Это не только порнография, которая изображает насилие в отношении женщин. Телевидение и фильмы наполнены сценами, где женщинам угрожают, насилуют, избивают, пытали и убивали. Ряд исследований телевидения указывают на пагубные последствия просмотра изображений насилия в СМИ (например, Eron, 1982; National Institute of Mental Здоровье, 1982; Huston et al., 1992). Эрон (1982) обнаружил, что дети, которые много часов смотрели сцены насилия по телевизору в начальной школе, как правило, проявляли более агрессивные поведение в подростковом возрасте и чаще подвергались аресту за преступные действия во взрослом возрасте. Метаанализ 188 исследований выявил сильную положительную связь между воздействием телевизионное насилие и антисоциальное и агрессивное поведение (Комсток и Пайк, 1990; Пайк и Комсток, 1994). Те, кто подвергается насилию на телевидении и в кино, также могут становятся менее чувствительными к насилию в реальном мире, менее чувствительны к боли и страданиям других и начинают видеть мир как подлое и опасное место (Murray, 1995). А недавно опубликованное национальное исследование насилия на телевидении показало, что контекст показанного насилия важен: телевидение не показывает практически никаких последствий насильственного поведения; жертвам не причиняется вред, а правонарушители не наказываются (Mediascope, 1996). Кажется, что многие телевизионные изображения насилия показывают, что насилие работает.

Ни одно из исследований насилия на телевидении не фокусировалось конкретно на насилии в отношении женщин. Национальное исследование насилия на телевидении (Mediascope, 1996) обнаружило что 75 процентов жертв насилия в телевизионных изображениях - мужчины, и только 9 процентов - женщины (остальные - нечеловеческие персонажи). Исследования еще не изучили тип насилия, направленного против женщин-жертв на телевидении, как он сравнивается с насилием, направленным против жертв-мужчин, и есть ли различное воздействие на зрителей насилия в отношении женщин и мужчин.

Для большей части западноевропейских и американских записей

история, жены не имели независимого правового статуса; в основном они были собственностью своих мужей. Право мужа физически наказывать свою жену было поддержана Верховным судом Миссисипи в 1824 году ( Брэдли против штата 1, мисс 157) и снова судом Северной Каролины в 1868 году ( State v. Rhodes , 61 NC 453, 353; цитируется в Pleck, 1989). В 1871 году решением суда в Алабаме ( Фулхэм против штата , 46 Ala. 146-147) этот штат стал первым государством, лишившим мужа права избивать свою жену. (Фэган и Браун, 1994). В течение 1870-х годов, совпадающих с ростом движения за защиту детей, росли опасения, что избиение жены должно рассматриваться как преступление. хотя мало кто из мужчин когда-либо был наказан (Pleck, 1989). В 1890-х годах социальная работа заменила уголовное правосудие в качестве предпочтительной системы борьбы с насилием в семье и общими интерес к избиению жен угас до 1960-х годов (Fagan and Browne, 1994).

Статус женщины как собственности также можно увидеть в разработке законов, касающихся изнасилования. Браунмиллер (1975: 8) утверждает, что «изнасилование вошло в закон & hellip; как имущественное преступление человека против человека. Женщина, конечно, рассматривалась как собственность ». Она отмечает, что до конца тринадцатого века были только незамужние девственницы. считаются безупречными в своих преследованиях; изнасилованные замужние женщины наказывались вместе со своим насильником. В то время Статут Вест-министра, выдвинутый Эдвардом В Англии я распространил те же наказания на мужчин, изнасиловавших замужних женщин, и на тех, кто изнасиловал девственниц. Однако изнасилование в браке было по определению невозможно. Брак законы традиционно предполагали подразумеваемое согласие на сексуальные отношения жен и позволяли мужьям применять силу, чтобы добиться согласия (Fagan and Browne, 1994). Это было только недавно лет, когда законы начали признавать изнасилование в браке: сегодня каждый штат в Соединенных Штатах изменил или отменил исключение брака в своих законах об изнасиловании (личных общение, Национальный центр обмена информацией по вопросам изнасилования в браке и на свидании, Беркли, Калифорния).

Сексуальные сценарии . Ожидания относительно свиданий и интимных отношений

tionships are conveyed by culturally transmitted scripts. Scripts support violence when they encourage men to feel superior, entitled, and licensed as sexual aggressors with women as their prey, while holding women responsible for controlling the extent of sexual involvement (White and Koss, 1993). Parents socialize daughters to resist sexual advances and sons to initiate sexual activity (Ross, 1977). By adolescence, both boys and girls have been found to endorse scripts about sexual interaction that delineate a justifiable rape. For example, approximately 25 percent of middle school, high school, and college students state that it is acceptable for a man to force sex on a woman if he spent money on her (Goodchilds and Zellman, 1984; Muehlenhard et al., 1985; Goodchilds et al., 1988).

Since Burt (1980) first defined "rape myths" and developed a scale to measure them, a large body of research has examined the role of attitudes and false beliefs about rape on perpetration of sexual assault and on society's response to sexual assault. Typical rape myths include denial of rape's existence (e.g., most rape claims are false, or women generally lie about rape), excusing the rape (e.g., she led him on, he couldn't help himself, rape only happens to "bad" women), and minimizing the seriousness of rape (e.g., Hall et al., 1986; Briere et al., 1985). Despite psychometrically weak measurement instruments, the study of rape myths has provided important understandings about sexual aggression (Lonsway and Fitzgerald, 1994). Not surprisingly, men are more accepting of rape myths than women (e.g., Muehlenhard and Linton, 1987; Margolin et al., 1989; Dye and Roth, 1990). A number of studies have found a significant association between acceptance of rape myths and self-reported sexually aggressive behavior (Field 1978; Koss et al., 1985; Murphy et al., 1986; Muehlenhard and Linton, 1987; Reilly et al., 1992).

