#97494: Digital Technology and Domestic Violence

In most jurisdictions in the United States, the term of "domestic violence" is used to describe intimate partner violence as well as family violence, such as child abuse [8]. The term "domestic violence" is broader and includes violence in a household against another member in that household [20]. Intimate partner violence (IPV) is characterized by a cluster of behaviors that an individual in an intimate relationship uses to control and maintain power over his or her partner [1]. These behaviors include physical, psychological, verbal, sexual, and economic/financial actions to threaten, assault, and ultimately control the victim. Power, intimidation, and control are key dimensions to abuse, and advances in online and offline technology offer a new arsenal of tools for abusers. Cell phones, video cameras, and global positioning systems (GPS) are examples of offline technologies domestic violence perpetrators may use to harass, intimidate, and locate victims. Perpetrators may call victims' cell phones or text message incessantly asking where they are, what they are doing, and who they are with. Abusers also utilize Internet tools like e-mail and social networking sites to threaten and intimidate. Technology-based IPV is often accompanied by offline violence, but there are instances where abusers simply use technology-based violence. In a study of adolescents 14 to 19 years of age, 17% used only some form of technology to engage in intimate partner violence [10]. Ultimately, in this new age of technology, abusers use these tools to create a sense of their omnipotence in order to control and demean their victims [9]. With the growing sophistication of technology, some scholars have observed that abuse can now emanate from a spaceless terrain [52]. The purpose of this course is to increase healthcare professionals' awareness of how Internet and digital technologies can place victims at risk, allowing for better patient education. Practitioners are encouraged to familiarize themselves with these new technologic tools, reformulate ways of thinking about safety planning, and consider about how to best educate the general public on how technology has changed the face of intimate partner violence.

The World Health Organization (WHO) defines violence broadly to encompass a wide range of behaviors. The formal WHO definition is [2]:

The WHO defines intimate partner violence as [63]:

In their definition of violence, the WHO utilizes the term "power" to communicate that abuse can go beyond physical acts of violence and includes behaviors that emanate from a power relationship, such as threats and intimidation, as well as acts of omission and neglect [2]. Furthermore, the concept of intentionality is used to convey that abuse does not necessarily mean that there is an intent to cause injury; a perpetrator may employ force with no intention of physically hurting or injuring the victim. However, the consequences of psychological, emotional, or financial abuse can have tremendous short- and long-term implications without being physically injuring [2].

Some have argued that the WHO definition is not always culturally specific. In India, IPV can involve other family members and not just an intimate partner [16]. Types of abuse or violence may also encompass behaviors that reflect the cultural norms. The abuse of infertile women or women who have not delivered any sons, for example, is common in India [16].

The U.S. Department of Justice defines domestic violence "as felony or misdemeanor crimes of violence committed by a current or former spouse or intimate partner of the victim, by a person with whom the victim shares a child in common, by a person who is cohabitating with or has cohabitated with the victim as a spouse or intimate partner" [11].This definition has continued to use the term domestic violence, further evidence that the term is still used interchangeably with IPV. The Centers for Disease Control and Prevention (CDC) defines intimate partner violence as a continuum ranging from a single episode to ongoing episodes of abuse that may include physical violence, sexual violence, stalking, and psychological aggression used by one individual on another party within the context of an intimate relationship [3]. The perpetrator or victim can be male or female, and the abuse can be perpetrated within a current or former dating relationship or marital dyad or within a heterosexual or homosexual context.Table 1summarizes the types of abuse or violence that can occur.

In this course, the terms "abuser," "batterer," and "perpetrator." It is acknowledged that there are distinct differences and political ramifications in how terms used to describe IPV are utilized; however, it is beyond the scope of this curriculum to address this issue.

