Academic Edi o : Michele Roccella
Recei ed: 11 Decembe 2024
Re ised: 13 Janua y 2025
Accep ed: 14 Janua y 2025
Published: 15 Janua y 2025
Ci a ion: Fá e o, M.; Oli ei a, R.; Del
Campo, A.; Fe nandes, A.; Mo ei a, D.;
Lanza o e-Fe nández, M.D.;
Sousa-Gomes, V. In ima e Pa ne
Violence: The Rela ionship Be ween
he S ages o Change, Main enance
Fac o s, and he Decision o Keep o
Lea e he Violen Pa ne . J. Clin. Med.
2025,14, 517. h ps://doi.o g/
10.3390/jcm14020517
Copy igh : © 2025 by he au ho s.
Licensee MDPI, Basel, Swi ze land.
This a icle is an open access a icle
dis ibu ed unde he e ms and
condi ions o he C ea i e Commons
A ibu ion (CC BY) license
(h ps://c ea i ecommons.o g/
licenses/by/4.0/).
Re iew
In ima e Pa ne Violence: The Rela ionship Be ween he S ages
o Change, Main enance Fac o s, and he Decision o Keep o
Lea e he Violen Pa ne
Ma isal a Fá e o 1,2,*,†, Ri a Oli ei a 1,†, Amaia Del Campo 3, Amadeu Fe nandes 1, Diana Mo ei a 2,4,5,6,
Ma ia Dolo es Lanza o e-Fe nández 7and Valé ia Sousa-Gomes 1,2,5
1Social and Beha io al Sciences Depa men , Uni e si y o Maia, 4475-690 Maia, Po ugal;
[email p o ec ed] (R.O.); [email p o ec ed] (A.F.); [email p o ec ed] (V.S.-G.)
2Cen e o Psychology, Uni e si y o Po o-CPUP, 4200-135 Po o, Po ugal; [email p o ec ed]
3Facul y o Educa ion, Uni e si y o Salamanca, 37008 Salamanca, Spain; [email p o ec ed]
4Facul y o Philosophy and Social Sciences, Cen e o Philosophical and Humanis ic S udies,
Uni e sidade Ca ólica Po uguesa, 4710-362 B aga, Po ugal
5Ins i u e o Psychology and Neu opsychology o Po o–IPNP Heal h, 4000-055 Po o, Po ugal
6Cen o de Solida iedade de B aga/P ojec o Homem, 4700-024 B aga, Po ugal
7Pe sonali y, Psychological E alua ion and T ea men , Uni e si y o Se illa, 41004 Se ille, Spain;
[email p o ec ed]
*Co espondence: m a e [email p o ec ed]
†These au ho s con ibu ed equally o his wo k.
Abs ac : Objec i es: Violence in in ima e ela ionships (IPV) is unde s ood as one o he
mos common o ms o iolence, being main ained by cul u al habi s and cus oms, and
legi imized om gene a ion o gene a ion. This s udy aims a a comp ehensi e e iew o
he li e a u e on IPV, he ela ionship be ween he s ages o change, main enance ac o s,
and he decision o keep o lea e he iolen pa ne . Me hods: A comp ehensi e li e a u e
sea ch was conduc ed o iden i y jou nal a icles ocused on IPV, ollowing online da abases
as well as a manual e iew om ele an pee - e iewed jou nals. Resul s: Seeking help is
one o he main s eps in he p ocess o change, and he s ages o change a e di ec ly ela ed
o he success o in e en ions, so iden i ying s ages ea ly p o ides a mo e app op ia e and
e ec i e choice o in e en ion. Conclusions: Thus, e alua ing he s age o p epa a ion o
he change in which he ic ims a e ound is impo an o he indi idual unde s anding
o he expe ience and suppo ing he in e en ion. In his sense, he Domes ic Violence
Su i o Assessmen (DVSA) will also be p esen ed, an ins umen o e alua ing he
p ocess o in en ional change in ic ims o IPV, using he TTM.
