Victimization and Help-Seeking Among Survivors of Intimate Partner Violence

Intimate partner violence (IPV)¹ is commonly defined as a pattern of physical, psychological, emotional, and/or sexual abuse between two current or former spouses, ex-spouses, and couples with a child in common.² A number of states also include current or former dating partners in their legal definitions of IPV (Gover 2011). Recent research published by the Centers for Disease Control and Prevention (CDC) suggests that one in four women experience severe physical abuse at the hands of their intimate partner during their lifetime (Black et al. 2011). In addition to the immediate physical injuries suffered by survivors, long-term physiological consequences include migraines, neck and back pain, impaired vision and hearing, insomnia, hyperventilation, gastrointestinal symptoms, and pelvic pain (Campbell 2002). Attempts to end violent relationships may force victims to choose between living with violence or dissolving the relationship and facing possible homelessness (Baker, Cook, and Norris 2003). Given the prevalence of IPV, as well as its impact on individual victims and society as a whole, IPV is considered a violation of human rights and a public health priority (Velzeboer et al. 2003).

The first step to escaping IPV often involves help seeking, whether from formal sources of support such as police or other representatives of the criminal justice system, lawyers, medical or mental health professionals, or social services (Amar and Gennaro 2005; Amar, Bess, and Stockbridge 2010; Ashley, Silber, and Foshee 2005; Fisher et al. 2003; Fugate et al. 2005) or informal sources of support, including friends, family, or religious leaders (Sabina, Cuevas, and Schally 2013). Help-seeking is often a process that begins with a victim’s resistance to disclose, particularly to formal systems, followed by a number of incidents or a particularly egregious incident that triggers victims to pursue assistance (Fugate et al. 2005). However, multiple factors influence this process, including the severity of violence, whether the victim and perpetrator are married, and the victim’s economic independence, fear of retaliation, parental status, and level of marginalization from formal sources of support, such as for those lacking legal immigration status (Abraham 2000; Goodman, Bennett, and Dutton 1999; Hutchison and Hirschel 1998; Krishnan, Hilbert, and VanLeeuwen 2001; Raj and Silverman 2002; Wolf et al. 2003). The multitude of factors that hinder help-seeking complicates not only estimates of help-seeking among victims and theoretical explanations of this phenomenon, but also the capacity to develop policies and programs responsive to the needs of those contemplating disclosing IPV (Fanslow and Robinson 2010). Thus, the purpose of the following discussion is to review the literature on help-seeking among survivors of intimate partner violence, including dating violence and stalking; offer a synthesis of the information documented in prior research; and identify gaps in the current literature that may be areas for future research and policy attention.

This essay on help-seeking behaviors among victims of IPV is organized into five sections. Section I provides an overview of the incidence of help-seeking behavior as well as the formal and informal outlets IPV survivors elect to contact for assistance. Theoretical explanations of help-seeking behaviors comprise Section II, whereas Section III discusses factors associated with the decision to seek help. Conversely, Section IV describes the reasons underlying decisions not to disclose IPV victimization. Last, the positive and negative outcomes of help-seeking are considered in Section V.

Help-seeking by IPV victims and survivors is defined as a range of behaviors from seeking advice and support from friends, obtaining counseling and/or medical care, calling law enforcement, moving to a domestic violence shelter, pursuing an order of protection, or initiating a legal separation or divorce from the batterer. Incidence estimates of help-seeking among victims of IPV vary depending on sample selection (Shannon et al. 2006). However, prior research consistently demonstrates a preference for informal support providers over formal support providers regardless of victim characteristics such as race/ethnicity and age (Barrett and St. Pierre 2011; Du Mont et al. 2005; Fraser et al. 2002; Ocampo, Shelley, and Jaycox 2007).

