Journal of Traumatic Stress, Vol. 17, No. 5, October 2004, pp.

413–421 (

C 2004)

The Differential Association of Intimate Partner

Physical, Sexual, Psychological, and Stalking Violence
and Posttraumatic Stress Symptoms in a Nationally
Representative Sample of Women

Kathleen C. Basile,1,2 Ileana Arias,1 Sujata Desai,1 and Martie P. Thompson1

This study examines whether experiences with four different types of intimate partner violence (IPV)
increase risk for posttraumatic stress disorder (PTSD) symptoms. We examined impacts of physical,
sexual, psychological, and stalking victimization by a current partner on PTSD symptoms, the extent
to which each type of IPV accounted for significant variance in PTSD symptoms when controlling
for other forms, and the increase in PTSD symptoms from multiple forms of IPV. Findings reveal that
all types of violence were associated with increased PTSD symptoms. When controlling for other
types of violence, physical, psychological, and stalking violence were still associated with PTSD
symptoms. There was evidence of a dose response in which the more types of violence experienced,
the more PTSD symptoms.

KEY WORDS: intimate partner violence; physical violence; sexual violence; psychological violence; stalking;
posttraumatic stress disorder symptoms; nationally representative sample of women.

Intimate partner violence (IPV), defined here as the
use of actual or threatened physical, sexual, psycholog-
ical, or stalking violence, by current or former partners
(including same or opposite sex), is a significant pub-
lic health problem in the United States. The National
Violence Against Women Survey (Tjaden & Thoennes,
2000a), sponsored by the National Institute of Justice
(NIJ) and the Centers for Disease Control and Prevention
(CDC) indicated that approximately 1.5 million women
and 834,700 men are physically assaulted or raped by in-
timate partners in the United States annually. Women who
are physically assaulted by an intimate partner experience
an average of 3.4 separate assaults per year and those who
are raped experience 1.6 rapes annually on average. In
1 Centersfor Disease Control and Prevention, Atlanta, Georgia.
2 To
whom correspondence should be addressed at Division of Vio-
lence Prevention, Centers for Disease Control and Prevention, Mailstop
K60, 4770 Buford Highway, Atlanta, Georgia 30341-3724; e-mail:
kbasile@cdc.gov.
addition, 503,485 women and 185,496 men are stalked
annually by an intimate partner.
Although both men and women report IPV vic-
timization, IPV victimization is more prevalent and fre-
quent among women than men and differences between
women’s and men’s rates of victimization become greater
as the severity of assault increases (Stets & Straus, 1990).
Female victims of IPV are significantly more likely than
men to sustain an injury, receive medical care, be hos-
pitalized, receive counseling, and lose time from work
(Tjaden & Thoennes, 2000b). Relative to men, women
are more likely to be injured if they are victimized by
an intimate partner than if they are assaulted by a nonin-
timate (Bachman & Saltzman, 1995), and are 13 times
more likely to suffer an injury from IPV than from
an accident (Stark, Flitcraft, & Frazier, 1979). Injuries
resulting from IPV victimization can include bruises,
scratches, burns, broken bones, miscarriages, and knife
and gunshot wounds (Crowell & Burgess, 1996). In addi-
tion to physical injuries, women victims of physical IPV

