Does Childhood Psychological Abuse Contribute to Intimate Partner Violence Victimization? An Investigation Using the Childhood Experience of Care and Abuse Interview

Abstract

Although psychological abuse is recognized as a particularly insidious form of child abuse, research on the impact of this type of abuse related to intimate partner violence (IPV) is scant. This study examined the contribution of childhood psychological abuse to IPV in female victims and non-victims. Furthermore, it investigated the role of cumulative abuse in predicting IPV. The study included 38 women victims of IPV and 40 non-IPV women. All participants were investigated using the Childhood Experience of Care and Abuse Interview (CECA); the Revised Conflict Tactics Scale (CTS2) and the IPV History Interview were used to assess IPV in the last year and lifetime, respectively. Results indicated that psychological abuse was a stronger predictor of IPV than other maltreatment types. Furthermore, dose–response effects of cumulative abuse on IPV are well evidenced. Future research should continue examining impacts of psychological abuse on IPV so as to further inform clinical practice and intervention planning.

Keywords

childhood maltreatment family violence intimate partner violence psychological abuse CECA interview

Introduction

Violence against women is a major global public health problem (World Health Organization [WHO], 2013) and a serious violation of human rights. Intimate partner violence (IPV) is identified as acts or threats involving physical, sexual, and psychological violence or stalking, carried out or received during a present or past intimate relationship (Ali, Dhingra, & McGarry, 2016; American Psychological Association [APA], 1996; Centers for Disease Control and Prevention [CDC], 2015). In this study, the expression IPV solely refers to the victimization of women in the context of an intimate partner relationship. Worldwide data have shown that 30% of all women who have had at least one partner in their life have experienced physical and/or sexual IPV, with 23% living in high-income countries (WHO, 2013). A recent review (Hamberger & Larsen, 2015) has shown that women are more likely than men to sustain more severe and more frequent injury, whereas men are the predominant perpetrators of sexual abuse. Increasing the knowledge about the characteristics of this phenomenon and its early causes is therefore of particular interest (de Zulueta, 1993; McMahon et al., 2015).

In Italy, about 2,800,000 women aged between 16 and 70 have suffered at least one incident of sexual or physical violence during or after the end of a relationship according to a national survey conducted in 2014 by the National Institute of Statistics (Istituto Nazionale di Statistica [ISTAT], 2014). Sociocultural environment, the lack of availability of services to prevent domestic violence, and the absence of social and community support may contribute to explain rates of women’s IPV in Italy. Furthermore, a gendered social determinants model offers another framework for examining relevant factors that affect women’s risk of IPV. Data on the Global Gender Gap Index (GGGI) place Italy at Rank 71 in 2013 (World Economic Forum, 2013). Italy’s ranking is one of the lowest in the high-income countries. In Italy, there is a gap of power in relations between men and women largely probably due to the absence of policies toward women. In particular, there is need to promote the introduction or reintegration of women who are inactive for the care of children in the labor market or to make nursery schools available, to promote fair wages. On the political level, Italian women’s equality in the exercise of political rights is relatively a recent conquest. Women obtained the right to vote only in 1946, and only in 1974, the right to divorce has been enshrined. In 1975, Italy endorsed the Family Law, which equates the rights and duties of the spouses, and only 3 years later the right to abortion was finally recognized. The existence of laws and policies that feed the gender gap between men and women send the implicit message to society and women that women are less valuable than men. This could have implications for the likelihood of tolerating violence behavior by partner (Guidugli, Barbaranelli, Giacomantonio, Di Giorgio, & Gramazio, 2015).

Rates of child maltreatment in Italy also are alarming. A survey conducted in 2011 by the Italian Coordination Services against Child Maltreatment and Abuse (Coordinamento Italiano Servizi contro il Maltrattamento e l’Abuso all’Infanzia [CISMAI]) and “Terre des Hommes International Federation” has highlighted that 6.36% of minors assisted by the social services are victims of a type of childhood abuse and that 0.98% of minor residents in Italy are assisted for maltreatment. Cultural instances of socially approved violence such as physical punishment as an acceptable or normal part of rearing a child or the use of violence as entertainment on TV may be linked to an increased risk of violent victimization both in childhood and in adulthood.

In addition to contextual aspects, life events have been identified as IPV precursors. International literature has identified an association between various types of traumatic childhood experiences and IPV (McMahon et al., 2015; Whitfield, Anda, Dube, & Felitti, 2003; Widom, Czaja, & Dutton, 2014). Numerous studies have underlined the role of childhood physical and sexual abuse (Coid et al., 2001; Daigneault, Hébert, & McDuff, 2009; Fergusson, Boden, & Horwood, 2008; Fry, McCoy, & Swales, 2012; Seedat, Stein, & Forde, 2005) or witnessing violence (Bensley, Van Eenwyk, & Simmons, 2003; Ehrensaft et al., 2003; Fritz, Slep, & O’Leary, 2012; Fry et al., 2012; Renner & Slack, 2006) in increasing women’s likelihood of adult IPV. However, the research has sometimes shown contradictory findings. Some studies have not found associations between childhood sexual abuse and IPV (Bensley et al., 2003; Engstrom, El-Bassel, & Gilbert, 2012; Renner & Whitney, 2012). Furthermore, some research has shown that direct childhood experience of violence rather than witnessing it is key in IPV development (Stith et al., 2000).

