July 7, 2009
Psychiatric Times. Vol. 26 No. 7
TRAUMA AND VIOLENCE
Battered Woman Syndrome
Key Elements of a Diagnosis and Treatment Plan
Lenore E. Walker, EdD, ABPP-CL & Fam
Women who are victims of intimate-partner violence have been identified by the mental health field for more than 30 years now.1-3 It is understood that domestic violence is part of gender violence, and that many more women than men are the victims of physical, sexual, and psychological abuse.4-6Even when women strike back or engage in mutual violence, it is usually the woman who is most likely to be hurt—both physically and emotionally. Women who strike back in self-defense are often arrested along with the batterer.
It is further understood that gender violence is fostered by the socialization of men to be more powerful than women. In some men, this process creates the need to abuse power and to control women.5While the term “victim” is not always considered politically correct, in fact, until battered women take back some control over their lives, they may not truly be considered survivors.7 Psychological symptoms, called battered woman syndrome (BWS), develop in some women and make it difficult for them to regain control. Mental health professionals have been able to assist these battered women with empowerment techniques and with accurate diagnosis and proper treatment, as described here.
BATTERED WOMAN SYNDROME
BWS has been identified as a subcategory of posttraumatic stress disorder (PTSD).8 Although not all battered women meet all the DSM-IV-TR criteria for PTSD,9 a sufficient number do; thus, a form of trauma treatment is most helpful.10
Table 1 lists 6 groups of criteria that recently have been found to be part of BWS.8
A number of steps will help you obtain accurate information when you are interviewing a woman whom you believe may be abused by her intimate partner (Table 2).
Begin by speaking with the woman without her partner present (if they are still together) and together form a safety plan. This can be difficult because batterers often want to be present during the entire examination so they can directly or even subtly remind the woman not to disclose their secret. It is not uncommon to feel as if the man were in the interview—even if he is waiting outside.
For a woman in a battering relationship, the most dangerous time is when she and her partner are discussing or thinking about separation.11,12 Even if the woman is no longer living with the batterer, she may not be safe. It is important to help her feel safer by making it clear that you will not take advantage of her. The clinician can set up boundaries between himself or herself and the woman by asking her permission to touch her, to write notes, and to discuss areas of confidentiality and privilege. Individual or group therapy rather than couples therapy is recommended, at least initially.
A battered woman needs to feel validated when she describes the abuse. This can be done by emphasizing the positive things she did to protect herself and her children if they were involved. Tell her that no matter what she may have done or said, no one deserves to be abused. Be careful not to ask or even intimate that she might have done something to provoke the batterer. Such questions will not create the rapport that facilitates empowerment—nor do they create a safe space for the woman.
Most battered women have been told of their faults over and over by the batterer. They also have experienced his jealousy, overpossessiveness, and attempts to isolate them from significant friends or family. They may need education about the impact of abuse on their physical as well as mental health.13
Therapy should emphasize the woman’s strengths so that she trusts herself and others again. Naming her a battered woman with BWS may help her accept that she is not “crazy” (as the batterer predicted her doctor would find).
Risk and assessment
It is important to do a risk assessment while also completing a mental status examination. Some battered women have other disorders in addition to PTSD and BWS.7,8,13
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