Concurrent Intimate Partner Violence: Survivors’ Health and Help-Seeking

Abstract

This study examined intimate partner violence patterns using the National Intimate Partner and Sexual Violence Survey, a nationally representative sample collected in 2010. The latent class analysis detected six distinctive patterns: Sexual Violence, Psychological Aggression, Multiple Violence, Coercive Control, Physical and Psychological Violence, and Stalking. Multiple Violence was the most common among males, while Coercive Control was the most common among females. Multiple Violence and Physical and Psychological Violence perpetrators inflicted more negative health consequences than the other types. Intervention and prevention approaches that consider perpetrator types as a part of survivor need assessments will improve services.

Keywords

intimate partner violence latent class analysis typology health outcome help-seeking

Introduction

Intimate partner violence (IPV) causes physical, sexual, and psychological harm through diverse actions, including physical, sexual, and psychological abuse and controlling behaviors (World Health Organization, 2010). The National Intimate Partner and Sexual Violence Survey (NISVS) estimated that 37.3% of women and 30.9% of men in the United States have experienced IPV during their lifetime (Smith et al., 2017). IPV commonly has negative physical and mental health consequences for both male and female survivors (Ansara & Hindin, 2011; Dutton et al., 2006; Okenwa et al., 2011; Stockl et al., 2012). Intervention efforts have been developed for IPV survivors, promoting their safety and well-being, and for perpetrators, educating them toward non-violent relationships.

No IPV is identical. One-size-fits-all solutions are difficult to develop and likely to be ineffective in addressing the wide variety of characteristics and circumstances surrounding IPV incidents. To better understand the complexity of IPV experiences, scholars have explored IPV typologies based on the form of violence (e.g., physical or psychological; Devries et al., 2013), context (e.g., coercive controlling or self-defending; Johnson, 2008), and circumstances (e.g., family-only or violence within and outside the family; Holtzworth-Munroe & Stuart, 1994). These typologies have provided useful guidance in developing targeted interventions that might work better for certain types of perpetrators/survivors than others (Boxall et al., 2015).

While previous studies have provided valuable insights about the patterns of IPV, they often fail to include certain forms of IPV, such as stalking, nor do they account for concurrent violence, in which a perpetrator commits multiple forms of IPV. During the past decade, a handful of studies have explored the different types of IPV within specific populations, such as dating adolescents and divorcing couples (Ansara & Hindin, 2010a; Beck et al., 2013; Choi et al., 2017; Weiss et al., 2017). This constrains the application of the research and limits generalization to the larger population, including male and female survivors in the United States. Moreover, variations in health status and subsequent help-seeking across different IPV experiences have been rarely studied (Ali et al., 2015).

NISVS conducted in 2010 provides timely data that allows us to navigate IPV experiences collected from a nationally representative sample in the United States. While the NISVS is a valuable source that captures lifetime IPV experiences from multiple perpetrators with concurrent violent behaviors, the bountiful data also complicate the quest to elucidate the impacts of IPV on survivors and develop targeted interventions for both perpetrators and survivors. This study is our first step to systematically identify diverse IPV patterns using perpetrators’ violent behaviors. Based on these IPV patterns, we explore differences across perpetrator subgroups in terms of gender, relationship status, health consequences, and survivor help-seeking.

Multiple Forms of Violence and Patterns of IPV

IPV survivors often experience more than one type of violence by an intimate partner, such as a combination of physical, psychological, and sexual abuse and stalking (Krebs et al., 2011; WHO, 2010). Several studies have examined IPV patterns empirically using latent class analysis on multiple forms of concurrent violence, based on a variety of samples such as divorcing couples (Beck et al., 2013), adolescents with dating experiences (Choi et al., 2017; Haynie et al., 2013; Reidy et al., 2016), and a community sample of female survivors (Weiss et al., 2017). Some studies have utilized samples from outside of the United States., such as Nepal (Clark et al., 2019), New Zealand (Cale et al., 2017), South Africa (McNaughton Reyes et al., 2018), and Canada (Ansara & Hindin, 2010a). Studies have also varied in terms of what they measured: some collected experiences of both victimization and perpetration from individuals (Choi et al., 2017; Haynie et al., 2013), while others collected data on either perpetration (Reidy et al., 2016) or victimization from individuals (Ansara & Hindin, 2010a; Cale et al., 2017; Clark et al., 2019; McNaughton Reyes et al., 2018; Weiss et al., 2017). Some studies asked about the perpetration experiences of couples (e.g., Beck et al., 2013). These studies have found such IPV patterns as multiple forms of violence, including both physical and non-physical IPV; sexual violence; a combination of mild physical and psychological violence; and a combination of non-physical abuse, such as psychological, emotional, or verbal (Ansara & Hindin, 2010a; Beck et al., 2013; Choi et al., 2017; Clark et al., 2019; McNaughton Reyes et al., 2018; Weiss et al., 2017).

While previous studies have helped us better understand the complexity of IPV by revealing IPV patterns within specific populations, their findings are not easily generalized to larger populations. Additionally, studies have mainly focused on female survivors’ experiences, excluding male survivors from the analysis, with just a few exceptions (e.g., Ansara & Hindin, 2010a). Furthermore, the measures used in these studies often did not include certain forms of IPV, such as stalking or coercive control.

