Violence toward men: Fact or fiction?
Note: This report represents the medical/scientific literature on this subject as of December 1994.
Full text
Depending on one's point of view and interpretation of the available evidence, male victims of spousal violence, or so-called "battered men," are either the missing persons of the family violence research literature and clinical caseloads or are an over-stated issue concocted to distract attention from battered women.
Perhaps no issue in the field of family violence has generated so much controversy and debate as the question of whether there are a significant number of male victims of spousal violence. Those who use a feminist perspective to examine violence in intimate relations constitute one side of the controversy and argue that it is clear that women are overwhelmingly the victims of intimate violence.1-5 On the other hand are those, including men who claim that they are "battered husbands," so-called men's rights group members, and a number of researchers6-10 who argue that there are a significant number of male victims of domestic violence, that male victims are indeed a social problem worthy of clinical and policy attention, and that there are as many male victims of violence as there are female victims.
The divisions between the two points of view are deep, emotional, and, in the words of one scholar, probably irreconcilable.3 Indeed, not only have the data and conclusions offered by both sides been attacked, but so have the individual scholars and authors.
If there is one possible point of agreement in the controversy about male victims of intimate violence, it is the importance of properly framing and analyzing the issue. The feminist sociologist Demie Kurz3 explains that the debate over men's and women's use of violence has significant consequences for popular and academic conceptions of battered women and for social policy. It also has consequences for clinical practice as well. How one frames the problem of intimate violence determines the amount of concern that will be generated, whether the problem will be recognized by clinicians, the nature of the solutions proposed, and finally, the amount of resources that will be directed toward treating and preventing the problem. Indeed, as soon as the American Medical Association (AMA) publicly announced its campaign to raise physicians' awareness about all forms of family violence and to improve medical practice, men physicians as well as self-described victims began to call and write the AMA and ask why "abused" or "battered" men had not been included in the public awareness campaigns, published articles, and clinical protocols.
This report examines the issue of male victims of intimate violence. As Kurz points out, how one frames the issue determines to a large part one's findings and conclusions. The first question posed in this report is, "How extensive is male victimization in intimate relations?" Clearly, by framing the question as a quantitative empirical one, the report tilts away from one tenet of a feminist research perspective that quantitative data cannot fully capture the nature of a phenomenon, because it cannot capture the subjective meaning of a phenomenon.11 A second purpose of the report is to try to interpret what the numbers actually mean. Does the experience of male victimization constitute battering in the same way female victimization does? Are the numbers and experiences of male victims sufficient to make male victimization a problem worthy of attention by physicians and medical professionals? Finally, the report concludes with recommendations for physicians.
Data on the extent of male victimization
There are three sources of data on the incidence and prevalence of family violence in general, and violence toward men in particular: clinical data, official report data, and social surveys. Clinical studies carried out by psychiatrists, psychologists, and counselors continue to be a frequent source of data on family violence. This is primarily due to the fact that these investigators have the most direct access to cases of family violence. The clinical or agency setting (including hospital emergency rooms and battered wife shelters) provides access to extensive in-depth information about particular cases of violence. Studies of wife abuse and violence toward women have relied heavily on samples of women who seek help at shelters.2,12,13 Such samples are important because they are often the only way of obtaining detailed data on the most severely battered women. Such data are also necessary to study the impact of intervention programs. However, such data, because they are based on small, non-representative samples, cannot be used to estimate the incidence and prevalence of the problem of intimate violence. Therefore, this report will not review suggestions about the extent of male victimization based on clinical data.
Official reports constitute a second source of data on family violence. While there is an abundance of official report data on child maltreatment (because of mandatory reporting laws), there has not been a tradition of officially reporting spouse abuse, with the exception of a handful of states that collect data on spouse abuse. The Uniform Crime Reports provide data on criminal family violence and family homicide, but these are limited to instances of family violence that are reported to the police. As noted below, only a small fraction of the instances of violence between marital partners are ever reported to the police.