For example, Barrett and St. Pierre (2011) examined sources of help-seeking among a large sample of female IPV survivors in Canada (N = 922). Consistent with other research, women preferentially sought help from informal sources of support over formal systems of support. Eighty percent of the sample reported engaging in at least one form of informal help-seeking, and 66 percent reported at least one form of formal help-seeking. Among those using informal strategies of help-seeking, women most frequently disclosed the abuse to friends or neighbors (68 percent), followed by family members (67 percent), and co-workers (28 percent) (Barrett and St. Pierre 2011). Formal help-seeking most commonly involved counselors (39 percent), talking with a doctor or nurse (32 percent), and contacting a crisis line or center (17 percent). Du Mont et al. (2005) examined changes in help seeking over time and documented an upward trend, such that victims were significantly more likely to disclose their victimization to a friend, neighbor, family member, medical professional, and/or religious leader in 1999 (81 percent) than in 1993 (73 percent). The proportion of victims of IPV seeking help from formal service providers increased even more dramatically between 1993 (25 percent) and 1999 (49 percent) (Du Mont et al. 2005). The greatest change in help-seeking from formal sources of support occurred regarding crisis lines or centers (4 percent in 1993 vs. 17 percent in 1999) and community or family centers (5 percent in 1993 vs. 15 percent in 1999). The authors credited the Canadian federal initiatives on family violence and gender equality implemented during the 1990s for the increase in disclosures and help-seeking behaviors among victims of IPV (Du Mont et al. 2005).

Some research specifically examines help-seeking behaviors among racial or ethnic groups that may be marginalized from support systems. Sabina, Cuevas, and Shally (2012) assessed a national sample of women who identified as Latina or Hispanic regarding their help-seeking behaviors for IPV. Seventy-seven percent sought assistance, primarily from informal sources of support (69 percent), although one-third additionally contacted formal sources of support (Sabina et al. 2012). Parents (27 percent) represented the most common source of informal support, whereas medical professionals (35 percent) comprised the most contacted form of formal source support (Sabina et al. 2012). Bui (2003) examined help-seeking behaviors among a sample of Vietnamese-American survivors of IPV. Most women initially contacted friends and/or family for support. Sixty-five percent sought police assistance, and half sought help from women’s shelters, victim advocates, legal and healthcare professionals, and/or refugee support programs (Bui 2003). Agencies with Vietnamese-speaking staff were targeted because most women required interpretation services and legal advice to navigate the complicated criminal justice system processes of serving as witnesses in court, filing a protective order, and initiating divorce proceedings and/or child custody and support agreements (Bui 2003). Latina, Hispanic, and Vietnamese survivors of IPV are less likely than survivors in the general population to seek help from informal and formal sources. However, the help-seeking patterns are the same. Latina, Hispanic, and Vietnamese survivors of IPV are more likely to seek help from informal sources initially than from formal sources.

In addition to race and ethnicity, age is an important factor to consider when examining IPV victim help-seeking behavior. Adolescents may be even less likely to seek help for dating violence than are adults. Ashley et al. (2005) determined that only 40 percent of teens reached out for assistance regarding victimization by dating violence, mostly from friends and family members. Consistent with Watson et al.’s (2001) findings that fewer than 1 in 10 adolescent IPV victims contact formal support systems, Ashley et al. (2005) found that few contacted formal sources of support, such as school counselors (13 percent), police (13 percent), teachers (12 percent), or crisis lines (12 percent).

The literature on IPV and help-seeking primarily describes the type of help-seeking behavior and factors related to help-seeking. Comparatively few researchers have investigated help-seeking from a theoretical perspective (Hirschel and Hutchison 2003; Liang et al. 2005). However, among theoretical conceptualizations of help-seeking behaviors, three general typologies emerge: psychological response, process, and sociocultural models.

Lenore Walker’s (1979)  battered woman syndrome emerges as the first major psychological response theory addressing IPV and help-seeking (Burgess-Proctor 2012). Walker’s (1979) theory confronted the cultural portrayal of battered women as individuals choosing to remain in violent relationships, and thus accountable for provoking and accepting the violence. Walker’s (1979) concept of learned helplessness explained that the trauma resulting from prolonged exposure to IPV triggers a psychological state of paralysis and belief that the abuse is insurmountable and help-seeking is futile. Battered woman syndrome theory inspired dialogues dissecting cultural stereotypes of IPV and the development of a field of research investigating the experiences of battered women. Nonetheless, some criticized Walker’s (1979) theory as pathologizing victims and contributing to tropes of battered women as irrational and submissive (Gondolf and Fisher 1988; Grigsby and Hartman 1997). Furthermore, some research documenting help-seeking behaviors and IPV contradicts the predictions of learned helplessness (Pagelow 1981). For example, Gondolf and Fisher’s (1988) “survivor” model countered the assumptions of battered woman syndrome through demonstrating that, in a sample of more than 6,000 domestic violence shelter inhabitants, women actively resist IPV and respond to escalating violence through increasing help-seeking efforts. Thus, under a “survivor” perspective, victims remain in violent relationships due to inadequate resources for help-seeking or “system failure,” rather than passivity and helplessness (Gondolf and Fisher 1988).