Studies show that there appear to be two major patterns of IPV [2]. The first is a more severe type of abuse that encompasses multiple and various forms of abusive behaviors. In this classification, the abuse and violence escalates and the perpetrator increasingly attempts to control, monitor, and intimidate the victim. The second is a more moderate form of abuse whereby physical violence is occasionally perpetrated [2]. Some IPV victims do not experience any physical or sexual abuse for many years; rather, they regularly experience non-physical forms of abuse, such as emotional, psychological, social, and economic abuse [4]. The terms emotional and psychological abuse are often used interchangeably; however, they are distinct entities [4]. Emotional abuse consists of behaviors that are meant to gradually deteriorate the victim's dignity, self-respect, and self-worth. These behaviors might involve insults, put-downs, name-calling, and public humiliation. On the other hand, psychological abuse is meant to gradually diminish a victim's rational perceptions, to make one feel "crazy." The underlying intention in all types of abuse is power and control [4]. Although there is no consensus operational definition for the term "coercive control," most agree that it can exist without the use of physical or sexual violence. Continual monitoring and surveillance, mind games, and low-level threats can serve as an effective means for the perpetrator to control the victim [17,38]. Rather, previous incidences of partner violence can result in the victim feeling threatened and intimidated [17,51]. Jealousy, controlling behaviors, and threatening and sexually coercive behaviors result in a continual sense of fear and isolation in victims [38]. Understanding these dynamics provides a context in how technology can be used by perpetrators to reinforce power and control.

IPV knows no geographic boundaries. In a comprehensive systematic review and meta-analysis of studies conducted in low-, middle-, and high-income countries, researchers found an overall prevalence rate of 24.2% for any type of IPV experienced in the past year [77]. The lifetime prevalence of any type of IPV was 37.3%. Most victims of inter-relationship sexual violence are women who were assaulted by their male partners; 99% of perpetrators of rape against women are men [5]. As of 2011 in the United States, 9% of women have been raped by an intimate partner in their lifetime and an additional 16% have been subjected to other forms of sexual violence by a partner [5]. Approximately 0.5% of men have been raped by an intimate partner (predominantly by a male partner) in their lifetime and 9.5% experienced other forms of sexual violence [5].In a 2024 systematic review focusing on IPV and immigrants in the United States, the authors noted that past-year IPV victimization rates ranged from 3.8% to 46.9% and lifetime rates ranged from 13.9% to 93% [79].

The prevalence of physical violence in relationships is high, and rates are similar among women and men. In a 2018 national survey study conducted by the CDC, 25% of women and 14% men reported having experienced severe physical violence by an intimate partner during their lifetime [45]. The lifetime prevalence of physical violence by an intimate partner is 31.5% among women, with about two-thirds of instances involving severe physical violence [5]. Physical violence by an intimate partner has been experienced by 27.5% of men in their lifetime, with about half of instances being acts of severe violence. However, the physical toll on women is typically more severe and with much greater consequences. Sexual, physical, emotional, and psychological abuse of women overlaps in many instances, and abuse (often ongoing) can escalate to accidental or intentional murder. Violence perpetrated by current or former boyfriends or husbands accounts for 40% to 70% of all female homicides each year [2].

Intimate partner violence affects all areas of life, including the workplace. In a quantitative survey study involving 32 different companies, more than half of the female respondents and one-quarter of the male respondents disclosed having experienced some form of intimate partner violence during their lifetime. Of these respondents, violence affected their work in terms of missed days, tardiness, and abuser visits to the workplace [53].

A 2024 study found a prevalence rate of 27% of psychological abuse/violence for the past year and a lifetime prevalence rate of 32.8% experienced by women [77]. In the United States, more than 43 million women and 38 million men report having experienced psychological aggression by an intimate partner in their lifetime [3]. One or more acts of psychological aggression by an intimate partner have been experienced by 47% of women and 46.5% of men in their lifetime [5]. This is not limited to the United States. In a study with 661 Portuguese college students, 75% of men and 72% women reported having experienced psychological abuse by a partner during their lifetime [54]. In addition, 9.25% of women and 2.5% of men have been stalked by an intimate partner or former intimate partner.

In societies/cultures rigidly bound by traditional gender roles, abuse of wives is often considered a husband's right. When women in these groups do not conform to social and cultural expectations, their husbands are expected to use violence to regain obedience and respect from their wives [2]. Not surprisingly, the rates of coercive control are higher among countries with low levels of gender equality [17]. Women in such societies/cultures often fear that if they seek help from the violence, they will be ostracized from their family and the community. Because their identities are bound to marriage, these women feel they have no choice but to tolerate the abuse [55]. Studies highlighted by the WHO show that intimate partner violence is highly prevalent in Nicaragua, Papua New Guinea, Turkey, Egypt, and Ethiopia. Acceptance of IPV may play a role. In Vietnam, for example, although the overall prevalence of acceptance of IPV had declined between 2006 and 2011 (from 65.1% to 36.1%), age and educational attainment influenced overall acceptance. For example, women who were younger and had lower educational attainment were more likely to condone IPV [56].