Gender and IPV Patterns

Previous studies of the patterns of IPV rarely examined gender differences (Ansara & Hindin, 2010a; Beck et al., 2013). Beck et al. (2013) revealed patterns of IPV among divorcing couples by considering IPV perpetrated by both wives and husbands. Using five different IPV types, such as psychological abuse, coercive controlling behaviors, physical abuse, threats of and escalated physical violence, and sexual violence, they suggested three IPV patterns: mutually low violence, lower level of coercive controlling violence by female perpetrators, and severe coercive controlling violence by male perpetrators (Beck et al., 2013). Ansara and Hindin (2010a) examined IPV patterns and differences between genders using victimization experiences among heterosexual men and women from the 2004 Canadian General Social Survey. They compared the experiences of men and women with respect to emotional and financial abuse, and physical and sexual violence, finding that women reported significantly more sexual violence victimization and more diverse types of IPV than men did. Specifically, while the men reported four types of victimization experiences (i.e., no violence; jealousy and verbal violence; physical aggression; and moderate violence, control, and verbal abuse), women experienced six types: no violence or abuse; jealousy and verbal violence; physical aggression; severe violence, control, and verbal abuse; physical aggression, control, and verbal abuse; and control and verbal abuse (Ansara & Hindin, 2010a). These findings suggest that while both men and women perpetrate multiple forms of IPV against their intimate partners, men tend to use a larger number and more severe forms of IPV than women.

IPV Patterns in Same-Sex Relationships

A recent analysis of the NISVS showed that rates of IPV in same-sex relationships are similar to or higher than those in opposite-sex relationships (Walters et al., 2013). Sexual minority individuals may be at a higher risk for IPV as they experience minority stress attributed to discrimination, stigma consciousness, internalized homophobia, and outness (Longobardi & Badenes-Ribera, 2017). However, there are only a few studies that have explored IPV patterns within same-sex relationships. Using 184 sexual minority individuals, Frankland and Brown (2014) found that the patterns of control and violence found within same-sex relationships were consistent with those among different-sex couples (Frankland & Brown, 2014). Psychological IPV seems to be as prevalent among sexual minority individuals as among their counterparts. Sutter et al. (2019) found psychological IPV victimization was the most prevalent among sexual minority women. A systematic review also noted that psychological violence was most common within same-sex relationships (Longobardi & Badenes-Ribera, 2017).

IPV Patterns Across Relationship Statuses

Previous research has provided somewhat mixed findings on the relationship between IPV patterns and relationship status. Researchers have found that unmarried cohabiting couples tend to report higher IPV rates than married couples (Brown & Bufanda, 2008; Kenney & McLanahan, 2006). Dating partners reported physical abuse, and severe forms of physical abuse, more than married partners did (Machado et al., 2014). In a study that analyzed physical aggression patterns across legally married, unmarried but cohabiting, and separated or divorced women and men in 19 countries, legally married couples in most countries had the lowest rates of physical aggression (Bernards & Graham, 2013). While many studies found that severe violence was less prevalent in married relationships, Brownridge (2010) reported no difference in the likelihood of reporting coercive controlling violence or mutual violence between married and cohabiting victims.

Health Outcomes Across IPV Patterns

IPV has been linked to negative health consequences for survivors (Dutton et al., 2006; Okenwa et al., 2011; Stockl et al., 2012). IPV survivors have reported numerous physical health concerns, such as headaches, insomnia, choking sensations, hyperventilation, gastrointestinal symptoms, chest pain, and pelvic pain (Dutton et al., 2006). Physical IPV was associated with a higher risk of poor health and depressive symptoms (Coker et al., 2002). Studies showed somewhat mixed results regarding the relationship between sexual violence and depressive symptoms. While one study showed that sexual violence was not associated with adverse mental health such as depressive symptoms (Choi et al., 2017), another study showed that sexual violence created depressive symptoms as much as other violent experiences did (Weiss et al., 2017). Survivors who experienced psychological IPV in addition to physical and/or sexual IPV were at a higher risk of developing symptoms of depression, anxiety, and psychogenic seizures than those who experienced physical, sexual, or psychological IPV separately (Meekers et al., 2013).

Recent studies that examined the differing impacts of IPV patterns on physical and mental health have commonly found that those who experienced either multiple forms of violence or severe violence had more negative mental health outcomes than those who experienced a single type of IPV or low to moderate IPV (Ansara & Hindin, 2011; Cale et al., 2017; Choi et al., 2017; Clark et al., 2019; Haynie et al., 2013; Weiss et al., 2017). Using a sample of adolescents who experienced dating violence, Haynie et al. (2013) found that survivors of multiple forms of IPV were more likely to have physical (e.g., headache, stomachache, backache, and dizziness) and psychological (e.g., feeling low, bad temper, nervousness, and difficulty sleeping) complaints (Haynie et al., 2013).

