 736 million women—almost one in three—have been subjected to physical and/or sexual intimate partner violence, non-partner sexual violence, or both at least once in their life. This figure does not include sexual harassment. The rates of depression, anxiety disorders, unplanned pregnancies, sexually transmitted infections, and HIV are higher in women who have experienced violence compared to women who have not, as well as many other health problems that can last after the violence has ended (UN Women, 2023).

Most violence against women is perpetrated by current or former husbands or intimate partners. More than 640 million or 26% of women aged 15 and older have been subjected to intimate partner violence (UN Women, 2023).

Of those who have been in a relationship, almost one in four adolescent girls aged 15–19 has experienced physical and/or sexual violence from an intimate partner or husband. Sixteen per cent of young women aged 15 to 24 experienced this violence in the past 12 months (UN Women, 2023).

1.2.1 Reproductive Coercion

Reproductive coercion is a specific form of intimate partner violence that is at the intersection of violence and reproductive health. It involves an abusive partner’s control of reproduction through explicit attempts to impregnate a partner (or get pregnant) against their wishes, controlling outcomes of a pregnancy, coercion to have unprotected sex, and interfering with condoms or contraception to promote a pregnancy. Reproductive coercion can occur in the absence of physical violence and sexual violence and is independently associated with unintended pregnancy (Basile et al., 2021).

Reproductive coercion is associated with poor sexual and reproductive health outcomes such as unintended pregnancy and sexually transmitted infections, including HIV infection. Mechanisms include forced unprotected intercourse, condom nonuse, inconsistent condom use, fear of condom negotiation, and inconsistent contraceptive use. Many victims experience reproductive coercion as part of abusive control characteristic of intimate partner violence (Basile et al., 2021).

1.2.2 Intimate Partner Violence During Pregnancy

Intimate partner violence during pregnancy is associated with health consequences for both the mother and the expected child. A systematic review of mainly high-income countries revealed that exposure to intimate partner violence during pregnancy tripled the odds of postpartum depression (Da Thi Tran, Murray, Van Vo, 2022).

In low- and middle-income countries, perinatal mental disorders such as depression, anxiety, and adjustment and somatic disorders were more prevalent in women exposed to partner violence during pregnancy or in the previous 12 months compared to unexposed women. Partner violence during pregnancy is an established risk factor for antepartum hemorrhage, low birth weight, intrauterine growth restriction, preterm delivery, and overall increased fetal morbidity (Da Thi Tran, Murray, Van Vo, 2022).

Controlling behaviors from an abusive partner often weakens a woman’s social networks and increases her social isolation. Emerging evidence since the beginning of the COVID pandemic has consistently revealed that stay-at-home orders, interrupted access to support services, and economic difficulties have worsened violence against women (Da Thi Tran, Murray, Van Vo, 2022).

More research is needed to understand the negative effects of intimate partner violence during pregnancy for both the mother and unborn child. Effects can be seen in negative health behaviors such as tobacco, alcohol, and drug use or delayed prenatal care. Reproductive health may be affected by many things including poor pregnancy weight gain, low birth weight, or obstetric complications. Physical and mental effects can include injury of all kinds—up to and including death; depression; poor attachment of mother to child; and others (ACOG, 2012).

1.3 Co-occurring Domestic Violence and Child Maltreatment

Intimate partner violence is often associated with the abuse of children. This is an important public health issue because witnessing violence in the home as a child is a strong risk factor for involvement in abusive relationships as an adult. In addition, experiencing abuse as a child has been associated with other risk factors such as depression, substance abuse, poor school performance, and high-risk sexual activity.

As many as 10 million children witness the abuse of a parent or adult caregiver each year. The co-occurrence of domestic violence and child maltreatment is estimated to occur in 30–60% of families experiencing domestic violence (FDCF, 2023). In fact, children in homes where intimate partner violence is present are more than twice as likely to be physically abused and nearly 10 times more likely to be psychologically abused (Brown et al., 2021).

Both forms of family violence—partner-to-partner and parent-to-child violence—place children at increased risk for poor developmental, socio-emotional, and behavioral outcomes. These children are at high risk of experiencing anxiety and depression and developing additional behavior problems such as aggression and delinquency (Brown et al., 2021).