Many first, second, or later generations of individuals from these cultures living in the United States experience and/or perpetrate the violence typical of their society of origin. Throughout the world, when physical abuse occurs in a marriage, psychological aggression almost always occurs and sexual assault occurs in one-quarter to one-half of instances [2]. However, in many countries (including the United States) studies are not conducted and/or intimate partner violence is hidden or not reported out of fear. In the United States, the prevalence of intimate partner violence varies among various ethnic/racial groups (Table 2) [5].

In order to understand the pervasive social, psychological, and cultural impact of the Internet on the lives of individuals, it is important to obtain a brief glimpse of Internet and digital technology usage and consumption. In 2018, 85.3% of American households had an Internet subscription, and in 2021,77% of households in the U.S. had broadband Internet [76,102]. Pew Internet Research Center reports that 89% of men and 88% of women 18 years of age and older use the Internet [76]. Individuals 18 to 29 years of age are the most likely to utilize the Internet (100%), while adults 65 years of age and older are the least likely (75%) [76].

There is no doubt that Internet technology has become a ubiquitous part of the American landscape. Although data published in the last several years is among the most current, the Internet landscape changes so rapidly that obtaining accurate data is nearly impossible.

A range of terminologies have been used to discuss intimate partner violence perpetrated through the use of electronic communications or digital technologies. The prefixes digital, Internet, cyber, online, technology-facilitated, electronic (or e-) have been used to refer to various devices [80]. A systematic review found 30 different terms employed across 33 different studies [81]. Further, there are conflicting and diverse definitions of intimate partner violence and which behaviors constitute abuse. The authors of the review settled on the term "cyber intimate partner victimization," defining it as "the intentional use of technology to abuse an intimate partner or an ex-intimate partner by implementing control and monitoring tactics, or by disseminating information, of a sexual nature or not, without consent. Moreover, these abusive behaviors, when they are known by the victim (e.g., when the geolocation is discovered), make her feel distressed, afraid, or preoccupied for her security" [81]. Nonetheless, it remains unclear if digital abuse and cyber intimate partner violence are extensions of offline, traditional IPV or if it represents a new form of intimate partner violence. The differing terminologies and definitions have made it difficult for researchers to employ standardization to allow comparison across studies. The lack of uniform definition and measurement has also yielded prevalence rates ranging from as low as 1% to as high as 78% [81].

The prefixes used to describe various technologies (e.g., cyber, digital, technology, electronic) are numerous, reflecting the ever-changing landscape of technology [105]. The terms after the prefixes (e.g., abuse, violence) further complicate the picture. Some researchers focus on specific forms of interpersonal violence, such as sexual, physical, or psychological, while others measure it more globally. It appears that technology tends to be used as an extension of existing in-person abuse and/or to facilitate abuse. The lack of consensus definitions and measurements creates a challenging environment in which to compare this phenomenon across studies and to understand the prevalence and context, impact, and significance.

In general, Internet and electronic technology may be used by perpetrators to determine victims' plans and movements. If a victim is not technologically sophisticated, she or he can inadvertently provide more information than intended to the abuser. When IPV or dating violence is perpetrated using technology, victims may be pressured by their partners to share passwords, usernames, or pin codes as a symbol of love [67].The spaceless nature of technology may make victims feel like they are hostages, even after they have left a partner. The sense that a perpetrator is omnipresent and not able to be avoided creates continual fear and hypervigilance [111]. The following sections will explore specific ways technologic tools have been used by perpetrators of intimate partner violence to stalk, control, and abuse their victims.