A smaller number of studies have examined the relationship between IPV and other types of childhood maltreatment characterized by the deprivation of physical and emotional needs, such as neglect (Renner & Whitney, 2012; Widom et al., 2014) as well as psychological or emotional abuse (Berzenski & Yates, 2010; LoCascio et al., 2020; Zamir & Lavee, 2014). Psychological abuse involves coercive control over the victim by a parent or significant other and includes verbal and nonverbal acts, repeated or occasional rejection, degradation, deprivation of basic physical or emotional needs, threats, and corruption and exploitation (Moran, Bifulco, Ball, Jacobs, & Benaim, 2002). It is recognized as the most common type of maltreatment. Although psychological abuse can occur in isolation, it and other forms of abuse commonly co-occur in the same settings and may at times exist as features of the same actions (Briere & Runtz, 1990; Finkelhor, Ormrod, Turner, & Hamby, 2005; Moran et al., 2002). Some authors have suggested that psychological maltreatment is an inherent embedded element in all other forms of abuse and that the psychological meanings associated with acts of physical or sexual abuse constitute the real traumas more than the severity of the acts themselves (Claussen & Crittenden, 1991; Hart, Binggeli, & Brassard, 1997). The failure to distinguish specific types of abuse can lead to difficulties when attempting to establish specificity of outcome of abuse experiences (Crittenden, 1985). There is a growing body of studies that has considered psychological abuse as a distinct form of maltreatment with specific and independent consequences (Berzenski & Yates, 2010; Gross & Keller, 1992; Infurna et al., 2015; Paradis & Boucher, 2010) rather than as an underlying component of all other types of abuse (Claussen & Crittenden, 1991; Garbarino, Guttmann, & Seeley, 1986; Hart & Brassard, 1987). The latest findings indicate that relative to other forms of maltreatment (i.e., physical abuse, sexual abuse), psychological abuse might be the most pervasive and damaging type of abuse (Hart et al., 1997; McGee, Wolfe, & Wilson, 1997; Riggs, 2010). However, for a long time research has disregarded this type of abuse, probably because of the lack of a shared conceptual definition, which makes its identification difficult for services (Garbarino, Eckenrode, & Bolger, 1997). Only recently have researchers begun to investigate the impact of this type of abuse on the intrapsychic and interpersonal functioning, showing its effects as particularly pernicious (Reyome, 2010). In particular, several studies have shown that childhood psychological abuse is more strongly associated with more varied outcomes (e.g., psychopathological symptoms, interpersonal problems in adult couple relationships, low self-esteem), compared with physical or sexual abuse (Infurna et al., 2016; Paradis & Boucher, 2010; Schneider, Ross, Graham, & Zielinski, 2005; Spertus, Yehuda, Wong, Halligan, & Seremetis, 2003; Spinazzola et al., 2014).

Research on the contribution of psychological abuse to IPV is only just beginning (Reyome, 2010). Only a few studies have been conducted, but these have found significant associations between IPV and emotional abuse, in adolescence (Berzenski & Yates, 2010; Crawford & O’Dougherty, 2007; Wekerle et al., 2009) and in adulthood (Cascardi, O’Leary, Lawrence, & Schlee, 1995; Seedat et al., 2005; Valdez, Lim, & Lilly, 2013; Zamir & Lavee, 2014). It is particularly relevant that in some studies, childhood psychological abuse is the strongest predictor of IPV compared with other types of childhood maltreatment, such as physical or sexual abuse (Berzenski & Yates, 2010; Cascardi et al., 1995; Crawford & O’Dougherty, 2007; Seedat et al., 2005; Wekerle et al., 2009).

Attachment theory, specifically its conceptualization of internal representational models, offers a useful framework for understanding how childhood psychological abuse may predict IPV above and beyond other types of abuse (Riggs, 2010). Domination of the child is considered a key characteristic of this category of abuse (Bifulco, Moran, Baines, Bunn, & Stanford, 2002). Characterized by rejecting, disparagement, threatening, isolating, or exploiting caregiving, childhood psychological abuse is associated more than other forms of abuse with the development of maladaptive models of Self and Other that introduce the expectation of couple relationships characterized by violence (Crawford & O’Dougherty, 2007). In particular, internal working models (IWMs) of the self as bad, unworthy, or incapable might create a greater likelihood of tolerating poor treatment by partner, whereas IWMs of others as abusive, hostile, or rejecting can decrease the likelihood of considering relational violence in romantic context outside the range of normal human experiences (Riggs, 2010). International literature has highlighted that emotional dysregulation, maladaptive interpersonal schemas of mistrust, emotional inhibition, self-sacrifice, shame and abandonment, poor social functioning, and psychological disorders resulting from early experiences of psychological abuse may culminate in dysfunctions in intimate relationships, such as enmeshment or fear of intimacy, sexual problems, or relational violence (Riggs, 2010).

Sociocultural factors and gender inequalities that characterize Italian society described above may further increase the influence of childhood psychological abuse on the IPV.

Despite a recent increase of interest in empirical investigations into the relationship between childhood psychological maltreatment and IPV (Berzenski & Yates, 2010; Crawford & O’Dougherty, 2007; Valdez et al., 2013; Zamir & Lavee, 2014), there remains a need to investigate if and to what degree psychological abuse increases women’s likelihood of adult IPV. This has direct implications on clinical practice and intervention planning. Specifically, an increased clinical awareness about the impacts of particularly pernicious psychological abuse on intimate relationships may facilitate IPV prevention.