Help-Seeking Across IPV Patterns

Many IPV survivors seek help from various sources after victimization, including formal help (e.g., police and health clinic) and informal help (e.g., family and friends). Survivor help-seeking seems to be associated with the type of IPV experienced. Survivors of physical IPV were more likely to seek help than survivors who experienced other forms of violence (Duterte et al., 2008; Fanslow & Robinson, 2010; Henning & Klesges, 2002; Kim & Lee, 2011). Survivors of psychological IPV were less likely to utilize services than those who experienced physical or sexual IPV (Lucea et al., 2013). Survivors who experienced sexual IPV were more likely to seek medical attention and legal services than those who experienced psychological IPV, but less likely to do so than those who experienced physical IPV (Duterte et al., 2008). Female IPV survivors who experienced stalking sought help from more sources, both formal and informal, than those who only experienced physical abuse (Flicker et al., 2011).

While these results suggest that help-seeking is related to a specific form of IPV, having multiple forms of IPV experiences seem to affect this relationship. Using a sample of female IPV survivors, Flicker et al. (2011) examined help-seeking behaviors among IPV survivors depending on the types and severity of IPV experienced. They found that experiencing more severe abuse increased the likelihood of seeking mental health, medical, and police help; cumulative IPV experience increased the likelihood of seeking an order of protection (Flicker et al., 2011). Individuals who experienced both physical IPV and stalking were more likely to seek help than those who experienced physical IPV only (Flicker et al., 2011). Ansara and Hindin (2010b) showed somewhat similar results regarding the relationship between IPV patterns and help-seeking. Using a sample of people who reported physical or sexual violence by a current or ex-spouse, they showed that survivors of severe violence were more likely to seek help, especially formal help from health professionals, police, or counselors (Ansara & Hindin, 2010b).

This study aims to expand previous studies to better understand IPV experiences among men and women in the United States. Previous studies have revealed variations in IPV experience but have mainly focused on specific subpopulations (e.g., only women or dating relationships), often ignoring male survivors’ experiences. Additionally, certain forms of IPV, such as stalking or coercive control, were not always included in their analyses. A more detailed examination of IPV experiences can help identify survivors’ needs for mental and physical health services. This effort could lead to the development of well-tailored interventions and support to address those service needs. As a first step, we identify patterns of IPV based on a variety of violence victimization experienced by survivors, and assess differences across survivors’ gender and their relationship to perpetrators. Second, we examine associations between diverse patterns of IPV, and health consequences and survivors’ help-seeking behaviors.

Methods

Study Sample

This study used data from the NISVS, which collected IPV victimization experiences from 16,507 respondents (9,086 women and 7,421 men) aged 18 or older in 2010 in the United States (United States Department of Health and Human Services & Centers for Disease Control and Prevention, 2010). Through telephone surveys, the NISVS was designed to describe the prevalence and characteristics of intimate partner and sexual violence, stalking, patterns of violence, and their health consequences from a nationally representative sample (United States Department of Health and Human Services & Centers for Disease Control and Prevention, 2010). We used the data from 8,587 survey respondents who reported IPV victimization experiences from 16,023 perpetrators (e.g., spouse, live-in partner, boyfriend, or girlfriend).

Measurements

Perpetration Type

The NISVS asked the respondents about their lifetime victimization experiences, in which multiple perpetrators might have been identified. For this study, the perpetrator's behaviors, measured by 60 items in total, were classified into eight categories: (a) psychological aggression (5 items) (e.g., told you that you were a loser, a failure, or not good enough; told you no one else would want you); (b) coercive control (12 items) (e.g., tried to keep you from family or friends; threatened to take your children away); (c) control of reproductive health (2 items) (i.e., tried to get you pregnant when you did not want to; refused to use a condom); (d) severe physical violence (9 items) (e.g., kicking; slamming; beating); (e) less severe physical violence (3 items) (e.g., threatening to physically harm you; pushing or shoving); (f) stalking (7 items) (e.g., making unwanted phone calls to you; watched you from a distance); (g) rape (12 items) (e.g., having sex by using physical force); and (h) non-rape sexual assaults (10 items) (e.g., exposing their body parts to you; fondling or grabbing your sexual body parts). We recoded all categories dichotomously. For example, if perpetrators committed at least one of the five behaviors for psychological aggression, they were coded 1 for psychological aggression. Note that some research suggests that summing IPV experiences generates more robust classifications (e.g., Hardesty et al., 2015). However, dichotomous IPV measures were chosen for this study after the preliminary analysis of data showed that summing each of eight IPV categories tended to produce skewed classification results because of a wide range of differences in the frequencies across perpetrators’ behaviors.

Relationship Status

The NISVS included questions about each victim's relationship with a perpetrator at the first and last incidence of IPV. Relationships included intimate partners (i.e., spouse, live-in partner, fiancé, boy or girlfriend, dating partner, someone seeing, and sex partner) and non-intimate partners (i.e., family member, acquaintance, stranger, and other relationships). Perpetrators identified as intimate partners either at the first or last victimization were included in this study. If a relationship with a perpetrator at the first victimization differed from a relationship at the last one, the more intimate relationship with the victim was used. We deemed a spousal relationship more intimate than a live-in partner, a fiancé more intimate than a boy or girlfriend, and so forth. For instance, if a perpetrator was identified as an acquaintance (non-intimate) at the first victimization but identified as a dating partner (intimate) at the last one, they were deemed to be intimate partners and included in the study sample. We categorized seven intimate relationships into three groups for analysis: spouse/live-in partner; fiancé/boy or girlfriend; and dating partner/someone you are seeing/sex partner.