Although this course focuses on increasing practitioners' awareness of how technology can be used by abusers to harm victims of IPV, it is important to briefly review how the Internet and other forms of electronic technology have positively changed the landscape of the counseling, social service, mental health, and health arenas, particularly for victims of violence. In a study exploring how Internet technology was used by IPV organizations, seven types of direct online services were identified [37]:

Empowerment is a recurrent theme in the use of technology by IPV victims. First, victims are able to easily access information. Being able to easily retrieve information and communicate with practitioners using multiple communication vehicles can promote patient/client autonomy, increasing victims' sense of confidence, self-efficacy, and empowerment in terms of making decisions that promote their well-being and safety. For example, all 50 states have an IPV coalition, with a website for the public to access information about IPV, resources, shelters, and safety planning. Victims of intimate partner violence can also research information about restraining orders, shelters, and employment opportunities [35]. In a study by the Technology Safety Project of the Washington State Coalition Against Domestic Violence, a project designed to promote awareness of how technology can increase the risk of IPV, participants indicated that the Internet was an important tool when researching strategies to promote safety, allowing victims to play an active role in their own care [21,39,91]. Internet technology has also been used to provide education regarding general life skills for IPV victims, such as job training, money management, and practical survival skills. Victims have reported using the Internet to help search for housing, obtain assistance in creating a résumé, and enhance their skills in order to get a job [21]. Some of these services are offered in both real-time and non-real-time [115]. Internet technology may also be used to help raise awareness about IPV and to educate the public about intimate partner violence, how to obtain services, and how to protect oneself [71; 91; 115].

IPV victims often feel psychologically isolated, with overwhelming feelings of shame and worthlessness. They may also be physically isolated, given that abusers monitor victims' movements and/or restrict interaction with friends and family members. However, the Internet has opened opportunities for individuals to obtain social support. Online support groups, such as online self-help groups and discussion forums, can create communities for individuals to connect with each other based on common experiences. Victims and survivors of IPV share their stories in these online communities and through various Internet tools, including online social networking sites, video conferencing, and e-mail, to derive support from others with similar experiences [26,116]. Victims may feel more empowered and able to open up regarding IPV experiences online due to the relative anonymity and lack of stigma [71,72,116].

Because IPV situations are intense and manifest as crises to victims, Internet and electronic technologies can quickly connect victims to helping professionals. For example, victims can e-mail their counselors to obtain support during crisis situations. Providers can also more readily provide victims with information about potential options and resources, instead of having to wait for office visits [36,115]. For those who do not own or cannot safely use a cell phone, some organizations will provide disposable phones as part of the safety plan. Knowing that they have a cell phone available to call for help gave victims some semblance of control and safety [116]. In one research project, funds were provided for healthcare providers to use personal digital assistants (PDAs) to screen for abuse [40]. When the practitioner determined that an individual was at-risk, information was transmitted as quickly as possible to social workers to follow-up, mobilize resources, and electronically file mandatory reports of IPV [40]. Ultimately, this could improve the practitioner/patient relationship through the provision of more seamless services, which can increase patient satisfaction and reduce attrition.

Just as perpetrators of IPV can use electronic tools to harass their victims, victims can use technology to increase their sense of security. Victims may install cameras in their homes for additional security and in order to obtain evidence if the abuser is violating a restraining order. Data accumulated by mobile apps can detect IPV, and video cameras and audio recordings can quickly capture sounds and images for legal purposes[115]. Others use text messages as a way to let friends and family members know they may be in danger and to reach out for help [92]. On smartphones, victims can access recorders and video cameras to document abuse [92]. There are apps targeted to helping IPV victims such as myPlan and I-Decide to help individuals formulate safety plans [115,116]. There are also apps to promote safety for IPV victims (Resources).

MyPlan has been examined empirically to assess its effectiveness in helping IPV survivors and even bystanders (e.g., friends, family members). One experimental study involved college/university student participants who were randomly assigned to the myPlan app or to a control group of a website with basic emergency safety planning strategies to support a friend [117]. The participants were recruited based on a knowledge of a female friend who may be in an unsafe relationship and whom the participants were concerned about. The myPlan group had lower scores of decisional conflict and higher ratings of their own values and decisional preparedness compared with those in the control group. MyPlan has also been adapted to different cultures and low-income communities and countries. An experimental study randomly assigned 352 women in Kenya who were experiencing IPV to either an intervention group, which consisted of myPlan, or a control group, which consisted of referral to services [118]. The participants in the myPlan group reported greater safety preparedness immediately post-intervention compared with their control group counterparts. At three months, they reported an increased use of helpful safety strategies and felt they had the information to make better safety decisions. They also scored higher in resilience and helpfulness in safety strategies used compared with the control group [118].