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C 2004 Springer Science+Business Media, Inc.
414
experience adverse physical health consequences such
as chronic pain disorders and gastrointestinal disorders
(Coker, Smith, Bethea, King, & McKeown, 2000; Crowell
& Burgess, 1996; Tjaden & Thoennes, 2000b), as well as
adverse psychological consequences such as depression,
suicidal behavior, substance abuse, and low self-esteem
(Resnick, Kilpatrick, Dansky, Saunders, & Best, 1993;
Ruback & Thompson, 2001). Plichta and Falik (2001)
found similar physical and psychological consequences
among women who had experienced sexual IPV. Among
their sample of wife rape victims, Finkelhor and Yllo
(1985) found that the women were unable to trust men,
had an aversion to intimacy and sex, and feared repeat
assault. Sexual IPV has also been associated with sex-
ually transmitted disease infection (Molina & Basinait-
Smith, 1998). Psychological IPV has been associated also
with a range of physical and psychological consequences
(Aguilar & Nightingale, 1994; Kahn, Welch, & Zillmer,
1993; Marshall, 1996).
As early as the mid-eighties, Walker (1984) sug-
gested that the range of psychological symptoms fre-
quently experienced by victims of IPV overlapped sig-
nificantly with those that comprise diagnostic criteria for
posttraumatic stress disorder (PTSD). More recent em-
pirical data suggest that female victims of physical, sex-
ual, psychological, and stalking IPV are at particular risk
for PTSD (Arias & Pape, 1999; Mechanic, Uhlmansiefk,
Weaver, & Resick, 2000; Vitanza, Vogel, & Marshall,
1995). For example, Mechanic et al. (2000) found that
women who were what the authors called “relentlessly
stalked” by intimate partners (defined as reporting at least
six different types of stalking events that each occurred
once a week or more frequently) had higher rates of de-
pression and PTSD than women who were less frequently
stalked.
Among battered women, estimates of the prevalence
of PTSD range from 33% (Astin, Lawrence, & Foy,
1993; Cascardi, O’Leary, Lawrence, & Schlee, 1995) to
84% (Kemp, Rawlings, & Green, 1991), depending on
the population sampled, the method of assessment of
PTSD, and time since the last IPV event. Mertin and
Mohr (2001) reported that 42% of their sample of bat-
tered women’s shelter residents met DSM-IV (Ameri-
can Psychiatric Association, 1994) diagnostic criteria for
PTSD when they entered the shelter while 14% continued
to meet criteria for the disorder 12 months later. Simi-
larly, Rothbaum, Foa, Riggs, Murdock, and Walsh (1992)
found that 50% of rape victims met PTSD diagnostic
criteria 3 months after the rape, and 90% of rape vic-
tims met diagnostic criteria for PTSD within 2 weeks
of the rape with the exception of the duration criterion
(criterion E).
Basile, Arias, Desai, and Thompson
The conceptualization of IPV victims’ psycholog-
ical reactions as PTSD has been noted as problematic
(Crowell & Burgess, 1996). The diagnostic criteria for
PTSD were designed to reflect dysfunctional reactions to
single traumatic events and may not capture reactions to
repeated or chronic traumatization such as intimate part-
ner physical or psychological victimization and stalking
as completely (Herman, 1992). PTSD does not account for
all the psychological symptoms exhibited by victims of
IPV such as depression and other anxiety disorder symp-
toms. However, these symptoms frequently co-occur with
those of PTSD (Brown, Campbell, Lehman, Grisham, &
Mancill, 2001) and between 79% and 88% of individu-
als with PTSD have been found to meet criteria for at
least one other psychiatric diagnosis (Kessler, Sonnega,
Bromet, Hughes, & Nelson, 1995). Additionally, victims
of IPV may exhibit most but not all of the symptoms of
PTSD. For example, victims of IPV may report night-
mares, heightened arousal, and poor concentration but
little or no avoidance of trauma-related events such as
the home or abusive intimate partner. Accordingly, PTSD
symptoms may be more relevant among IPV victims than
full PTSD. Although not meeting all criteria for a diagno-
sis of PTSD, partial or subthreshold PTSD may lead to as
much impairment as full PTSD. Definitions of subthresh-
old PTSD vary. Stein, Walker, Hazen, and Forde (1997)
used a conservative definition (i.e., meeting DSM-IV cri-
teria except missing one or two of the required criterion C
symptoms and/or missing one of the two required crite-
rion D symptoms) and found that 53% of those who met
criteria for subthreshold PTSD sought services for their
symptoms compared to 60% of individuals who met full
PTSD criteria.
Studies that have examined the relationship between
IPV victimization and PTSD have relied primarily on clin-
ical samples of women such as those residing in battered
women’s shelters or those contacting outpatient physi-
cal and mental health clinics for services. Clinical and
convenience samples limit our ability to generalize find-
ings to the general population. Population-based studies
enable us to identify accurate rates of victimization and
risk and protective factors and consequences. Studies that
examine the relationship between PTSD and IPV have
focused on single forms of IPV. Physical, sexual, psycho-
logical, and stalking IPV victimization often co-occur.
Follingstad, Rutledge, Berg, Hause, and Polek (1990)
found that among a sample of 234 women with a history
