Battered person syndrome

Battered person syndrome
Classification and external resources
Specialty
ICD-10	T74.1
ICD-9-CM	995.81
Patient UK	Battered person syndrome

Battered person syndrome is a physical and psychological condition of a person who has suffered (usually persistent) emotional, physical, or sexual abuse from another person. It is classified as ICD-9 code 995.81 "Battered person syndrome" not elsewhere classified (NEC).
The condition is the basis for the battered spouse defense that has been used in cases of physically and psychologically abused spouses who have killed their abusers. The condition was first researched extensively by Lenore E. Walker, who used Martin Seligman's learned helplessness theory to explain why abused spouses stayed in destructive relationships.

Diagnosis

ICD9 code 995.81 shows the syndrome as including "battered person/man/spouse syndrome NEC", and any person presenting with identified physical descriptors rather than psychological descriptors falls under the general heading of "Adult physical abuse", classified under "Injury and Poisoning". DSM-IV-TR does not provide a distinct diagnostic category for reactions to battering. Rather the diverse reactions of battered people are treated as separate diagnoses, for example, posttraumatic stress disorder (PTSD) or depression.

Symptoms

Symptoms of Battered Person Syndrome,
a few of which are shared with PTSD

Symptoms	Battered person syndrome	Post-traumatic stress disorder (PTSD)
The person fears for their life	Y	Y
Is fearful for more than 4 weeks	Y	Y
Performance at work or other important daily life activities is affected	Y	Y
Manipulated through threats of violence, unwanted sex, degradation, isolation and more	Y
Dislike their bodies and experience somatic health issues	Y
Sexual intimacy issues	Y

When Battered Person Syndrome (BPS) manifests as PTSD, it consists of the following symptoms: (a) re-experiencing the battering as if it were recurring even when it is not, (b) attempts to avoid the psychological impact of battering by avoiding activities, people, and emotions, (c) hyperarousal or hypervigilance, (d) disrupted interpersonal relationships, (e) body image distortion or other somatic concerns, and (f) sexuality and intimacy issues.

Additionally, repeated cycles of violence and reconciliation can result in the following beliefs and attitudes:

• The abused thinks that the violence was his or her fault.
• The abused has an inability to place the responsibility for the violence elsewhere.
• The abused fears for her/his life, and/or, the lives of loved ones whom the abuser might or has threatened to harm (e.g., children-in-common, close relatives or friends).
• The abused has an irrational belief that the abuser is omnipresent and omniscient.

Causes

The syndrome develops in response to a three-stage cycle found in domestic violence situations. First, tension builds in the relationship. Second, the abusive partner releases tension via violence while blaming the victim for having caused the violence. Third, the violent partner makes gestures of contrition. However, the partner does not find solutions to avoid another phase of tension building and release so the cycle repeats. The repetition of the violence despite the abuser's attempts to "make nice" results in the abused partner feeling at fault for not preventing a repeat cycle of violence. However, since the victim is not at fault and the violence is internally driven by the abuser, this self-blame results in feelings of helplessness rather than empowerment. The feeling of being both responsible for and helpless to stop the violence leads in turn to depression and passivity. This learned depression and passivity makes it difficult for the abused partner to marshal the resources and support system needed to leave.

Feelings of depression and passivity may also be created by lack of social support outside of the abusive situation. Research in the 1980s by Gondolf and Fisher found that women in abusive situations increase help-seeking behavior as violence intensifies. However, their attempts at seeking help are often frustrated by unresponsive extended family and social services. In a 2002 study, Gondolf found that more than half of women had negative views of shelters and programs for battered women because of negative experiences with those programs.

Legal history

The battered person syndrome first rose to prominence in the 1970s, when it was used as a legal defense for abused women who murdered their husbands in a pre-meditated fashion. Defense lawyers used the syndrome to explain premeditation as follows: the woman could not leave the relationship due to learned helplessness. Nor could they fight back when actually being attacked. In the face of increasing violence, the woman's belief was that the only way she could protect herself and her children was to eliminate the partner when he was more vulnerable, for example, while sleeping.

In recent years BPS has been questioned as a legal defense on several grounds. First, legal changes in many states now make it possible to admit a history of past abuse into evidence. Second, not all battered persons act the same. Third, it pleads pathology when there may in fact be completely rational reasons for the victim's assessment that their life or that of their children was in danger. For example, if life-threatening attacks were preceded by a certain look in the eyes in the past, the victim may have had probable cause for believing that another life-threatening attack was likely to occur. Fourth, it does not provide for the possibility that a person may be abused but have chosen to kill for reasons other than on-going abuse – for example, jealousy or greed. Fifth, it paints survivors of domestic violence exclusively as passive victims rather than resourceful survivors.