Keywo ds: in ima e pa ne iolence; ic ims; main enance ac o s; ans heo e ical model
o change; DVSA
1. In oduc ion
Clinical Impac S a emen : In ima e Pa ne Violence is one o he mos common o ms
o iolence, a ec ing indi iduals ega dless o hei gende , class, e hnici y, and sexual
o ien a ion, and causes se e al consequences o he ic im in he sho , medium, and long
e m. Bo h ic imiza ion and disclosu e can be in luenced by he quali y, ype, and sou ce
o social suppo . The eques o help implies a s ep in he p ocess o change, and he le el
o p epa edness o change is di ec ly ela ed o he success o he he apeu ic in e en ion
in IPV.
J. Clin. Med. 2025,14, 517 h ps://doi.o g/10.3390/jcm14020517
J. Clin. Med. 2025,14, 517 2 o 12
In ima e Pa ne Violence: The Rela ionship Be ween he S ages o Change, Main e-
nance Fac o s, and he Decision o Keep o Lea e he Violen Pa ne .
In ima e Pa ne Violence (IPV) e e s o he p ac ice o abusi e beha io s be ween
indi iduals who a e in an in ima e ela ionship [
1
,
2
], be i pe iodic o con inuous ac s [
3
].
An in ima e pa ne is de ined as an indi idual wi h whom a close/in ima e ela ion-
ship is main ained, cha ac e ized by he emo ional connec ion be ween hem, ca essing,
equen con ac , and knowledge o each o he ’s pe sonal li e, as well as iden i ica ion
as a couple [
4
]. Thus, in ima e ela ionships a e any ela ionships ha a e o a physical,
emo ional, o exclusi ely sexual na u e [
3
]. As such, spouses, pa ne s in a de ac o union,
boy iends/gi l iends, and con inuous sexual pa ne s a e conside ed in ima e pa ne s [
4
].
I is impo an o no e ha IPV can be pe pe a ed by cu en o o me pa ne s [
5
], as well
as by pa ne s who may o may no cohabi a e [
4
]. So, IPV e e s o beha io s by a cu en
o o me in ima e pa ne ha cause physical, sexual, o psychological consequences, and
may include physical agg ession, psychological abuse, and sexual coe cion [6].
Al hough he e m “domes ic iolence” (DV) is commonly used, i di e s om he
concep p esen ed in his s udy, bu he e is a connec ion be ween he wo [
7
,
8
]. DV pe ains
o iolen beha io o a pa e n o coe ci e manipula ion, exe cised di ec ly o indi ec ly
on any indi idual li ing wi hin he same household (e.g., spouse, pa ne , child, a he ,
mo he , g and a he , g andmo he ), o owa ds a pa ne , ex-pa ne , o amily membe (in
he case o non-cohabi a ion) [
9
]. Conjugal iolence (CV) is a speci ic aspec o DV [
10
] and
pe ains o he a o emen ioned iolen beha io s ela ed o DV, solely commi ed be ween
spouses/pa ne s o ex-spouses/ex-pa ne s [11].
IPV is a se ious wo ldwide p oblem, pe sis ing o e se e al gene a ions, and en-
compasses habi s and cus oms ha a e legi imized by adi ions and cul u es, such as
pa ia chal ideology, as well as by he silence o he ic ims [
12
–
14
]. I has a oused he
in e es o se e al esea che s, social s uc u es, and he communi y in gene al [15,16].
IPV has been amed wi hin policies o p e en ion, c iminaliza ion, and ic im sup-
po [17], and nowadays i is conside ed a c ime in se e al coun ies [18].
IPV is a complex phenomenon because he e is an in ense emo ional componen ,
as well as he sha ing o li e plans and esponsibili ies [
11
]. The e o e, he o ende has
in o ma ion and s a egies ha can be used o con ol he ic im and lead him/he o
become dependen on he o ende , making he p ocess o lea ing he ela ionship mo e
cos ly [10].
I is a public heal h p oblem, as well as a social and c iminal p oblem [
4
], and ep esen s
a se e e iola ion o human igh s [
2
,
5
,
19
]. This is a silen phenomenon, as i is a ype o
c ime wi h some o he highes a es o da k igu es [20].
