Psychiatric Annals

CME Article 

Assessment of Intimate Partner Violence and the Battered Woman Syndrome

Cheryl Paradis, PsyD

Abstract

Forensic experts are often retained to conduct an evaluation of the mental state at the time of the offense of women charged with assaulting or killing spouses or partners. Many of these women report histories of intimate partner violence and a cluster of psychiatric/psychological symptoms that researchers have termed the battered woman syndrome (BWS). The clinical picture is similar to posttraumatic stress disorder. Expert testimony on BWS has become more accepted in the legal system during the past 30 years. Testimony can be mitigating and, at times, sufficient for the trier of fact to conclude that the defendant acted in self-defense. This article reviews research on BWS and describes the forensic expert's role in these cases. In addition to assessing mental state at the time of the offense, the expert often dispels myths associated with BWS and describes how each defendant did or did not fit the stereotype of the battered woman. [Psychiatr Ann. 2017;47(12):593–597.]

Abstract

Forensic experts are often retained to conduct an evaluation of the mental state at the time of the offense of women charged with assaulting or killing spouses or partners. Many of these women report histories of intimate partner violence and a cluster of psychiatric/psychological symptoms that researchers have termed the battered woman syndrome (BWS). The clinical picture is similar to posttraumatic stress disorder. Expert testimony on BWS has become more accepted in the legal system during the past 30 years. Testimony can be mitigating and, at times, sufficient for the trier of fact to conclude that the defendant acted in self-defense. This article reviews research on BWS and describes the forensic expert's role in these cases. In addition to assessing mental state at the time of the offense, the expert often dispels myths associated with BWS and describes how each defendant did or did not fit the stereotype of the battered woman. [Psychiatr Ann. 2017;47(12):593–597.]

Battered woman syndrome (BWS) is not classified as a psychiatric illness, but it is considered a cluster of depressive and anxiety symptoms that are closely related to posttraumatic stress disorder. BWS results from exposure to severe and ongoing abuse by a spouse or partner. Women with BWS typically experience heightened arousal and fear; many experience distorted thinking. Their fears, however, are often realistic, as many female murder victims are killed by their spouses or partners. When women kill their partners, it often occurs in the context of domestic violence. Some women who kill their abusive partners use a self-defense strategy, whereas others raise the BWS defense or present mitigating psychological testimony. This article reviews the relevant research, presents an illustrative case, and describes how forensic experts conduct these evaluations.

Illustrative Case

The defendant was 26 years old when she emigrated to the United States from China to complete her graduate studies. Within 1 year, she had married a man who had also emigrated to the US. She was in the eighth month of her pregnancy when she killed him. Her attorney hired a psychiatric expert who evaluated her and concluded that she suffered from battered woman syndrome (BWS) and, due to mental disease or defect, was not legally responsible for killing her husband. In some jurisdictions this defense is equated with the insanity defense.

I was retained by the prosecutor to conduct an independent examination of the defendant. She stated that she initially ignored the warning signs of her husband's jealousy and possessiveness. After the first few times he hit her, he apologized, begged forgiveness, and promised to change. She reported that the beatings became more frequent after she became pregnant and that he controlled and isolated her by monitoring her schedule and forbidding contact with friends. During her pregnancy she became increasingly depressed and suicidal. On the night she killed him, he reportedly threatened her with a knife and her parents if she allowed them to visit after the birth. After he went to sleep she felt frightened and hopeless, convinced there was no way to protect herself, her parents, or her unborn child. She saw the knife at their bedside and a hammer near the newly assembled crib. She hit her husband with the hammer while he was asleep and then stabbed him twice before cutting her own wrists. She thought: “I wanted all of us to die. It would be more peaceful to be dead.” She called 911and an ambulance brought her to the emergency department where her son was delivered by cesarean section.

After my evaluation I agreed with the defense expert that the defendant suffered with BWS. However, I did not believe that she suffered from symptoms of psychosis at the time of the offense, and thus did not agree with the defense's expert that she was not legally responsible. Instead, I concluded that she acted in a state of high emotion rather than in a calculated manner. After reading my report the prosecutor offered a plea deal that she accepted. She was released with time served and an agreement that she and the baby immediately return to China.

Intimate Partner Violence: Prevalence and Barriers to Reporting

Studies have found that women commit approximately 10% to 15% of homicides in America and that spouses/partners are the victims in the great majority of those cases.1 These cases typically involve intimate partner violence (IPV).1–4 In this article, the term “spouse” or “partner” is used for couples who were legally married, common law married, or long-term domestic partners.