Social surveys are the third source of data. Such surveys are constrained by the low base rate of most forms of abuse and violence in families and the sensitive and taboo nature of the topic. Some investigators cope with the problem of the low base rate by employing purposive or non-representative sampling techniques to identify cases. A second approach has been to use available large groups of subjects. Investigators of courtship violence have made extensive use of survey research techniques using college students as subjects.14-18 Straus and Gelles carried out two national surveys of family violence, one in 1976 and a second in 1986.19 Another source of survey data on violence between intimates is the victimization data collected in the annual National Crime Victims Survey (NCVS). The U.S. Justice Department has published three reports on intimate violence based on the data collected by the NCVS.20-22
Each of the major data sources has its own validity problems. Clinical data are never representative, and few investigators gathering data from clinical samples employ comparison groups. Official records suffer from variations in definitions, differing reporting and recording practices, and biased samples of violent and abusive behaviors and persons.23-25 The biases of social survey data on intimate violence include inaccurate recall, differential interpretation of questions, and intended and unintended response error.24
The advantages and disadvantages of the sources of data are quite obvious when one examines the available data on male victimization. It is also important to point out at this juncture that not only are there three distinct sources of data on violence between intimate partners, but each source of data focuses on a different type or level of violence. Clinical and official report data generally focus on the most extreme forms of violence that comes to official or clinical attention is generally violence that is serious enough to cause physical injury. Survey data cast a much wider net and focus on a broader range of violent acts. For example, the two national surveys of family violence examined violence ranging from pushing and slapping to using a knife or firing a gun. The less severe forms of violence are the most common. As will be seen in the review below, surveys (with the exception of the NCVS, which measures self-reported criminal victimization) tend to find more equal rates of male-to-female and female-to-male violence. Clinical and official data, however, tend to reveal greater differences, with more female than male victims of violence. The differences between the sources of data are due both to the different methodologies for collecting data and to the different types of violence that are measured.
Homicide
Homicides typically provide detailed information on the context and sequence of violent events because most cases are known and there are extensive police and court records. Overall, for all forms of homicide, women are much less likely to be homicidal offenders compared to men. According to Straus,9 FBI statistics for 1989 show that only 14 percent of homicide offenders were female. However, the percentage of female homicide offenders varies by the relationship between the offender and the victim. The closer the relationship, the greater the percentage of female homicide offenders. Female perpetrated homicides of strangers occurs at a rate that is less than one-twentieth of the male rate. The proportion of female offenders goes up for murders of acquaintances. Females murdered family members at a rate about half the rate of men between 1976 and 1979 and a third the rate of men between 1980-1984.9 When the victim is a spouse, the female rate for the period 1976 to 1985 was 75 percent the rate of male-to-female spousal killings. (See Wilson and Daly26 for summaries.)
In some jurisdictions, the rate of female-to-male spousal homicides actually exceeds the rate of male-to-female spousal homicides. For instance, for every 100 male-to-female spousal homicides in Detroit in 1982-1983, there were 200 female-to-male homicides.27 Female-to-male homicides also exceeded male-to-female in Chicago between 1965 and 1989, in Detroit in 1972, and in Houston in 1969.26 The investigators, however, offer no explanations for why rate of female-to-male homicide exceeds the rate of male-to-female homicide in these specific jurisdictions.
The high rate of female-to-male homicide is not only unique to intimate relationships, it is also somewhat unique to the United States. Although there are between 75 and 200 female-to-male spousal killings for every 100 male-to-female spousal killings in the United States, the average ratio of female-to-male spousal killings in other countries surveyed by Wilson and Daly26 was about 30 (that is, 30 women killed their husbands for every 100 men who killed their wives). Wilson and Daly state that the especially high rate of female-to-male spousal killings in the United States is not due to the availability of guns in the United States, nor is it due to social change.
Thus, at least for the United States, there is some symmetry in the rates of women and men killing their spouses. Some researchers, such as Wilson and Daly,26 use anecdotal and qualitative data to make the point that although the actual numbers may appear similar, the quality of female killings differs from male killings: males often stalk their victims and hunt down and kill spouses who have left them; males often kill wives after lengthy periods of physical and emotional abuse; and males are much more likely to kill their wives and children in acts of familicide. Other studies of family homicide point out that women are much more likely than men to kill in self-defense,28-31 although differences across ethnic communities are marked. (See Mann32 for example.)
