The contribution of exposure to traumatic events, complex post-traumatic distress and gender role conflict to violence among men being treated in centers for the prevention of domestic violence

Intimate partner violence (IPV) against women is still a major social problem and a significant health issue for women. Several approaches (for review see Godbout et al., 2017) – i.e., social learning, attachment, and socialization-to-gender-norms – have focused on men's exposure as children to violence and the intergenerational transmission of violence as a central explanation.  Each of these perspectives has contributed one central idea to explain this phenomenon. The trauma theory has a suggested model which tries to integrate some of these perspectives into one mechanism. The current study aimed to continue this effort and explores, on the basis of the trauma perspective, a comprehensive model for predicting male IPV.

The trauma model combines elements from both attachment and social learning theories to describe how the exposure to traumatic events affects IPV. Specifically, the model uses social information processing to describe how trauma symptomatology (i.e., PTSD) affects IPV. It suggests that a consistent sense of perceived threat following the traumatic events (i.e., especially hyper-arousal symptoms) may lead to a deficit in social information processing. This cognitive bias may lead to impulsive behavior such as violence. Nevertheless, the models based on this theory lack  comprehensive psychological and social perspectives which have been suggested by other theoretical explanations.

The current study therefore explored a comprehensive model for predicting the association between child abuse and male IPV. It uses additional perspectives to broaden the understanding of how trauma impacts male IPV. First, it uses the self-trauma model, which suggests how complex trauma might affect male IPV.  That is, in addition to PTSD, the damage to an individual's basic schema might lead to additional psychological results that contribute to IPV. These psychological results have been termed CPTSD, a diagnosis which in addition to PTSD also includes  disturbances in self organization (i.e., affect dysregulation, negative self-concept), leading to the intergenerational transmission of violence. Second, the current study also used the trauma model's perspective on power and control due to traumatic events; that is, the sense of helplessness and loss of control resulting from traumatic event exposure might help explain how dominance impacts the association between trauma and male-perpetrated IPV. Individuals exposed to trauma may feel a profound sense of powerlessness that contributes not only to PTSD and/or CPTSD, but also to beliefs about lower levels of power and control, leading to abusive coercion strategies. Third, based on socialization to gender norms, men exposed to trauma may perceive their resultant PTSD/CPTSD as not aligning with social standards, potentially leading to further gender role conflict, such as gender role conflict restricted emotionality which may in turn promote IPV.

Thus, this study's main objective was to examine the unique and the combined contribution of   these three theoretical explanations for understanding the association between exposure to childhood trauma and male perpetration of IPV among men who turn to, or are directed to, centers for the prevention of domestic violence. The first model examined the theoretical assumption that exposure to childhood traumatic events would lead to complex psychological problems such as complex post-traumatic stress disorder (CPTSD) – a construct which encompasses both PTSD and disturbances in self organization (DSO) – consequently contributing to IPV. The second model examined dominance over women as being a motivational factor which might stem from the psychological results of traumatic event exposure in childhood (i.e., PTSD), and promoting IPV.  The third model studied how gender role conflict restricted emotionally (GRC-RE), an inner conflict caused by social expectations of men, contributes to psychological distress after traumatic events (i.e., PTSD), which then leads to IPV. Finally, in order to study the contribution of all of the abovementioned suggested factors, the variables were jointly tested in one summary model.

This study examined 234 men drawn randomly from the 1600 men who received intervention during the year 2016 at Prevention and Treatment of Domestic Violence Centers in Israel (PTDVC).  Study participants received questionnaires measuring exposure to traumatic events (LEC), PTSD and CPTSD (ITQ), depression and anxiety (BSI), dominance (DOM), gender-role conflict (GRC), and violent behaviors in partner relationships (CTS). The three theoretical hypotheses and one summary study model were examined via a Structural Equation Modeling (SEM) analysis.

The first model revealed that childhood violence exposure was associated indirectly with psychological IPV through its linkage with CPTSD factors. The second hypothesis, which took into account the role of dominance as being part of exposure to trauma, was partially confirmed. An indirect association between child abuse (namely, exposure to violence and physical neglect in childhood) and higher psychological and physical IPV was found. This path led from a greater number of PTSD symptoms to a higher level of dominance and then to a higher level of IPV use. The third model, which studied the possible contribution of male gender expectations, indicated an indirect association between child abuse, exposure to violence and physical neglect in childhood, and higher psychological and physical IPV, through more PTSD symptoms and then a higher GRC level. The findings of the full study model with all of the main study variables showed the central role of DSO and dominance, found in each of the separate models, in expanding the trauma model. 

These findings add to the discussion regarding the complexity of the intergenerational transmission of violence and, specifically, shed light on the consequences of child abuse and neglect for male-perpetrated IPV. New paths of association between exposure to traumatic events in childhood and the frequency of physical and psychological IPV were explored in this study. One path has suggested complex psychological results such as CPTSD as being a mediator in the association between exposure to childhood traumatic events and IPV. The second path found that dominance served as a mediator between PTSD and IPV, thereby providing proof of elements which have previously been explained by another approach (i.e., the feminist approach) as a possible mechanism of the trauma model for the intergenerational transmission of violence and the prediction of IPV. Finally, we suggested adding to the trauma perspective additional elements suggested by the "psychology of men" approach.  Gender role conflict restricted emotionally which captures the role of the uniqueness of men’s gender-related distress as a mediator between PTSD and IPV, also forms part of this model. In summary, the findings suggest an expanded trauma model to explain the contribution of the psychological results of traumatic event exposure in childhood and the effects of social expectations for predicting various IPV dimensions.

The results of the current study have some important clinical implications. First, they support the need to screen for traumatic experiences and resultant PTSD among this population. Specifically, this research supports the call for, and further implementation of, trauma-informed interventions for this population. Such interventions would take into account the effects of traumatic events, resultant PTSD, and the psychologically complex circumstances of such events on male-perpetrated IPV. What makes the current study unique in terms of its approach to IPV is that it relates not only to PTSD symptoms – especially hyper-arousal symptoms (as per trauma theory) – but also focuses on disturbances in self organization (i.e., emotional dysregulation, changes in self-concept, and interpersonal relationship problems). In addition, it also considers the way inner gender conflict, which is associated with the PTSD distress, contributes to IPV. Thus, in order to reduce impulsive IPV, these interventions must also focus on emotional regulation techniques and psycho-education methods in order to lessen the impact of gender norm expectations on men.