The early studies of rape myths were performed on college campuses and found that 25 percent to 35 percent of the students accepted a variety of them (Giacopassi and Dull, 1986; Gilmartin-Zena, 1987). Since the mid 1980s, many college

campuses have instituted rape awareness and rape education programs. Recent research found fewer than 2 percent of students accepting of sexual aggression or coercion, but up to 36 percent expected that sexual aggression would occur under certain circumstances (Cook, 1995). Cook (1995) surmises that rape education has made it unacceptable to admit to believing rape myths, but that behavioral expectations are still consistent with acceptance of rape myths. It will be valuable for prevention efforts for research to continue to track any changes in rape myth acceptance and sexual script expectations among students, as well as the general public.

Cultural Mores Ethnographic and anthropologic studies determine the critical role that sociocultural mores play in defining and promoting violence against women. Anthropologists have found cultural differences in the amount of and acceptability of intimate partner violence in different societies. A review of 14 different societies (Counts et al., 1992) found that physical chastisement of wives was tolerated in all the societies and considered necessary in many societies, but the rates and severity of wife beating were found to range from almost nonexistent to very frequent. These differences seem to be related to negative sanctions for men who overstepped "acceptable" limits, sanctuaries for women to escape violence, and a sense of honor based on nonviolence or decent treatment of women (Campbell, 1992).

Two general types of rape have been identified. Transgressive or non-normative rape is uncondoned genital contact against the will of the woman and in violation of social norms; tolerated or normative rape is unwanted genital contact that is supported by social norms (Heise, 1993; Rozee, 1993). Normative rape is reported in nearly all societies (97 percent; Rozee, 1993), and all have mechanisms that "legitimate, obfuscate, deny, and thereby perpetuate violence" (Heise et al., 1994:1). Ethnographic studies have found rape in 42 percent to 90 percent of nonindustrial societies, depending on how it is defined and on the cultural and geographic representative-

ness of the sample (Minturn et al., 1969; Bart et al., 1975; Broude and Green, 1976; Sanday, 1981; Levinson, 1989; Rozee, 1993; for a review see Koss et al., 1994). In preliterate societies, there were significantly greater frequencies of rape in those characterized by patrilocality, high degree of interpersonal violence, and an ideology of male toughness. Rape is also prevalent under conditions of marked social inequity and social disorganization, such as slavery and war (Quinsey, 1984).

It is generally accepted that multiple classes of influences—from the individual to the macrolevel—determine the expression of assaultive and sexually aggressive behavior in men (for recent reviews see Ellis, 1989; Sugarman and Hotaling, 1989; Craig, 1990; Hall, 1990; Malamuth and Dean, 1991; Berkowitz, 1992; Shotland, 1992; White and Koss, 1993; White, in press). Although it is possible to model at a general level the causal factors that explain the variance among the forms of violence against women, the heterogeneity of violent men precludes the delineation of a single set of causes that accurately classifies types of offenders. Therefore, researchers have turned to multivariate modeling of violence. Recent efforts include a biopsychosocial model of battering that examines the relative contribution of three domains of predictors including the physical (e.g., testosterone, prolactin, and alcohol), the social (e.g., negative life events, quality of relationships, family income, and social support), and psychiatric symptoms (McKenry et al., 1995). The results showed significant zero-order correlations within each class of predictors, but in multivariate analysis the social variables predicted violence better than the other variables.

Work by Malamuth and colleagues (1991, 1993, 1995) has generated and tested a model to explain both sexual and nonsexual aggression toward women. Their results suggest that

there are common pathways to all forms of aggression, but different specific factors may influence the development of nonsexual versus sexual aggression toward women. Furthermore, some of the same factors that contribute to sexual aggression in early adulthood appear to lead to other conflictual behaviors with women in later life. Male sexual aggression was best predicted by a history of promiscuous-impersonal sex and distrust of women coupled with gratification from dominating them. Physical aggression was best predicted by relationship distress and verbal aggression. General hostility and defensiveness contributed to both types of aggression. This work supports the findings of other researchers (O'Leary and Arias, 1988; O'Leary et al., 1994) that psychological abuse may be a precursor to physical aggression. These findings point to the need for more work that looks at commonalities and differences among all forms of violence against women and general violence.

All this work is a marked improvement over earlier research that focused on single causes or theories. The field appears to be developing toward an integrative, metatheoretical model of violence that considers multiple variables operating at different times in a probabilistic fashion (Leonard, 1993; White, in press). Future work guided by these models can examine the relationship of one form of violence to another; make better connections between macrolevel societal variables and individual variables to establish how culture is expressed; address both structural and contextual causes of violence; use a life-span perspective capable of capturing the processes by which earlier experiences affect later ones; and focus on the gendered nature of violence against women that involves personality and cognitive factors embedded in a social structure that directs and defines the meaning of violence in gendered social relationships. An understanding of the multiple factors that lead to violent behavior in general and to specific forms of violent behavior directed at women is critical to developing effective prevention strategies.

Although most research on the causes of violence focuses on why men use violence and the conditions that support and maintain that violence, some researchers have tried to ask why a particular woman is the target of violence. This line of research has a dismal record of success. A primary problem confronted in trying to identify women's risk factors for violence is the confounding that occurs when traits and behaviors are assessed at some point postvictimization and assumed to represent the previctimization state. An interpretation of current findings is that they represent aftereffects of the violence itself or overly negative self-descriptions triggered by the trauma.