Process models focus on describing the nonlinear sequence of internal and external reactions to victimization and consider help-seeking a process rather than a discrete incident. Internal reactions of self-blame, shame, and fears of retaliation; negative judgment; loss of child custody; and homelessness may influence external behavioral reactions to victimization (Lutenbacher, Cohen, and Mitzel 2003; Peckover 2003), such as attempts to manage partner violence, informal and formal help-seeking, and ending and reinitiating the abusive relationship multiple times (Liang et al. 2005). Consistent with Gondolf and Fisher (1988), Merritt-Gray and Wuest’s (1995)  reclaiming-self theory emphasizes victims’ active resistance throughout the process of relationship termination and disagrees with the understanding that violence creates learned helplessness and acceptance. One of the most widely recognized models of IPV help-seeking conceptualizes responses to stigmatizing experiences such as IPV as the culmination of a three-stage cognitive process (Liang et al. 2005). This cognitive theory involves first defining relationship behaviors as abusive, deciding to disclose the abuse and obtain assistance, and selecting a target for disclosure and help-seeking (Liang et al. 2005). Despite the fact that three separate stages are identified, Liang et al. (2005) described the process as nonlinear and, in some cases, even bidirectional, in which each stage can shape and inform the others. Each stage in the cognitive process may additionally be influenced by individual, interpersonal, and sociocultural factors. For example, cognitive distortions such as victim blaming may emerge individually as a result of abuser manipulations, interpersonally through negative reactions to disclosures, and socioculturally in settings that reinforce the privacy of domestic spheres (Liang et al. 2005). Such distortions can emerge as barriers to help-seeking in each stage of the cognitive process and influence the feedback loops between help-seeking stages (Liang et al. 2005).

Other process models describe the decision making and cognition underlying help seeking in greater depth. Process models based on rational choice understand victims as “rational” and “thoughtful” decision makers, in whom the costs and benefits of disclosing victimization are weighed (e.g., the degree to which the type of crime is consistently penalized vs. the likelihood that the victim will be blamed or protected) and then a decision is made. Although many rational choice applications examine offending behavior, and to some extent formal and informal sanctions, fewer consider the cost-benefit analysis characterizing victim behavior (Kingsnorth and MacIntosh 2004). However, several exceptions exist in the literature. Choice and Lamke (1997) proposed a rational choice model that isolated two primary questions for victims who were considering ending a violent relationship: “Will I be better off?” and “Can I do it?” Such questions represent the weighting of the perceived costs and benefits of ending a violent relationship with a loved one and/or co-parent alongside a rational consideration of one’s access to resources required for sustainable independence (Choice and Lamke 1997).

Kingsnorth and MacIntosh (2004) argue that rational choice theory benefits understandings of victim help-seeking behaviors because it suggests that cost-benefit analyses may differ at each locus of decision-making in formal help-seeking, consistent with observations that victim willingness to serve as a witness for the state often waivers across processing points—from police contact, arrest, and prosecution (Kingsnorth and MacIntosh 2004). Kingsnorth and MacIntosh (2004) applied rational choice theory to a victim reporting analysis of more than 5,000 domestic violence cases processed by the Sacramento County District Attorney’s Office over a period of six months. Multivariate logit regression revealed that white men and women were more likely to support arrest and prosecution than were African-American victims of IPV, consistent with the expectation that white victims may estimate greater benefits of formal help-seeking than African-American victims due to the distrust engendered by the overrepresentation of African Americans in the criminal justice system. Other significant factors included victim sex and suspect history of IPV, supporting rational choice expectations that a criminal history increases victim risk calculations, and that, in general, male perpetrators pose greater risk to victims than do female perpetrators of IPV. Victim cohabitation with suspects appeared to decrease benefit estimates of supporting prosecution, potentially based on fears of retaliation or economic risk. Conversely, the presence of children increased support for prosecution, possibly reflecting the risks of child endangerment posed by suspects (Kingsnorth and MacIntosh 2004).