It more than half of cases of partner violence, one or both caregivers are aggressive toward the child. In the context of child welfare, approximately 42% of families investigated for maltreatment report some form of intimate partner violence (Brown et al., 2021). This has compelled child welfare and domestic violence programs to re-evaluate their services and interventions with families experiencing both forms of abuse (FDCF, 2023).

Mothers and fathers who perpetrate violence toward their partners are twice as likely to abuse their children. Victims of partner violence are also more likely to expose their children to maltreatment. Specifically, mothers who are victims of partner violence report that they were more likely to be physically abusive and/or neglectful to their child (Brown et al., 2021).

Mothers who endorse attitudes justifying intimate partner violence also report that their children not only experience physical abuse and forms of harsh discipline, but are similarly exposed to psychological aggression, such as insults or an absence of affection. Among child welfare-involved families, children in homes with partner violence are more likely to experience physical abuse and neglect (Brown et al., 2021).

Even when children are not direct targets of violence in the home, they can be harmed by witnessing its occurrence. The witnessing of domestic violence can be auditory, visual, or inferred, including cases in which the child perceives the aftermath of violence, such as physical injuries to family members or damage to property (CWIG, 2021).

Children who witness domestic violence can suffer emotional and developmental difficulties that are similar to those of children who are direct victims of abuse. Many states recognize the need to protect and care for these children and currently address in statute the issue of children who witness domestic violence in their homes (CWIG, 2021).

The Child Protection Investigations Project (CPI), a collaboration between the Florida Department of Children and Families, the Office of the Attorney General, local certified domestic violence centers, community-based care agencies, and child welfare professionals provides community response to families experiencing the co-occurrence of domestic violence and child abuse. CPI bridges the gap between child welfare and domestic violence service providers, enhancing family safety, creating permanency for children, reducing removals of children from non-offending parents, and holding batterers accountable (FDCF, 2023).

In 2015, the Florida Legislature expanded the CPI Project to all 67 counties in Florida. There are currently 40 certified domestic violence centers that participate in the CPI Project (FDCF, 2023).

1.4 Elder Abuse and Abuse of Vulnerable Adults

Florida’s future is linked to the financial health and physical security of its elder population.

Florida Department of Elder Affairs

Elder abuse is a failure to act or an intentional act by a caregiver that causes or creates a risk of harm to an elder (Huecker et al., 2023). Some individuals experience multiple forms of abuse at the same time or over time. For every known case of elder abuse there are many unknown cases, particularly related to financial exploitation.

Elder abuse impacts communities on many levels, including personal relationships, community engagement, public health, safety, and economics. Research indicates that in the United States, one in ten older people living in the community experience some form of abuse. Recent research has suggested that elder abuse increased in severity during the COVID pandemic; one study found that abuse doubled to one in five older people during the pandemic (NCEA, 2023).

Elder abuse is frequently committed by those known to and trusted by older adults, such as family members, caregivers, friends, loved ones, service providers, and peers. Maltreatment can also be caused by strangers. Abusers can be anyone, of any age, race, or socioeconomic status (NCEA, 2023).

Florida has approximately 5.9 million residents aged 60 and older, representing approximately 21% of Florida’s population (Kilduff, 2021). That is the 2nd largest number of elders as a percentage of population than in any other state except Maine. With a large, growing, and physically and culturally diverse elder population, the state faces many challenges.

1.5 Sexual Harassment

Sexual harassment refers to a wide range of unwelcomed sex and gender-related behaviors, ranging from unwanted sexual actions and assaults to sexual propositions and requests, sexual comments, and non-verbal sexual gestures (Hardies, 2023).

Research indicates that 40−75% of women and 15−30% of men experience potentially harassing behaviors at work. This can include being called insulting names, getting inappropriate remarks about looks, being a victim of stereotyping and prejudice, being stared at, and unnecessary and unwanted touch (Hardies, 2023).

Sexual harassment has various adverse negative effects on people's lives, affecting job satisfaction, job productivity, and psychological and physical wellbeing. Moreover, sexual harassment affects not just the involved victims, it also negatively affects people witnessing such harassment (Hardies, 2023).