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Abstract

Intimate Partner Violence (IPV) represents a significant public and social health concern and may present particular complexities in military veteran relationships which are subject to unique stressors including separations, transition to civilian life and increased risk of Post-Traumatic Stress Disorder (PTSD). Public understanding is vital in terms of ensuring access to services and appropriate intervention. However, little is known about the public perception of IPV in this context. This study sought to assess how public recognition and discourse is affected by military veteran status and a diagnosis of PTSD. Community participants (N = 269) were randomly allocated to one of four conditions and presented with a story containing IPV in which the profession (military veteran/civilian worker) and diagnostic status (PTSD/No PTSD) were manipulated. All participants rated the extent to which they felt the story contained IPV; additionally, half (n = 123) took part in a story completion task designed to elicit qualitative data with regards to public discourse. The mean scores in all conditions were weighted towards IPV recognition. Results indicated a small interaction between job role and PTSD (F[1265] = 7.888, p < 0.01, partial n² = 0.029) meaning that the public are more likely to recognise IPV when it is perpetrated by a military veteran than a civilian with PTSD. Diagnostic status made no difference to recognising abuse perpetrated by a military veteran. However, the fit of the model was weak (r² = .040) meaning that the large majority of variance was due to factors not accounted for. Qualitative findings indicated that in a military population trauma may be assumed even where not indicated and the public appear less likely to consider current stressors or acknowledge that PTSD cannot justify abuse. Victims of IPV in military relationships may therefore be particularly vulnerable to discourses that prioritise the victim status of the perpetrator.

Keywords

domestic abuse intimate partner violence military veterans PTSD trauma

Introduction

The Ministry of Defence (2018) has identified the need for specialist strategies to address Intimate Partner Violence (IPV) within military communities. The extent to which rates of IPV are higher in the military is unclear (Kwan et al., 2020; MacManus et al., 2022; Rentz et al., 2006; Sparrow et al., 2018; Taft et al., 2011). However, there is strong evidence that where it does occur the risk of physical harm is greater (Aronson et al., 2014; Hoyt et al., 2014).

Military relationships may be subject to unique stressors such as long periods of separation, frequent relocation and financial dependency (Jones, 2012), which can continue to play out long after a person has retired from service (Burland & Lundquist, 2013; Sparrow, et al., 2017). As a necessity, military culture normalises the use of instrumental violence (Bradley, 2007), which may generalise across contexts (Jones, 2012; Lysova and Straus, 2019), with combat experience being a specific risk factor (Kwan et al., 2018). Hyper-masculine ideals may also foster abuse (Herrero et al., 2017; Taft, Watkins et al., 2011). A further complexity is the role of post-traumatic stress disorder (PTSD), which occurs at a higher rate in the military than in the general population, and at higher rates in veterans than serving personnel (NHS Digital, 2014; Stevelink et al., 2018).

The interplay between PTSD and IPV has significant implications for intervention. Mental distress may be particularly stigmatised in military culture, preventing people from accessing treatment (Aronson et al., 2014; Cornish et al., 2014; Greene-Shortridge et al., 2007; Silvestrini & Chen, 2022) but trauma symptoms, in turn, may limit the efficacy of IPV intervention (Taft, Wadswirth et al., 2011). Military personnel may be most likely to disclose psychological difficulties to family and friends (Stevelink et al., 2019); thus, the social network around a military couple can be vital in facilitating access to services (Aronson et al., 2014). As such, public understanding with regards to IPV and PTSD in this community demands attention.

Public understanding, that is to say the general, non-expert population’s understanding of IPV is well evidenced – with physical and sexual abuse particularly recognised as unacceptable (Carlson & Worden, 2005). Demographics such as age, gender, ethnicity, and experience of IPV may have some bearing on beliefs, although findings are inconsistent and risk stereotyping groups (Gracia & Tomás, 2014; Wagers et al., 2017; Worden & Carlson, 2005).

More convincing is the evidence that public understanding of IPV is mediated by contextual factors, such as the relationship between the perpetrator and victim, leading to what Lelaurain et al. (2018) term ‘conditional logics’ by which the public navigate ambivalence regarding abuse by citing factors which minimise or legitimise behaviour (Carlson & Worden, 2005; Sorenson & Thomas, 2009; Taylor & Sorenson, 2005; Worden & Carlson, 2005). Public discourse is also reproduced across health and social care settings by professionals who inevitably act from within their social context (Bradbury-Jones et al., 2014; Buck & Collins, 2007; Ramsey et al., 2012; Saletti-Cuesta et al., 2018).

Therefore, there are indicators that myths that legitimise abuse may remain latent if not overt in public and professional discourse (Lelaurain et al., 2018; Refuge, n.d.) with concerning implications for disclosure and access to support (Barnett, 2001; Bradbury-Jones et al., 2014). However, little is known about the way in which understanding of the specific issues facing military veteran couples intersects with wider public discourse. Conceivably, abuse may be reframed through the lens of trauma (Worden & Carlson, 2005); equally, ideas regarding military culture as aggressive (Taft, Watkins et al., 2011) may align with broader ideas about who perpetrates violence and why. The role of social discourses in personal and professional support is particularly pertinent given the role of civilian services who are required to support veterans but may lack understanding of the military context (Home Office, 2020). Research is therefore needed in order to inform campaigning and intervention with the veteran community.

Current Study

The current study aims to consider two key factors that may impact on IPV recognition and discourse in the general public; namely, (a) PTSD and no PTSD diagnosis, and (b) across military veteran and civilian status in a general sample. As a scoping study, no prediction as to direction of effect was possible. Instead, two broad hypotheses were made:

1. Public recognition of an incident as a form of IPV will be affected by:

a. Whether the perpetrator is a military veteran or a civilian worker.

b. Whether the perpetrator has a diagnosis or no diagnosis of PTSD.