Factors that have been at one time or another linked to women's likelihood of being raped or battered are passivity, hostility, low self-esteem, alcohol and drug use, violence in the family of origin, having more education or income than their intimate partners, and the use of violence toward children. However, based on a critical review of all 52 studies conducted in the prior 15 years that included comparison groups, Hotaling and Sugarman (1986) found that the only risk marker consistently associated with being the victim of physical abuse was having witnessed parental violence as a child. And this factor characterized not only the victimized women, but also their male assailants. Recent studies also found no specific personality and attitudinal characteristics that make certain women more vulnerable to battering (e.g., Pittman and Taylor, 1992). Although alcoholic women are more likely to report moderate to severe violence in their relationships than more moderate drinkers, the association disappears after controlling for alcohol problems in their partners (Miller, 1992, as cited in Leonard, 1993). On the basis of findings such as these, several writers have concluded that the major risk factor for battering is being a woman.

Personality traits and attitudes that could increase vulnerability to rape have also been explored. The earliest studies,

and the only ones to implicate victim personality traits, used different recruitment techniques to obtain subjects: the rape victims were often found among those who had sought help at crisis centers; the nonvictims were college student volunteers (Selkin, 1978; Myers et al., 1984). These methodological differences bias the samples, especially on personality traits like dominance, femininity, and social presence—exactly the variables on which the groups were found to differ. When identical selection procedures were used to select victims and nonvictims, no differences were found in personality characteristics, assertiveness, or identification with feminine stereotyped behavior (Koss, 1985; Koss and Dinero, 1989).

One risk profile did emerge that characterized a small subset (10 percent) of women for whom the risk of rape was twice the rate for women without the profile. Those women were characterized by a background of childhood sexual abuse, liberal sexual attitudes, and higher than average alcohol use and larger number of sexual partners. Researchers presume that having a large number of sexual partners implies short-term relationships and therefore more dating partners, but neither frequency of dates nor number of dating partners has been directly tested as a risk factor. Koss and Dinero (1989) concluded that sexual assault was generally not predictable, but to the extent it could be, was accounted for by variables that represented the aftereffects of childhood sexual abuse, including influences on drinking, sexual values, and level of sexual activity. Recent prospective data support this assertion (Gidycz et al., 1995). Adolescent sexual victimization significantly predicted alcohol consumption at the onset of college, while alcohol consumption during college did not predict subsequent victimization. The link between childhood sexual abuse and adult victimization has been replicated many times across ethnic groups (Wyatt et al., 1992; Gidycz et al., 1993; Urquiza and Goodlin-Jones, 1994; Wyatt and Riederle, 1994). The other certain risk factor for rape (in addition to being female and having been abused previously) is being young: epidemiological data indicate that women

between 16 and 24 years old have the highest rates of sexual assault and rape (Bastian, 1995).

Another line of research has compared the resistance strategies used by women who were raped to those of women whose attack was aborted without penetration. Studies of this type have consistently reported that active strategies such as screaming, fleeing, or physically struggling are associated with higher rates of rape avoidance (Javorek, 1979; Bart, 1981; Quinsey and Upfold, 1985; Levine-MacCombie and Koss, 1986; Siegel et al., 1989; Ullman and Knight, 1991, 1992). Although some of the studies found increased risk of injury among women who resisted, the studies that looked at the actual sequence of events (Quinsey and Upfold, 1985; Ullman and Knight, 1992) found the correlation between resistance and injury disappeared when the violence of the attacker was taken into account. Researchers have uniformly found that offender characteristics are more important than the victim behavior in predicting the outcome of an assault.

The role of alcohol use by victims has also been investigated. Trouble with alcohol and peer pressure to drink have been associated with adolescents' risks of personal victimization, in general, and sexual victimization, in particular (Esbensen and Huizinga, 1991; Windle, 1994; Gidycz et al., 1995). About one-half of college student rape victims report that they were drinking at the time of their assault (Koss and Dinero, 1989), and estimated peak blood alcohol level during the prior 30 days was correlated with lifetime sexual victimization (Norris et al., 1996). Alcohol use is one of the variables that differentiated dates in which sexual aggression occurred from dates involving the same respondents without aggression (Muehlenhard and Linton, 1987).

These studies provide some evidence that the habitual use of alcohol is associated with sexual victimization, but they do not explain the causal pathways. The evidence suggests that alcohol abuse is an aftereffect of earlier victimization, but the effect that alcohol might have on future victimization is unclear. Alcohol may directly increase the risk of victimization

through cognitive and motor impairment that prevents women from recognizing, escaping, or resisting sexual aggression (Nurius and Norris, 1996). Studies of the cognitive effects of alcohol on victims parallel efforts to examine the social information processing of offenders. Rape victims who were drinking report that their judgment was impaired at the time of assault (Frintner and Rubinson, 1993).

It is possible, however, that the effect of alcohol is less direct. Drinking may increase the likelihood of victimization by placing women in settings in which their chances of encountering a potential offender are higher than the average. Several studies have suggested that bar settings increased women's vulnerability to violence independent of the increased vulnerability due to alcohol consumption. For example, exposure to obnoxious behavior, as well as sexual and physical violence, were predicted by the frequency of going to bars (Fillmore, 1985; Lasley, 1989). Alternatively, alcohol consumption by women may be misperceived and misinterpreted by the men they meet as a sexual availability cue. Although scientific evidence suggests that women become less physiologically aroused after drinking, men perceived them as more sexual, more likely to initiate sexual intercourse, and more aroused by erotica (Crowe and George, 1989; George et al., 1990, 1995; Corcoran and Thomas, 1991). In one study, 75 percent of college men admitted to getting a date drunk or high on drugs to try to have sex with her (Mosher and Anderson, 1986).