Acco ding o a ious da a, IPV occu s mainly om adolescence onwa ds [
21
–
23
], and
is qui e equen in ma i al o cohabi a ion ela ionships [2].
The e is a la ge a ia ion in IPV p e alence, anging om 6.1% (physical o sexual)
o 28.7% (psychological) [
24
]. The ic ims a e mos ly women [
25
], which can be seen in
he da a con ained in he 2021 Annual In e nal Secu i y Repo [
26
], in which 74.9% o
ic ims we e women. Despi e his inding, IPV also encompasses iolence agains men [
27
].
Se e al s udies indica e simila le els o he impac o ic imiza ion be ween men and
women [5,28].
IPV leads o se e al consequences o he ic im in he sho , medium, and
long e m [
11
,
16
,
26
,
29
,
30
], namely physical, ela ional [
16
,
20
,
29
,
31
–
34
], psychological/
emo ional [
16
,
31
–
33
,
35
], economic [
20
,
29
,
33
], beha io al [
31
], and sexual damage [
2
,
33
].
The se e i y o he consequences de i es om he deg ee o p oximi y o he o ende , he
ype and du a ion o he ic imiza ion, and he ic im’s age (bo h ch onological and de el-
J. Clin. Med. 2025,14, 517 3 o 12
opmen al) [
33
,
36
]. In he mos signi ican cases, he e may be mo e se e e consequences,
such as empo a y o pe manen disabili y, o dea h o he ic im [14,16,36,37].
2. P ocess o Change
2.1. Seeking Help
In e en ion in IPV is ex emely di icul because ic ims end o only ask o help
when he episodes a e al eady a an ex eme s age, ha is, when hey can no longe
wi hs and he iolence [
38
]. Al hough ic ims a e awa e o he p oblem hey a e acing,
hey belie e he e is no solu ion and ha no one can help hem [
39
]. Mo eo e , many ic ims
e use o ask o help due o ea , shame, and social isola ion [
31
,
39
–
41
], as well as he ea
o humilia ion o disc edi ing by iends, amily, police, and legal o ganiza ions, among
o he s [
41
]. Se e al s udies indica e ha ic ims do no ask o help because hey do no
wan o dis u b amily and iends, o because hey ea epe cussions and accoun abili y
o he iolence [31,37,42].
The iolence in lic ed by pa ne s on ic ims makes i impossible o p ese e and c ea e
social ela ionships, as i isola es and weakens hem [
43
,
44
]. As such, seeking help is seen
as a signi ican s ep in ending abusi e ela ionships, and disclosing he iolence su e ed
has a signi ican impac on ic ims [
39
,
45
]. The as majo i y o ic ims only disclose
he abusi e si ua ion when hey ecognize he dange hey a e in when hey ecognize
hei pa ne ’s beha io is no no mal, o when hey ealize hey a e no able o ace he
si ua ion alone [
45
,
46
]. Despi e his awa eness, he eques o help ends o be mos ly
made by emale ic ims [
47
,
48
], wi h male indi iduals ending o hide he si ua ion hey
a e expe iencing, mainly due o he di icul ies hey expe ience in alking abou he abusi e
episodes o no ecognizing hem as iolence [48].
Social suppo ne wo ks a e a esou ce ha helps o minimize he epe cussions o IPV,
in which ic ims can ob ain suppo o supp ess hei needs in day- o-day e en s, as well
as in c ises [
49
]. In his con ex , he concep o social suppo is de ined by he p esence o
a ailabili y o esou ces he ic im can access o seek help [50].
S udies indica e ha he p esence o an adequa e social suppo ne wo k p o ides
a dec eased isk o de eloping psychological diso de s such as anxie y, dep ession, and
pos - auma ic s ess [
51
–
55
], and also p o ides a educ ion in consequences in e ms
o physical heal h and emo ional well-being [
32
,
55
,
56
]. Fu he mo e, i also educes he
p opensi y o suicidal idea ion [
51
,
57
]. The p esence o a social suppo ne wo k also
helps he ic im o acqui e coping s a egies ha con ibu e o inc easing he ic im’s
abili y o ind a way o sol e he c isis [
51
,
54
,
56
,
58
]. Machisa e al. [
44
] concluded ha he
p esence o a social suppo ne wo k p omo es esilience in ic ims. Vameghi e al. [
59
]
demons a ed ha he phenomenon o IPV ends o be less equen when he e is an ac i e
social suppo ne wo k.