2. Public discourse regarding an incident of IPV will be affected by:

a. Whether the perpetrator is a military veteran or a civilian worker.

b. Whether the perpetrator has a diagnosis or no diagnosis of PTSD.

The study also considered variance in recognition of IPV due to participant demographic factors and relevant experience in line with the wider literature (Carlson & Worden, 2005). However, given the mixed findings no hypotheses were made regarding presence or direction of an effect.

Method

Ethical Approval

The study received ethical approval from The University of Bath Psychology Department Research Ethics Panel (reference 19–282).

Design

The study employed a cross-sectional, between groups, mixed methods design. All participants completed a quantitative measure. In order to limit risk of saturation and in line with recommendations for the methodology used (Clarke et al., 2017) half were then randomly allocated to complete an additional qualitative task.

Participants

Adults aged 18 years and over, and currently residing in the UK were recruited via the University of Bath Department of Psychology study participation panel, on social media (Facebook and Twitter) and using snowball sampling (N = 269).

Demographic data were collected with regards to age, gender, ethnicity and sexual orientation (Table 1). Age ranged from 20–75 years (mean 38.7, SD 11.5) and was normally distributed. Ethnicity (85.5% White British) was somewhat representative, where 80.5% of the population in England and Wales are recorded as White British (Office for National Statistics, 2019), but did not adequately capture the range of ethnic identities in the UK. Sexual orientation (82.2% heterosexual) was reasonably well matched with the general population (94.6%; Office for National Statistics, 2020)). There was a clear overrepresentation of female participants (79.9%).

Table 1.

Demographic Data (N = 269).

Category	R, M, SD
Age (n = 268)	20 – 75, 38.72, 11.475
Gender	n (%)
Male	52 (19.3)
Female	215 (79.9)
Other	2 (.7)
Ethnicity (n = 268)
White – Welsh/English/Scottish/Northern Irish/British	230 (85.8)
White – Irish	1 (.4)
Any other white background	21 (7.8)
Asian or asian british - Chinese	1 (.4)
Asian or asian british – Indian	8 (3)
Asian or asian british - Pakistani	1 (.4)
Arab	1 (.4)
Mixed white and black caribbean	2 (.7)
Mixed white and asian	2 (.7)
Any other mixed background	1 (.4)
Sexual orientation (n = 267)
Heterosexual	221 (82.8)
Gay/Lesbian	21 (7.9)
Bisexual	22 (8.2)
Other	3 (1.1)

Questions about relevant experience were used to capture professional, direct personal and indirect personal experience of IPV, PTSD and military service. Summary statistics (Table 2) showed that participants had a high level of professional experience across IPV, PTSD and military service. This was particularly notable in terms of professional experience of working with someone who has experienced IPV (50.6%) and PTSD (43.9%). However, there was also a high level of ‘indirect’ personal experience (i.e., supporting someone) with 52.8% for IPV and 39% for PTSD respectively. Direct experience of IPV (29.7%) and of PTSD (18.6%) were also both notably higher than population estimates (NHS Digital, 2014; Office for National Statistics, 2019).

Table 2.

Summary of Participant Relevant Experience (N = 269).

		Experienced IPV N (%)	Perpetrated IPV N (%)	Experienced PTSD N (%)	Partner experiencing PTSD N (%)	In the military N (%)	Partner in the military N (%)
Professional	Yes	136(50.6)	80(29.7)	118(43.9)	54(20.1)	63(23.4)	44(16.4)
Experience	No	131(48.7)	184(68.4)	149(55.4)	210(78.1)	205(76.2)	224(83.3)
Experience	Prefer not to say	2(.7)	5(1.9)	2(.7)	5(1.9)	1(.4)	1(.4)
Indirect	Yes	142(52.8)	37(13.8)	105(39)	42(15.6)	46(17.1)	41(15.2)
Personal	No	127(47.2)	231(85.9)	162(60.2)	225(83.6)	222(82.5)	228(84.8)
Experience	Prefer not to say	0(0)	1(.4)	2(.7)	2(.7)	1(.4)	0(0)
Direct Personal	Yes	80(29.7)	10(3.7)	50(18.6)	25(9.3)	3(1.1)	119(7.1)
Experiance	No	184(68.4)	257(95.5)	215(79.9)	242(90)	265(98.5)	250(92.9)
Experiance	Prefer not to say	5(1.9)	2(.7)	4(1.5)	2(.7)	1(.4)	0(0)

Measures

A rating scale and a story completion task were designed for specific use in this study.

Intimate Partner Violence Rating Scale

Participants were asked to rate the extent to which they thought the behaviour described in the study story constituted IPV using a Likert scale of 0–10 (recorded to one decimal place) where 0 = definitely not abuse, 5 = not sure if abuse and 10 = definitely is abuse. This aimed to test the hypothesis that the status of a perpetrator as a military veteran experiencing PTSD would impact upon recognition of IPV.

Story Completion Task

This asked the participants to complete an unfinished story imagining that they were offering advice as a friend of the victim. This generated textual data for qualitative analysis focused on public discourses about military veteran status and diagnosis of PTSD in an incident of IPV.