Cumulative effects of trauma, in addition to the unique or specific effects of the individual types of maltreatment, are firmly established in the literature (Briere, Kaltman, & Green, 2008; Chartier, Walker, & Naimark, 2010; Finkelhor, Ormrod, & Turner, 2007; Scott-Storey, 2011). Dose–response effects of combined childhood adversity on adult psychopathology and health are well evidenced (Felitti, 2002a, 2002b; Felitti et al., 1998). The majority of recent studies increasingly highlight that IPV victimization is strongly associated with a developmental context characterized by the co-occurrence of various types of adverse childhood experiences (Parks, Kim, Day, Garza, & Larkby, 2011; Renner & Slack, 2006; Widom et al., 2014). It could be argued that IPV is ultimately more ascribable to cumulative trauma experienced during childhood (Taylor et al., 2008; Whitfield et al., 2003). Exposure to cumulative childhood maltreatment affects developmental processes related to the strengthening of interpersonal and emotion regulation. In particular, it interferes negatively with the ability to regulate emotions and produces deficits that concern perception of Self, perception of the perpetrator, the system of meanings, and interpersonal schemas introducing the expectation of being re-victimized (Herman, 1992; van der Kolk, Roth, Pelcovitz, Sunday, & Spinazzola, 2005).

Establishing the relationship between childhood maltreatment and IPV is hampered by several study limitations that in part may also explain the heterogeneity of the results: (a) although many studies have identified various types of adverse childhood experiences as important precursors of IPV, rarely is a range of experiences investigated together in the same study; (b) furthermore, the literature has disregarded the effect of serious forms of abuse such as psychological abuse; (c) retrospective self-reports for assessment of childhood abuse produce considerable difficulty in detecting the complexity of the developmental experiences because they often do not differentiate the severity or frequency but only the presence or absence of abuse; (d) although the Conflict Tactics Scale (CTS; Straus, 1979) and the Revised Conflict Tactics Scale (CTS2; Straus, Hamby, Boney-McCoy, & Sugarman, 1996) are the most frequently used scales in the literature for the assessment of IPV, they have some limitations: they do not provide data on the intensity of the violence, its duration, or contextual aspects such as the type of relationship with the aggressor (if husband, partner etc.). Furthermore, they do not allow a detailed assessment for adult psychological violence, and they measure the IPV perpetrated only by the current partner or last partner and not lifetime IPV. Therefore, a combination of qualitative and quantitative methods for assessment of IPV is recommended (Woodin, Sotskova, & O’Leary, 2013).

The present study aimed to overcome some of these limitations: It examined a wide range of adverse childhood experiences (antipathy; neglect; physical, sexual, and psychological abuse; and witnessing violence) by means of the Childhood Experience of Care and Abuse Interview (CECA; Bifulco, Brown, & Harris, 1994; Giannone et al., 2011), often taken as a gold standard tool to detect childhood abuse and neglect experiences (Thabrew, de Sylva, & Romans, 2012). Furthermore, the study utilized multiple indicators of adult IPV to comprehensively examine the extent of IPV.

The study aimed to measure the association between IPV and six different types of adverse childhood experiences before age 17 to determine whether some of these are more strongly associated with adult IPV. This study examined if and to what degree childhood psychological abuse would predict adult IPV above and beyond the contribution of antipathy, neglect, physical and sexual abuse, and witnessing violence. Specifically, it was hypothesized that childhood psychological abuse would show a stronger predictive value for IPV than other forms of childhood abuse. Furthermore, this study investigated associations between cumulative experiences of childhood maltreatment and adult IPV. Therefore, it was hypothesized that a dose–response effect would be shown: with an increase in the number of types of childhood maltreatment, the likelihood of IPV also increased.

Method

Participants and Procedures

The present study is part of a larger research project on psychopathological outcomes associated with childhood maltreatment and involves a sample of 78 Italian women (M = 34.45, SD = 10.76, range 18-55 years) split into two subgroups: IPV (38) and non-IPV comparison women (40) loosely matched for age and education. All participants were informed about the study purposes, and they signed the informed consent before the assessment. Ethical permission was provided from University of Palermo and outpatient services of public health of Palermo.

The following inclusion criteria were determined: being presently engaged in an intimate partner relationship (or having been engaged in the past 5 years), being or having been a victim of violence by one or more partners (only for the IPV women group), ability to express valid consent to the research, and absence of mental diseases and serious medical conditions.

IPV women were recruited from public outpatient services for women’s health that includes a service for victims of violence and family counseling centers located in Palermo (which offer information and some psychological interventions for the women). Participation in the study was voluntary. The presence of IPV experiences was verified through CTS2 self-report (Straus et al., 1996) and a qualitative in-depth interview, the IPV History Interview. Women were included in the IPV group if they had reported at least one act of partner violence defined by Straus severe (Straus et al., 1996) or minor acts but frequent (from three to more than 20 times in the last year) and a score of 1 or 2 (marked, moderate) on the IPV History Interview.

A total of 55 women were assessed. Among these, one was excluded because she had never been involved in an intimate relationship, six had never been victimized, and 10 did not complete the assessment. The control group was recruited by a convenience sampling criterion, and it includes volunteers recruited through advertisements affixed in departments of the University of Palermo and social aggregation centers. Non-IPV control women were also screened by the CTS2 self-report (Straus et al., 1996) and the IPV History Interview to ensure that they had not experienced IPV. They were included in this group if they had not reported any acts of partner violence or minor and low frequency acts (once or two times in the last year) on CTS2 and a score of 3 or 4 (mild, little/none) on the IPV History Interview. All measures were administered by trained researchers in safe settings, with a session taking approximately 1.5 hr.