The consequences of violence against women are far broader than the impact on the women victims. Their families and friends may be affected. In the case of intimate partner violence, there is increasing evidence of the negative impact on children of exposure to violence in the family. Society suffers economically, both in the use of resources and in the loss of productivity due to fear and injury. Understanding the

consequences of violence is necessary for planning and implementing interventions to deal with those consequences. This section examines research findings about the consequences violence against women has on the individual victim, those closest to her, and on society as a whole.

Research in recent years has brought an increased understanding of the impact of trauma, in general, and of violence against women, in particular. Both rape and intimate partner violence are associated with a host of short- and long-term problems, including physical injury and illness, psychological symptoms, economic costs, and death. It should be noted that part of what is known about the consequences of violence against women comes from studies of women who were seeking help, so it may not be representative of all victims. It is possible that these women suffered more severe trauma than women who do not seek help, and so represent the worst cases. The opposite is also possible: that women who come forward have suffered less fear and damage to their self-esteem, and therefore the worst cases remain hidden. Women who agree to participate in research may come from different social, ethnic, and economic backgrounds than those who do not participate. Finally, researchers do not always have the understanding or the resources to reach subgroups of victims who may either be at high risk for violence or face special challenges in recovery.

Virtually absent from the research are studies addressed specifically to the experiences of older women, disabled women, immigrant and refugee women, migrant farm worker women, rural women, Asian American women, American Indian women, homeless women, lesbian and bisexual women, drug-addicted women, and institutionalized women (Eaton, 1995; Gilfus, 1995). Whether or not these groups differ in the overall level of violence they experience, the evidence suggests that the descriptive characteristics of the as-

saults are very similar (Torres, 1991; Wyatt, 1992). However, the same act can have very different meanings depending on many features that shape perceptions and behavior, including the age of the victim, her relationship with the perpetrator, culture, social class, sexual orientation, previous history of violence, perceived intent of the violence, and perceived causes and effects of the violence (Murphy and O'Leary, 1994). Victims from oppressed racial, ethnic, or cultural groups or who are lesbian or bisexual face additional challenges that may influence their strategies and resources for recovery (Brown and Root, 1990; Sue and Sue, 1990; Wyatt, 1992; Garnets and Kimmel, 1993; Schriver, 1995). Most studies of the consequences of violence look at impairments; only a few studies examine resilience and strengths as protectors against untoward outcomes or as alternative results to impairment (Gilfus, 1995).

Also missing in the literature is a developmentally oriented approach that follows the outcomes of exposure to violence into later stages of adult development. Little is known of the impact of trauma on social roles, life patterns, and timing of life transitions. A life-span perspective would look at differential effects on women's lives when violence involves multiple types and perpetrators, is ongoing, cumulative, and becomes a chronic feature of the environment. Many social and public health consequences of violence are unstudied, including labor force participation, economic well-being, fertility decisions, divorce rates, and health status (Gilfus, 1995).

Rape and Sexual Assault Surveys of adult females have found that women characterize the ''typical" rape as entailing a high risk of physical injury and of death (Warr, 1985; Gordon and Riger, 1989). However, the data show that between one-half and two-thirds of rape victims sustain no physical injuries (Beebe, 1991; Koss et al., 1991; Kilpatrick et al., 1992); and

only about 4 percent sustain serious physical injuries (Kilpatrick et al., 1992). Genital injuries are more likely in elderly victims (Muram et al., 1992). It appears that very few homicides are associated with rape: in 1993 only 106 of the 5,278 female homicide victims were also raped (Federal Bureau of Investigation, 1993). Even though serious physical injury is relatively rare, the fear of injury or death during rape is very real. Almost one-half of rape victims in a recent national study (Kilpatrick et al., 1992) feared serious injury or death during the attack. Rape can also result in transmission of a sexually transmitted disease (STD) to the victim, or in pregnancy. STD infection has been found in up to 43 percent of rape victims (Jenny et al., 1990), with most studies reporting STD infection rates between approximately 5 and 15 percent depending on diseases screened for and type of test used (Lacey, 1990; Murphy, 1990; Beebe, 1991). The rate of the human immunodeficiency virus (HIV) transmission due to rape is unknown (Koss et al., 1994), but it is of concern to a sizable proportion of rape victims (Baker et al., 1990). Pregnancy is estimated to result from approximately 5 percent of rapes (Beebe, 1991; Koss et al., 1991).

Rape has health effects that extend beyond the emergency period. Self-report and interview-administered symptom checklists routinely reveal that victims of rape or sexual assault experienced more symptoms of physical and psychological ill health than nonvictimized women (Waigant et al., 1990; Koss et al., 1991; Golding, 1994; Kimerling and Calhoun, 1994). Sexual assault victims, compared with nonvictimized women, were more likely to report both medically explained (30 percent versus 16 percent) and medically unexplained symptoms (11 percent versus 5 percent). Consequently, rape and sexual assault victims also seek more medical care than nonvictims. In longitudinal data, rape victims seeking care at a rape crisis center were initially similar to matched nonvictims in their self-reported physician visits, but at 4 months and 1 year after the rapes they were seeking care more frequently (Kimerling and Calhoun, 1994). These

findings are consistent with studies using population data on medical use: women in primary care populations with a history of severe sexual and physical assault had nearly twice as many documented physician visits a year as nonvictimized women (6.9 versus 3.5; Koss et al., 1991). Utilization data across 5 years preceding and following victimization ruled out the possibility that the victims had been high users of services prior to their attacks.