Procedure

The study was hosted online by Qualtrics. Participants were recruited via a UK university research community participation panel, social media (Twitter and Facebook), and using snowballing. The study focus was described as ‘work, wellbeing and relationships’ in order to limit priming with regards to IPV content. An information page provided further limited details including a warning that participants would be requested to read an account of an argument in which a man becomes very angry, bearing in mind the potential to cause distress. Following informed consent, demographic information were collected. Participants were then randomly allocated to one of the four conditions:

• Condition 1: Military Veteran, PTSD (COND1 MVet PTSD)

• Condition 2: Military Veteran, No PTSD (COND2 MVet NPTSD)

• Condition 3: Control (Construction Worker), PTSD (COND3 ConW PTSD)

• Condition 4: Control (Construction Worker), No PTSD (COND4 ConW NPTSD)

Construction work was identified as the civilian role (control) with parallels in terms of being a male dominated industry with positions across social class and educational attainment.

In each condition all participants were first asked to read the study story. The story described a married heterosexual couple, Danny and Naomi, having an argument during which Danny, having hidden Naomi’s phone, then punched a wall and threw the phone in her direction. The story ended with Naomi describing the incident to her friend Steph and asking for advice. The story thus contained evidence of IPV, namely control (hiding the phone) and physical threats (punching the wall and throwing the phone). In each condition the story was identical except for the job role and diagnostic status of Danny, which were manipulated as previously outlined.

Half of the participants in each condition were next randomly allocated to the story completion task. Story completion is a novel method for generating qualitative data. It is well suited to between groups comparison as IVs can be manipulated within story prompts. It also provides a distancing effect allowing sensitive subjects to be more safely explored and potentially limiting desirability affects which can be a concern in the wider IPV literature (Clarke et al., 2017; Visschers et al., 2017). Participants were asked to complete the story as if they were Steph, responding to Naomi’s request for advice and were instructed to write at least 10 lines in order to generate rich data for qualitative exploration.

All participants were then requested to complete the IPV rating scale and relevant experience questionnaire. At every stage, an ‘exit study’ button was available, redirecting participants to a debrief page, that included details of relevant agencies, thereby ensuring that it was possible to access support without needing to complete the study. The debrief page was made available to all participants following study completion.

Data Analysis Plan

Quantitative data

Exploratory analysis identified outliers in Conditions 1 and 3, negative skew across all four conditions, and kurtosis in Condition 1. As such, assumptions of normal distribution were not met. However, given the mixed evidence as to the requirement of normal distribution when calculating an F-statistic (Field, 2018) and debate as to acceptable levels of skew and kurtosis (Bandalos, 2018; Morgan et al., 2000), a 2 X 2 ANOVA was employed to calculate main and interactive effects of Job Role (Military Veteran/Construction Worker) and Diagnostic status (PTSD/No PTSD) (independent variables) on IPV rating (dependent variable). In order to enhance robustness, parameter estimates were based on 1000 bootstrapped resamples (Field, 2018). Simple effects were then calculated using independent t-tests, bootstrapped at 1000.

A secondary analysis was completed in order to identify any significant impact of demographic or relevant experience variables on IPV rating. An ANCOVA (with parameter estimates bootstrapped at 1000) was performed with each variable entered into the model separately. Again, significant findings were followed up with a calculation of simple effects using independent t-tests bootstrapped at 1000.

Qualitative data

Data were uploaded to NVivo and analysed first using thematic analysis as outlined by Braun et al. (2015) in order to explore public discourse with regards to IPV and any impact of military veteran status and PTSD diagnosis. The first author immersed themselves in the data before identifying initial extracts across all four conditions relevant to the research question and labelling initial codes. Codes were then drawn together into themes and sub-themes. The data was next split according to condition and cross-referenced with the initial themes to check that meaning was adequately captured and no condition specific themes were missed. In line with Terry et al., (2017) the analysis was understood as inherently a process of construction meaning that secondary ratings would not necessarily add to the validity of findings. Instead the primary author participated in supervisions with the second author, reflecting upon data representation and relevance. Finally, frequency analysis of coding was completed in order to identify any differences between groups in terms of the prominence of themes.

Results

Results with regards to, first, the quantitative analysis of the IPV rating and, second, the qualitative analysis of the story completion task are presented below.

IPV Rating

Summary statistics for the IPV rating are provided in Table 3. The highest mean IPV rating was found in COND4 (ConW NPTSD) (8.84/10 where 10 means the behaviour is ‘definitely domestic abuse’; Range; 4.7–10; SD 1.45), but in all conditions means were weighted towards IPV recognition (COND1 MVet PTSD: Mean 8.74; Range 2.8–10; SD 1.63, COND2 MVet NPTSD: Mean 8.46; Range 4–10; SD 1.56, COND3 ConW PTSD: Mean 7.93; Range .9–10, SD: 2.19) leading to data skew, as previously discussed. In all conditions, the maximum IPV rating (10/10) was given by at least one participant indicating that some participants in each condition recognised that the behaviour definitely constituted abuse.

Table 3.

Summary Statistics (N = 269).

		COND1 MVet PTSD N = 67 (24.9%)		COND2 MVet NPTSD N = 67 (24.9%)		COND3 ConW PTSD N = 66 (24.5%)		COND4 ConW NPTSD N = 69 (25.7%)
		Statistic	Std. Error	Statistic	Std. Error	Statistic	Std. Error	Statistic	Std. Error
Mean		8.736	.1988	8.461	.1901	7.933	.2699	8.842	.1749
95% confidence interval for mean	Lower bound	8.339		8.082		7.394		8.493
95% confidence interval for mean	Upper bound	9.133		8.841		8.472		9.191
Median		9.300		8.800		8.200		9.800
Variance		2.648		2.422		4.807		2.111
Std. Deviation		1.6273		1.5564		2.1924		1.4530
Minimum		2.8^a		4.0		.9^a		4.7
Maximum		10.0		10.0		10.0		10.0
Range		7.2		6.0		9.1		5.3
Skewness		−1.500	.293	−.921	.293	−1.062	.295	−1.040	.289
Kurtosis		2.039	.578	.189	.578	.652	.582	.044	.570

^aSignificant outliers as identified by box plots.