of battering only three reported never experiencing psy-
chological abuse. Finkelhor and Yllo (1985) found that
48% of the 50 women in their qualitative sample were
classified as experiencing battering rapes, or rape in the
context of a physically violent marriage. Other researchers
Violence and Posttraumatic Stress Symptoms
examining rape in marriage have reported similar findings
on sexual and physical IPV co-occurring (Basile, 1999;
Bergen, 1996; Frieze, 1983; Pagelow, 1992; Peacock,
1998; Russell, 1990). Mechanic et al.’s (2000) sample of
women who were relentlessly stalked by intimate partners
was also physically, sexually, and emotionally abused by
the same partners. In order to determine the relationship
between any form of IPV and PTSD, other forms of vic-
timization need to be accounted for or controlled. Arias
and Pape (1999) found that physical violence was not
related to PTSD symptomatology among women residing
in a battered women’s shelter when their experiences of
psychological victimization were statistically controlled.
Additionally, the impact of multiple forms of victimiza-
tion co-occurring on the risk for PTSD has not been de-
termined.
The purpose of this study was to identify the extent to
which experiences with IPV victimization were related to
PTSD symptoms using a nationally representative sample
of women. We specifically assessed variation in PTSD as
a function of physical, sexual, psychological, and stalking
victimization experiences by a current partner. We were
additionally interested in the extent to which each type
of IPV accounted for significant variance in PTSD symp-
tomatology when controlling for other co-occurring forms
of IPV, and the increase in risk for PTSD symptoms as
a function of experiencing multiple forms of IPV victim-
ization. Based on findings in previous research (Arias &
Pape, 1999; Follingstad et al., 1990; Mechanic et al., 2000;
Vitanza et al., 1995), we hypothesized that (1) physical,
sexual, psychological, and stalking IPV would be signif-
icantly associated with PTSD symptoms both separately
and (2) in combination; and (3) the more IPV victimization
experienced by a woman, the higher the levels of PTSD
symptoms.
Method
Sample and Procedures
Data for this study come from the National Violence
Against Women Survey (NVAWS), a survey of women’s
and men’s personal safety that was funded by the National
Institute of Justice and the Centers for Disease Control
and Prevention. Data were collected during the period
of November 1995 to May 1996 from 8,000 women and
8,000 men. The NVAWS was a random digit dial survey
of households with telephones in the United States. El-
igible respondents were adult women or men (18 years
old or older). For households with more than one eligi-
ble respondent, the adult with the most recent birthday
was selected. Only female interviewers surveyed female
415
respondents, and both women and men surveyed male
respondents. A Spanish-language version of the survey
was given to Spanish-speaking respondents. Households
were called five times on different days and at different
times to maximize the response rate. The response rate
among those contacted was 72% for women and 69%
for men. See Tjaden and Thoennes (2000a) for more
detail on the sampling methods and procedures for the
NVAWS.
The sample used for this study consists of women
who reported any violence (physical, sexual, psycho-
logical, or stalking) by their current spouse or partner
(including same or opposite sex, living together or not
living together). Only women who had experienced vio-
lence in their current relationship were assessed for PTSD
symptoms.3 Therefore, the sample size for this study was
380. The violence could have occurred at any time during
the current relationship.
Table 1 presents sample descriptives. The first two
columns of Table 1 include descriptives for the full
NVAWS sample of women and are presented for compar-
ison purposes. As seen in the third and fourth columns
of Table 1, the majority of the women in this sam-
ple were White (73.4%), educated with at least a high
school diploma (85.5%), married (70.5%), and employed
(61.3%). The average age was 40.
Measures
Adult Victimization by a Current Partner
Four types of adult victimization by a current partner
were examined. Physical violence was measured by sum-
ming an affirmative response to 12 items from the Conflict
Tactics Scale (Straus, 1979). Examples of items are yes/no
responses to being slapped, hit, kicked, or beaten up. All
12 items were summed to create a scale ranging from 0 (no
physical violence) to 12 (12 types of physical violence).
The standardized alpha coefficient for this scale for the
sample of women in this study was .83. Sexual violence
was measured by summing five items that asked if respon-
dents were ever forced or threatened with force to have
vaginal or anal penetration by a penis, fingers, tongue
or other object, or oral penetration by a penis or other
object by a current partner. All five items were summed
3 Since PTSD symptomatology was not assessed among nonvictims
of intimate partner violence, our study does not address whether
intimate partner violence victimization increases the risk for PTSD
symptoms. Rather, we assess the extent to which victimization experi-
ences among victims of intimate partner violence are related to PTSD
symptoms.
416 Basile, Arias, Desai, and Thompson