The expe ience o IPV and i s disclosu e can be in luenced by ac o s such as he quali y,
ype, and sou ce o social suppo ecei ed [
50
]. The social suppo ne wo k consis s o
indi iduals who can help he ic im, whom he ic im can us [
60
], and mobilizes physical,
in o ma ional, social, psychological, and/o emo ional esou ces [
57
,
61
,
62
]. Se e al au ho s
di ide social suppo in o wo dimensions: o mal and in o mal [46,50,63].
The o mal suppo ne wo ks include c iminal police bodies (CPBs), legal se ices,
heal h se ices, psychology se ices, social wo ke s, ic im ca e se ices, shel e s, and
ic im suppo lines, among o he se ices, which ha e o ganized esponses o assis
ic ims [
43
,
45
,
46
,
50
,
51
,
63
–
65
]. Vic im ca e se ices a e made up o p o essionals om
di e en a eas, which en iches he unde s anding o he phenomenon and leads o mo e
app op ia e in e en ion [
31
,
66
]. Thus, his ype o suppo can play a undamen al ole in
he ic im’s p ocess o change, as long as he ne wo k is o ganized and s uc u ed wi h o he
J. Clin. Med. 2025,14, 517 4 o 12
esou ces [
43
,
56
,
67
,
68
]. Vic ims end o u n o o mal suppo ne wo ks based on ac o s
such as he se e i y and equency o iolen episodes, and pe cei ed suppo , among
o he s, which helps in he p ocess o p epa ing o change [
56
,
67
,
68
]. Some au ho s indica e
ha ic ims end o a oid he o mal suppo ne wo k, mainly because hey deny he
phenomenon and/o because hey do no ecognize he g a i y o he phenomenon hey a e
expe iencing [
69
,
70
]. Some s udies conduc ed wi h ic ims o IPV indica e ha some imes
ic ims may expe ience e- ic imiza ion by specialized suppo se ices [
43
,
44
,
51
,
56
,
58
].
S udies such as he one by F eeland e al. [
71
] indica e ha , in some si ua ions, CPBs
end o minimize he abusi e expe ience o e en dissuade he ic im’s a emp o ile a
complain . This phenomenon was also iden i ied in some counseling se ices and suppo
o ganiza ions [
71
]. On he o he hand, he o mal suppo ne wo k was also conside ed
use ul and seen as a undamen al esou ce in he sea ch o help [71].
Rega ding he in o mal suppo ne wo k, i is made up o amily membe s, iends,
neighbo s, co-wo ke s, and o ganiza ional g oups o which he ic im belongs (e.g., chu ch,
spo s clubs, o poli ical, ec ea ional, and cul u al g oups) [
43
,
45
,
46
,
56
,
63
,
72
,
73
], which
may p o ide ma e ial and emo ional esponses, such as he exp ession o a ec ion, empa hy,
conce n, a ailabili y o goods, and inancial suppo , among o he s, and become essen ial
o he well-being o he ic im [
72
]. The in o mal suppo ne wo k is a esou ce ha should
be ins iga ed, because, in addi ion o p o iding almos immedia e answe s, i helps he
ic im eel suppo ed and, consequen ly, he o ende ealizes he ic im is no isola ed [
74
].
Mo eo e , he exis ence o an adequa e in o mal suppo ne wo k acili a es he p ocess o
ending he ela ionship, as i helps he ic im o ind s a egies and consciously make he
decision [
75
]. S udies such as he one by Sylaska and Edwa ds [
56
] e eal ha mos ic ims
disclose he IPV si ua ion o a leas one membe o he in o mal suppo ne wo k, as a
way o mi iga ing he s ess expe ienced and because hey eel hea d [
45
]. In he s udy by
Mahapa o and Singh [
58
], ic ims e ealed ha he ins i u ions o which hey eso ed only
p o ided a educ ion in anxious and dep essi e symp oms momen a ily and p o isionally,
while he suppo p o ided by he in o mal suppo ne wo k was seen as las ing. Despi e
he suppo p o ided by he in o mal suppo ne wo k being he mos sough a e by
ic ims, i ends o be men ioned as inadequa e by se e al au ho s [
46
,
72
]. In many s udies,
he pa icipan s who eques ed help mos ly did i in o mally [42,56,67,69,71,76].