A 2X2 ANOVA showed no significant main effect of Job Role (F[1, 265] = 1.002, p > 0.05) or Diagnostic Status (F[1265] = 2.265, p > 0.05) on IPV rating (Table 4). However, a significant, though small, interaction between Job Role and Diagnostic Status accounted for 2.9% of variance (F[1265] = 7.888, p < 0.01, partial n² = 0.029). Overall, the fit of the model was weak (r² = .040) meaning that the large majority of variance was due to factors not accounted for in the study design.

Table 4.

Analysis of Main and Interactive Effects.

Source	Type III Sum of Squares	df	Mean Square	F	Sig	Partial Eta Squared
Corrected model	33.091^a	3	11.030	3.697	.012	.040
Intercept	19,398.641	1	19,398.641	6501.806	.000	.961
Job	2.988	1	2.988	1.002	.318	.004
Diagnosis	6.758	1	6.758	2.265	.134	.008
Job*Diagnosis	23.536	1	23.536	7.888	.005	.029
Error	790.648	265	2.984
Total	20,248.790	269
Corrected total	823.739	268

^aR Squared = .040 (Adjusted R Squared = .029).

A test of simple effects (Table 5) indicated that job role had no significant impact on IPV rating where there was no diagnosis of PTSD (t[1134] = -1.476, p > 0.05) meaning that participants were equally likely to recognise IPV across job roles where there was no diagnosis of PTSD. However, the impact was trending towards significance (using Bonferroni corrections) where there was a diagnosis of PTSD (t[1131] = 2.399, p = 0.018), with participants giving a higher IPV rating where the perpetrator was a MVet. This means that participants were more likely to recognise IPV when the perpetrator was a MVet with PTSD than a ConW with PTSD.

Table 5.

Tests of Simple Effects.

	t	df	Sig. (2 -tailed)	Mean Difference	Std. Error Difference	95% Confidence Interval of the Difference
	t	df	Sig. (2 -tailed)	Mean Difference	Std. Error Difference	Lower	Upper
Job role
PTSD	2.399	131	.018	.8025	.3345	.1409	1.4641
NPTSD	−1.476	134	.142	−.3808	.2581	−.8913	.1297
Diagnostic status
MVet	.998	132	.320	.2746	.2751	−.2695	.8188
ConW	−2.850	133	.005	−.9087	.3188	−1.5393	−.2781

Diagnostic status had no significant impact in the MVet group (t[1132] = 0.998, p > 0.05) meaning that participants were equally likely to identify IPV perpetrated by a MVet whether or not they had a diagnosis of PTSD. However, in the ConW group a significant difference was found (t[1133] = -2.850, p = 0.005) with participants giving a higher IPV rating where there was no diagnosis of PTSD. This means that when the perpetrator was a ConW the participants were more likely to recognise IPV when there was no diagnosis of PTSD.

Covariates

The secondary analysis (ANCOVA) indicated that none of the demographic variables impacted significantly on variance in IPV rating. In terms of relevant experience, only professional experience of working with people who have experienced IPV (PEWPIPV) was shown to have a significant impact on IPV rating, accounting for 2.7% of variance (F[1262] = 7.398, p = 0.007, partial n² = 0.027). The significant interaction of Job Role and Diagnostic Status held (F[1262] = 10.316, p = 0.001, partial n² = 0.038). The model fit, though improved, remained weak (r² = .071) (Table 6).

Table 6.

Analysis of Covariance With Professional Experience of Working With People who Have Experienced IPV as a Covariate.

Source	Type III Sum of Squares	Df	Mean Square	F	Sig	Partial Eta Squared
Corrected model	57.265^a	4	14.316	4.982	.001	.071
Intercept	8828.748	1	8828.748	3072.342	.000	.921
PEWPIPV	21.260	1	21.260	7.398	.007	.027
Job	2.619	1	2.619	.912	.341	.003
Diagnosis	6.009	1	6.009	2.091	.149	.008
Job*Diagnosis	29.645	1	29.645	10.316	.001	.038
Error	752.889	262	2.874
Total	20,172.370	267
Corrected total	810.154	266

^aRSquared = .071 (Adjusted R Squared = .056).

An independent t test (bootstrapped at 1000) was performed in order to identify the direction of the relationship between PEWPIPV and IPV rating. It was found that people who did have professional experience provided a significantly higher rating (t[265,1] = -2.527, p = 0.012). Assumption of homogeneity of regression slope was met. This means that participants who had professional experience in the IPV field were more able to recognise IPV.

Story Completion Task

Thematic analysis led to the identification of three superordinate themes: (a) Description of the Behaviour; (b) Causes of the Behaviour; and (c) Solutions to the Behaviour. Each superordinate theme had a number of themes. In line with the study hypothesis a key point of interest was similarities and differences across the conditions. Notably, similar themes were found in all four conditions and no unique themes were identified within conditions. However, important differences were found in the frequency of themes between conditions. Findings from the thematic and frequency analysis are discussed below. Data extracts are provided in Tables 7, 8, and 9 and summaries of frequency coding in Figures 1 - 3.

Table 7.

Data extracts for ‘Describing the Behaviour’.