Health Consequences

Survivors were asked about the mental and physical health consequences that each perpetrator caused. Having negative mental health consequences was measured by four questions preceded by this statement: throughout your relationship with the perpetrator (indicated as initials) when the perpetrator did this/these things, did you ever (a) have nightmares about it?; (b) try hard not to think about it or go out of your way to avoid being reminded of it?; (c) feel like you were constantly on guard, watchful, or easily startled?; and (d) feel numb or detached from others, your activities, or your surroundings? If survivors answered “yes” to any of the four questions, we coded it as having negative mental health consequences. Survivors were coded as having a negative physical health consequence if they answered “yes” to a question asking if they were injured when the victimization occurred with any of the perpetrators. The NISVS asked about negative physical health consequences only when respondents experienced physical violence, stalking, or sexual violence, excluding those victimized by other forms of IPV, such as coercive control and psychological aggression. Therefore, the percentages of those with negative physical health consequences were obtained based on respondents who experienced physical violence, stalking, or sexual violence.

Survivors’ Service Needs and Help-Seeking

Five dichotomous questions asked if survivors ever needed any of the following services because of any of the things that any of the perpetrators did: medical care, housing services, community services, victim's advocate services, or legal services. Those who indicated that they needed one of them were coded as having service needs after victimization. Formal and informal help-seeking variables were created to examine differences in survivors’ help-seeking behaviors depending on victimization experiences. Four dichotomous questions asked if they ever talked to any of the following people about what the perpetrator did: the police, a doctor or nurse, a psychologist or counselor, or a crisis hotline operator. Those who indicated that they talked to such professionals were coded as seeking formal help. Four additional dichotomous questions asked if survivors ever talked to any of the following people about what the perpetrator did: a friend, a family member, a romantic or sexual partner, or anyone else. Those who talked to such people were coded as seeking informal help.

Perpetrator and Survivor Sex Category

The perpetrator sex category was determined by a question asking if the spouse, person they were living with as a couple, or the person they were romantically or sexually involved with was male or female. Additionally, the survivor–perpetrator sex category was created dichotomously (same sex/different sex) using a question asking if the respondent was male or female.

Analysis

We conducted a latent class analysis with Mplus ver.7 to identify patterns of IPV perpetration among 16,023 perpetrators. Eight categories of IPV were used to identify homogeneous groups called “classes.” Employing a mixture model allowed us to include categorical latent variables in the model. After analysis, we reviewed a set of goodness of fit statistics (e.g., Bayesian information criterion) to determine the optimal class solution. However, statistics alone are not sufficient criteria to decide on the number of classes (Berlin et al., 2014). Therefore, we considered several factors to identify the optimal number of classes, such as substantive meanings of each solution, parsimony, theory, and the size of the smallest class in terms of its precision relative to the other classes (Bauer & Curran, 2003).

The specific analysis process was as follows. First, we started the analysis with a one-class model and created models sequentially with increasing numbers of classes, based on a robust maximum likelihood estimation, until we no longer obtained greater statistically and practically proper solutions using the Lo-Mendell-Rubin adjusted likelihood ratio test of model fit (Lo et al., 2001). Second, candidate models were identified based on information criteria model fit statistics, such as Akaike Information Criteria (AIC), Bayesian Information Criterion (BIC), adjusted BIC, entropy measure, and the size and characteristics of the smallest class. For example, lower values of BIC and adjusted BIC indicated a better model fit (Magidson & Vermunt, 2004). Higher values of the entropy measure indicated a better classification of individuals: a value of 0.8 or above, indicating that 80% of the individuals were most relevantly classified in latent classes, was sufficiently high (Clark & Muthén, 2009). Finally, the number of latent classes was determined based on distinct and practically meaningful class division, parsimony, and theory. After the optimal number of classes was determined, perpetrators were assigned to a class based on the highest probability of membership they showed. Probabilities of .70–1.00 were deemed to indicate a high probability of having committed a specific type of perpetration; .40–.69, a moderate probability; and .40 or less, a low probability (Collins & Lanza, 2010).

Subsequently, we conducted bivariate analyses using SPSS to examine differences across the classes in perpetrator sex, survivor–perpetrator sex, survivor–perpetrator relationship status, health consequences of IPV, survivors’ service needs, and help-seeking. The Marascuilo procedure was used to examine significant differences in each variable by comparing multiple possible pairs (Marascuilo & McSweeney, 1967). The sample weights in the NISVS were not used since they were created for respondents—survivors—not for perpetrators, thus, they were not relevant for the perpetrator-centered analysis in this study.

Results

We used the latent class analysis procedure to obtain the optimal number of latent classes. In the first step, we estimated 12 models, containing from 1 up to 12 classes based on the Lo-Mendell-Rubin test (Lo et al., 2001). Table 1 describes fit statistics for these 12 models. Among them, Models 2 through 4 were excluded from further consideration because they had higher AIC and BIC values than other models, and relatively low entropy measures (e.g., 0.72 for Model 3 and 0.75 for Model 4). Models 8 through 12 were also excluded since the smallest class sizes were too small (ranging from 0.86% to 1.8%). After reviewing the remaining Models 5 through 7 comprehensively, Model 6 was determined to be an optimal class solution based on parsimony, distinct and meaningful class divisions, and entropy values (0.87 for Model 6 vs. 0.85 for Model 5 and 0.86 for Model 7).