I is impo an o no e ha , in many cases, ic ims only disclosed he abusi e si ua-
ion a e he end o he ela ionship [
40
] o when he iolence became ecu en and/o
se e e [
47
]. None heless, s udies such as he one by Machado e al. [
76
] showed ha mos
ic ims do no make any eques o help.
2.2. T ans heo e ical Model o Change (TTM)
The T ans heo e ical Model o Change (TTM) is an explana o y model o he change
p ocess, based on a eminis pe spec i e, de eloped by P ochaska and DiClemen e in
he 1970s [
77
,
78
], and i aims o help unde s and, measu e, and in e ene in beha io
change [79,80].
In he i s s age, p e-con empla ion, he ic im has no in en ion o changing sho ly [
81
–
85
]
and does no ecognize he exis ence o a p oblem and he associa ed isks [80,82,86].
In he con empla ion s age, he e is an awa eness o he p oblem [
80
,
83
–
85
,
87
], bu he
ic im is no commi ed o making an e o o sol e i [
81
,
82
,
88
], and no se ing deadlines
o begin he change p ocess [89].
In he p epa a ion s age, he indi idual makes some e o s o change he beha io [
81
],
and is commi ed o ul illing his o he goal [90] by es ablishing a plan [80,82].
J. Clin. Med. 2025,14, 517 5 o 12
In he ac ion s age, he ic im e ec i ely begins o ac , by changing beha io s o he
en i onmen , o sol e he p oblem [
65
,
80
,
81
,
87
,
91
]. Due o he possibili y o elapse, his s age
equi es s ong dedica ion and commi men , as well as signi ican commi men [65,90].
Finally, he main enance s age encompasses he consolida ion o he esul s achie ed
in he ac ion s age and he ic im s i es o p e en po en ial elapses [65,83,89,90].
Yea s la e , he e mina ion s age was added, in which he beha io al changes ob ained
a e solid enough o he ic im o eel con iden ha he p e ious beha io s will no e u n,
hus p esen ing a educed possibili y o elapse [91].
Using he TTM, ins umen s we e de eloped o measu e he s ages o change, namely
he Uni e si y Rhode Island Change Assessmen (URICA) [
92
]. This ins umen is applied
in se e al a eas ela ed o heal h and addic i e beha io s, as well as in he a ea o IPV [
93
].
3. Con ibu ion o he TTM in he P ocess o Change in Vic ims o IPV
Al hough he e a e ew s udies speci ically add essing IPV, he e is esea ch ha
applies con ibu ions o he T ans heo e ical Model o Change (TTM) o ic ims o his
phenomenon [
94
,
95
]. Reisenho e and Ta [
96
] conduc ed a s udy analyzing he applica-
bili y o TTM in he con ex o IPV o p o ide ins uc ions and guidance o p o essionals
wo king wi h ic ims. The s udy concluded ha p o essionals should indeed use he s ages
o change p o ided by he TTM as a way o e alua ing he change p ocess [
96
]. Simila ly,
Zamo a e al. [
95
] analyzed he epo s o 35 women who expe ienced IPV using he TTM
and concluded ha he s ages desc ibed in he model a e applicable o IPV. Ca allo e al. [
97
]
also analyzed he sequence o e en s ha led o he disclosu e o IPV episodes among
19 ic ims
, using TTM. This s udy ound ha disclosu e ypically occu s a e a signi ican
e en , which becomes a u ning poin ollowing a se ies o less se e e e en s. The decision
o disclose is o en in luenced by a balance be ween he pe cei ed isks and he po en ial
bene i s o disclosu e [
97
]. Fu he mo e, he s udy by Ca allo e al. [
97
] ecommended ha
heal hca e p o essionals should use an assessmen based on he s ages o change o be e
unde s and bo h he change p ocess and he phenomenon o IPV disclosu e.