Theme	Sub-Theme	Example data extract for each sub-theme	Coding Frequency^a
Describing the behaviour	Unacceptable	COND1 P104 ‘it is never acceptable to use violence against someone whether it is verbal or physical.’	10
		COND2 P206 ‘you need to recognise this isn’t OK.’	9
		COND3 P68 ‘does he know what he’s done is wrong and that he cannot continue to behave this way?’	5
		COND4 P5 ‘naomi should sit him down and ask him what makes him think that such behaviour is remotely acceptable.’	12
	Violent	COND1 P117 ‘arguments are a normal part of any relationship, but reacting to them violently is not.’	5
		COND2 P15 ‘it sounds as if danny has a really violent temper’	9
		COND3 P31 ‘you [...] can’t allow him to hurt you physically or emotionally any longer.’	6
		COND4 P257 ‘she is unhappy about his outbursts and their increasing violence.’	7
	Controlling	COND1 P198 ‘hiding your phone from you is very controlling and worrying in itself.’	5
		COND2 P111 ‘the fact that he has hidden her phone shows that he is trying to control her.’	3
		COND3 P50 ‘she would ask why he was hiding her phone and whether that had happened much in the past because it’s a strong sign of controlling behaviour in a relationship.’	5
		COND4 P29 ‘steph says that she thinks danny is exhibiting “coercive control” by hiding the phone (she saw a government funded advert about it and a storyline on a soap).’	9
	Domestic abuse	COND1 P126 ‘this is domestic violence’	3
		COND2 P164 ‘she highlights to naomi that this behaviour is abusive.’	6
		COND3 P115 ‘naomi should [...] free herself from what appears to be an abusive relationship	2
		COND4 P64 ‘you are being abused.’	5

^aIndicates the no. of responses coded for this theme in each condition.

Table 8.

Data extracts for ‘Causes of the Behaviour’.

Theme	Sub-Theme	Example Data Extract	Coding Frequency^a
Causes of the behaviour	Stress	COND1 P193 ‘he is clearly struggling with [...] how to cope with the stress that’s occurring.’	1
		COND2 P195 ‘Naomi tells steph it is just because danny is stressed.’	4
		COND3 P231 ‘Steph responds saying that [...] she knows he’s been under a lot of stress lately.’	3
		COND4 P134‘He’s obviously under a lot of stress and I get that, but he’s taking it out on you.’	5
	Emotional difficulties	COND1 P156 ‘I imagine he doesn’t want to take it out on you but without proper support his feelings are being misdirected?’	3
		COND2 P30 ‘men tend to bottle things up as it's a macho image to not whine and cry.’	7
		COND3 P31 ‘he seems to have a lot of anger built up and you’re his only outlet.’	5
		COND4 P158 ‘he needs help with his anger.’	3
	Impact of work	COND1 P233 ‘I know that Danny finds things hard because of his experiences in the army.’	2
		COND2 P78 ‘I hate the army it does horrible things to people.’	10
		COND3 P92 ‘if he has only really known one work environment from a very young age, and probably a male dominated industry to suddenly find himself without a job, at home lacking purpose and focus [sic] very difficult.’	3
		COND4 P158 ‘Danny reveals that he has struggled to come to terms with leaving the construction industry.’	3
	PTSD	COND1 P198 ‘danny isn’t well my love’	14
		COND2 P30 ‘Naomi you should sit down and talk to him calmly without having shouting session. Perhaps, he’s living through some trauma you don’t know about.’	9
		COND3 P50 ‘Steph would also recognise that the PTSD diagnosis might have something to do with their arguments.’	12
		COND4 No data coded	0
	PTSD is not an excuse	COND1 P245 ‘his behaviour, whilst being a product of his trauma, is unacceptable.’	3
		COND2 P67 ‘Steph is very clear that no amount of PTSD or any other issue is an excuse for Danny’s behaviour.’	2
		COND3 P92 ‘that doesn’t excuse Danny’s reaction and aggressive behaviour but his diagnosis of PTSD can give an insight into why he may be reacting and behaving the way he is.’	6
		COND4 No data coded	0

^aIndicates the no. of responses coded for this theme in each condition.

Table 9.

Data extracts for ‘Solutions to the Behaviour’.