A number of long-lasting symptoms and illnesses have been associated with sexual victimization including chronic pelvic pain; premenstrual syndrome; gastrointestinal disorders; and a variety of chronic pain disorders, including headache, back pain, and facial pain (for reviews see Koss and Heslet, 1992; Dunn and Gilchrist, 1993; Hendricks-Mathews, 1993). Persons with serious drug-related problems and high-risk sexual behaviors were also characterized by elevated prevalence of sexual victimization (Paone et al., 1992). These findings suggest that victimized women may become inappropriate users of medical services by somaticizing their distress; however, the number of sexual assault victims who qualify for the psychiatric diagnosis of somatization disorder is small. In a comparison of sexual assault victims with matched nonvictimized women on nine psychiatric diagnoses and a sample size of more than 3,000, too few cases of somatization disorder were identified to analyze statistically (Burnam et al., 1988).

Intimate Partner Violence A woman is more likely to be injured if she is victimized by an intimate than by a stranger (Bachman and Saltzman, 1995). Victims of battering suffer from a host of physical injuries, from bruises, scratches, and cuts to burns, broken bones, concussions, miscarriages, stab wounds, and gunshot wounds to permanent damage to vision or hearing, joints, or internal organs to death. Bruises and lacerations to the head, face, neck, breasts, and abdomen are typical. Review of emergency room medical records in one urban hospital revealed that 50 percent of all injuries to

women seen in the emergency room and 21 percent of the injuries that required emergency surgery could be attributed to battering. The review also found that 50 percent of the rapes of women over age 30 had been committed by the woman's intimate partner (Stark et al., 1981). Victims of partner violence were 13 times more likely to have injuries to the breast, chest, or abdomen than were accident victims (Stark et al., 1979), and three times as likely as nonbattered women to sustain injuries while pregnant (Stark and Flitcraft, 1988). Assaults directed at the abdomen can be associated with injuries both to the victim and the fetus (Helton et al., 1987a,b). In a representative national sample, 15 percent of pregnant women were assaulted by their partners at least once during the first half of pregnancy and 17 percent during the latter half (Gelles, 1988). A study of women attending prenatal clinics also found 17 percent of them suffered physical or sexual abuse during pregnancy (McFarlane et al., 1992). Several studies have found that white women experience more abuse during pregnancy than African American or Hispanic women (Berenson et al., 1991; McFarlane et al., 1992).

Women involved with a violent partner may be frequent users of medical services even if they do not identify the reason for their visit as the violence. They are likely to show evidence of injuries in various stages of healing, indicating the ongoing nature of the abusive behavior (Burge, 1989). Among women patients in a community-based family practice clinic who were living with a partner, recently separated, or divorced, 25 percent were assaulted by their partners during the previous year, and 15 percent sustained injuries from a partner (Hamberger et al., 1992). Some of this violence is lethal. Between 1976 and 1987, 38,468 people were killed by their intimate partners; 61 percent involved men who killed women. Among white couples, 75 percent of the victims were women (Browne and Williams, 1989, 1993).

Victims of intimate partner violence and rape exhibit a variety of psychological symptoms that are similar to those of victims of other types of trauma, such as war and natural disaster. Following a trauma, many victims experience shock, denial, disbelief, fear, confusion, and withdrawal (Burgess and Holmstrom, 1974; Walker, 1979; Browne, 1987; Herman, 1992; Janoff-Bulman, 1992; van der Kolk, 1994). Assaulted women may become dependent and suggestible and have difficulty undertaking long-range planning or decision making (Bard and Sangrey, 1986). Although a single victimization may lead to permanent emotional scars, ongoing and repetitive violence is clearly highly deleterious to psychological adjustment (Follingstad et al., 1991). In one national study, the more a woman had been assaulted, the more psychological distress she experienced (Gelles and Harrop, 1989).¹

A large empirical literature documents the psychological symptoms experienced in the aftermath of rape (for reviews see Frieze et al., 1987; Resick, 1987, 1990; McCann et al., 1988; Roth and Lebowitz, 1988; Hanson, 1990; Lurigio and Resick, 1990). Rape (with the exception of marital rape) is more likely than partner violence to be an isolated incident, which creates a somewhat different course of recovery. For many victims, postrape distress peaks approximately 3 weeks after the assault, continues at a high level for the next month, and by 2 or 3 months later recovery has begun (Davidson and Foa, 1991; Rothbaum et al., 1992). Many differences between rape victims and nonvictimized women disappear after 3 months with the exception of continued reports of fear, self-esteem problems, and sexual problems, which may persist for up to 18 months or longer (Resick, 1987). Approximately one-fourth of women continue to have problems for several years (Hanson, 1990).

Women who have sustained sexual or physical assault have been found to disproportionately suffer from depression, thoughts of suicide, and suicide attempts (Hilberman and

Munson, 1978; Hilberman, 1980; Kilpatrick et al., 1985; Stark and Flitcraft, 1988; McGrath et al., 1990; Dutton, 1992a,b; Herman, 1992). In one community sample, 19 percent of rape victims had attempted suicide in comparison with 2 percent of nonvictims (Kilpatrick et al., 1985). In other studies, 13 percent of rape victims suffered from a major depressive disorder sometime in their life, compared with only 5 percent of nonvictims (Burnam et al., 1988; Sorenson and Golding, 1990). Depression scores for victims of intimate partner violence on a widely used epidemiological measure (Radloff, 1977) were twice as high as the standard norms and well above the high-risk cutoff scores (Walker, 1984).