In e ms o he cha ac e is ics o each s age o change, s udies ha e highligh ed
he ollowing pa e ns among ic ims: (a) P e-con empla ion: This s age is ma ked by
su e ing and ambi alen eelings owa d he iolence, o en cha ac e ized by minimiza ion,
no maliza ion, o denial o he iolence and excusing he o ende ’s beha io . Vic ims
in his s age show low le els o ange owa ds he abuse and may no ye ecognize he
se e i y o he si ua ion [
26
,
65
,
98
,
99
]. They may also a ionalize he abuse o eel i is
no se e e enough o wa an ac ion. (b) Con empla ion: In his s age, ic ims begin o
ecognize he abusi e beha io and expe ience highe le els o ange . They a ibu e hei
su e ing o he iolence and may s a o conside ending he ela ionship. Howe e , hey
o en s ill expe ience con lic ing emo ions owa d he abuse , exp essing eelings o loyal y
o a achmen . Fo ins ance, ic ims migh hesi a e o lea e due o ma i al commi men s
o ea o he consequences [
98
]. The e is a g owing awa eness o he p oblem, bu hey
may s ill be unce ain abou aking s eps o add ess i [
99
]. (c) P epa a ion: Vic ims in
his s age ypically begin de eloping a s a egy o end he ela ionship, o en seeking
suppo o ga he ing esou ces [
98
]. Howe e , hey o en ace signi ican di icul ies in
de e mining how o p oceed and expe ience high le els o s ess. These di icul ies can
include unce ain y abou how o lea e sa ely, ea s o e alia ion, o inancial ins abili y [
82
].
(d) Ac ion: This s age is ma ked by conc e e e o s o change he si ua ion. Vic ims may
end he ela ionship, seek legal p o ec ion, o ind sa e y in shel e s. Signi ican beha io al
and en i onmen al changes ake place, including con ac ing suppo se ices o con iding
in us ed indi iduals [
99
]. I is a c i ical s age, bu i can also in ol e he isk o elapse o
e-engagemen wi h he abuse . (e) Main enance: A e ending he abusi e ela ionship,
J. Clin. Med. 2025,14, 517 6 o 12
ic ims wo k o main ain he changes achie ed and p e en elapse. This phase may
in ol e managing ongoing emo ional and psychological di icul ies, such as dep ession,
anxie y, and discou agemen abou he u u e. Howe e , ic ims may also expe ience an
expansion o social ne wo ks and inc eased suppo [
99
]. In his s age, long- e m coping
mechanisms and ongoing psychological suppo a e c ucial o main aining a sa e and
heal hy li e pos - iolence.
The esea ch highligh s ha hese s ages a e no always linea ; ic ims may mo e be-
ween s ages o expe ience mul iple s ages simul aneously, depending on he ci cums ances
and he suppo a ailable o hem.
4. Domes ic Violence Su i o Assessmen (DVSA)
The Domes ic Violence Su i o Assessmen (DVSA) [
100
], which is being alida ed
o Po ugal by he au ho s o he p esen wo k, is an ins umen ha , h ough he TTM,
aims o assess he p ocess o in en ional change among IPV ic ims [
101
]. This ins umen
was de eloped by esea che s, wi h he collabo a ion o psychologis s and ic im suppo
p o essionals, o ob ain a be e unde s anding o he ic ims’ cogni i e s a us o suppo
hem du ing he ollow-up p ocess, helping hem o sol e hei dilemmas [
100
]. The
ques ions de eloped in his ins umen a e based on he subjec i e change p ocess o each
ic im, examining hei pe cep ions abou he iolen ela ionship wi h hei pa ne s and
how hey in e up o s op he pe pe ua ion o iolence [101].