Theme	Sub-Theme	Example Data Extract	Coding Frequency^a
Solutions to the behaviour	Naomi should stay elsewhere	COND1 P245 ‘maybe it would be a good idea to take some time apart to give each other space.’	9
		COND2 P206 ‘if you need to leave, but you don’t want to split up, that’s allowed. You can maintain a safe distance and still make clear to him you love and support him and want to come back as soon as he is getting help.’	13
		‘COND3 P165 ‘some time apart will give you both some space to think; you can consider how you feel about his behaviour and what it means to your relationship.’	15
		COND4 P113 ‘why don’t you come and stay with me for a few weeks to allow some cooling off time and space.’	6
	Naomi should consider the relationship	COND1 P19 ‘do you still love him? Do you want to stay with him?’	5
		COND2 P45 ‘you should really evaluate your relationship.’	2
		COND3 P12 ‘Steph asks Naomi whether she still loves her husband and whether they still assume they have a future together.’	3
		COND4 P236 ‘you need to take yourself away from the situation and think about whether you feel safe and secure in the relationship.’	2
	Naomi should leave Danny	COND1 P19 ‘do you want to stay with him? If you don’t, either come and stay with me for a bit or find a women’s refuge if necessary. Just leave.’	4
		COND2 P241 ‘you need to leave him. He will do this again. You can stay with me or I can help you find a woman’s shelter.’	7
		COND3 P2 ‘if he cares enough for you he will understand and seek help; if not I think you should leave.’	5
		COND4 P5 ‘her gut feeling is that naomi should plan a safe exit, and get the hell out of it, before she falls pregnant, or he actually harms her physically.’	14
	Help as a couple	COND1 P104 ‘maybe use a mediator, a professional.’	7
		COND2 P188 ‘Steph says that if she doesn’t leave then they should at least see a councillor.’	2
		COND3 P185 ‘Steph suggests they go to relate.’	5
		COND4 P236 ‘you should think about couple therapy if you decide that you want to stay with Danny.’	5
	Concern for Danny	COND1 P171 ‘you shouldn’t have to go through this and neither should he. He seems to be getting worse. He has been through so much but this can’t keep happening.’	6
		COND2 P15 ‘he needs to know that he is not alone, and that lots of people who served in the army are affected, and that there are ways to recover.’	3
		COND3 P92 ‘It’s clear your [sic] are BOTH going through a very difficult time at the moment.’	4
		COND4 P134 honey, I’m worried about you. But also worried about him.’	1
	Help for Danny	COND1 P54 ‘encourage Danny to see a mental health specialist and look into longer term therapy that can support him to manage his triggers.’	19
		COND2 P15 ‘have you considered asking for help? […] could you [...] ask danny to go to his GP? He might even let you go with him. He needs to know that he is not alone, and that lots of people who served in the army are affected.’COND3 P20 ‘he should ask the G.P to send him for anger management classes.’	19
		COND4 P257 ‘if he can’t talk to her, then suggest	21
		‘another friend, therapist or similar third party to help him work out his troubles.’	11
	Naomi should help Danny	COND1 P26 ‘try to always show that you can be open to talk about anything and that it's better to talk than let things get out of hand. Think about what seems to trigger the arguments and his reactions. If he’s open to it try and talk to him about the PTSD and whether he feels that’s what is causing his strong reactions. Show understanding.’	14
		COND2 P15 ‘I really must get him help.....perhaps I can get in touch with the army and see what they can offer.'	7
		COND3 P200 ‘Naomi speaks to Danny and he agrees to get help. Naomi supports him by taking him to and from appointments with a therapist, and helping him to avoid stressful situations as much as possible.’COND4 P66 ‘if he is willing at this point to seek help'	10
		‘then they should together look at what help he needs.’	6
	Concern for Naomi	COND1 P245 ‘whilst he’s suffering with PTSD, you are also carrying some of the burden.’	7
		COND2 P121 ‘Naomi I’m worried about you and for you.’	7
		COND3 P47 Steph responds ‘by acknowledging this must have been very scary and upsetting for naomi.’	10
		COND4 P134 ‘honey, I’m worried about you.’	9
	Help for Naomi	COND1 P41 ‘Naomi should consider if she requires additional help in helping Danny or counselling herself. A partner with mental health difficulties can be a strain on both parties and both parties may require support to overcome the issues.’	10
		COND2 P164 ‘Steph explained that there was [sic] lots of helplines in which naomi could call and they would be able to offer further support.’	7
		COND3 P92 ‘maybe you could speak to your GP for any advice or service to support spouses who are struggling with their partner’s mental health issues? It might be helpful to have advice on how to diffuse these situations and not engage in arguments with danny while he is recovering and have advice on the best way to support his and your needs during this difficult time.’	7
		COND4 P267 ‘if he becomes angry/violent back off and speak to family/friends and seek specialist advice.’	5
	Safety	COND1 P248 ‘there is a genuine concern for Naomi’s safety as these actions could lead to more physical ones.’	14
		COND2 P140 ‘steph is concerned for Naomi’s welfare, particularly Danny’s violent behaviour. She warns naomi that if the situation continues, she thinks she naomi is at risk of physical harm.’	13
		COND3 P125 ‘Danny’s exhibiting some dangerous behaviour, that may, if it hasn’t already escalate.’	15
		COND4 P49 ‘leave him. This is unsafe. Stay here I will get your things.’	14
	Police	COND1 N/A	0
		COND2 P258 ‘she might discuss whether naomi has ever considered calling the police when Danny’s anger escalates.’	2
		COND3 P86 ‘let her know [...] that if she wishes she can get help from the police.’	1
		COND4 P5 ‘Steph tells Naomi that [...] she should go to the police to report that she fears for her safety, and that this has happened before.’	2

^aIndicates the no. of responses coded for this theme in each condition.

Figure 1.

Frequency of coding between groups for ‘Describing the Behaviour’.

Figure 2.

Frequency of coding between groups for ‘Causes of the Behaviour’.

Figure 3.

Frequency of coding between groups for ‘Solutions to the Behaviour’.

Describing the Behaviour

Participant responses consistently included a description of Danny’s behaviour with four themes identified with regards to this description: Danny’s behaviour was (a) unacceptable; (b) violent; (c) controlling; and (d) domestic abuse.

Participants described Danny’s behaviour as ‘unacceptable’ although this was less common in COND3 (ConW PTSD). Participants commented upon the aggression, and ‘violence’ displayed by Danny. Some also reflected on the element of control. Interestingly, participants in COND4 (ConW NPTSD) commented more on control than on violence. A few participants used ‘domestic abuse’ or a related term to directly label the behaviour, though this was slightly more frequent in COND2 and COND4 where there was no diagnosis of PTSD.

Causes of the Behaviour

Participants attempted to contextualise Danny’s behaviour, drawing on the story to identify a cause. Themes were: (a) stress; (b) emotional difficulties; (c) the impact of work; (d) PTSD; and (e) PTSD is not an excuse.

In all four conditions participants described how Danny’s behaviour should be understood in the context of ‘stress’. Responses suggested emotional difficulties such as ‘anger’ or a ‘difficulty expressing feelings’ might also be a root cause. The impact of work was again suggested in all four conditions though particularly in COND2 (MVet NPTSD). In COND1 (MVet PTSD), 2 (MVet NPTSD) and 3 (ConW PTSD) participants described how PTSD, trauma and mental ill-health may be causing IPV. However, in each, and most frequently in COND3 (ConW PTSD), a smaller number also suggested that PTSD should not be considered an ‘excuse’.