Other psychological symptoms reported by both victims of rape and partner violence include lowered self-esteem, guilt, shame, anxiety, alcohol and drug abuse, and posttraumatic stress disorder (PTSD) (Walker, 1979; Burnam et al., 1988; Winfield et al., 1990; Herman, 1992). Even when evaluated many years after they were sexually assaulted, survivors were more likely to receive several psychiatric diagnoses, including major depression, alcohol abuse and dependence, drug abuse and dependence, generalized anxiety, obsessive-compulsive disorder, and PTSD (Kilpatrick et al., 1985; Burnam et al., 1988; Winfield et al., 1990). Women who were both beaten and sexually attacked by their partners were at particular risk of the most severe psychological consequences (Shields and Hanneke, 1983; Pagelow, 1984; Browne, 1987).

There are few reliable predictors of positive readjustment among rape survivors (Hanson, 1990; Lurigio and Resick, 1990). In general, those assaulted at a younger age are more distressed than those who were raped in adulthood (Burnam et al., 1988). Some research has suggested that Asian and Mexican American women have more difficult recoveries than do other women (Williams and Holmes, 1981; Ruch and Leon, 1983; Ruch et al., 1991). Victims of these ethnic backgrounds, as well as Moslem victims, face cultures in which intense, irremediable shame is linked to rape. However, recent direct comparisons have revealed no ethnic differences

in the psychological impact of rape as measured by self-report and interview-assessed prevalence of mental disorders among Hispanic, African American, and white women (Burnam et al., 1988; Wyatt, 1992).

The actual violence of an attack may be less important in predicting a woman's response than the perceived threat (Kilpatrick et al., 1987). The fear that one will be injured or killed is equally as common among women who are raped by husbands and dates as among women who are raped by total strangers (Kilpatrick et al., 1992). Likewise, acquaintance rapes are equally as devastating to the victim as stranger rapes, as measured by standard measures of psychopathology (Koss et al., 1988; Katz, 1991). However, women who know their offender are much less likely to report the rapes to police or to seek victim assistance services (Stewart et al., 1987; Golding et al., 1989). The impact of rape may be moderated by social support (Ruch and Chandler, 1983; Sales et al., 1984). Unsupportive behavior, by significant others in particular, predicts poorer social adjustment (Davis et al., 1991), and proceeding with prosecution appears to prolong recovery (Sales et al., 1984).

One way of systematizing some of the psychological responses evidenced by women victims of partner assault and rape is the diagnostic construct of posttraumatic stress disorder (PTSD) (Burge, 1989; Kemp et al., 1991; Dutton, 1992a). This construct has been used to understand a range of psychological responses to traumatic experiences, from natural disaster or military combat to rape and other forms of criminal attack (Figley, 1985; van der Kolk, 1987; Herman, 1992; Davidson and Foa, 1993). On the basis of clinical and empirical inquiries, a growing number of clinicians now suggest that PTSD may also be the most accurate diagnosis for many survivors of interpersonal and family violence (Herman, 1986, 1992; Bryer et al., 1987; van der Kolk, 1987; Burge, 1989; Gondolf, 1990; Koss, 1990; Davidson and Foa, 1991; Kemp et al., 1991; Koss and Harvey, 1991; Walker, 1991, 1992; Browne, 1992; Dutton, 1992a).

As early as 1974, Burgess and Holmstrom described what they termed "rape trauma syndrome" to describe the psychological aftermath of rape. Today, many assaulted women, like other victims of trauma receive diagnoses of PTSD. Among victims of intimate partner violence recruited from shelters and therapist referrals, 81 percent of those who had experienced physical attacks and 63 percent of those who had experienced verbal abuse were diagnosed with PTSD. Most rape victims (94 percent) who are evaluated at crisis centers and emergency rooms meet the criteria for PTSD within the first few weeks of the assault, and 46 percent still do so 3 months later (Rothbaum et al., 1992). Rape and physical assault are both more likely to lead to PTSD than other traumatic events affecting civilians, including robbery, the tragic death of close friends or family, and natural disaster (Norris, 1992).

Although the concept was initially constructed to explain reaction patterns in survivors of natural disasters and combatants in war, it is not surprising to find a high prevalence of PTSD among survivors of intimate violence. The most common trauma suggested for PTSD in the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994:427) is "a serious threat to one's life or physical integrity; [or] a serious threat or harm to one's children …," experiences known to characterize the lives of women in relationships with violent mates. Factors most often associated with the development of PTSD include perception of life threat, threat of physical violence, physical injury, extreme fear or terror, and a sense of helplessness at the time of the incident (March, 1990; Herman, 1992; Davidson and Foa, 1993). Moreover, some researchers suggest that PTSD is most likely to develop when traumatic events occur in an environment previously deemed safe (Foa et al., 1989), another dimension clearly applicable to violence occurring in one's home.

Many of the psychological aftereffects of violence against women can be understood as elements of a PTSD diagnosis

(but see below). The PTSD construct has the advantage of providing a framework for recognizing the severe impact of events external to the individual (van der Kolk, 1987; Herman, 1992). However, for reactions to be seen as expectable responses to severe stressors, the trauma must be known. Unfortunately, in most mental health settings, routine screening for a history of family violence is almost never done; thus, serious or chronic psychological and physical conditions are treated without knowledge of the core trauma that may underlie current symptoms.

Finally, PTSD sufferers can become aware of the potential links between the symptoms that plague them and the exposure to an extreme external stressor. Clinical researchers consistently note how abused women internalize the derogatory attributions and justifications of the violence against them (Walker, 1979, 1984; Pagelow, 1984; Browne, 1987). An enhanced understanding of the range of responses manifested by all types of people who are faced with physical or sexual danger or attack expands the interpretation of symptoms beyond internal or gender explanations and empowers both survivors and providers to proceed with focused goals of safety, symptom mastery, reintegration, and healing (Herman, 1992).