Table 1. Sample Descriptives

Women responding to
Full sample (N = 8, 000) PTSD itemsa (N = 380)
M SD M SD

PTSD symptoms NA NA 1.61 0.74

Physical violence 0.15 0.88 3.05 2.59
Sexual violence 0.01 0.19 0.22 0.81
Psychological violence 0.81 1.50 3.23 2.86
Stalking 0.02 0.34 0.32 1.33
Age 44.19 16.13 39.60 12.38
% n % n

Education 88.8 7,107 85.5 325

Employed 58.9 4,708 61.3 233
Hispanic ethnicity 7.9 628 12.6 48
Race
White 80.7 6,452 73.4 279
Black or other 17.5 1,398 23.9 91
Married 62.5 4,999 70.5 268

a Of the 8,000 women respondents, only women who reported violence by a current partner were asked
PTSD items.

to create a scale ranging from 0 (no sexual violence) to
5 (5 types of sexual violence). The standardized alpha
coefficient for this scale for the sample of women in this
study was .76. Psychological violence was measured by
creating a scale of 13 items assessing power and control
tactics. Respondents were asked to think about their cur-
rent partners and respond with “yes” or “no” to statements
such as “He is jealous or possessive,” “He tries to limit
your contact with family or friends,” “He makes you feel
inadequate,” and “He insists on knowing who you are
with at all times.” In addition, one measure of threaten-
ing behavior was included as part of the psychological
violence measure by asking if the respondent’s current
partner had ever threatened to harm or kill her. All 14
items were summed to create a scale ranging from 0 (no
psychological violence) to 12 (12 types of psychological
violence). The standardized alpha coefficient for this scale
for the sample of women in this study was .79. Stalking
was measured by summing responses to questions that
asked if a current partner had ever committed one or more
of eight harassing acts such as: following the respondent
or spying on her, standing outside her home, school, or
workplace, vandalizing her property or destroying some-
thing she loved, or leaving unwanted items for her to find.
In line with Tjaden and Thoennes (2000c), respondents
were not included as stalking victims unless the stalking
happened on more than one occasion and the women were
very frightened or believed that they or someone close to
them would be seriously harmed or killed when they were
being stalked. All eight items were summed to create a
scale ranging from 0 (no stalking violence) to 8 (8 types
of stalking violence). The standardized alpha coefficient
for this scale for the sample of women in this study was
.89.
Posttraumatic Stress Disorder (PTSD) Symptoms
Twenty-one items measuring symptoms of posttrau-
matic stress were adapted from Weiss and Marmar’s
(1996) revision of the Impact of Event Scale developed by
Horowitz, Wilner, and Alvarez (1979). Using a four-point
scale (1 = not at all, 2 = a little bit, 3 = moderately, and
4 = quite a bit)4 respondents were asked to reflect on the
violence they had experienced with their current partner
and indicate how much they were “bothered” by vari-
ous “difficulties.” Examples of items are “Any reminder
brought back feelings about it,” “My feelings about it were
kind of numb,” and “I had dreams about it.” A mean score
of the 21 items was calculated and used in analyses. The
standardized alpha coefficient for the 21-item scale for
this sample of women was .95.
Covariates
We controlled for six demographic variables in this
study. Age was measured in years. Highest level of ed-
ucation was measured in categories ranging from no
schooling to postgraduate level. Employment status was
coded as employed (1) or not employed (0). Race was
4 Weiss and Marmar’s (1996) revision of the Impact of Event Scale used
five response categories instead of four, and contained one additional
item that was not included in the NVAWS (“I tried not to talk about
it”).
Violence and Posttraumatic Stress Symptoms
coded as White (1) or Black or other (0) because the
sample size did not allow for the examination of other
racial groups. Ethnicity was coded as Hispanic (1) or
non-Hispanic (0). Marital status was coded as married
(1) or not married (0). All demographic variables were
measured at the time of the survey and are descriptive of
respondent characteristics at the time of the survey rather
than at the time of victimization.
Data Analyses
Data were analyzed using multiple regression and
hierarchical multiple regression. The dependent variable
for all analyses was symptoms of PTSD. First, hierarchical
regression models were conducted using one of the four
types of violence (physical, sexual, psychological, stalk-
ing) by a current partner as a key indicator in each model
in order to determine the significance of the association