Measures

The Italian version (Giannone et al., 2011) of the CECA (Bifulco et al., 1994) was used to assess childhood maltreatment experiences. The CECA is a retrospective, semi-structured interview. It uses an investigator-based approach to rating and behavioral indicators instead of the subject’s own feelings in rating severity. This approach minimizes biases from reporting style (such as the tendency to idealize or normalize lived experiences). Furthermore, it allows researchers to obtain data about the context of experience (such as relationship to perpetrator, frequency, and length of abuse). Attention was paid to issues of “scaffolding” responses and aiding recall through the use of chronological questioning and descriptions of “typical day” experiences. All childhood maltreatment experiences are rated on 4-point scales of severity (1: marked; 2: moderate; 3: mild; 4: little/none) according to predetermined criteria and manualized threshold examples. Scoring criteria are provided in Bifulco and Moran (1998). The interviews, lasting approximately 1 hr, were audio-recorded and rated by two trained interviewers. Very good inter-rater agreement was found for all CECA subscales (.76 ≤ K ≤ 1; .85 ≤ intraclass correlation coefficient [ICC] ≤ .95); inconsistencies were resolved in consensus meetings to finalize scoring. A full description of CECA scales is given elsewhere (Bifulco & Moran, 1998), but brief definitions of the scales analyzed in this study are provided below:

Antipathy: This rates parental hostility, rejection, or coldness shown toward the child and scapegoating in relation to siblings. This is taken to equate with parental emotional neglect as described in the literature;

Neglect: This includes parents’ disinterest in material care (feeding and clothing), health, friendships, schoolwork, and career prospects;

Physical abuse: This reflects violence toward the child from adults in the household, usually parents but also occasionally from other adults or older siblings, taking into account the intensity of the attacks in terms of the type of hitting (use of implements, such as belts or sticks, punching or kicking the child, or use of a gun or knife) and frequency (e.g., weekly or more);

Psychological abuse: This assesses behaviors intended to control and dominate the child through acts which are humiliating/degrading, terrorizing, extremely rejecting, depriving of basic needs or valued objects, inflicting marked distress/discomfort, corrupting/exploiting, cognitively disorientating, or emotionally blackmailing;

Sexual abuse: This includes any age-inappropriate sexual contact from an adult or older peer, with the severity of the abuse taking into account the degree and intrusiveness of sexual contact (e.g., whether penetration was involved), the relationship of trust with the perpetrator (e.g., teachers or stepfathers), and the frequency and duration of the abuse;

Witnessing violence: This assesses the amount of violence between parents, taking into account the degree of violence (punches, kicks, slaps, pushes, bites, and strangling; use of a gun or knife) as well as the frequency (e.g., weekly or more).

The number of types of maltreatment was computed assigning a dichotomous score of 1: present (marked, moderate) or 0: absent (mild or little/none) for each maltreatment subscale and by summing the six dichotomous subscales. The number of types of maltreatment scores ranged from 0 to 4: ≥0 = no childhood maltreatment; 1 = one type of maltreatment; 2 = two types of maltreatment; 3 = three types of maltreatment; ≥4 = four or more types of maltreatment.

The CTS2 was used to assess adult IPV in the past 12 months. This instrument, recently validated in Italy (Signorelli, Arcidiacono, Musumeci, Di Nuovo, & Aguglia, 2014), is a 39-item self-report instrument containing five subscales (negotiation, violence, extreme violence, injury, and sexual coercion). As the Italian version does not discriminate between acts of physical violence and psychological aggression, we used the original subscales identified by Straus et al. (1996). Specifically, the subscales psychological aggression, sexual coercion, physical assault, and injury from a partner were considered for these analyses, all of which have good reliability (α = .88–.95). Respondents rate each item on a 7-point Likert-type scale ranging from 0 = never to 6 = more than 20 times. Three indicators of IPV have been used to describe the victimization to obtain a broad evaluation of the IPV: the prevalence score indicates through a dichotomous score the presence/absence of any type of IPV assessed; the frequency or chronicity score (Straus et al., 1996) is the sum of the number of times that each act occurred over the past 12 months. A potential weakness of this approach is that the sum of events can be very different from the gravity of a single experience (Widom et al., 2014). Finally, the variety score referred to the sum of the occurrence (yes/no) of each item within that scale. These variety scores are less skewed and more reliable than frequency scores (Kwong, Bartholomew, Henderson, & Trinke, 2003; Moffitt et al., 1997). Moreover, because IPV tends to proceed from less severe to more severe types of violence, variety scores capture the full range of experiences within an abusive relationship.

The IPV History Interview was used to assess lifetime IPV perpetrated by one or more partners. It is a semi-structured interview created ad hoc by our research group on the basis of scientific literature on this theme. The IPV History, as the CECA, assesses the types of violence on a 4-point scale of severity according to predetermined criteria (described in the appendix to the interview), which takes into account the frequency and severity of violent acts. Very good inter-rater agreement was found for all subscales (.78 ≤ K ≤ .84; .90 ≤ ICC ≤ .96), and inconsistencies were resolved in consensus meetings to finalize scoring. Administered following the CECA, it allowed us to recognize women’s victimization histories throughout their entire lives, taking into account the total number of previous abusive relationships and the experiences of violence by other non-partners. This interview takes about 10 to 15 min and includes three scales:

Physical violence: This assesses violent acts toward the woman, taking into account the type of attack (use of a gun or knife, punches, kicks, bites, and strangling) and frequency (once or more times a week);

Sexual violence: This rates violent sexual acts distinguishing between imposed (vaginal, oral, or anal) sex with or without the use of physical force (hitting, holding down) or other coercive instruments such as threats;

Psychological violence: This assesses behaviors directed to a woman’s psychological control and includes seven categories: humiliation, terror, cognitive disorientation (trying to convince the woman she is insane, weak, and stupid), emotional blackmail, deprivation of basic needs such as economic resources and social contacts, deprivation of valued objects, and corruption or exploitation.