Walker4 describes a battered woman as “a woman who is repeatedly subjected to any forceful physical or psychological behavior by a man in order to coerce her to do something he wants her to do without any concern for her rights.” Research findings estimate that 25% to 50% of women are abused at some point in their lives and that the severity of IPV and the risk of being killed increase when women try to leave their abusive partners.1–9 Studies show that most women killed by their spouses were victims of IPV.10,11

Although the reported lifetime rates of IPV vary by country and among racial/ethnic groups, IPV is a worldwide phenomenon found in every ethnic, national, and socioeconomic group. The cultural roles of women within various communities are associated with the prevalence of IPV. For example, higher rates of IPV are found in patriarchal cultures where coercive power is used to control women and promote male dominance. Although rates of IPV vary among different communities, researchers are clear that it would be a mistake to conclude that domestic violence is accepted in any ethnic or racial group. They stress the importance of examining cultural influences, particularly structures of power/gendered violence, while rejecting stereotyping and xenophobia.5,7,8,11–14

IPV is endemic to all cultures, and can be found in all relationship structures. However, people who face additional institutional and social barriers may find it harder to leave relationships. The more marginalized identities a person occupies, the more difficult it will be to access the resources (financial and social) necessary to escape an abusive relationship. As an example, all women face the institutional barrier of long waiting lists at shelters. Transgender women, however, are often denied entry to many of these shelters, drastically slashing the resources available to them.15

Published rates likely misrepresent the extent of IPV. The filing of police reports and other help-seeking behaviors are often influenced by socioeconomic status, ethnic/racial background, cultural factors, immigration status, and sexual identity.3,7 Immigrant women, such as in the Illustrative Case in this article, face unique barriers in reporting battering and leaving an abusive relationship. The batterer can threaten to have her deported. Lack of English proficiency can further impede her access to, let alone awareness of, available services for battered women. Studies also show that immigrant women who are battered and who lack fluency in English are less likely to contact the police.16,17 Many battered women have also been raised to value a strong commitment to marriage and place the integrity of the family as the primary concern, above their own health and welfare; moreover, they may view IPV as a private matter between a husband and wife.7,18

Battered Woman Syndrome

Although some women remain in a violent domestic relationship due to realistic concerns about safety, others do not leave their abusive spouses because they have developed serious psychological problems from the abuse. This pattern of psychological symptoms and behaviors is known as BWS. A syndrome is not a psychiatric diagnosis but instead is a cluster of identifiable features or symptoms. There is some controversy about the term BWS, primarily because women experience such diverse psychological reactions to IPV that it does not perfectly fit the definition of a syndrome. However, because BWS is the term most recognized by the public and court systems, it will be used in this article; however, the reader should be mindful that each woman has a unique history and presentation.

The psychologist Lenore Walker4,8 pioneered the study of the psychological effects of IPV and coined the term BWS. Walker described a three-phase cycle. First is the tension-building phase that is followed by an acute battering incident. This is followed by a loving contrition or absence of threat phase. During the last phase, also referred to as the “honeymoon phase,” the batterer often expresses remorse and promises never to be violent again. According to Walker, the woman often believes or hopes her partner will change, at least at the beginning of their relationship. The abuse can escalate over the years to the point that the woman typically feels powerless or trapped.4,8

It is a myth that every battered woman experiences all three of the phases described by Walker.9,13,19 Walker noted that, in the most violent relationships, the last phase, when the fear or danger subsides, may no longer exist. Walker reported that all three phases were present in only approximately one-third of the cases she investigated.9,13

Walker4 and other researchers6–9 in the field of IPV have identified that symptoms associated with the BWS are similar to those of posttraumatic stress disorder: anxiety, depression, sleep disturbances, nightmares, hyperarousal, hypervigilance, and psychological numbness. Women suffering more severe abuse develop greater degrees of psychological disturbance and some attempt suicide.6,9,13

Women with BWS often experience distorted thinking; they may believe the abuse is their own fault or perceive the abuser as all powerful. Researchers have used the behavioral research paradigms of “learned helplessness” and the Stockholm syndrome to understand conditions under which women come to view themselves as powerless and unable to escape abuse, even concluding that whatever they might do will not help and that their best chance of survival is to placate the abusers.9,20,21 In Stockholm syndrome, a dependent relationship arises in extended hostage situations, during which time some hostages develop a pathological bond with their hostage taker(s).22 There are limitations to these paradigms because they perpetuate a myth that battered women are inherently passive or helpless, when, in fact, many battered women use a number of survival skills and active coping strategies to protect themselves and their children.