Despite the successes of psychological response and process models in explaining help-seeking behaviors, critics view these models as insufficient explanations with respect to cultural and structural variables (Burgess-Proctor 2012). Overstreet and Quinn’s (2013)  IPV stigmatization model considers three elements of “stigma” and their relationships to the decision to seek assistance regarding violent relationships. Stigma occurs when a group of people with minimal societal power are differentiated and negatively stereotyped, thus leading to discrimination (Link and Phelan 2001). Cultural stigma manifests in messages suggesting that victims of IPV are responsible for provoking or accepting their victimization. When individuals identify negative stereotypes about victims of IPV as accurate, stigma internalization occurs. Last, anticipated stigma is the fear of the outcome of disclosure (Overstreet and Quinn 2013). The IPV stigmatization model proposes that greater cultural stigma increases internalized and anticipated stigma and decreases the likelihood of help-seeking. A review of 16 mostly qualitative articles on IPV and help-seeking behaviors revealed support for the IPV stigmatization model (Overstreet and Quinn 2013). Anticipated stigma, internalized stigma, and cultural stigma acted as barriers to formal and informal help-seeking in each stage of the help-seeking process. The authors suggest future research should examine the impact of stigma on help-seeking through quantitative analyses, a consideration of nonverbal factors influencing anticipated stigma and the social contexts affecting stigma internalization, and an assessment of the consequences of remaining a “closeted” victim of IPV (Overstreet and Quinn 2013).

Moe (2007) interpreted battered women’s help-seeking behaviors through applying Ptacek’s (1999) concept of “social entrapment.” Ptacek (1999) proposed that methods of coercive control used by batterers in combination with unsupportive community networks and inadequate criminal justice, social service, and healthcare system responses to IPV result in the social entrapment of women in violent relationships. Moe’s (2007) qualitative interviews with domestic violence shelter residents revealed that social entrapment interfered with help-seeking, with the combination of abuser tactics and inadequate responses to formal and informal help-seeking resulting in victim self-blame and a return to the abusive relationship. Both stigma and social entrapment models of help-seeking connect to another subset of perspectives known as the “barriers” or ecological models.

The “barrier model” suggests that victims of IPV confront four types of barriers, conceptualized by four types of concentric circles (Grisby and Hartman 1997). The first circle, representing barriers most immediate to victims, comprises trauma history or experiences of childhood abuse and/or neglect. The next concentric circle symbolizes barriers stemming from the psychological impact of IPV, followed by a circle signifying family and social role expectations that prioritize family preservation and victim responsibility for their abuser’s violence (Grisby and Hartman 1997). The outermost circle represents environmental barriers to help-seeking and relationship dissolution, such as a lack of financial resource, alternative housing, and adequate formal and informal support systems (Grisby and Hartman 1997). Similarly, Kennedy et al. (2012) constructed a model of help-seeking among female victims of sexual and physical abuse that considers factors such as cumulative victimization and trauma, stressors co-occurring with IPV victimization, and social location (i.e., the experience of social identities linked with economic opportunity, violent victimization, chronic stressors, and health disparities such as socioeconomic status, race/ethnicity, and gender/sex) (Kennedy et al. 2012). In addition, the model integrates a life course approach that considers developmental trajectories and role transitions, such as marriage or parenthood (Kennedy et al. 2012). Kennedy et al.’s (2012) model is unique in that it emphasizes the attainment of needed assistance and support rather than focusing on barriers to/and processes of help-seeking.

More recently, Burgess-Proctor (2012) extended the feminist pathways model to explain help-seeking behaviors among women and girls in violent intimate relationships. A pathways approach considers a history of victimization as a risk factor for later offending and considers developmental stages, in combination with individual, cultural, and structural factors, that impact help-seeking decision making (Burgess-Proctor 2012). Interviews conducted with more than 20 women across two states found that victimization experiences in childhood both inhibited and promoted help-seeking behaviors with respect to later relationships violence (Burgess-Proctor 2012). Specifically, childhood victimization experiences inhibited help-seeking by creating an expectation of abuse, lowering one’s self-worth, prompting withdrawal, engendering learned silence, and by promoting attachment to one’s abusive partner. Conversely, childhood victimization experiences were also found to promote help-seeking by encouraging boundary drawing, fostering a “fighter” mentality, and inspiring a determination to end the cycle of violence (Burgess-Proctor 2012).