Data Analysis

Data were analyzed using SPSS 20.0. Descriptive statistics were calculated for both groups; to estimate the significance of differences between the two groups with respect to age and types of childhood maltreatment, an independent sample t test, chi-square test, and Mann–Whitney U test were used for categorical variables.

The reliability of the CTS2 scale was assessed using Cronbach’s index of internal consistency; for CECA and the IPV History Interview, the inter-rater reliability was assessed using the Cohen’s kappa statistic (K; Cohen, 1960) for nominal scales, with the criteria for kappa values established as “good to excellent” (≥.60), “moderate” (.41-.60), or “poor” (≤.40); the ICC was used for items with ordinal (e.g., Likert-type ratings) or continuous (e.g., number of a certain element) responses (Shrout & Fleiss, 1979).

Two multivariate logistic regression models were tested to verify the association between IPV and specific types of childhood maltreatment (Model 1) and the total number of types of childhood maltreatment (Model 2). The outcome variable, IPV, was dichotomized (1: present = marked or moderate on IPV History Interview; 0: absent = mild or little/none) on the IPV History Interview (Model 1). Both models were adjusted for age and educational level. The associations between childhood maltreatment and IPV were reported as odds ratios (OR) together with their 95% confidence intervals (CI).

Results

Sociodemographic Characteristics

Table 1 shows the sociodemographic characteristics of the study sample with differences between groups. These were nonsignificant between two groups for age, educational level, occupational status, and cohabitation with the partner during the last year. However, non-IPV women were more frequently single than IPV women, who were more often married and had more children.

Table 1.

Sociodemographic Variables.

Variables^a	IPV Women (n = 38)		Non-IPV Women (n = 40)			p
Age in years (mean ± SD)	34.29	9.5	34.88	11.6	0.242^b	.809
Educational level,^c n (%)					1.746^d	.186
School	29	76.3	25	62.5
Higher education	9	23.7	15	37.5
Occupational status, n (%)					0.074^d	.786
Employed	15	39.5	17	42.5
Unemployed	23	60.5	23	57.5
Marital Status, n (%)					520.00^e	.008
Single	14	36.8	24	60
Married	16	42.1	16	40
Divorced/Separated	8	21.1	0	0
Cohabitation during last year, n (%)					0.044^d	.834
Yes	18	47.4	18	45
No	20	52.6	22	55
Number of children, n (%)					−3.778^b	<.001
0	8	21.1	26	65
1	10	26.3	3	7.5
≥2	20	52.7	11	27

Note. IPV = Intimate Partner Violence; CECA = Childhood Experience of Care and Abuse.

Sociodemographic variables are evaluated by means of the CECA interview.

t value.

School includes first level primary (from 6 to 11) and secondary school (from 11 to 14); higher education includes second level secondary school (from 14 to 18) and higher instruction (university degree).

χ² value.

Mann–Whitney U.

Bold text indicates a statistical significance with a p-value less than 0.05.

IPV Prevalence Characteristics

Table 2 shows data concerning IPV prevalence characteristics. With regard to the IPV during the last year, CTS2 frequency scores highlighted significant differences as expected between the two groups with respect to physical assault and psychological aggression and injury. Through the IPV History Interview, we observed serious lifetime IPV experiences in the IPV women group: 32 women (84.2%) reported physical violence, 28 women (73.7%) reported psychological violence, and 10 women (26.3%) reported sexual violence. The interview also revealed that 16 women (42.1%) had suffered two different types of violence and eight women (21.1%) had suffered all three types of violence. Only four women (10.5%) in the IPV group had two abusing partners during their lifetimes and one (2.6%) suffered violence experiences by a non-partner.

Table 2.

IPV Prevalence Characteristics.

Variables	IPV Women (n = 38)		Non-IPV Women (n = 40)			p
CTS2 (last year)
Physical assault
Prevalence, n (%)	14	36.8	5	12.5	6.267^a	.012
Chronicity (mean ± SD)	6.61	13.71	0.40	1.63	−2.771^b	.009
Variety (mean ± SD)	2.26	3.80	0.22	0.66	−3.257^b	.002
Psychological aggression
Prevalence, n (%)	19	50	21	52.5	0.049^a	.825
Chronicity (mean ± SD)	7.26	11.01	2.60	4.03	−2.458^b	.018
Variety (mean ± SD)	1.89	2.51	1.08	1.32	−1.788^b	.079
Sexual coercion
Prevalence, n (%)	5	13.2	1	2.5	3.117^a	.077
Chronicity (mean ± SD)	1.53	5.19	0.08	0.47	−1.716^b	.094
Variety (mean ± SD)	0.37	1.17	0.02	0.15	−1.791^b	.081
Injury
Prevalence, n (%)	11	28.9	0	0	13.480^a	<.001
Chronicity (mean ± SD)	1.97	4.11	0	0	−2.960^b	.005
Variety (mean ± SD)	0.87	1.54	0	0	−3.464^b	.001
IPV history (lifetime),^c n (%)
Physical violence	32	84.2	0	0
Psychological violence	28	73.7	0	0
Sexual violence	10	26.3	0	0
No. of IPV lifetime experiences, n (%)
0	0	0	40	100
1	14	36.8	0	0
2	16	42.1	0	0
3	8	21.1	0	0
No. of abusing partners, n (%)
0	0	0	40	100
1	34	89.5	0	0
2	4	10.5	0	0
Experience of violence from other (non-partners), n (%)
Yes	1	2.6	0	0
No	37	97.4	40	100

Note. IPV = intimate partner violence; CTS = Conflict Tactics Scale.

χ² value.

t value.

Presence (1: marked or 2: moderate) of IPV lifetime experiences.