Yet there are problems with the PTSD conceptualization. First, it doesn't account for many of the symptoms manifested by victims of violence. For example, thoughts of suicide and suicide attempts, substance abuse, and sexual problems are not among the PTSD criteria. Second, the diagnosis better captures the psychiatric consequences of a single victimization than the consequences of chronic abusive conditions (Herman, 1992). Third, the description of traumatic events as outside usual human experience is not accurate in describing women's experiences with intimate violence. Fourth, the diagnosis fails to acknowledge the cognitive effects of this kind of violence. People who have been untouched often maintain beliefs (or schema) about personal invulnerability, safety, trust, and intimacy, that are incom-

patible with the experience of violence (McCann and Perlman, 1990; Norris and Kaniasty, 1991).

In recent years, the notion of a battered woman syndrome has been used in a variety of legal proceedings, including criminal prosecutions of batterers, criminal prosecutions of women who have attacked their batterers, and divorce and child custody proceedings. The idea of the battered woman's syndrome developed as an attempt to explain the psychological effects of being in a battering relationship and has similarities with the PTSD conceptualization, but it is not a recognized psychiatric syndrome. Rather, it refers to the consequences of being battered as those consequences are represented in expert testimony in legal settings. The use of "battered woman syndrome" has been criticized for making those consequences of intimate partner violence for women a pathology and ignoring differences among battered women's responses to violence (e.g., Dutton, 1993, Schopp et al., 1994). Furthermore, because expert testimony about the experiences of battered women often encompasses more than just a discussion of psychological consequences, the term battered woman syndrome is misleading (Dutton, 1993).

Children in families in which the woman is battered are at risk of both physical (Walker, 1984; Straus and Gelles, 1990) and sexual abuse (Herman and Hirschman, 1981; Paveza, 1988). Even if children are not themselves abused, living in a family in which there is violence between their parents puts children at risk. These children have been found to exhibit high levels of aggressive and antisocial, as well as fearful and inhibited, behaviors (Jaffe et al., 1986a; Christopherpoulos et al., 1987). Other studies have shown that children who have experienced parental violence have more deficits in social competence (Jaffe et al., 1986b; Wolfe et al., 1986) and higher levels of depression, anxiety, and temperament problems than children in nonviolent homes (Jaffe et al., 1986b; Christopher-

poulos et al., 1987; Holden and Ritchie, 1991). Jaffe et al. (1990) also found that children exposed to family violence see violence as an acceptable and useful means of resolving conflict.

Interpreting these findings should be done with caution. Not only is there debate about what constitutes exposure to violence (e.g., actually seeing the violent acts or seeing the results of the violence), but some of the studies have methodological weaknesses. For example, samples are often drawn from among children residing in shelters for battered women. These children are under a lot of stress—beyond that of witnessing violence—related to dislocation and family crisis that may influence their behaviors and feelings. The source of the information may influence the findings; mothers report more behavior problems in children than children self-report (Sternberg et al., 1993). However, these studies suggest that children exposed to parental violence are at potential risk of emotional and behavioral difficulties that may be long lasting.

Depression, developmental problems, acute and chronic physical and mental health problems, and aggressive or delinquent behavior are characteristic of children exposed to battering. An unknown number of the 3 million children exposed to battering each year (Jaffe et al., 1990) end up in foster care. Increased costs for schools, counseling, and juvenile justice programs have not been calculated. There are also unknown long-term costs associated with young boys who are learning how to be future batterers by modeling their fathers' behavior.

Longitudinal investigations that are both labor intensive and expensive are an important way to investigate how witnessing violence between one's parents during childhood is related to violence in one's own intimate relationships during adulthood. Widely cited assertions of intergenerational relationships in intimate partner violence are based on cross-sectional studies, and the findings are open to multiple explanations, including biases inherent in self-report data. There

is evidence that longitudinal research following child victims may be needed to overcome possible problems with forgetting of childhood experiences (L. M. Williams, 1994).

Physical and sexual assaults may also affect other family members and friends, making them into secondary victims. Davis and colleagues (1995) found that rape, attempted rape, and aggravated assault of women all had negative psychological consequences on their friends, family members, and romantic partners, regardless of the victim's level of distress. Female friends and family members were more affected than male friends and family members, particularly in regard to increased fear of violent crime. Some rape victims also experience sexual dysfunction and difficulties with interpersonal relationships, both of which can have negative effects on their family relationships. Sexual dysfunction may be long lasting: Burgess and Holmstrom (1979) found that 30 percent of rape victims reported that their sexual functioning had not returned to normal as long as 6 years after the assaults.

Criminologists recognize that one social consequence of crime that affects many people beyond those who have been directly victimized is fear of crime (Hindelang et al., 1978; Skogan and Maxfield, 1981). The consequences of fear of crime are real, measurable, and potentially severe (Conklin, 1975; Skogan and Maxfield, 1981). Because women fear crime more than men (Warr, 1985; Gordon and Riger, 1989; Federal Bureau of Investigation, 1991), these consequences are disproportionately borne by women.

Women's fear of crime seems to be driven primarily by their fear of rape (Warr, 1985; Gordon and Riger, 1989; Klodawsky and Lundy, 1994; Softas-Nall et al., 1995). Women perceive rape as a very serious crime—at least as serious, if not more so, than murder (Warr, 1985; Softas-Nall et al., 1995).

