Adult health

Your partner apologizes and says the hurtful behavior won't happen again — but you fear it will. At times you wonder whether you're imagining the abuse, yet the emotional or physical pain you feel is real. If this sounds familiar, you might be experiencing domestic violence.

Recognize domestic violence

Domestic violence — also called intimate partner violence — occurs between people in an intimate relationship. Domestic violence can take many forms, including emotional, sexual and physical abuse and threats of abuse. Abuse by a partner can happen to anyone, but domestic violence is most often directed toward women. Domestic violence can happen in heterosexual and same-sex relationships.

Abusive relationships always involve an imbalance of power and control. An abuser uses intimidating, hurtful words and behaviors to control a partner.

It might not be easy to identify domestic violence at first. While some relationships are clearly abusive from the outset, abuse often starts subtly and gets worse over time. You might be experiencing domestic violence if you're in a relationship with someone who:

• Calls you names, insults you or puts you down
• Prevents or discourages you from going to work or school or seeing family members or friends
• Tries to control how you spend money, where you go, what medicines you take or what you wear
• Acts jealous or possessive or constantly accuses you of being unfaithful
• Gets angry when drinking alcohol or using drugs
• Threatens you with violence or a weapon
• Hits, kicks, shoves, slaps, chokes or otherwise hurts you, your children or your pets
• Forces you to have sex or engage in sexual acts against your will
• Blames you for his or her violent behavior or tells you that you deserve it

If you're in a same-sex relationship or if you're bisexual or transgender, you might also be experiencing abuse if you're in a relationship with someone who:

• Threatens to tell friends, family, colleagues or community members your sexual orientation or gender identity
• Tells you that authorities won't help you because of your sexuality or gender identity
• Justifies abuse by questioning your sexuality or gender identity

Pregnancy, children, family members and domestic violence

Sometimes domestic violence begins — or increases — during pregnancy. Domestic violence puts your health and the baby's health at risk. The danger continues after the baby is born.

Even if your child isn't abused, simply witnessing domestic violence can be harmful. Children who grow up in abusive homes are more likely to be abused and have behavioral problems than are other children. As adults, they're more likely to become abusers or think abuse is a normal part of relationships.

You might worry that telling the truth will further endanger you, your child or other family members — and that it might break up your family. But seeking help is the best way to protect yourself and your loved ones.

Break the cycle

If you're in an abusive situation, you might recognize this pattern:

• Your abuser threatens violence.
• Your abuser strikes.
• Your abuser apologizes, promises to change and offers gifts.
• The cycle repeats itself.

The longer you stay in an abusive relationship, the greater the physical and emotional toll. You might become depressed and anxious, or you might begin to doubt your ability to take care of yourself. You might feel helpless or paralyzed.

You may also wonder if the abuse is your fault — a common point of confusion among survivors of domestic abuse that may make it more difficult to seek help.

Don't take the blame

You may not be ready to seek help because you believe you're at least partially to blame for the abuse in the relationship. Reasons may include:

• Your partner blames you for the violence in your relationship. Abusive partners rarely take responsibility for their actions.
• Your partner only exhibits abusive behavior with you. Abusers are often concerned with outward appearances and may appear charming and stable to those outside of your relationship. This may cause you to believe that his or her actions can only be explained by something you've done.
• Therapists and health care providers who see you alone or with your partner haven't detected a problem. If you haven't told your health care provider about the abuse, they may only take note of unhealthy patterns in your thinking or behavior. This can lead to a misdiagnosis. For example, survivors of intimate partner violence may develop symptoms that resemble chronic disorders such as irritable bowel syndrome or fibromyalgia. Exposure to intimate partner violence also increases your risk of mental health conditions such as depression, anxiety and post-traumatic stress disorder (PTSD).
• You have acted out verbally or physically against your abuser, yelling, pushing or hitting your partner during conflicts. You may worry that you are abusive, but it's much more likely that you acted in self-defense or intense emotional distress. Your abuser may use such incidents to manipulate you, describing them as proof that you are the abusive partner.

If you're having trouble identifying what's happening, take a step back and look at larger patterns in your relationship. Then review the signs of domestic violence. In an abusive relationship, the person who routinely uses these behaviors is the abuser. The person on the receiving end is being abused.

Unique challenges

• If you're an immigrant, you may be hesitant to seek help out of fear that you will be deported. Language barriers, lack of economic independence and limited social support can increase your isolation and your ability to access resources.

  Laws in the United States guarantee protection from domestic abuse, regardless of your immigrant status. Free or low-cost resources are available, including lawyers, shelter and medical care for you and your children. You may also be eligible for legal protections that allow immigrants who experience domestic violence to stay in the United States.

  Call a national domestic violence hotline for guidance. These services are free and protect your privacy.

• If you're an older woman, you may face challenges related to your age and the length of your relationship. You may have grown up in a time when domestic violence was simply not discussed. You or your partner may have health problems that increase your dependency or sense of responsibility.
• If you're in a same-sex relationship, you might be less likely to seek help after an assault if you don't want to disclose your sexual orientation. If you've been sexually assaulted by another woman, you might also fear that you won't be believed.

Still, the only way to break the cycle of domestic violence is to take action. Start by telling someone about the abuse, whether it's a friend, a loved one, a health care provider or another close contact. You can also call a national domestic violence hotline.

At first, you might find it hard to talk about the abuse. But understand that you are not alone and there are experts who can help you. You'll also likely feel relief and receive much-needed support.

Create a safety plan

Leaving an abuser can be dangerous. Consider taking these precautions:

• Call a women's shelter or domestic violence hotline for advice. Make the call at a safe time — when the abuser isn't around — or from a friend's house or other safe location.
• Pack an emergency bag that includes items you'll need when you leave, such as extra clothes and keys. Leave the bag in a safe place. Keep important personal papers, money and prescription medications handy so that you can take them with you on short notice.
• Know exactly where you'll go and how you'll get there.

Protect your communication and location

An abuser can use technology to monitor your telephone and online communication and to track your location. If you're concerned for your safety, seek help. To maintain your privacy:

• Use phones cautiously. Your abuser might intercept calls and listen to your conversations. An abusive partner might use caller ID, check your cellphone or search your phone billing records to see your call and texting history.
• Use your home computer cautiously. Your abuser might use spyware to monitor your emails and the websites you visit. Consider using a computer at work, at the library or at a friend's house to seek help.
• Turn off GPS devices. Your abuser might use a GPS device on your vehicle or your phone to pinpoint your location.
• Frequently change your email password. Choose passwords that would be difficult for your abuser to guess.
• Clear your viewing history. Follow your browser's instructions to clear any record of websites or graphics you've viewed.

Where to find help

In an emergency, call 911 or your local emergency number or law enforcement agency. The following resources also can help:

• Someone you trust. Turn to a friend, loved one, neighbor, co-worker, or religious or spiritual adviser for support.
• National Domestic Violence Hotline: 800-799-SAFE (800-799-7233; toll-free). Call the hotline for crisis intervention and referrals to resources, such as women's shelters.
• Your health care provider. A health care provider typically will treat injuries and can refer you to safe housing and other local resources.
• A local women's shelter or crisis center. Shelters and crisis centers typically provide 24-hour emergency shelter as well as advice on legal matters and advocacy and support services.
• A counseling or mental health center. Counseling and support groups for women in abusive relationships are available in most communities.
• A local court. A court can help you obtain a restraining order that legally mandates the abuser to stay away from you or face arrest. Local advocates might be available to help guide you through the process.

It can be hard to recognize or admit that you're in an abusive relationship — but help is available. Remember, no one deserves to be abused.