Police calls
A second source of official data on spousal violence is data on police calls and arrest. Police call data are subject to much more bias than are homicide data. First, the vast majority of instances of spousal violence do not result in a call to the police, and a vast majority of police calls for instances of domestic violence do not result in an arrest. Gelles and Straus33 found that police were called to less than one in twenty houses (4.8 percent) in which there had been some kind of spousal violence in the previous year, and when the police were called, they arrested an offender in only 15 percent of the cases.
Police call data show an overwhelming pattern of male-to-female violence compared to female-to-male violence. Dobash and Dobash2 examined police call data in Scotland and found that, when the sex of the participants was recorded, women were the victims of domestic violence in 94 percent of the cases and the offenders in 3 percent of the cases. Other analyses of police data reveal similar patterns.34-37
The small percentage of female offenders could be a result of the fact that police calls are more likely to occur when an injury occurs. Even though this may affect the kinds of cases of spousal violence that come to official attention, it does suggest that male-to-female violence is more likely to cause injury than female-to-male violence. A second plausible explanation for the small percentage of female offenders may be the reluctance of the police to make an arrest when a female is the offender. Buzawa and Buzawa38 note that male victims of domestic assault are uniformly dissatisfied with police response and feel that police have a limited understanding of male victimization.
National crime victims survey
The National Crime Victims Survey (NCVS) yields government crime statistics, but it is not official report data. Rather, NCVS data are self-report survey data collected by the Bureau of the Census for the US Department of Justice in an annual survey of approximately 60,000 households.
The NCVS data are quite similar to police call data. First, the reported rate of marital violence is quite low2.2 per 1000 couples. Second the rate of assaults by husbands (3.9 per 1000) is 13 times greater than the rate of assaults by wives (.3 per 1000). Stated another way, more than 90 percent of the reports of marital violence are instances of violence by men directed at their wives or ex-wives.
The NCVS data have some important methodological biases. First, the survey questions ask respondents to report on crime victimizations. Thus, an act of marital violence must be conceptualized by the respondent as a "crime" if it is to be reported. Second, although the NCVS is now conducted by telephone, the data analyzed by Gaquin21 and Langan and Innes22 were collected using in-person interviews. Thus, it is plausible that in some interviews, the non-interviewed partner was present during the interview, thus suppressing the likelihood than any marital violence would be reported.
Self-report survey data
The basis of the claims that men are the victims as well as perpetrators of intimate violence is largely self-report social survey data. Data from the First National Family Violence Survey, collected in 1976 revealed high levels of wife-to-husband violence.39-41 The survey, based on in-person interviews conducted with a nationally representative sample of 2,143 households, found that the incidence of severe husband-to-wife violence, that is violence that had a high probability of causing an injury, was 38 per 1000, while the rate of severe wife-to-husband violence was 46 per 1000. Mean and median number of instances of severe violence each year were also comparable .Mean number of incidents of husband-to-wife severe violence was 8.0 times per year while mean wife-to-husband severe violence was 8.9 times per year. The median number of incidents of severe husband-to-wife violence was 2.4 times per year compared to 3.0 times per year for wife-to-husband. Steinmetz41 drew on these and other self-report survey results as well as evidence from historical records and contemporary popular culture (comic strips) and labeled the phenomenon of wife-to-husband violence--the battered-husband syndrome.
The Second National Family Violence Survey collected self-report data by telephone from a nationally representative sample of 6002 households.8,14,33,44 Again, the rates of overall and severe violence between partners were roughly similar. The overall rate of husband-to-wife violence was 116 per 1000, while the overall rate of wife-to-husband violence was 124 per 1000. The rate of severe assaults by men was 34 per 1000 compared to a rate of severe assaults by women of 48 per 1000. None of these differences was statistically significant.