The perceived risk of being raped is also high. Warr (1985) found young, urban women believed they were three times as likely to be raped as murdered and equally as likely to be raped as to suffer a less serious offense, such as theft of an auto. Similar ratings of seriousness and a high perceived risk of rape have been found in studies of women in Canada (Gomme, 1986), Great Britain (Smith, 1989), Germany (Kirchhoff and Kirchhoff, 1984), Holland (Van Dijk, 1978), and Greece (Softas-Nall et al., 1995). All these studies also found that women curtail their activities because of this fear: 42 percent of women in Warr's (1985) sample avoided going out alone (compared with only 8 percent of men), and 27 percent of women even refused to answer their door in response to fear.

Existing data give some indication of the social consequences and attendant costs of violence. Straus (1986) estimated that intrafamilial homicide cost $1.7 billion annually; Meyer (1992) calculated the medical costs and lost work productivity of domestic violence at $5 to $10 billion per year; and the Bureau of National Affairs (1990) estimated the annual cost of domestic violence to employers for health care and lost productivity at $3 to $5 billion. Though alarming, the limited data available on women victims of violence and exclusion of sexual violence from these studies suggest that these figures may significantly underestimate the economic toll of violence.

It is estimated that between 12 percent and 35 percent of women visiting emergency rooms with injuries are there because of battering (Randall, 1990; Abbott et al., 1995). Outside of emergency departments, there is practically no information on a myriad of other health costs related to battering and sexual assault, such as treatment for depression and PTSD, drug and alcohol abuse, prenatal complications, sui-

cide attempts, and other chronic physical and psychological conditions.

Estimates of the number of women who are homeless because of battering range from 27 percent (Knickman and Weitzman, 1989) to 41 percent (Bassuk and Rosenberg, 1988) to 63 percent of all homeless women (D'Ercole and Struening, 1990). In New York City, homeless shelters cost $125-130 per day per family; battered women's shelters with a variety of services cost more than $200 a day (Lucy Friedman, personal communication). But there is little information about other social service costs resulting from battering, such as the number of women and children on welfare because of abuse or the total costs of providing battered women with job training and placement, victim assistance services, and child care.

Battering and sexual assault puts an enormous burden on the criminal justice system; a study in the District of Columbia found that 22 percent of 911 calls were from victims of battering (Baker et al., 1989). Yet the full extent of costs to the courts—civil and family, as well as criminal—and law enforcement generally have not been calculated. These include costs associated with getting and enforcing orders of protection; divorce, child custody, and support proceedings; and prosecutions for assault, sexual assault, stalking, trespassing, harassment, and murder, all of which involve personnel costs for prosecutors, judges, defense lawyers, court staff, and police, among others. In addition, anecdotal evidence suggests that some battered women may be forced into performing criminal acts by their batterers (Browne, 1987).

Researchers are just beginning to look at the indirect costs of battering and sexual assault—costs that result not from using services but from reduced productivity and changes in quality of life. For example, a study by Victim Services in New York City found that 56 percent of working battered women had lost a job as a direct result of the violence, and 75

percent had been harassed while they were at work by their partners (Friedman and Couper, 1987). Resick et al. (1981) found women's work performance to suffer up to 8 months after rape. The costs of such reduced productivity or of constricted opportunity are unknown. How many women are prohibited from working by jealous partners or cannot concentrate at work because of battering or sexual assault? How many days are missed by women embarrassed to come to work with a black eye, afraid that the batterer will harass them at the office, or fearful of leaving their homes after being raped? Do partners or family members of rape victims lose time from work because of caring for injured victims or accompanying them to court?

Diminished quality of life is another unexplored indirect cost. What are the costs associated with the isolation, fear, and lack of freedom that plague the lives of battered women and their children? How many activities and opportunities do women forsake out of fear of sexual assault? What are the long-term costs to society of batterers'—and victims'—inability to parent their children? Information on the direct and indirect costs of violence against women would provide a useful guideline for evaluating the cost-effectiveness of intervention programs.

Better understanding of the causes of violence against women will be useful in designing both prevention programs and interventions with offenders. Research has begun to identify childhood precursors to later violent aggressive behavior, and criminological research has studied the progression of criminal careers. Yet little research has considered the development of violence against women and whether pathways to violence against women are similar to the development of other violent behaviors. Nor is it known if physical and sexual violence against women develop in a similar manner and what the nature and extent of the relations among them

are. Identifying precursors to violence against women may be important for early intervention and prevention efforts.

Most of the information on violence against women comes from either clinical samples or general population surveys. Clinical samples are most likely not representative of either victims or perpetrators; in general population surveys, the numbers of ethnic, racial, cultural, and other subgroups are too small for analysis. Differences among subgroups in the causes of violence against women could have important implications for prevention and intervention strategies. Subgroups about which information is lacking include racial and ethnic minorities, lesbians, migrant workers, immigrants, the homeless, the disabled, and the elderly.

Although some of the direct effects of physical and sexual violence (and psychological abuse) on individual women have been fairly well documented, understanding indirect effects to victims, the consequences to women in general, and consequences to the society as a whole is only beginning. Research suggests that women who have been victims of violence seek physicians' care not directly related to the violence nearly twice as often as other women. Some preliminary data indicate that intimate partner violence may play a role in

women's need to receive and remain on welfare. As mandatory arrest laws continue to be passed, and as more jurisdictions encourage filing charges in cases of sexual assault, the criminal justice system faces increased costs. Some research on rape has found reduced job performance for up to 8 months after an assault. There is very little information on lost productivity and reduced performance, on the job and at home, of victims of violence.