Research suggests that the decision to pursue or reject help-seeking for IPV is influenced by a number of individual, cultural, and institutional factors, such as patriarchy, poverty, and racial or ethnic discrimination (Moe 2007). Specifically, studies indicate that gender, socioeconomic status, education, age, ethnicity, and immigration status appear to influence the decision to seek help and/or access systems of support for those in violent intimate relationships at least at some times, under some circumstances.

For example, gender inconsistently relates to help-seeking behaviors with respect to dating violence. Ashley et al. (2005) determined that gender, race, and age did not vary between adolescent IPV victims who sought help and those who did not; however, among victims of dating violence who sought assistance, males (63 percent) contacted formal sources of support more frequently than females (34 percent) (Ashley et al. 2005). Black et al. (2008) found female high school students more likely than males (78 percent vs. 52 percent, respectively) to reach out to friends regarding experiences with dating violence victimization, consistent with Watson et al.’s (2001) study findings. Love and Richards (2013) examined focus groups of male and female (mostly) African-American adolescents regarding their perceptions of IPV among their peers, as well as their help-seeking behavior. Findings demonstrated stark gender differences in help-seeking behavior among adolescents. Results indicated that most male participants would not tell anyone if they experienced IPV, with male adolescents citing that they would need to solve the problem on their own. Conversely, the majority of female participants reported that they would disclose IPV victimization. The majority of female participants cited that they would seek help from informal support providers such as a close friend, sister, or their mother. When participants were asked about disclosing to formal support providers such as teachers, school counselors, and Student Resource Officers (SROs) about IPV, no participants indicated that they would disclose to a SRO and very few indicated that they would disclose to a school counselor or a teacher.

Unsurprisingly, factors related to independence and self-sufficiency, such as education, employment, income, and age, are associated with help-seeking behaviors in the literature. These factors relate to the understanding that “marital dependency” or economic dependence on one’s abuser diminishes the likelihood of victims of IPV seeking help or ending the relationship (Kaukinen et al. 2013). Baker et al. (2003) investigated predictors of help-seeking informal support systems, finding that women contacting welfare and shelters systems had lower incomes and more children than did those who engaged the solicitor’s office to file a temporary protection order. Conversely, women pursuing support from shelters and the solicitor’s office were older and had higher levels of education than those seeking assistance from welfare systems (Baker et al. 2003). Conversely, Beaulaurier et al. (2005) documented barriers to help-seeking specific to middle age. One hundred and thirty-four women aged 45 and older indicated that feelings of self-blame, powerlessness, hopelessness, family protectiveness, and secrecy deterred them from seeking help. Beaulaurier et al. (2005) suggested that middle-aged and older women might be particularly protective of and dependent on family preservation.

Kaukinen, Meyer and Akers (2013) examined a nationally representative Canadian sample to determine whether women in “status compatible” relationships, with education levels, employment status, and income equivalent to or surpassing that of their abusive partners, were more likely to seek help than those without status compatibility. Results indicated that women in status-compatible relationships were more likely to contact family, friends, police, and health services regarding the violence than were women whose partner’s status exceeded their own (Kaukinen et al. 2013). However, contrary to the status compatibility perspective, higher incomes depressed the odds of women contacting health, social service, and legal support systems. Kaukinen et al. (2013) speculated that higher income women may confront greater professional sanctions for disclosing IPV victimization than lower income women.