Bold text indicates a statistical significance with a p-value less than 0.05.

Childhood Maltreatment and IPV

Table 3 shows the presence of childhood maltreatment in the two groups. The results show that the majority of women in the IPV group had severe traumatic childhood experiences: They showed a significantly higher presence of antipathy (OR = 2.37, t = 3.36, p = .001), neglect (OR = 2.60, t = 3.53, p = .001), physical abuse (OR = 2.33, t = 3.23, p = .002), sexual abuse (OR = 5.05, t = 4.05, p < .001), psychological abuse (OR = 4.00, t = 4.07, p < .001), and witnessing violence (OR = 2.15, t = 2.19, p = .032) than non-IPV women. The most frequently reported maltreatment types in the IPV group were antipathy (n = 16; 42.1%) and neglect (n = 15; 39.5%) followed by physical abuse (n = 14; 36.8%).

Table 3.

Presence of Childhood Maltreatment Experiences in the Two Groups.

	IPV Women (n = 38)		Non-IPV Women (n = 40)		OR	t	p
	n	%	n	%	OR	t	p
Maltreatment^a
Antipathy	16	42.1	5	12.5	2.37	3.36	.001
Neglect	15	39.5	8	20	2.60	3.53	.001
Physical abuse	14	36.8	2	5	2.33	3.23	.002
Sexual abuse	10	26.3	0	0	5.05	4.05	<.001
Psychological abuse	13	34.2	1	2.5	4.05	4.07	<.001
Witnessing violence	8	21.1	3	7.5	2.15	2.19	.032
	n	%	n	%	OR	χ²	p
No. of types of maltreatment
1	8	21.1	8	20	0.91	0.01	.908
2	2	5.3	2	5	1.48	0.003	.958
3	4	10.5	1	2.5	5.44	2.09	.148
≥4^b	11	28.9	1	2.5	15.17	10.47	.001
At least one type^c	25	65.8	12	30	4.22	10.01	.002

Note. IPV = intimate partner violence; OR = odds ratio.

Frequencies of maltreatment are calculated through dichotomous indexes which reflect the presence (1: marked; 2: moderate) or absence (3: mild; 4: little/none) of specific types of maltreatment.

Women who experienced four or more types of maltreatment were collapsed into one group (≥4).

Maltreatment was dichotomized (1: present; 0: absent).

Bold text indicates a statistical significance with a p-value less than 0.05.

The two groups also showed significant differences with respect to the number of types of maltreatment experiences. In particular, women in the IPV group reported a significantly higher frequency of four or more forms of childhood abuse than non-IPV women (n = 11; 28.9% compared with n = 1; 2.5% in the non-IPV group, OR = 15.17; χ² = 10.47; p = .001). The results also showed significant differences between the two groups with regard to having experienced at least one type of childhood maltreatment (n = 25; 65.8% in the IPV group compared with n = 12; 30% in the non-IPV group, OR = 4.22; χ² = 10.01; p = .002).

Multivariate Logistic Regression Models

Table 4 shows associations between IPV and specific types of childhood maltreatment (Model 1) and between IPV and a number of types of childhood maltreatment (Model 2) assessed using multivariate logistic regression analyses. Model 1 was assessed using both simultaneous and stepwise logistic regression analyses. ORs can be interpreted as a measure to increase/reduce the likelihood of IPV in the presence of adverse childhood experiences.

Table 4.

Multivariate Logistic Regression Model.

	Association With IPV^a
	OR	95% CI	p
Maltreatment (Model 1)
Antipathy	0.80	[0.309, 2.098]	.657
Neglect	1.67	[0.680, 4.099]	.263
Physical abuse	0.62	[0.224, 1.762]	.376
Sexual abuse	4.24	[1.124, 16.026]	.033
Psychological abuse	3.45	[1.079, 11.086]	.037
Witnessing violence	1.32	[0.549, 3.204]	.530
No. of types of maltreatment (Model 2)
1	1.85	[0.544, 6.339]	.323
2	2.40	[0.280, 20.610]	.424
3	10.44	[1.001, 108.829]	.050
≥4	23.32	[2.610, 208.415]	.005

IPV = intimate partner violence.

The association between IPV and selected variables as potential predictors is reported as odds ratios (OR) with confidence intervals (CIs) at 95%.

Bold text indicates a statistical significance with a p-value less than 0.05.

The simultaneous multivariate logistic regression model for childhood experiences of maltreatment (Model 1) controlled for age and educational level was highly significant (p < .001). Only childhood sexual abuse (OR = 4.24) and childhood psychological abuse (OR = 3.45) were significant IPV predictors. Antipathy, neglect, physical abuse, and witnessing violence showed no significant effects on IPV. Moreover, the model provided for a good adaptation assessed with the pseudo-R² test (Nagelkerke’s R² = .43), and even Hosmer–Lemeshow’s test indicated a good data adaptation to the model (χ² = 8.24, p = .410). The results of the stepwise multivariate logistic regression model also showed that sexual abuse (p = .03; OR = 3.99; 95% CI = [1.14, 13.93]) and psychological abuse (p = .016; OR = 3.12; 95% CI = [1.23, 7.89]) were the only significant IPV predictors. This model was highly significant (p < .001). The model provided for a good adaptation assessed with the pseudo-R² test (Nagelkerke’s R² = .40), and Hosmer–Lemeshow’s test indicated a good data adaptation to the model (χ² = 9.38; p = .311).