Although most victims of IPV never react violently, Huss et al.23 estimate that each year more than 1,000 women kill their partners. Literature indicates that the majority of these cases occur during an acute battering incident.24 Browne5 reported that, in the majority of cases in which the women claimed to have BWS, the homicides took place during acute battering incidents or confrontations. It is in these situations that claims of self-defense are most often successful as jurors accept that these women required the use of lethal force to protect themselves or their children. In cases where women assaulted or killed a sleeping spouse or during occasions absent of direct threat, their actions do not neatly fit the self-defense paradigm. In these cases, they may use the BWS defense.

Expert testimony on BWS has become more widely accepted in courts during the past 30 years, even as some have described the BWS defense as imperfect.25,26 When an expert describes the defendant's mental state at the time of the instant offense, it can be sufficient for the trier of fact to conclude that she acted in self-defense. At other times, mitigating testimony can result in a lighter sentence and a conviction of manslaughter rather than murder. Research shows that defendants are more likely to be given more lenient sentences when psychiatric and psychological testimony is introduced.2 Wells27 found that among 200 women charged with killing their partners, 46 were acquitted, 98 were found guilty of manslaughter, and 38 were convicted of murder.

Forensic Assessment and Expert Testimony

The expert's role is to conduct a thorough examination to determine whether the defendant meets the criteria for BWS and assess her mental state at the time of the offense. Whether retained by the prosecution, the defense, or the court, the evaluation typically involves four steps: (1) determine whether there is evidence of domestic abuse, (2) assess whether the defendant developed BWS or symptoms of any psychiatric illness, (3) reach a conclusion about the defendant's mental state at the time of the offense, and (4) communicate the findings to the referring attorney or court personnel.

Because a woman can kill for reasons other than IPV (eg, financial, child custody, retaliation), the psychiatrist or psychologist first determines whether there is evidence of domestic abuse. It is important to examine collateral sources (eg, hospital and police records) and interview family members or other witnesses. Records often provide documentation of any history of physical injuries. In addition to reviewing records, the expert conducts in-depth interviews, not only to gather psychosocial information, but also to learn about the defendant's abuse history. It is not uncommon to encounter women who have suffered complex trauma, including childhood abuse, sexual assault, or sex trafficking.28

The expert must examine issues related to power imbalances, including financial, psychological, and physical aspects. Important questions to ask and answer include (1) Did the abuser have control over all financial resources? (2) Did the abuser exert psychological control in the relationship through intrusiveness, over-possessiveness, jealousy, or the use of isolation from supportive others? (3) Were threats of harm made, either direct or implied? (4) Was there a size and physical strength differential between the abuser and the defendant?

If the expert concludes that the defendant was the victim of IPV, the next step is to determine whether the defendant has symptoms of BWS or meets diagnostic criteria for other disorders (eg, depression, PTSD, other trauma-related disorders). It is important to keep in mind that although many women struggle with serious emotional problems stemming from the abuse, not all develop the pattern of psychological symptoms and behaviors that accompany BWS. Women differ in their resilience and ability to cope with IPV. In addition to completing a full psychosocial history and mental status examination, experts may administer psychological tests to assess personality and to rule out feigning or malingering.

The third step is the assessment of the defendant's state of mind at the time of the offense. In this phase, the expert seeks to address the following questions. (1) Did the defendant honestly believe the threat was imminent? (2) Were her beliefs reasonable, taking into account her psychological functioning and history of abuse? (3) Did she believe the force she used was necessary to protect herself or her family from death or serious bodily injury? (4) Was the abuse increasing in frequency or severity, such that it was reasonable for her to believe she or her family were genuinely in danger? (5) Had the abuser used a weapon before? (6) Was there a weapon in the house and, if so, was it easily accessible to the abuser? These questions are more easily resolved if the assault or killing took place during an acute battering incident. The case becomes more complex if the offense occurred during a nonconfrontational period of time.

After completing the evaluation, the expert communicates his or her findings to the court (or defense attorney or prosecutor). The expert may then be asked to prepare a report or to testify about the findings in court. When describing the circumstances of the specific case, the expert is often the best person to help tell the woman's story. For those with a history of complex trauma, the expert is well positioned to educate court personnel about the history and impact of abuse prior to, or outside, the relationship with the current abusive partner with descriptions of how her thoughts and behaviors either fit, or did not fit, with BWS and how she perceived the threat from the abusive spouse.