Women of color in violent relationships often report confronting unique barriers, including culturally insensitive and inaccessible support systems and social isolation (Barnett 2001; Barret and St. Pierre 2011). Racialized poverty may serve to particularly isolate African-American and Latino/Hispanic women from access to medical and mental health services compared to white women (Vega and Alegría 2001). Lipsky et al. (2006) examined differences in formal help-seeking behaviors among Hispanic, non-Hispanic black, and non-Hispanic white women. Both non-Hispanic white and African-American women sought housing assistance services and/or visited hospital emergency departments with greater frequency than did Hispanic women (Lipsky et al. 2006). Police contact was similar among white and Hispanic victims of IPV, and less than that of non-Hispanic African-American women (Lipsky et al. 2006). Higher levels of acculturation predicted greater social services and healthcare help-seeking behaviors among Hispanic women (Lipsky et al. 2006). Reina, Lohman, and Maldonado (2014) found that immigration status, the patriarchal Latino culture, and insufficient bilingual service providers deterred Latina immigrant women from seeking assistance from antiviolence advocacy organizations. Shame, isolation, and lack of awareness regarding support for immigrants victimized by IPV also hindered help-seeking (Reina et al. 2014). Researchers concluded that immigration status continues to be a source of power and control for batterers and negatively impacts help-seeking among Latina IPV victims (Reina et al. 2014).

Cultural norms that prescribe distinct gender roles including female loyalty to family may also influence help-seeking behaviors. Amar et al. (2010) found in focus groups that familial modeling impacts victims’ decision to seek help for violent relationships and that many women feel cultural pressure to conform to intergenerational family norms. In addition to culture, geographic location (rural vs. urban communities) has been explored in terms of help-seeking for IPV (Shannon et al. 2006). For example, researchers in Kentucky explored help-seeking behavior among a large sample of IPV victims who obtained protective orders from the court in both rural and urban geographic locations. Results indicated that urban women engaged in a significantly higher number of help-seeking behaviors than did rural women (Shannon et al. 2006).

In addition to gender, race, and age, other factors that influence help-seeking among IPV victims include victimization type, childhood victimization, and severity of IPV. Sabina et al. (2012) found that help-seeking among Latinas or Hispanic women was influenced by experiences of childhood victimization (measured as physical assaults or sexual fondling during childhood) and IPV severity (measured as weapons use or threatened weapon use). Childhood victimization experiences decreased the likelihood of both formal and informal help-seeking behaviors whereas stalking victimization decreased the odds of formal help-seeking. Sabina and colleagues (2012) suggested that childhood and stalking victims experience trauma responses characterized by internalizing behaviors that distract from help-seeking (Sabina et al. 2012). Results also indicated that IPV victimization with a weapon increased the odds of formal help-seeking strategies. However, overall Latina victims were more likely to engage in informal versus formal help-seeking.

Du Mont et al.’s (2005) examination of help-seeking behavior among Canadian victims of IPV over time investigated the reasons behind women’s decisions not to contact service providers in 1993 (76 percent of the sample) and 1999 (51 percent of the sample). Results indicated that the number one reason for resisting help-seeking was the lack of desire or need for help (42 percent in 1993 and 49 percent in 1999), followed by women’s perception that the incident failed to meet the threshold of seriousness necessitating services (26 percent in 1993 and 19 percent in 1999). The relationship between perceived seriousness of violence and help seeking is consistent with Barret and St. Pierre’s (2011) findings that severity of violent victimization increased the likelihood of women seeking both formal and informal support services. In addition, a statistically equivalent proportion of women reported reasons of shame or embarrassment for not seeking services in 1993 (6 percent) and 1999 (9 percent) (Du Mont et al. 2005).

In Baker et al.’s (2003) research, women experiencing physical and/or sexual IPV gave a combination of reasons for not seeking help from formal systems. Some women did not contact welfare systems because they thought it would be fruitless—resulting in rejection or an overinvestment of time (Baker et al. 2003). With respect to police or courts, women feared the possibilities of retaliation from their partners, arrest of their partners, police indifference, and/or their own arrest (Baker et al. 2003). Temporary protection orders (TPOs) were avoided due to inaccurate or a lack of knowledge regarding eligibility, the filing process, and the cost of TPOs, and uncertainty regarding the effectiveness of TPOs. Survivors also reported apprehension about seeking help from shelters due to embarrassment, as well as the concern for the impact on their children’s lives (Baker et al. 2003). Among women who sought medical attention from a healthcare provider, reasons for not disclosing the abuse include safety concerns and fear of losing their children (Peckover 2003).