between each type of violence and PTSD symptoms. For
each of these models, the six demographic variables were
entered into the first step. One of the four types of violence
was entered in the second step. Then a multivariate model
was run including demographics first, followed by all four
types of violence in the second step in order to examine
the relative contribution of each type of violence. Finally,
a dose-response regression model was conducted, where
we examined the effects of experiencing more than one
type of violent victimization on PTSD symptoms. Four
Z-score variables were created for the four types of IPV,
and these four new variables were summed to create a
dose variable. The dose variable ranged from −2.56 to
14.81. A final regression was run in which demograph-
ics were added first, followed by the dose variable. For
all models, age, education, ethnicity, and race were con-
sistently nonsignificant covariates. Therefore, these four
demographic variables were trimmed from the analyses
and only employment status and marital status were in-
cluded as covariates in the final models presented in this
paper. For all regression analyses, variance inflation fac-
tors (VIF) were examined. VIF is an index of how much
the error term is being inflated by collinearity between
variables (Fox, 1991). For all variables, the VIF did not
exceed 1.30, which indicates that multicollinearity is not
a problem between the independent variables.
Results
The mean scores and standard deviations for the four
summed IPV victimization scales are given in Table 1.
It appears that among this sample of victimized women,
physical and psychological violence are the most common
types of violence they reported from a current partner. Al-
417
though not shown in the table, 93% of victimized women
in this sample experienced at least one type of physical
violence and 52% of victimized women in this sample
experienced at least one type of psychological violence.
Sexual and stalking violence were reported less among
this sample. Nine percent of the victimized women in this
sample experienced at least one type of the five types of
sexual violence and 7% of victimized women sampled
experienced at least one type of stalking violence. Thus,
results for both sexual violence and stalking should be
interpreted with caution.
The associations between the four types of violence
and PTSD symptoms were examined and Phi and Pearson
coefficients are presented in Table 2. As seen in Table 2,
none of the coefficients between the four types of violence
exceeded .44.
Results of the regression models assessing the re-
lationship of each type of violence to PTSD symptoms
are found in Table 3. Findings revealed, consistent with
our first hypothesis, that all four types of violence were
significantly related to PTSD symptomatology. Specifi-
cally, when controlling for the two demographic variables,
physical, sexual, psychological, and stalking violence by
a current partner were significantly related to higher lev-
els of PTSD symptoms. In each case, the increase in
variance accounted for by the key indicator was signifi-
cant (physical, F = 53.94, p < .001; sexual, F = 14.18,
p < .001; psychological, F = 85.78, p < .001; stalking,
F = 22.95, p < .001).
Table 4 presents the results of the regression analysis
in which all four types of violence were simultaneously
included as indicators of PTSD symptoms. After con-
trolling for marital status in Step 1 (F = 8.14, p < .01),
findings revealed that physical, psychological, and stalk-
ing violence emerged as statistically significant correlates
of PTSD symptoms in Step 2 (F = 39.40, p < .001). As
shown in Table 4, the R 2 for this model indicates that 39%
of the variance in PTSD symptoms was explained by the
independent variables. The increase in the R 2 from Step 1
to Step 2 was significant (F = 48.31, p < .001), suggest-
ing that violent victimization contributes significantly to
PTSD symptoms over and above demographic variables.
Specifically, 36% of the variance in PTSD symptoms is
explained solely by the three types of violence added in
Step 2.
The dose-response model analysis results are pre-
sented in Table 5. After controlling for marital status
in Step 1, there was a positive association between the
dose variable and PTSD symptoms in Step 2. It appears
that the more types of current partner violence women
experienced, the more likely they were to have PTSD
symptoms. The R 2 change between Step 1 and Step 2 was
418 Basile, Arias, Desai, and Thompson

Table 2. Correlation Coefficients for Covariates, Four Types of Violence, and PTSD Symptoms