Regardless of the tools used, it is always important for victims to remain vigilant regarding possible monitoring by their abusers. Victims who know or suspect that their online activities are being monitored should avoid visiting IPV sites or contacting triggering individuals unless an escape plan is in place.

Traditionally, safety planning has involved identifying practical approaches for lessening the risk of harm, including a plan of action if the victim decides to leave the abusive relationship such as having a bag packed with all the necessary documents; this is still advisable [73]. However, safety planning should also be supplemented with extra precautions that ensure victims understand how electronic communication tools can place them at risk and further steps to protect their safety. Practitioners serve a vital role in educating their patients or clients.

Many IPV organizations disseminate a message of fear in their communications about Internet safety [41]. Providers often suggest and may even pressure victims to disconnect themselves from their devices, change passwords/settings, and/or remove themselves from social networking sites [119]. However, this places the burden back on the victim and can result in further isolation and less access to existing support networks. It may also be associated with further escalation of the abuse [111]. Although fear can initially invoke safety behaviors, fear tactics tend to actually prevent the behavior that one is trying to promote over time. In other words, while a low amount of fear may not trigger any safety behaviors because individuals do not perceive the threat as real, employing a tremendous amount of fear in education and communications can also prove ineffective if individuals perceive there are no viable options to mitigate the fear. In these cases, victims may merely suppress the fear and not engage in any safety behavior [41]. As a result, practitioners must strike a balance in providing both education and support. The following precautions can promote technologic safety for victims and survivors of intimate partner violence [42,43,44,70,93,113,114]:

Ultimately, it is important for practitioners to emphasize and implement a survivor-centered approach to safety planning. It is important to partner with survivors to discuss how they want to implement their specific safety plan [116]. Some may want to remove and disconnect themselves from online platforms while others will feel that online social support networks are important. Their input on how they want their data stored and used should be solicited. Providers should also avoid assuming that in-person services are optimal; some prefer services to provided online and non-real time because they feel it is safer and more convenient [116].

Many adults may be categorized as what is termed "digital immigrants," meaning they did not grow up in the digital world and are trying to learn and adapt to this new environment [46]. Digital immigrants may employ technology and acknowledge its importance for some tasks, but tend to be less familiar with its potential [47]. On the other hand, adolescents and young adults are generally considered "digital natives," as they were raised using digital technology and have no difficulty speaking about and utilizing new technologic mediums with ease and familiarity [46]. Digital natives tend to use technology for numerous tasks and adapt as the tools change [47]. It is likely that the majority of health and mental health practitioners fall into the category of "digital immigrants," and many patients/clients, particularly adolescents and young adults, are "digital natives." Consequently, practitioners must quickly build their knowledge of new technology and how it is being used by their potentially younger patients or clients [47]. Unfortunately, this includes the need to understand how Internet technologies are being used to perpetuate abuse.

In order for practitioners to effectively educate patients/clients about the role of technology in intimate partner violence, they must understand the capacity of available programs and applications. Fortunately, there is a tremendous amount of information available online (Resources). These resources can be used to obtain a foundational knowledge in order to more effectively educate patients and clients.

Organizations and facilities share some responsibility in training professionals to become more computer and Internet savvy in general, especially in educating practitioners in how intimate partners can use the Internet and other forms of electronic communications to threaten, abuse, and intimidate their victims. It is important to identify cyberstalking and cyberabuse as crimes and respond accordingly, providing immediate services to protect victims [48]. When victims indicate that they feel they are being watched or that an abuser appears to know every movement made by the victim, practitioners should acknowledge and validate the experience [48].

To address the emotional turmoil and fear that victims of intimate partner violence experience, a variety of interventions can be offered [48]:

Community partnerships are vital, as it is often impossible for one organization or agency to provide multilevel services to meet all the needs of victims [48]. If Internet/technologic safety is an issue, collaborations with technology experts, legal professionals familiar with laws pertaining to stalking (particularly cyberstalking), and/or businesses that are willing to donate cell phones to victims can all be valuable.