Violence and severe violence were measured using the Conflict Tactics Scales, developed by Murray Straus at the University of New Hampshire.43,44 Straus9,44 and Gelles45 note that one explanation for the seemingly equal rates of overall and severe violence is that men tend to under-report their own use of violence. In order to correct for the under-reporting of violence by men, Straus9 has re-analyzed the data from the Second National Family Violence Survey and recomputed the rates on the basis of only the interviews with the 2994 women in the survey. The result of the re-analysis is that the overall rate of violence by wives was 124 per 1000 compared to 122 per 1000 for men. The rate of minor violence by wives was 78 per 1000, compared to 72 per 1000 for men. Finally, the rate of severe violence by wives was 46 per 1000, compared to 50 per 1000 by husbands. None of the differences was statistically significant.
Other self-report survey studies, many of which measure violence using the Conflict Tactics Scales, find results similar to those from the two National Family Violence Surveys. Straus9 notes that he examined more than 30 studies that collected data using self-reports from non self-selected samples (that is, community random samples or samples of college students) and that the rate of assault by women on males is about the same as the rate of assault by men on female partners. (See for example references 46-50.) Self-report surveys of individuals in dating relationships indicate that, on average, the rate of female-to-male violence is actually higher than the rate of male-to-female violence.8,51,52
Criticism of self-report surveys and the conflict tactics scales
The surprising finding of the high and seemingly similar rates of female-to-male compared to male-to-female intimate violence produced immediate and pointed criticism of the data, measurement techniques, and the investigators themselves.2-4,53-55 The most important criticisms are of the Conflict Tactics Scales. Critics point out that the scales are restricted to conflict-related violence, measure only a limited set of violent acts, consider threats of violence the same as actual violent acts, ignore the context of the violent acts, fail to measure process and sequence of violence, and do not measure the outcomes or consequences of violence. Straus9,44 responds that the critics are often inaccurate in their criticism, in particular the Second National Family Violence Survey did measure process and sequence and did assess consequences. In addition, the violence that is measured is not strictly limited to conflict-related violence.
Self-reported data on injury
One reason frequency counts of violent acts (incidence, mean, and median) between men and women can be misleading is that men are generally taller, heavier, and stronger than women and often have greater facility and training in the use of violence and weapons than do women. Thus, although the rate of engaging in violence may be similar, the consequences of the violent acts may be quite different.
Stets and Straus8 and Brush49 provide data on injury as a result of assaults. Stets and Straus, analyzing data from the Second National Family Violence Survey, found a rate of 3 percent for injury-producing assaults by men and 0.4 percent for injury-producing assaults by women. The difference was even greater for severe assault that needed medical attention--7.3 percent of women and 1 percent of men reported that the physical injury they received required medical attention.8 Brush, examining data from the National Survey of Families and Households, found a rate of injury-producing assaults by men of 1.2 percent compared to a rate of 0.2 percent for injury-producing assaults by women.49 Straus9 calculated a rate of injury-producing assaults from the Second National Family Violence Survey. The rate for husbands is 3.7 per 1000 while the rate for wives is 0.6 per 1000. Thus, the rate of injury-producing assaults by men is 6 times the rate for women. Interestingly, these rates are comparable to the rates of intimate violence in the National Crime Victims Study, confirming the assumption that acts of intimate violence reported as crimes are those that involve injury.
Sequence of acts
There is one final comparison available from the self-report data--that is whether violence by women is generally used in self-defense in response to violent acts initiated by men. Analyses of homicide data suggest that a substantial portion of lethal assaults by women are self-defense or in retaliation after years of brutal victimization.28-31
Self-report survey data, however, yield a different pattern. Straus9 found that of the 495 women respondents in the Second National Family Violence Survey who reported one or more acts of violence by themselves or their husbands, 25.9 percent of the violent acts were by the husband only, 48.6 percent involved violence by both partners, and 25.5 percent involved violence only by the woman.
When asked about the most recent violent incident and what happened, 42.3 percent of the female respondents said their husbands or male partners struck first, 53.1 percent said they struck first, and 3.1 percent could not remember who struck first or could not disentangle the actual sequence of events. However, it should be pointed out that the question that asked about the sequence of violence was phrased, "Let's talk about the last time you or your spouse/former spouse/partner/ former partner got into a physical fight and [identify most violent act]. In that particular instance, who started the physical conflict, you or your (spouse/partner)." It is possible that the interview subjects interpreted the question to mean that both of them had to be involved in the physical conflict. Thus, the phrase, "who started the physical conflict" could have been taken to mean the person who started the conflict leading to physical force.