Solutions to the Behaviour

Participants offered solutions to Naomi according to two themes: (a) The Relationship, and (b) Help. Further subthemes identified within ‘The Relationship’ were ‘Naomi should Stay Elsewhere’; ‘Naomi should Consider the Relationship’ and ‘Naomi should Leave Danny’. Within the theme of Help, sub-themes were Help as a Couple; Concern for Danny; Help for Danny; Naomi should Help Danny; Concern for Naomi; Help for Naomi; Safety and Police.

The Relationship

Participants across the conditions suggested that Naomi should consider staying elsewhere, most indicating that this should be temporary, in order to have time to think. A smaller number suggested that Naomi should consider the future of the relationship, and more explicitly that she should consider permanently leaving Danny, particularly in COND4 (ConW NPTSD).

Help

Some participants suggested that Naomi and Danny should attend couples’ therapy. More often however, responses expressed concern for Danny and indicated that he required individual support, usually via a GP or therapist, though these themes were less frequent in COND4 (ConW NPTSD). Again, in all conditions but particularly COND1 (MVet PTSD) participants suggested that Naomi should take some responsibility for helping Danny either directly, or indirectly by accessing him professional input.

Concern was expressed for Naomi across all four conditions, with the suggestion that she too should access support such as therapy or via domestic abuse charities. However, help for Naomi was a less frequent theme than help for Danny and it was not always clear whether the help should be for her own needs, or to improve her capacity to support Danny. In all four conditions participants questioned Naomi’s safety, often noting the risk of escalating violence. A small number of participants, except in COND1 (MVet PTSD) indicated that Naomi should contact the police.

Discussion

The aim of this study was to investigate public understanding of IPV in the context of military veteran status and a diagnosis of PTSD. The study predicted that the extent to which the public recognise an incident of IPV would be affected by whether a perpetrator is a military veteran with a diagnosis of PTSD when compared to a military veteran without PTSD, a civilian worker with PTSD and a civilian worker without PTSD. This prediction was only partially met.

Whilst job role and PTSD diagnosis were not found to impact independently, a small interaction between the two was found. Although only trending towards significance it is interesting to note that where an individual has a diagnosis of PTSD, their status as a military veteran makes it more likely that the public will recognise IPV compared to a civilian. Assumptions may be made about the abusive potential of veterans, perhaps drawing on discourses regarding aggression in the military (Taft, Watkins et al., 2011), in spite of the evidence which indicates equal rates of IPV in the general population. In turn, this stigmatisation may lead to a stereotyping effect by which abuse is normalised within the cohort.

The presence of PTSD made no difference to recognising abuse perpetrated by a military veteran (compared to no-PTSD/MVet). This was unexpected given the evidence elsewhere that mental ill-health may be used to minimise abuse (Lelaurain et al., 2018). However, the story completion responses indicated that trauma was assumed even where not indicated meaning that the experimental manipulation may not have been effective. As such, the public perhaps make assumptions about military service leading to PTSD, and further that this then explains IPV. An effect of PTSD diagnosis was found in the construction worker condition with participants more able to recognise IPV in the absence of PTSD diagnosis. This is an important finding indicating that the public may conceive of the diagnosis as a mitigating factor in terms of recognising and so reporting abuse in civilian relationships.

The findings add to the growing evidence that demographic factors may not significantly impact upon understanding of IPV (Carlson & Worden, 2005) and demonstrate that this finding holds true in the context of military veteran status and PTSD. The only experiential factor shown to relate was professional experience of working with people who have experienced abuse. Interestingly, this is distinct from the work of Carlson and Worden (2005) who grouped both professional and indirect personal experience together, and found a correlation with abuse recognition. It is of note that professional experience of working with PTSD or in a military context did not improve recognition. This may highlight limited understanding in these professions, as has been more widely researched in health and social care sectors (Bradbury-Jones et al., 2014; Buck & Collins, 2007; Johnson et al., 1994; Ramsey et al., 2012; Robinson et al., 2018; Saletti-Cuesta et al., 2018).

The secondary hypothesis of this study was that military veteran status and diagnosis of PTSD would impact on public discourse with regards to IPV. Again, this hypothesis was only partially met. Thematic analysis of the story completion task did not lead to any themes unique to the interaction of military veteran status and a diagnosis of PTSD. Nonetheless, findings contribute to the more general literature and furthermore the frequency analysis identified themes that may be particularly pertinent to discourse regarding IPV in this cohort.

In line with Carlson and Worden (2005), findings indicated that the public identify threatening and controlling behaviour (perpetrated by a husband towards his wife) as unacceptable. However, seen alongside the IPV rating analysis, lack of acceptability does not necessarily tally with absolute confidence that behaviour constitutes abuse. This discrepancy confirms findings elsewhere (Carlson & Worden, 2005) and is concerning given the evidence that victims may require social and professional support in order to identify experiences as domestic abuse (Barnett, 2001; Bradbury-Jones et al., 2014).

A related concern is that participants tended to focus more on the acts of physical aggression than the controlling behaviour, particularly where a diagnosis of PTSD was indicated or assumed. This suggests that both in the military veteran context and more widely a diagnosis of PTSD may lead people to focus on physical risk, as has been found elsewhere (Robinson et al., 2018; Taylor & Sorenson, 2005) and helps to make sense of the uncertainty many participants demonstrated on the IPV rating scale. Given that abuse rarely begins with overt physical harm (Barnett, 2001), the finding suggests that the public, including professionals, may not recognise early indicators of abuse and act on them prior to escalation.