Types of violence 1 2 3 4 5 6 7 8 9 10

1. Age —
2. Education −.01
3. Employed −.10 .35∗∗
4. Ethnicity −.16∗∗ −.16∗∗ −.10
5. Race .08 .08 .02 −.41∗∗∗
6. Married .13∗ .08 −.01 −.09 .19∗∗∗
7. Physical −.11∗ −.14∗∗ −.13∗ −.04 .07 −.09
violence
8. Sexual −.03 −.02 .01 .03 .01 −.10 .06
violence
9. Psych −.08 −.18∗∗ −.15∗ .00 −.04 −.19∗∗ .32∗∗ .07
violence
10. Stalking −.03 .01 .02 −.05 .02 −.17∗∗ .44∗∗ .33∗∗ .23∗∗
11. PTSD −.07 −.16∗∗ −.17∗∗ .07 −.05 −.26∗∗ .38∗∗ .22∗∗ .52∗∗ .28∗∗
symptoms

Note. Pearson correlation coefficients are presented for all associations between two continuous variables or between a continuous
and a dichotomous variable. Phi coefficients are presented for associations between two dichotomous variables.
∗ p < .05. ∗∗ p < .01. ∗∗∗ p < .001.

significant (F = 131.74, p < .001), indicating that 32%
of the variance in PTSD symptoms is explained solely by
the dose variable. This finding confirms hypothesis 3.
Discussion
The purpose of this study was to examine the re-
lationship between four different types of violence by a
current intimate partner and PTSD symptoms. The study
allowed us to replicate previous findings regarding the
psychological impact of IPV and extend those empirical
findings by focusing on a population-based sample of
women. The results of our analyses indicated that physi-
cal violence, sexual violence, psychological violence, and
stalking are related to each other and co-occur. All four
forms of violence were related to PTSD symptomatol-
ogy after controlling for age, education, employment and
marital status, and race and ethnicity. Further, physical,
psychological, and stalking violence were associated with
PTSD symptoms in the multivariate model (Table 4). This
finding partially confirms hypothesis 2 and this pattern
of results is consistent with previous research (Arias &
Pape, 1999; Rothbaum et al., 1992; Vitanza et al., 1995)
employing clinical samples. Although the lack of a sig-
nificant association between sexual violence and PTSD
symptoms in the multivariate model (Table 4) may be
the result of differential effects of sexual violence relative
to other forms of IPV, our failure to find a significant
association is likely due to a restricted range of sexual
violence. Only 34 women in our sample reported being a
victim of sexual violence by a current spouse or partner.
Similarly, there were only 31 women who reported stalk-
ing by a current partner, however the range of 0 to 8 of the
summed stalking variable could explain why it was sig-
nificant and sexual violence was not. The fact that sexual
violence was significant in the bivariate model (Table 3)
suggests that sexual violence is associated with PTSD
symptoms. It is likely that it fell out of the multivari-
ate model (Table 4) because of its low correlation with
PTSD symptoms (Table 2) due to a small sample size.

Table 3. Results of Hierarchical Multiple Regressions to Predict PTSD Symptoms

Physical Sexual Psychological Stalking

Indicators β R2 β R2 β R2 β R2

Step 1 .10∗∗∗ .10∗∗∗ .07∗∗∗ .08∗∗∗

Employed −.18∗∗∗ −.14∗∗ −.17∗∗ −.13∗
Married −.25∗∗∗ −.28∗∗∗ −.20∗∗ −.25∗∗∗
Step 2 .21∗∗∗ .13∗∗∗ .29∗∗∗ .14∗∗∗
Employed −.14∗∗ −.15∗∗ −.10 −.13∗∗
Married −.22∗∗∗ −.26∗∗∗ −.11∗ −.21∗∗∗
Key indicator .35∗∗∗ .19∗∗∗ −.49∗∗∗ .25∗∗∗

Note. Initial analysis included age, education, employment status, ethnicity, race, and marital status in Step 1
as covariates. This table presents trimmed models.
∗ p < .05. ∗∗ p < .01. ∗∗∗ p < .001.
Violence and Posttraumatic Stress Symptoms 419