Bauer et al. (2000) also found that reasons for not seeking help may be influenced by level of acculturation, with Latina and Asian immigrant women suggesting that isolation, language barriers, discrimination, culturally specific statements regarding divorce, and immigration law threatening family disruption or deportation all act as barriers to seeking support regarding IPV victimization. Other research finds victims of IPV reluctant to seek help based on concern regarding the reaction of the perpetrator, preferring to avoid police involvement, costliness, prolonged waiting periods, an absence of confidence in service providers, privacy concerns, self-sufficiency, relationship termination, shame, embarrassment, and lack of comfort disclosing to male healthcare providers (Bacchus, Mezey and Bewley 2003; Hegarty and Taft 2001).

Although IPV creates dangerous and even lethal situations, help-seeking to manage or severe violent relationships does not always produce positive outcomes. Victim disclosures may be met by skepticism, victim blaming, or even indifference. Even witnesses to IPV may avoid involving themselves, as one recent study found few adolescents reported a willingness to intervene in a hypothetical observation of physical dating violence and the understanding that few others would intervene as well (Ocampo et al. 2007). Ocampo et al.’s (2007) research using a sample of ninth-graders found that respondents reported avoiding and distrusting adults for help-seeking while acknowledging that peer support would largely be emotional, offering victims someone to talk to, but little else. Conversely, in a series of interviews with African-American survivors of IPV, Morrison et al. (2006) determined that family and friends commonly offered instrumental support, such as child care, transportation, and housing, but were less forthcoming with emotional support. Family and friends often expressed frustration, minimal empathy, and/or an unwillingness to become involved, which may have depressed additional efforts at help-seeking by victims (Morrison et al. 2006). Other research determines that responses to initial disclosures regarding IPV impact women’s confidence and intent to seek additional support (Waldrop and Resick 2004). Fugate et al. (2005) note that the fear of negative responses to IPV disclosures, such as demanding relationship termination or imposing a definition of the abusive behavior on the victim, can inhibit women’s help-seeking.

Baker et al.’s (2003) research on responses to disclosures of IPV found women reporting several types of social support: emotional (interest, encouragement, and availability), informational (strategies regarding changing the situation or resources), and tangible support (offers of money, food, clothing, housing, and childcare) (Baker et al. 2003). Informal sources of support (family, friends, and church) offered significantly more emotional support than informational or tangible support. Family and friends on average offered support on 2.7 occasions, significantly more than did churches (1.5) (Baker et al. 2003). Women rated the welfare and police system responses as somewhat satisfactory, and the court and shelter responses as mostly to very satisfying (Baker et al. 2003). Positive outcomes from formal support providers included police referrals; charges against the abuser by the solicitor’s office; and emotional support, affirmations, and resource numbers given by shelter staff (Baker et al. 2003). Negative experiences with seeking formal support from police comprised lengthy response times, a lack of understanding regarding the seriousness of IPV, and inadequate enforcement of TPOs, such as failing to pursue those alleged to have violated TPOs (Baker et al. 2003). With respect to welfare and shelter systems, women indicated the need for staff to be trained on the dynamics of IPV and treating survivors with empathy and respect. Women reported a desire for shelters to offer assistance with obtaining much-needed resources, such as permanent housing. Negative aspects of help-seeking in court systems included the requirement of facing one’s abuser in court to obtain a TPO and dissatisfaction with the solicitor’s office regarding inadequate sentences and communication with the victim (Baker et al. 2003). Outcomes of homelessness varied by formal support system, with homelessness most likely for those who contacted shelters (100 percent), followed by welfare systems (57 percent), and the solicitor’s office (33 percent) (Baker et al. 2003).

Bacchus et al. (2003) found that another source of formal support, health professionals, was perceived as unhelpful in response to disclosures of IPV, likely due to the limited time allocated to general practitioner appointments. Feder et al. (2006) conducted a meta-analysis of 25 studies on health professionals’ responses to disclosures of IPV and desired responses. Unhelpful responses included those by health professionals that were perceived as judgmental or suggested victim blame and those that trivialized the violence. Findings indicated that ideal responses were patient, empathetic, and affirmed that the victim was not to blame for the violence. Women also indicated that they needed medical professionals to respect their decisions with regard to further disclosures, engaging the legal system, and/or ending the relationship (Feder et al. 2006).