In terms of understanding the cause of IPV, the study found clear evidence of ‘conditional logic’ (Lelaurain et al., 2018) by which participates contextualised abuse. A new finding is the extent to which PTSD is used to frame IPV both in military relationships and more generally as borne out in the significantly lower IPV recognition when the perpetrator was a construction worker with PTSD compared to one without. Furthermore, in a military context the public appear less likely to consider current stressors or acknowledge that PTSD cannot justify abuse. Victims of IPV in military relationships may therefore be particularly vulnerable to discourses that prioritise the victim status of the perpetrator. This aligns with emerging evidence that military partners can feel obliged to support perpetrators experiencing post-conflict distress (Finley et al., 2010; Gray, 2015), thereby limiting social support and help-seeking.

Public discourse regarding solutions to IPV is an under-researched area (Taylor & Sorenson, 2005) and the findings here offer a number of useful insights. PTSD diagnosis (stated or assumed) appeared to focus participants on the needs of the perpetrator, meaning that victims in military veteran relationships may be particularly vulnerable to having their needs overlooked.

Victim safety was raised by participants across conditions and so it is interesting to note that contacting the police was rarely mentioned, even where they were clearly able to identify IPV according to the IPV rating scale. The extent to which this may reflect concerns regarding the efficacy of police intervention (Leisenring, 2012) or a lack of understanding with regards to IPV and the law is unclear. Again, this may be particularly pertinent in a military context where veterans and their family manage a transition from internal to civilian jurisdiction.

Limitations

There were a number of limitations to the study that should be borne in mind. Men and older adults were not adequately represented, nor did the ethnic identities of participants adequately represent the British population. In addition, the questions used to determine relevant professional and personal experience may not have adequately differentiated between the two. In spite of efforts to minimise priming, the study clearly recruited an expert sample which may go some way to explain the heavy skew towards greater recognition of IPV and the link made between IPV and PTSD in both military conditions.

The measures used were developed specifically for this study and without psychometric validation the results using the IPV rating scale should be treated with caution. Most participants wrote less than the 10 lines requested for the story completion task meaning that the level of nuance hoped for was not achieved. It may be that the incident described was too clearly IPV and a more subtle account of abuse may have promoted greater diversity and complexity of response.

Future Research

IPV may be associated with a range of psychopathology (Shorey et al., 2012) and so research into the ways in which other diagnoses impact upon understanding of IPV is of interest. Important evidence is emerging regarding bi-directional violence as well as PTSD as a risk factor for being victim to IPV in military relationships (Misca & Forgey, 2017; Sparrow et al., 2017; Tharp et al., 2016). The minimisation of female violence in public discourse (Carlson & Worden, 2005; Sorenson & Thomas, 2009), the role of mental distress in mitigating violence found in this study and the promotion of hyper-masculine ideals (Taft, Watkins et al., 2011) may have particularly toxic implications for male victims of abuse in the military which warrants investigation.

Recommendations for Practice

The findings in this study confirm that public awareness campaigning needs to move beyond basic condemnation of IPV (Carlson & Worden, 2005). Campaigns may do well to focus on less overt behaviours including threats, control and coercion making clear that these constitute IPV and demand action which can include, but should not be limited to police involvement. Professionals working in mental health and military contexts would benefit from training to identify these forms of IPV particularly given the greater prevalence of escalation to high risk behaviours (Aronson et al., 2014) and the importance of early intervention as identified by the Ministry of Defence (2018). Public and professional perception of PTSD as a mitigating factor in IPV should be addressed. Targeted campaigning should be sensitive to the ways in which the victim status of the perpetrator may be prioritised in military relationships.

Conclusion

This study was the first to look specifically at public understanding of IPV in the context of military veteran status and PTSD and adds a number of new findings to the literature. Results indicated that the public are more likely to recognise IPV when it is perpetrated by a military veteran than a civilian with PTSD, and they are less likely to recognise abuse perpetrated by a civilian with PTSD, than without. Both public and professionals are less likely to acknowledge controlling behaviour. PTSD may be seen to mitigate IPV and in a military context prioritise the needs of the perpetrator in public consciousness. Awareness campaigns are advised to focus on clarifying what constitutes IPV and to consider the particular vulnerabilities of partners of abusive military veterans to discourses which prioritise the needs of the perpetrator.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Jessica Mackinnon

Author Biographies

Jessica Mackinnon is a clinical psychologist working in acute inpatient mental health. She has an interest in forensic mental health, trauma and the social stories which impact on people’s lives.

Rachel Paskell is a Lecturer at the University of Bath, with a specialist interest in trauma and chronic/prolonged stress. As a Chartered Clinical Psychologist, accredited CBT practitioner and EMDR therapist, Rachel previously worked in military veteran mental health services and is now working in acute hospital intensive care unit.

Catherine Hamilton-Giachritsis is a registered forensic and clinical psychologist. Currently working at the University of Bath, UK, her research focuses on childhood trauma and maltreatment, including outcomes for young people and their families.

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What do the Public Understand About Intimate Partner Violence in the Context of Military Veteran Status and PTSD?

Abstract

Keywords

Introduction

Current Study

Method

Ethical Approval

Design

Participants

Measures

Intimate Partner Violence Rating Scale

Story Completion Task

Procedure

Data Analysis Plan

Quantitative data

Qualitative data

Results

IPV Rating

Covariates

Story Completion Task

Describing the Behaviour

Causes of the Behaviour

Solutions to the Behaviour

The Relationship

Help

Discussion

Limitations

Future Research

Recommendations for Practice

Conclusion

Footnotes

Declaration of Conflicting Interests

Funding

ORCID iD

Author Biographies

References