Purpose: To examine dose-response effects of cumulative violence exposure including parent-to-youth aggression, marital physical aggression, and community violence, and to explore whether separate interpersonal domains of exposure differentially influence adverse outcomes.Methods: The present study uses parent-reports and child-reports of youth violence exposure from the first three waves of a prospective, longitudinal study of 103 community-based families. Outcomes were criterion levels (T score >= 60) of somatic complaints, depressive symptoms, anxiety, over-arousal, aggression, delinquent behaviors, and presence versus absence of academic failure.Results: After controlling for initial symptoms, income and parents' psychopathology, adjusted relative risks showed that marital aggression contributed uniquely to anxiety, and parent-to-youth aggression contributed uniquely to somatic complaints and aggression. All three domains significantly contributed to academic failure. With each one-point increase on the cumulative violence exposure index that summed across interpersonal domains and across time, there was an increased risk of more than 50% for meeting criterion levels of depressive symptoms and anxiety, and a 10%-25% increased risk for somatic complaints, delinquent behaviors, and academic failure. Significant curvilinear effects showed high cumulative violence increased risk of comorbid symptoms; 76% of youth with higher cumulative violence met thresholds on 3+ adverse outcomes, compared to 36% and 7% for youth with moderate and low violence exposure.Conclusions: These data highlight the importance of assessing violence exposure across multiple interpersonal domains and across time. Awareness of the contributions of violence exposure to common symptoms and particularly comorbid symptoms can inform interventions for wide-ranging adolescent problems. (C) 2010 Society for Adolescent Health and Medicine. All rights reserved.

This article reviews empirical support for treatments targeting women sexually assaulted during adolescence or adulthood. Thirty-two articles were located using data from 20 separate samples. Of the 20 samples, 12 targeted victims with chronic symptoms, three focused on the acute period post-assault, two included women with chronic and acute symptoms, and three were secondary prevention programs. The majority of studies focus on posttraumatic stress disorder (PTSD), depression, and/or anxiety as treatment targets. Cognitive Processing Therapy and Prolonged Exposure have garnered the most support with this population. Stress Inoculation Training and Eye Movement Desensitization and Reprocessing also show some efficacy. Of the four studies that compared active treatments, few differences were found. Overall, cognitive behavioral interventions lead to better PTSD outcomes than supportive counseling does. However, even in the strongest treatments more than one-third of women retain a PTSD diagnosis at post-treatment or drop out of treatment. Discussion highlights the paucity of research in this area, methodological limitations of examined studies, generalizability of findings, and important directions for future research at various stages of trauma recovery.

With considerable literature establishing how separate types of violence disrupt the lives of children, there is emerging interest in examining violence across multiple interpersonal domains. This article examines four commonly occurring and frequently researched domains of violence exposure: marital physical aggression, mother-to-youth aggression, father-to-youth aggression, and community violence. A community-based sample of 103 parents and youth provided three waves of data at annual intervals beginning when the youth were aged 9–10. We explored stability of exposure, co-occurrence across different types of violence exposure, and associations with co-occurring risk factors. Approximately 30–45% of youth reported intermittent exposure over the 3 years. In addition to overlap among types of violence exposure within the family, we found overlap between parent-to-youth aggression and community violence, an association that was exacerbated in families where fathers reported high levels of global distress symptoms. Mother-to-youth, father-to-youth, and community violence related to youth behavior problems beyond the contextual risk factors of low income, stressful life events, and parents’ global distress symptoms. These results highlight the importance of examining violence longitudinally, across multiple types, and with attention to contextual factors.

This study used three-level generalized hierarchical linear modeling to examine trajectories of husbands' and wives' physical and emotional aggression over three assessments and the effects of years since marriage. In this community sample of 118 couples, physical aggression significantly decreased over time (43% per year). Emotional aggression did not significantly change over time, but trajectories significantly differed for husbands (3% increase) versus wives (10% decrease). Longer-duration marriages had lower physical aggression and, for wives only, lower emotional aggression. Aggression trajectories showed considerable variability: 44%-55% of physically aggressive spouses desisted from one assessment to the next; 5%-12% reported start-ups in physical aggression. Discussion addresses the role of gender and type of aggression in aggression trajectories.

Interventions for youth exposed to family violence recently have incorporated a trauma focus with the objective of reducing Posttraumatic Stress Disorder (PTSD) symptoms along with alleviating other wide-ranging childhood disorders. This paper describes generally agreed-upon treatment components for youth exposed to violence in the home, including re-exposure interventions, education about violence and cognitive restructuring, processing of emotional cues, social problem-solving skills, and parenting interventions. Empirically evaluated treatment programs for different developmental stages (preschool, school-age, and adolescence) are summarized and remaining questions about how to best focus treatment efforts for youth traumatized by family violence are presented.

Exposure to child physical abuse and parents' domestic violence can subject youth to pervasive traumatic stress and lead to Post-traumatic Stress Disorder (PTSD). The often repeating and ongoing nature of family violence exposure may result in youth exhibiting problems in multiple domains of functioning and meeting criteria for multiple disorders in addition to PTSD. These characteristics as well as unique factors related to children's developmental level and symptom presentation complicate a PTSD diagnosis. This paper describes evolving conceptualizations in the burgeoning field of trauma related to family violence exposure, and reviews considerations that inform assessment and treatment planning for this population.

The present study compares observed communication and couples’ reports of husbands’ frightening behaviors among couples with no history of husbands’ physical marital aggression, a past history of such aggression, and recent history of such aggression. Ninety community couples reported on husbands’ physical marital aggression during two visits to the lab, approximately 1.5 years apart. During the second visit, we videotaped couples’ discussions of conflictual marital issues. Poor communication, as indexed by high hostility, low problem-description and low warmth, characterized couples with recent aggression, as compared to past aggression or no aggression. Husbands’ frightening behavior characterized the couples with either recent or past aggression, compared to no aggression. In addition, for couples who had experienced severe aggression, the rates of husbands’ frightening behavior were similar regardless of whether husbands persisted, reduced or desisted in the severe aggression. Discussion addresses possible reasons that reductions and desistance in husbands’ aggression may be associated with more positive communication patterns but with continued reports of frightening behavior.