The multivariate logistic regression model for the number of types of maltreatment was significant (p = .006); having suffered three types of maltreatment (OR = 10.44) and four or more types (OR = 23.32) were significantly associated with IPV. This suggests a dose–response effect. The model provided for a good adaptation assessed with the pseudo-R² test (Nagelkerke’s R² = .27), and Hosmer–Lemeshow’s test indicated a good data adaptation to the model (χ² = 7.12; p = .416).

Discussion

To the best of our knowledge, this is the first study that investigates the impact of a range of childhood maltreatment in relation to IPV. In fact, most of the research has investigated only two or three types of childhood abuse, disregarding the effects of some types of abuse including psychological abuse (Reyome, 2010). The results show that psychological abuse was a stronger predictor of IPV than other types of childhood maltreatment. The findings also show evidence of a dose–response effect of the numbers of types of maltreatment and IPV in adulthood.

Childhood Maltreatment and IPV

Sexual abuse and psychological abuse are the only significant IPV predictors in this study. Thus, our hypothesis that psychological abuse would show a stronger association with IPV than other types of childhood maltreatment is confirmed: antipathy, neglect, physical abuse, and witnessing violence did not show significant effects on IPV. These results confirm the assumptions of the literature that childhood psychological abuse is significantly associated with IPV (Berzenski & Yates, 2010; Wekerle et al., 2009; Zamir & Lavee, 2014) and support a growing body of research that identifies psychological abuse as a particularly insidious form of childhood abuse, with specific and independent long-term effects (Berzenski & Yates, 2010; Gross & Keller, 1992; Infurna et al., 2015; Paradis & Boucher, 2010) rather than underlying components of all other types of abuse (Claussen & Crittenden, 1991; Garbarino et al., 1986; S. N. Hart & Brassard, 1987; Hart et al., 1987). In this study, childhood sexual abuse showed a stronger association with IPV than psychological abuse. This finding is consistent with numerous studies that have highlighted the predictive effects of sexual abuse on IPV (Daigneault et al., 2009; Fergusson et al., 2008; Fry et al., 2012; McMahon et al., 2015; Renner & Slack, 2006; Whitfield et al., 2003). In particular, in our sample, sexual abuse is of the most marked severity involving repeated sexual intercourse by family members (Bifulco & Moran, 1998). As is known, the literature on childhood maltreatment has pointed out that specific characteristics of abuse (frequency and/or duration of abuse, bodily penetration in the case of sexual abuse, and the intrafamilial or extrafamilial nature of the relationship with the abuser) are associated with worse outcomes (Briere & Jordan, 2009). Intrafamilial sexual abuse is a type of sexual abuse particularly harmful for the development of the Self, with long-term effects on psychological and interpersonal functioning (Finkelhor & Browne, 1985; Herman, Russell, & Trocki, 1986). Although in our results sexual abuse is the strongest predictor of IPV, the association found between psychological abuse and IPV is the most relevant result of this study because it highlights the contribution of another important precursor of IPV, whose role is often overlooked in the literature. Psychological abuse as defined by Bifulco and colleagues (2002) implies extreme levels of control, domination, and disparagement exercised by the parent or another significant figure toward the child. Due to these characteristics, psychological abuse is associated more than other forms of abuse with the development of maladaptive models of Self and Other that introduce the expectation of violence in romantic contexts in women (Riggs, 2010). Interpersonal schemas of mistrust, self-sacrifice, and emotional inhibition were identified as mediators of the relationship between childhood psychological abuse and IPV (Crawford & O’Dougherty, 2007). These interpersonal schemas guide the interpretation of relationship information and influence relationship behavior. For example, an interpersonal schema of mistrust resulting from early experiences of psychological abuse might create a greater likelihood of tolerating poor treatment by a partner and can increase the likelihood of considering relational violence as normal. In addition, the use of dissociation as a fundamental defense mechanism in adulthood predisposes the victims of childhood psychological abuse to later experiences of victimization. It also represents a factor of vulnerability for the development of psychopathology (Riggs, 2010). Maladaptive interpersonal schemas, problems in social functioning, and psychopathology resulting from early experiences of psychological abuse can culminate in romantic relationship dysfunction, such as interpersonal violence.

Physical abuse is not significantly associated with IPV in our sample of women. This result may seem surprising, given the studies that identify this form of abuse as a precursor to IPV (Bensley et al., 2003; Fergusson et al., 2008; Whitfield et al., 2003). However, this finding is confirmed by other research (Berzenski & Yates, 2010; Seedat et al., 2005), which has found that only psychological abuse and sexual abuse predict IPV. Childhood psychological abuse is emerging, therefore, as one of the most destructive types of abuse with specific and independent long-term effects that are potentially more insidious than other forms of childhood abuse; for this reason, it requires more attention both in the clinical and research setting (Berzenski & Yates, 2010; Infurna et al., 2016; Spertus et al., 2003).

Number of Types of Childhood Maltreatment and IPV

The international literature has widely recognized that many victims of childhood maltreatment often experience more than one type of abuse (Dong et al., 2004; Felitti et al., 1998; Green et al., 2010); this phenomenon has been described as polyvictimization (Finkelhor et al., 2007) or multi-type maltreatment (Higgins & McCabe, 2000). About 39.4% in the IPV women group had experienced three or more forms of childhood maltreatment. This is consistent with several studies that have frequently shown the presence of multiple forms of childhood maltreatment in women with IPV (Renner & Slack, 2006; Renner & Whitney, 2012; Widom et al., 2014).