Table 4. Results of Multivariate Regression Analysis to Predict PTSD which have been suggested to be as harmful as full PTSD
Symptoms
and more relevant among victims of IPV than full PTSD
Indicators β R2 (Stein et al., 1997).
This study has a few limitations. First, this study is
Step 1 .03∗∗
Married −.18∗∗ cross-sectional and therefore does not allow for the ex-
Step 2 .39∗∗∗ amination of changes in PTSD symptoms over time and
Married −.10 their temporal relationship to the demographic variables
Physical violence .26∗∗∗
Psychological violence .38∗∗∗ and violence. As a result, we do not know if changes
Stalking .17∗∗ in employment and marital status came before or after
changes in PTSD symptoms. For example, it could be
Note. The initial model included age, education, employment status,
ethnicity, race, and marital status in Step 1 and physical, sexual, psy- that a change in employment status (i.e., losing a job) led
chological, and stalking violence in Step 2. This table presents a trimmed to increases in PTSD symptomology, but we cannot be
model. sure of the order of events. In addition, it could be that
∗∗ p < .01. ∗∗∗ p < .001.
PTSD symptoms would decrease if women left their cur-
These findings suggest that sexual violence would likely rent violent partners. Longitudinal designs are necessary
have been significant in the multivariate model (Table 4) to determine the temporal relationship between changes in
if we had a bigger sample size of sexual violence vic- violence and changes in PTSD symptoms. Another limita-
tims. Stalking, on the other hand, has a slightly higher tion of this study is that it does not measure all the variables
correlation with PTSD symptoms (Table 2), which could that could plausibly lead to PTSD symptoms, such as the
explain why it remained significant in the multivariate death of a family member or close friend, a serious illness
model (Table 4). In addition, findings support a dose- of the respondent or a family member or close friend, or a
response phenomenon, in which the more types of vio- natural disaster. There are many unmeasured variables in
lence a woman experiences, the more increase in PTSD the NVAWS that could have resulted in PTSD symptoms
symptoms. This highlights the importance of examining in the respondent. Related to this, we could not directly
co-occurring types of violence in future research, as the compare IPV victims to nonvictims on PTSD symptoms
examination of individual types of violence in isolation of in this study because only respondents who reported vio-
the others could conceal the increased effect of the com- lence by a current partner were asked about PTSD symp-
bined forms of violence on health outcomes such as PTSD toms in the NVAWS. Further, some of the types of violence
symptomatology. Indeed, one of the major strengths of measured in this paper (sexual and stalking violence by
this study is that it examined multiple forms of violence a current partner) were not frequently reported in this
and their association with PTSD symptoms, which has not sample, which could be the reason why sexual violence
been done in much of the previous work in this area. This was not significantly associated with PTSD symptoms in
allowed us to determine unique effects of different types the multivariate model. In addition, NVAWS only focused
of IPV as well as their combined effects. In addition, we on individual level outcomes, limiting our understanding
focused on current relationships. Often, studies on IPV of the community or societal effects (i.e., costs to society
are designed to examine experiences with victimization in terms of workforce hours, sick leave, health care costs,
by a former partner (Straus, 1979). Further, we used data spillover violence in the workplace, effects on children
from a nationally representative sample, so the findings who witness) of IPV victimization. Finally, it is impor-
are easily generalized. We also looked at PTSD symptoms, tant to point out that while we state that the NVAWS is
a nationally representative sample, it does not represent
women who do not have telephones and therefore could
Table 5. Results of Dose Response Analysis to Predict PTSD
Symptoms not be a part of this study.
This study has implications for policy and practice.
Indicators β R2
The results strengthen the argument that public health
Step 1 .05∗∗ practitioners and policy makers should not overlook the
Married −.21∗∗ importance of addressing the deleterious effects of all
Step 2 .37∗∗∗
Married −.15∗∗ types of IPV (and the combined effect of multiple types)
Dose variable .58∗∗∗ in their efforts to prevent future victimization. The find-
ings also have implications for assessment and treatment
Note. The initial regression analysis included age, education, em-
ployment status, ethnicity, race, and marital status in Step 1 as
of PTSD among IPV victims. Interventions that focus
covariates. This table presents a trimmed model. specifically on treatment of PTSD and other mental health
∗∗ p < .01. ∗∗∗ p < .001.
issues should address all forms of IPV. Future research
420
using a longitudinal design would be beneficial to under-
stand the temporal relationship between experiences with
IPV and the development of PTSD symptoms. The field
would also benefit from future research that examines the
difference between IPV victims with subthreshold PTSD
versus full PTSD. Future research with larger samples of
victims of intimate partner sexual and stalking violence
would be beneficial to confirm or disconfirm the asso-
ciation between these two types of violence and PTSD
symptoms while controlling for other types of violence.
Finally, PTSD symptomatology is one of many outcomes
of IPV. Future research could also use a comprehen-
sive model, incorporating individual, family, community
and societal level variables as outcomes of IPV, to more
completely understand the effects of IPV on women’s
health.
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