Table 1.

Goodness of Fit Statistics (N = 16,023)

Model tested	Loglikelihood	AIC	BIC	Adjusted BIC	Entropy	Relative frequency for smallest class	p-Value LMR adjusted LRT
1-Class	−67,640	135,296	135,296	135,358	–	–	–
2-Class	−62,555	125,144	125,144	125,275	0.83	25.5%	<.001
3-Class	−61,865	123,781	123,781	123,981	0.72	14.6%	<.001
4-Class	−61,327	122,724	122,724	122,993	0.75	10.0%	<.001
5-Class	−60,619	121,326	121,326	121,664	0.85	12.4%	<.001
6-Class	−60,170	120,447	120,447	120,854	0.87	6.6%	<.001
7-Class	−59,764	119,653	119,653	120,129	0.86	6.9%	<.001
8-Class	−59,478	119,098	119,643	119,418	0.88	1.8%	<.001
9-Class	−59,201	118,561	119,176	118,921	0.88	1.8%	<.001
10- Class	−59,049	118,276	118,959	118,676	0.90	1.8%	<.001
11-Class	−58,932	118,061	118,814	118,502	0.86	1.8%	<.001
12-Class	−58,877	117,968	118,790	118,450	0.86	0.86%	0.08

AIC = Akaike Information Criterion; BIC = Bayesian Information Criterion; LMR adjusted LRT = Lo-Mendell-Rubin (LMR) adjusted likelihood ratio test.

Table 2 shows the final six-class solution (Model 6), with the estimated probabilities of committing eight different forms of IPV. The first class was characterized by a moderate probability (.54) of perpetrating non-rape sexual assaults and low probabilities of committing all other forms of IPV, ranging from .07 to .21. This group was labeled as Sexual Violence, which comprises 10.2% (n = 1,631) of all perpetrators. The second class was characterized by almost exclusively committing psychological aggression (1.0), and so it was labeled as Psychological Aggression (11.7%, n = 1,878). The third class, labeled as Multiple Violence, was most likely to commit multiple forms of IPV, such as psychological aggression, coercive control, and severe and less severe physical violence (23.9%, n = 3,833). The fourth class, characterized by the perfect probability of committing coercive control (1.0) and the moderate probability (.41) of perpetrating psychological aggression, was labeled as Coercive Control, and was the largest group (28.3%, n = 4,532). The fifth class (19.3%, n = 3,091) was characterized by the perfect probability of perpetrating less severe physical violence (1.0) and moderate probabilities of committing psychological aggression (.59) and coercive control (.59); this group was labeled as Physical and Psychological Violence. The last class, labeled Stalking, was the smallest group (6.6%, n = 1,057), and almost exclusively committed stalking (1.0).

Table 2.

Latent Class Analysis Results

IPV classes	Latent classes (probability of committing each type of IPV)
IPV classes	Sexual violence	Psychological aggression	Multiple violence	Coercive control	Physical and psychological violence	Stalking
Psychological aggression	0.13	1.00*	0.93*	0.41	0.59*	0.12
Coercive control	0.08	0.00	0.97*	1.00*	0.59*	0.00
Severe physical violence	0.20	0.03	0.82*	0.03	0.32	0.01
Less severe physical violence	0.07	0.00	0.92*	0.00	1.00*	0.00
Control of reproductive health	0.21	0.02	0.24	0.07	0.04	0.04
Rape	0.16	0.00	0.15	0.01	0.00	0.00
Non-rape sexual assaults	0.54*	0.03	0.45	0.06	0.02	0.09
Stalking	0.11	0.00	0.57	0.14	0.11	1.00*

*Salient IPV types per latent class.

Table 3 summarizes the characteristics of the total sample as well as the six identified perpetrator groups. In total, there were more men than women (53.7% vs. 46.3%) in the study sample. The sample consisted predominantly of perpetrators whose sex was different from the survivors (97.5%, n = 15,624), with a small number of perpetrators who had the same sex as the survivors (2.5%, n = 399). About a quarter of perpetrators (26.2%) caused negative mental health consequences for survivors, and 30.0% of perpetrators caused negative physical health consequences. Slightly less than one-third of perpetrators (30.6%) caused the survivors to seek services as a result of the IPV. About a quarter of the perpetrators (26.1%) induced formal help-seeking among survivors, and more than half of the perpetrators (56.7%) triggered survivors to engage in informal help-seeking.

Table 3.