Exposure to cumulative childhood maltreatment often has pervasive consequences regarding mental health. It interferes negatively with the ability to regulate emotions and produces deficits that concern perception of Self, perception of the perpetrator, the system of meanings, and interpersonal relationships that frequently are organized around the expectation of being re-victimized (Herman, 1992; van der Kolk et al., 2005). Neurobiological and epidemiological studies have shown that early experiences of abuse can produce lasting alterations on the functioning of neurobiological structures involved in the stress response system (Cowell, Cicchetti, Rogosch, & Toth, 2015; H. Hart & Rubia, 2012; Teicher et al., 2003). Cumulative abuse experiences can impair functions and brain structures to a greater extent than individual experiences of abuse; these brain impairments may hinder the acquisition of appropriate cognitive and interpersonal abilities (Cicchetti & Rogosch, 2009; De Bellis, 2001) and may also influence the choice to engage in violent romantic relationships.

Our hypothesis that as the number of types of childhood maltreatment increase, the likelihood of IPV also increases is confirmed. In particular, our results have shown a significant association between having experienced three types and four or more types of childhood maltreatment and IPV. It strengthens, therefore, the idea that cumulative trauma, characterized by multiple and persistent adverse experiences, represent an important precursor for IPV (Bensley et al., 2003; Bifulco, Damiani, Jacobs, Bunn, & Spence, in press; Taylor et al., 2008; Whitfield et al., 2003).

Limitations and Conclusions

Although this study adds to the literature on childhood maltreatment as predictor of IPV and an assessment of maltreatment that is very wide and detailed, it has some limitations. The relatively modest sample size and the sample recruitment modalities are limitations that may affect the generalizability of findings. Future studies should test these results in representative samples. However, the detailed collection of specific characteristics of IPV group and the use of an in-depth standardized interview for measuring childhood maltreatment make it particularly interesting from a clinical viewpoint and for research.

Another limitation is related to the retrospective nature of the data on childhood maltreatment obtained by means of the CECA interview. This is mitigated by the fact that this measure has a focus on objective characteristics, with detailed probing questions and “scaffolding” of memory through chronological questioning that aids reporting (Bifulco et al., 1994). Furthermore, the validity of the interview in its retrospective use has been proved by analyzing the independent reports collected by interviews about childhood memories of sisters raised in the same family (Bifulco, Brown, Lillie, & Jarvis, 1997). Finally, the current study has a cross-sectional design; thus, the results can only claim associations between childhood maltreatment and IPV rather than being causal predictors of IPV. These results should be confirmed through longitudinal studies.

The most important strength of this study is that it has investigated a wide range of childhood maltreatment experiences as predictors of IPV, including types of abuse disregarded in the literature such as psychological abuse and neglect and allowing a differential analysis of the relevance between these different forms of abuse. The study also uses a multimethod assessment approach for IPV (Woodin et al., 2013) by means of a self-report and a semi-structured interview. Unlike other research, the current study provides a complex assessment of various categories of violence, collecting data about the intensity, duration, context of violence, and the cumulative nature of this and the total number of previous abusive relationships.

The findings from this study have important implications for clinical practice and research. The strong association found between sexual and psychological abuse and IPV highlights the importance of a complex assessment for female victims of IPV in the context of prevention services, including all kinds of childhood maltreatment, as well as types that are more difficult to identify, such as psychological abuse, which may have been simultaneously present in childhood. This need is reinforced by the empirical evidence shown in this research that many women with IPV had an exposure to multiple types of childhood maltreatment. To improve the understanding of the intergenerational transmission of violence, it is necessary that future research will deepen to a certain degree and determine how psychological abuse increases a woman’s vulnerability to IPV. The use of the CECA in the clinical setting with IPV victims could facilitate the identification of the experiences of childhood maltreatment that have predisposed the subjects to difficulties in intimate relationships, such as IPV, by helping clinicians identify therapeutic approaches aimed at connecting the traumatic memories that emerge from interview with negative emotions associated with them.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author Biographies

Maria LoCascio is a psychologist, PhD in psychology and social science, at the Department of Psychological, Pedagogical and Educational Sciences, University of Palermo, Italy. Her scholarly work focuses on the long-term social and health effects of childhood maltreatment with a specific interest in the role of adverse childhood experiences in predicting intimate partner violence in adulthood.

Maria Rita Infurna is a psychologist, PhD in psychology and social science, at the Department of Psychological, Pedagogical and Educational Sciences, University of Palermo, Italy, and at the University of Heidelberg, Germany. She is adjunct professor at the University of Palermo and she has a specific research interest in the study of mental health disorders as sequelae of childhood maltreatment.

Cinzia Guarnaccia is a psychologist, PhD in psychology and public relations, at the Department of Psychological, Pedagogical and Educational Sciences, University of Palermo, Italy, and at the University of Paris, France. She is an adjunct professor at the University of Paris, France, and mainly focuses on the long-term outcomes of adverse childhood experiences and on the therapeutic communities for children and adolescent.

Laura Mancuso is a psychologist, PhD student in psychology and social science, at the Department of Psychological, Pedagogical and Educational Sciences, University of Palermo, Italy. She has a specific research interest in the effects of the childhood maltreatment on the parenting in adulthood.

Antonia Bifulco is professor of lifespan psychology and social science at Kingston University, UK, and co-director of the Centre for Abuse and Trauma Studies. Her research is focused on social and lifespan influences on psychological disorder and she has investigated childhood experience, adversity, and attachment style intergenerationally. She is an advocate of intensive interview measures and together with the CATS team runs training courses for researchers and practitioners on attachment style, childhood neglect/abuse, and parenting.

Francesca Giannone is an associate professor of dynamic psychology at the Department of Psychological, Pedagogical and Educational Sciences, University of Palermo, Italy. Her research and clinical interest concern the effects of childhood maltreatment on self-development, group psychotherapy, and therapeutic communities for adults and for children and young people.

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