The publicity from high-profile court cases and the portrayal of the battered woman in films have raised awareness of IPV but have also created a stereotype and myths about BWS. The stereotype is of a physically frail, defenseless, heterosexual white woman. She is expected to be passive and totally dependent (emotionally, financially) on her abuser.5,6,27,28 Schneider29 wrote about the “implicit but powerful view that battered women are all the same, that they are suffering from a psychological disability and this disability prevents them from acting normally.” Research shows that many laypersons agree with several myths, including that battered women are masochistic, emotionally disabled, partially responsible for the abuse, and could “simply leave” the situation.3,6,9,23,30 From an educative standpoint, the expert can explain the defendant's perception of her alternatives, and can also provide testimony that sheds light on the particular facts in a given case in relation to the data about prevalence of IPV that can address the various myths associated with BWS.

Another common myth is that a battered woman could easily escape her abuser. The expert dispels this myth by explaining the unique barriers each defendant faces. Barriers include lack of financial resources, isolation from supportive people, and concerns that her abusive partner could hurt others (eg, children, pets). Those who do leave often face real financial consequences, particularly if they do not work or have no other means of financial support, a situation that could lead to homelessness.26

The expert needs to explain the defendant's perceptions of her alternatives. She may have believed she would be severely beaten or killed if she tried to leave or succeeded in escaping.3,2,5,6 Many women rightly believe that orders of protection do not provide full or reliable protection. Research has shown that much IPV occurs after the battered woman leaves.31 Leaving an abusive relationship is fraught with potential negative consequences, such as retaliatory violence against her or her children, loss of home, loss of financial support, and/or loss of custody of her children.

Another myth is that IPV affects mostly poor women. When assessing wealthy or professional women defendants, the expert has an opportunity to address the particular barriers they face. Wealthier woman may live in communities that provide many benefits but may lack immediate access to the resources (eg, anonymous shelters for battered women and their children) all women facing IPV need. Moreover, a working woman's financial capacities may become a great source of tension, with her batterer blaming her professional successes for trouble in the marital relationship. Working women who have experienced IPV report that they fear disclosure of abuse will jeopardize hiring and advancement while experiencing their abusive partners' threats exerted in an effort to control, or even sabotage, their careers. Wealthy abusive spouses can also hide assets or hire attorneys to wage custody or other legal battles.32

Other groups of abused women also face unique barriers. For gay or transgender women, there remain additional concerns about how reports of IPV are handled by the police and adjudicated by court systems. They may even fear that their abusers would “out” them to their family or coworkers. Undocumented immigrants who are battered often fear that reporting IPV to the police could lead to their being deported.

Conclusions and Other Considerations

During the past 30 years, our broad understanding of IPV and BWS has evolved considerably. Today, experts are less likely to describe the defendants as primarily mentally ill and instead should focus on how the defendant was adversely impacted by IPV. The forensic expert is uniquely qualified to describe the relationship between history of abuse and the development of symptoms and behaviors consistent with BWS. Furthermore, the expert can offer in-depth explanations about a defendant's mental state at the time of the offense to provide the triers of fact with a nuanced context for judging the reasonableness of the resulting violent offenses.

Because defendants with BWS do not present in an identical manner, the expert must also emphasize that defendants do not fit neatly into standardized composites of IPV victims. Some experts have recommended not using the term BWS, or the term “learned helplessness,” because the terminology is viewed as a contributor to the stereotypes and myths associated with the battered woman. However, BWS continues to be recognized in most jurisdictions as a legal defense.

Most of the writings on the role of forensic experts in cases of IPV and BWS focus on defendants charged with assaulting or killing their abusive partners. It is important to note, however, that these issues also emerge in other forensic settings, including criminal (eg, child abuse, duress) and civil cases (eg, child custody, divorce).

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Authors

Cheryl Paradis, PsyD, is a Clinical Associate Professor, State University of New York, Downstate Medical Center; and a Professor, Marymount Manhattan College.

Address correspondence to Cheryl Paradis, PsyD, PO Box 050-145, Pratt Station, Brooklyn, NY 11205; email: cherylparadis1@gmail.com.

Disclosure: The author has no relevant financial relationships to disclose.

10.3928/00485713-20171107-01

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