Difference in Sex, Relationship, Health Status, and Help-Seeking Among Perpetrator Groups

	Sexual violence	Psychological aggression	Multiple violence	Coercive control	Physical and psychological	Stalking	total
	% (n)	% (n)	% (n)	% (n)	% (n)	% (n)	% (n)
Perpetrator sex¹
Male	12.6*	11.8	31.1*	21.7	15.5	7.2*	100.0
Male	(1,088)	(1,018)	(2,677)	(1,869)	(1,330)	(623)	(8,605)
Female	7.3	11.6	15.6	35.9*	23.7*	5.8	100.0
Female	(543)	(858)	(1,156)	(2,661)	(1,758)	(433)	(7,409)
Survivor–perpetrator sex¹
Different	10.2	11.6	24.0	28.2	19.4*	6.6	100.0
Different	(1,598)	(1,808)	(3,745)	(4,409)	(3,030)	(1,034)	(15,624)
Same	8.5	17.5*	22.1	30.8	15.3	5.8	100
Same	(34)	(70)	(88)	(123)	(61)	(23)	(399)
Relationship status¹
Spouse/live-in partner	4.1*	8.0*	33.5*	29.2	23.9*	1.2*	100.0
Spouse/live-in partner	(241)	(467)	(1,959)	(1,705)	(1,398)	(73)	(5,843)
Fiancé/ boy or girl friend	11.5*	13.3	21.0*	28.5	17.0	8.6*	100.0
Fiancé/ boy or girl friend	(927)	(1,071)	(1,684)	(2,293)	(1,367)	(691)	(8,033)
Dating partner/someone seeing	21.6*	15.8	8.8*	24.9	15.2	13.6*	100.0
Dating partner/someone seeing	(464)	(340)	(190)	(534)	(326)	(293)	(2,147)
Having negative mental health²	16.9^c	7.0^d	62.4^a	11.4^c	23.6^b	14.5^c	26.2
Having negative mental health²	(275)	(131)	(2,390)	(518)	(729)	(153)	(4,196)
Having negative physical health^2,3	27.7^b	23.2^b,c	51.5^a	21.0^c	20.2^c	21.3^c	30.0
Having negative physical health^2,3	(437)	(326)	(1,971)	(699)	(625)	(225)	(4,283)
Having service needs²	19.4^c	8.9^d	68.7^a	16.2^c	28.2^b	17.3^c	30.6
Having service needs²	(316)	(168)	(2,634)	(734)	(871)	(183)	(4,906)
Seeking formal help²	13.5^c	12.2^c	55.8^a	16.4^c	22.3^b	14.9^c	26.1
Seeking formal help²	(220)	(229)	(2,139)	(743)	(689)	(158)	(4,178)
Seeking informal help²	43.8^c	43.4^c	78.7^a	50.1^b	55.5^b	52.3^b	56.7
Seeking informal help²	(714)	(815)	(3016)	(2272)	(1715)	(553)	(9085)

Note.¹% (n) is calculated per perpetrator type; row totals per variable equal to 100%.

% (n) refers to “yes” responses per variable per perpetrator type.

Negative physical health consequences were measured from selected perpetrators only. Percentages were calculated by using the number of perpetrators who were selected for the questionnaire.

*asterisk indicates significant differences in sex or relationship status within each IPV pattern.

different superscript alphabet characters indicate statistically significant differences among proportions at p = .05 level.

The six perpetrator groups exhibited unique characteristics from one another. There were sex differences in the perpetrator groups. While Multiple Violence (31.1%) made up the largest class among male perpetrators, Coercive Control (35.9%) was the largest among female perpetrators. The percentage of females in Physical and Psychological Violence was significantly higher than males (23.7% vs. 15.5%). More men engaged in Sexual Violence (12.6% vs. 7.3%) and Stalking (7.2% vs. 5.8%) than women. There were significant differences among the perpetrator groups regarding the survivor–perpetrator sex category. Compared to different-sex relationships, same-sex relationships showed more Psychological Aggression (17.5% vs. 11.6%) but less Physical and Psychological Violence (15.3% vs. 19.4%) than their counterparts.

There were differences in perpetrator groups across relationship statuses. The Multiple Violence class was the most common among spouses/live-in partners, while the Coercive Control class was the most common among fiancés/boy or girlfriends and dating partners/someone they were seeing. Multiple Violence (33.5%) and Moderate Violence (23.9%) were more prevalent in spouse/live-in partner relationships than in any other relationship type. Sexual Violence (21.6%) and Stalking (13.6%) were most prevalent in a dating partner/someone they were seeing relationship.

The health consequences of IPV differed by the perpetrator group. Survivors who experienced Multiple Violence reported the most negative mental health consequences (62.4%), followed by those who experienced Physical and Psychological Violence (23.6%) and Sexual Violence (16.9%). Similarly, survivors who experienced Multiple Violence reported the most negative physical health consequences (51.5%), followed by those who experienced Sexual Violence (27.7%) and Psychological Aggression (23.2%). Survivors’ service needs also depended on the perpetrator group. Survivors who experienced Multiple Violence had the largest service needs (68.7%), followed by those who experienced Physical and Psychological Violence (28.2%) and Sexual Violence (19.4%). Survivors sought formal help the most when they were victimized by Multiple Violence (55.8%), followed by Physical and Psychological Violence (22.3%) and Coercive Control (16.4%). Similarly, survivors sought informal help the most when they were victimized by Multiple Violence (78.7%), followed by Physical and Psychological Violence (55.5%) and Stalking (52.3%).