The multitude of individual, cultural, and structural factors complicating victims’ decisions to seek help and the degree to which responses support versus blame victims likely account for the paucity of empirical tests of theories on help seeking and IPV. Moreover, the small number of studies that use population-based samples rather than convenience samples limits generalizations from the literature on help-seeking behaviors.

Existing studies do show a wide range of formal and informal help-seeking behaviors exhibited by victims of IPV, although estimates of their prevalence vary widely. Research has shown that most victims do seek some form of assistance, many from multiple sources, although most conclude that, overall, victims across cultures and ages are more likely to seek informal avenues of support from trusted friends and family members as opposed to relying on formal sources such as the court system, medical services, social services, mental health counseling, or shelters (Barrett and St. Pierre 2011; Du Mont et al. 2005; Fraser et al. 2002; Ocampo et al. 2007). Teen IPV victims in particular are less likely to seek any type of support than are their adult counterparts, especially from formal resources such as school authorities, law enforcement, or crisis lines.

Among existing theoretical research, three dominant typologies have emerged to explain victims’ responses to IPV: psychological response models, process models, and social-cultural models. Psychological response models generally point to the degree of victims’ feelings of helplessness as the biggest barrier to help-seeking and positive outcomes; however, Gondolf and Fisher’s survivor model shows that IPV victims are generally more likely to seek help as violence escalates, as opposed to succumbing to learned helplessness as a result of prolonged trauma; cases in which these victims are unable to exhibit help seeking is more likely a result of inadequate resources than learned helplessness (Gondolf and Fisher 1988). Process models examine IPV victims’ patterns of alternatively trying to manage and leave violent relationships, a process that is complicated by individual, interpersonal, and sociocultural factors in combination with cost-benefit analyses to various forms of help seeking. Sociocultural models take into account structural and cultural variables such as fear of stigmatization; inadequate formal support from medical, governmental, and law enforcement sources; family and societal expectations; a lack of social and emotional support from both formal and informal resources; and a history of childhood maltreatment as barriers to successful help-seeking endeavors. One common thread to these typologies in relation to help-seeking behaviors is the availability or lack thereof of formal resources that IPV victims believe they can count on.

A myriad of barriers to help-seeking behaviors among IPV victims exist; these barriers vary cross-culturally but generally include a lack of resource awareness or lack of resource availability; factors relating to self-sufficiency such as income, age, education, and employment; racialized factors such as isolation, degree of acculturation, immigration status, and trust of law enforcement; discomfort with unresponsive healthcare providers; unfamiliarity with or questioned effectiveness of TPOs; and the breaking of familial and cultural norms. Many barriers to help seeking also involve fear on the part of the victim: fear of shame, embarrassment, and loss of privacy; fear of retaliation from the perpetrator; fear of skepticism and arrest from law enforcement; and fear of losing custody of children. Overall, the many barriers to help-seeking behaviors among IPV victims make theoretical evaluations difficult and complicate the development of effective formal resources as a response to those seeking help for IPV.

However, some research has indicated that help-seeking behaviors from both formal and informal sources may be on the upswing (Du Mont et al. 2005). Additionally, the body of research detailing the preference of IPV victims regarding informal support providers has led to the application of bystander intervention models (for interrupting sexual violence) in efforts to expand support for victims of IPV. Bystander intervention aims to educate a whole community, such as a high school or college campus, regarding interpersonal violence and change the culture so that violence is viewed as wholly unacceptable. In turn, if the cultural norm of nonviolence is broken, the model expects that bystanders will collectively step in and intervene of behalf of a victim—instead of taking a “that’s not my problem” approach. Evaluations of bystander intervention models for IPV are still in their infancy, but initial evaluations have identified positive impact on both attitudes regarding violence and on individuals’ willingness to help victims (e.g., see Moynihan et al. 2011). Likewise, opportunities exist for formal IPV support providers to collaborate with individuals in communities who are already trusted by victims, such as church leaders, hair stylists, and childcare workers, to increase victim support. Given that these individuals already have social capital in their respective community and are free from the stigma that is often associated with formal support providers, forging these bridges may serve as an avenue to reach victims who would have never accessed formal help on their own.