Practitioners should also familiarize themselves with the Violence Against Women Act (VAWA). VAWA, enacted in 1994 and reauthorized in 2000, 2005, 2013, and 2021, was the first federal legislation that addressed IPV and other forms of violence against women. Since the first enactment, the legislation has been updated to touch on relevant issues such as privacy, the role of the Internet, and cyberstalking. Before anyone or any court can obtain private information, agencies funded by VAWA must make every reasonable effort to obtain permission and releases from victims [49]. Furthermore, VAWA restricts the online publication of filings for orders of protection as this could place victims at risk for discovery by perpetrators [49]. The 2005 reauthorization of VAWA updated stalking laws to reflect the use of Internet and electronic communications for the purposes of monitoring and harassing [49]. The 2013 reauthorization helped to ensure that services are available to persons of all sexual/gender identities, all races/ethnicities, college students, young adults, and immigrants [29]. The 2022reauthorization provides additional funding for culturally specific services, housing services such as federally assisted housing for victims, and access to unemployment insurance [94]. Finally, the Stopping Harmful Image Exploitation and Limiting Distribution (SHIELD) Act was introduced as a bipartisan bill in 2019. The goal was to provide protections for victims of nonconsensual sexual imagery and set criminal penalties for offenders. It was not enacted, but it was added as an amendment to the VAWA [114,120].

An ideal ecosystem for assisting and supporting victims of digital IPV should include professionals who have the knowledge and skills about how perpetrators use technology to control and monitor victims [121]. They should be able to explore with victims/survivors on how to handle the technologies to promote safety. Having the clinical skills to intervene in crisis and provide emotional support to enhance survivors' coping is equally vital to technology skills. Being familiar with the legal issues and having effective partnerships with local law enforcement and other resources is central to this ecosystem.

During the assessment process, a practitioner must be open and sensitive to the client's/patient's worldview, cultural belief systems, and how he/she views the injury or situation. Professionals should be willing to acknowledge that they do not possess enough or adequate knowledge in health beliefs and practices among the different ethnic and cultural groups they come in contact with. Reading and becoming familiar with medical anthropology is a good first step. Culturally sensitive assessment involves a dynamic framework whereby the practitioner engages in a continual process of questioning. By incorporating cultural sensitivity into the assessment of individuals with a history of being victims or perpetrators of IPV, it may be possible to intervene and offer treatment more effectively.

IPV is a social problem that has been studied from multidisciplinary lenses, and practitioners often have to work with an interdisciplinary team to be effective. Interprofessional collaboration (IPC) is characterized as a process whereby multiple providers from different professional fields work together to provide comprehensive services to patients. However, this requires professionals to alter the way they practice—moving from working in a silo to working in a collaborative and trusting manner, sharing information, resources, and multiple perspectives to address complex problems. Efficiency, cost containment, and measurable outcomes are key to IPC. More coordinated responses and maximizing interprofessional collaboration would yield improved outcomes, including delivering more effective services that avoid retraumatization, improving system responses, protecting the victim, and effectively sanctioning the abuser [95].

The core features of IPC include sharing, interdependency, communication, and mutual trust and understanding. Professionals from different disciplines share their philosophies, values, perspectives, data, and the planning of interventions [96]. IPC also involves the sharing of roles, responsibilities, decision making, and power [97]. Everyone on the team employs their expertise, knowledge and skills, working collectively on a shared, patient-centered goal or outcome [97,98]. Instead of working in autonomously, each team member's knowledge, expertise, and strengths are capitalized [96]. In order to share responsibilities, the differing roles and expertise are respected.

Although knowledge and skills sharing are often touted as imperative and valuable in IPC, it is challenging to implement. Division of responsibilities can result in blurred roles, because professionals have often been socialized in their training to operate autonomously [99]. Furthermore, definitions of IPV, screening and assessment practices, reporting requirements, and interventions vary in the different disciplines [99]. However, IPC is even more crucial when addressing technology-facilitated IPV. Including information technology experts and designers can add an important knowledge-sharing component.

Technology is a tool, and as with any tool, it can be used for positive means or abused to manipulate and exploit others. The solution is not to restrict access to technology but to educate consumers regarding its safe use. In addition to educating consumers, social service agencies, mental health organizations, and other helping organizations play a vital role in raising awareness among key stakeholders about how technology can be used by abusers to place IPV victims at risk. Furthermore, IPV advocates and practitioners can advocate for the formulation of new laws to protect victims of technology-based abuse. As more organizations use various forms of Internet technologies as part of their models of service delivery, it has become vital to incorporate security systems to protect the privacy of patients and clients, particularly victims of abuse.