Discussion

This study identified six distinctive IPV perpetrators using a latent class analysis of eight different IPV forms. This study's contribution reveals patterns of IPV based on survivors’ lifetime experiences of IPV from a nationally representative sample. Among the six types of IPV perpetrators, Coercive Control was the most common. This finding is similar to previous research; the most common victimization experiences for both men and women were non-physical violence, such as jealousy and verbal abuse (Ansara & Hindin, 2010a). Two groups of IPV perpetrators commonly used multiple forms of violence, including physical violence and other forms of violence. For example, the Multiple Violence group perpetrated many different forms of violence, including severe physical violence, less severe physical violence, psychological aggression, and coercive control. This type of perpetrator is similar to the typology described in a previous study—the intimate terrorists—who used severe violence and control (Johnson, 2008). The Physical and Psychological Violence class perpetrated less severe physical violence along with non-physical violence. This finding indicates that IPV perpetrations that involve physical violence tend to occur with other forms of IPV. Survivors often disclose a single violent incident or just one episode of their entire IPV experience when seeking help rather than revealing all the IPV they have experienced in their lives, possibly because they feel ashamed or because help sources are reluctant to ask sensitive questions (Dagenhardt et al., 2021; Evans & Feder, 2016). However, our results showed that many survivors experience multiple forms of violence from a single perpetrator. Practitioners who work with IPV survivors, such as law enforcement and health care providers, should pay attention to details regarding multiple forms of violence so as to assess victimization and its risks comprehensively, and to provide appropriate and relevant services. The typology suggested by this research could be used to help practitioners to be aware that a certain type of victimization can take place along with another type of victimization, and train them to competently assess the potential polyvictimization of their clients. Note that of the eight IPV categories, control of reproductive health and rape did not load on any of the six classes. This may be due to the low frequencies of these two categories, with a rape reported only by 5.3% of respondents, and control of reproductive health by 10.8%.

The IPV typology identified in this study contributes to the body of knowledge by revealing detailed sex differences in IPV patterns. Previous studies have found that female perpetrators tend to use less severe violence, such as less severe physical violence or a lower level of coercive controlling violence, whereas multiple and severe violence, similar to Multiple Violence in our study, tends to be committed almost entirely by male perpetrators against female survivors (Ansara & Hindin, 2010a; Beck et al., 2013). The study results confirm that men tend to use more severe violence than women, and women tend to use less severe types of violence (e.g., Physical and Psychological Violence). Additionally, it is also noticeable that more women used non-physical but controlling behaviors, such as Coercive Control, than men. While sex can be a critical factor in IPV typology, the current finding suggests that gendered discussions may not fully explain the IPV patterns found in this study. More attention needs to be given to the contextual factors in which IPV occurs. For example, reciprocal IPV, in which each party is involved in violence to a similar degree, may be different from self-defense or controlling behaviors. The NISVS did not collect data about situations, motives, and initiators of violence. Examining contextual factors to improve our understanding of IPV patterns and sex differences warrants further study.

Our study revealed similarities and differences in IPV patterns between same- and different-sex relationships. While similar patterns between the two were found in most IPV classes, same-sex relationships had more Psychological Aggression but less Physical and Psychological Violence than their counterparts. Psychological Aggression might be a specifically prevalent pattern in same-sex relationships, potentially related to minority stress (Longobardi & Badenes-Ribera, 2017). Given the limited number of studies that have examined various IPV patterns within same-sex relationships, this study can contribute to this important but not-so-well-understood area of study. Specifically, this study suggests the need to expand IPV typology beyond gender-based, heterosexual-oriented discussion. Sex has been related to IPV patterns and types of violence experienced, but it may not solely determine IPV patterns (Baker et al., 2013). It would be valuable to consider various additional factors that influence IPV, such as social status, cultural frames, and interpersonal dynamics (Baker et al., 2013).

Patterns of IPV varied depending on the relationship between survivors and perpetrators. Multiple Violence, and Physical and Psychological Violence, which encompassed multiple forms of violence, occurred more in committed relationships (e.g., spouses and live-in partners) than in less committed relationships (e.g., boy or girlfriends and dating partners) in this study. Meanwhile, Sexual Violence and Stalking occurred more in relatively less committed relationship types. This finding indicates that perpetrators with more intimate relationships with the survivors tend to use more severe violence against their partners. Our analysis, however, did not examine how violence has developed and changed over time within the same relationship and cannot draw a clear association between the intimacy of the relationship and the severity of violence. Previous studies have shown mixed results. While Shortt et al. (2012) found male perpetrators who stayed with the same partners were likely to continue to perpetrate IPV, a systematic review found that being married was a protective factor for IPV against women (Yakubovich et al., 2018).

Experiencing multiple forms of violence, such as Multiple Violence, had more negative mental and physical health consequences than experiencing violence from other perpetrator groups. Physical and Psychological Violence caused the second largest negative mental health consequences. These findings are similar to previous research that showed severe or multifaceted IPV creating more mental health issues (Ansara & Hindin, 2011; Cale et al., 2017; Choi et al., 2017; Clark et al., 2019; Haynie et al., 2013; Weiss et al., 2017). Sexual Violence created the second largest negative consequences to physical health. Moreover, Sexual Violence was associated with greater mental health issues than violence from any other perpetrator, followed by multifaceted IPV (Multiple Violence, and Physical and Psychological Violence). These findings suggest that Sexual Violence causes more physical and mental health issues than Coercive Control or Psychological Aggression.