Straus9 cites four other studies with similar results.15,56-58 Two of the studies15,57 were studies of dating couples. Saunders58 reports that 60 percent of the men and women reported that the husband hit first.
These data do not definitively settle the matter of whether women use violence primarily in self-defense. First, the questions ask about who hit first. Wives who hit first may still have struck in self-defense if they perceived that their husbands were about to attack them. While the question assesses the sequence of acts, it still does not provide a complete understanding of either the context or history of violence in the relationships. In addition, it is important to point out that virtually all the data reviewed in this section come from surveys of community samples. It is possible that the pattern of who strikes first is different for the more severe and injurious acts of violence examined in clinical or official report samples.
Are men "battered"?
That women are perpetrators of intimate violence there can be no doubt. There is consistent and reliable empirical evidence that women use violence toward their male partners in and outside of marriage. The question of whether there are "battered men" and the prevalence of the problem of the battering of men is more complex, and, to a certain extent, depends on what is meant by "battered" Some men are hit by their wives; some are injured, and some are killed. At the same time, the evidence cited above indicates that women are 6 times more likely to be injured than are men. Thus, from the standpoint of injury, there are indeed men who are harmed in instances of intimate violence, but considerably fewer men are injured than are women.
Studies of intrafamily homicide find that women use violence primarily in self-defense.28-31 However, many women also use violence for the same reasons men do: as expressive behavior, instrumental behavior, or as an attempt to exert control. Looking at Straus's data from the Second National Family Violence Survey, at least one-quarter of all partner violence is committed by women who report not having been struck by their male partners in the last 12 months. Some of this violence may be in self-defense if the women act to protect themselves from imminent harm; but given that these are women who report that their husbands had not hit them in the last 12 months, it is unlikely that many of these incidents were the result of women protecting themselves from imminent harm. The violence may have been as a response to acts of emotional abuse or psychological violence directed at the women. However, it is clear that the women who strike husbands who have not hit them are likely to be the only physical aggressors in the relationship.
Unquestionably then, the data indicate that there are indeed male victims of intimate violence. Using injury or context as the criteria for what constitutes "battered" or "abused," the number of battered men and the rate of man battering are considerably smaller than the rate of woman battering and the number of battered women. It is categorically false to imply that there are the same number of battered men as there are battered women. Although men and women may hit one another with about the same frequency, women inevitably suffer greater physical consequences of such violence. Women victims of intimate violence also suffer more emotional and psychological consequences than do men.8
Applying the rate of injury-producing assaults by women--the most conservative indicator of battering--to the 52 million married couples in the United States suggests that 104,000 men are injured by their wives each year. This figure underestimates the total number of injuries because it omits all injuries that occur in dating or cohabiting couples. On the other hand, the estimate overstates the extent of the problem because some of those men injured where struck by women acting in self-defense. If the biases cancel each other out (there is no way of knowing whether this assumption is accurate) and the 100,000 estimate is relatively correct, then the total number of male victims of spousal violence each year, while less than the number of female battering victims, is hardly a trivial number, especially from the point of view of the medical profession.
Conclusion and recommendations
Given the intensity of the debate about the existence, extent, and nature of violence toward men, recommendations for the medical community based on the available evidence and interpretations of the available evidence are difficult and will likely be controversial. The difficulty stems from the fact that there are few, if any, available and effective programs that have been developed for male victims of intimate violence, and discussion of the problem of "battered men" has been stifled by competing political agendas. Thus, even if physicians are successful in identifying male victims, there are few agencies or programs that can be used for referral. Although there are few specific agencies and programs for male victims, some shelters and programs for battered women do receive calls from male victims of domestic violence. In most cases, the men are referred for counseling and in some cases shelter referrals are also provided.
The controversy lies in the fact that adding men to the list of victims of intimate or family violence will be seen by many as reducing the attention, concern, and resources for battered women.
Recommendations
See CSA Report 7 (I-00), AMA Data on Violence Between Intimates, for updated AMA policy on domestic violence issues.
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