The service needs and help-seeking behavior showed similar patterns to health consequences; Multiple Violence created the highest level of service needs and help-seeking, followed by Physical and Psychological Violence. These similarities suggest that survivors’ help-seeking corresponds to the patterns of health consequences and service needs across perpetrator groups. However, help-seeking by survivors of Sexual Violence does not seem to confirm the patterns. Survivors of Sexual Violence had more negative health consequences and higher service needs but sought less formal and informal help than survivors of Coercive Control. As sexual assault is one of the most underreported crimes (Langton et al., 2012), survivors of sexual IPV may not seek help despite their mental and physical health needs. This finding indicates that sexual IPV victimization needs to be better addressed in survivor services. For instance, despite many positive changes in recent decades in this area (Campbell et al., 2019; Macy et al., 2018), policy efforts and program development need to be strengthened to increase awareness of sexual IPV for the purpose of prevention and relevant service provision.

There are limitations to this study. First, this study did not consider the context in which IPV occurred between perpetrators and survivors. The NISVS data provide extensive information regarding victimization, but it did not capture the IPV situation or survivors’ actions following particular IPV situations. By incorporating contextual factors into the IPV patterns, future research can reveal differences in IPV patterns that may vary by IPV context. The second limitation is that the NISVS asked about IPV experiences retrospectively. This could be problematic, especially when participants identified multiple perpetrators who might have perpetrated multiple forms of IPV over time. The third limitation is that this study did not include the frequency and magnitude of victimization experiences. As we used dichotomous variables regarding IPV experiences (e.g., having psychological aggression vs. not), this study did not differentiate one-time IPV incidents from long-persisting ones, which may result in different impacts on health, service needs, and help-seeking. Fourth, this study did not examine the impacts of various sociodemographic factors, other than sex, on survivors’ health, service needs, and help-seeking behaviors. Finally, we analyzed the data without weighting. The NISVS provides sample weights that allow us to have a nationally representative sample. However, as these weights are assigned to respondents, not the perpetrators that the respondents identified, we could not use them for the analysis. As a result, the generalizability of these results is unknown.

Conclusion

This study identifies the pattern of IPV based on lifetime IPV victimization among general populations in the United States and examines their associations with sex, perpetrator–survivor sex, relationship status, health consequences, service needs, and help-seeking behaviors. The recognition of different associations among IPV types with sex, perpetrator–survivor sex, and relationship status may inform service providers to better assess IPV situations and provide tailored services for survivors based on their sex and relationship with the perpetrators. Practice and policy efforts can raise awareness about how IPV tends to become more severe as a relationship develops. As such, IPV risks need to be reported and addressed as early as possible.

As the findings suggest that survivors of Multiple Violence are more likely to have both adverse mental and physical health outcomes than victims of any other perpetrator group, service providers may be able to assign resources to serve the most vulnerable survivors. The study findings can improve practices in legal and court systems. A stronger court order or legal action may be applicable for survivors of Multiple Violence, and of Physical and Psychological Violence in which multiple forms of violence are perpetrated, leading to more negative consequences.

The typology suggested by this study could be used to develop assessment questions and/or forms that help practitioners comprehensively assess the clients’ polyvictimization experiences. Intervention and prevention approaches that include identifying the type of perpetrator as a part of assisting the client will lead to an increased ability to meet the survivors’ needs accordingly.

Footnotes

Declaration of Conflicting Interests

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

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Woojong Kim

Author Biographies

Woojong Kim is an assistant professor in the Social Work program at the University of Michigan-Flint School of Education & Human Services. Her research focuses on physical and mental health outcomes of traumatic experiences, such as intimate partner violence (IPV) and environmental factors, and suggests prevention and intervention strategies.

Hyunkag Cho is an associate professor in the School of Social Work at Michigan State University. His research has focused on intimate partner violence (IPV), perception of IPV, survivors’ help-seeking, interpersonal and sociocultural factors for help-seeking, and the process of selecting a source of help.

Seunghye Hong is an associate professor in the Thompson School of Social Work & Public Health at the University of Hawaiʻi at Mānoa. Her research has focused on health and behavioral mental health, socio-ecological determinants of health/behavioral mental health and service use, aging/disability, immigration, disparities, and developmental/social/cultural contexts.

Abbie Nelson, LCSW, is a doctoral student in the School of Social Work at Michigan State University. Her research focuses on holistic interventions and services for intimate partner violence survivors. She is interested in creating interventions that address holistic healing of survivors that lead to empowerment and societal systemic change. She also works as a trauma therapist and instructor.

Jennifer Allen, MSW, is a PhD student in the School of Social Work at Michigan State University. Her research focuses on sexual minority/LGBTQIA + adolescents and adults, and her main interest is cumulative violence exposure across the lifespan (including intimate partner violence, sexual violence, and identity-based violence), as well as mental health outcomes and help-seeking behaviors after exposure to violence.

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