The assessmen p ocess o he e ec i eness o he DVSA indica ed i s use ulness o
he sys ema ic e iew o he di icul ies ha mos ic ims o IPV ace, aiding in he beginning
o he ollow-up [
100
]. The DVSA was also applied in he Mon gome y Coun y Ma yland
Abused Pe sons P og am, o e alua e he esul s o he indi idual psycho he apeu ic
ollow-up o 355 women ic ims o IPV [
102
]. This p og am main ains he use o DVSA
and indica es i is a e y use ul esou ce in measu ing he impac o ollow-up [102].
In he p ocess o alida ing he o iginal scale, he p o essionals who applied his
ins umen epo ed i was ele an bo h o ic ims who a e in abusi e ela ionships
and o ic ims who ha e al eady abandoned he ela ionship, bu who con inue o be
moni o ed [
101
]. They epo ed ha he scale is use ul o iden i ying a eas ha need
mo e a en ion in he in e en ion, as well as o ic ims o ob ain he alida ion ha hei
expe iences in he change p ocess a e common and ha change is a p olonged and las ing
p ocess [101].
DVSA con ains ques ions designed o assess aspec s o he change p ocess as women
ic ims shi hei pe spec i e on hei abusi e ela ionships and ake s eps o end he abuse.
The inal e sion consis s o wel e ques ions, six o which a e ela ed o changes in he
abusi e ela ionship and a e e e ed o as “ ela ionship ques ions”. The emaining six
ques ions ocus on changes wi hin he women hemsel es and a e e e ed o as “indi idual
ques ions” [101].
The ela ionship ques ions add ess he ollowing aspec s: igge s ha ini ia e abusi e
episodes; beha io s adop ed o manage hese episodes (bo h di ec and indi ec ); awa eness
o he need o legal suppo ; a achmen o he ela ionship (a achmen o he pa ne ,
social alue); pe spec i es on he ela ionship and a ailable op ions; managemen o loyal y
and pe sonal belie s (social s igma and alues ela ed o s aying o lea ing he ela ionship).
The main indi idual ques ions include access o help ( he belie ha amily, iends,
and o ganiza ions can p o ide assis ance); sel -iden i y (sepa a ion o he couple’s iden-
i y); sel -con idence; emo ional esponses o abuse (le el o awa eness and con ol o e
emo ions); men al heal h, s ess, dep ession, and PTSD (Pos -T auma ic S ess Diso de );
and con ol o e inances.
J. Clin. Med. 2025,14, 517 7 o 12
5. Discussion and Conclusions
The objec i e o his wo k was o p esen a comp ehensi e e iew o IPV and he
change p ocess.
As seen, IPV cons i u es one o he mos common o ms o iolence, p ese ed h ough-
ou gene a ions, being g ounded in habi s and p ac ices ha a e legi imized by adi ions
and cul u es, and main ained by he silence o he ic ims [
12
–
14
,
103
], IPV gene a es
ex eme consequences in he sho , medium, and long e m [16,29,104].
The exis ence o an in ense emo ional componen [
11
] allows he agg esso o a ange
in o ma ion and s a egies ha a e used as a o m o con ol and dependence on he ic im,
s a egies ha a e demons a ed in PCW [
105
,
106
]. These s a egies make he p ocess o
b eaking up he ela ionship mo e di icul [
10
]. The e o e, unde s anding hese s a egies
and he dynamics associa ed wi h he IPV ha suppo he main enance o he abusi e
ela ionship become impo an o in e en ion wi h ic ims [
11
]. Howe e , i mus be
bo ne in mind ha in e en ion wi h ic ims becomes di icul due o he ime gap be ween
he occu ence o he i s abusi e episodes and he sea ch o help [
38
], his being a s ep
wi h a signi ican impac ha also lea es a ma k on he change p ocess [39,45].
Fu he mo e, in ol emen in he change p ocess is an indica o o a success ul in e -
en ion wi h ic ims [
35
], and some in es iga ions apply TTM con ibu ions o ic ims o
IPV, e.g. [
26
,
95
–
97
]. Thus, i is impo an o iden i y he s age in which he ic im is, o
adap he in e en ion o hei needs [93,107].
Fo his, he ins umen s o e alua ing he s ages o change become use ul o he
e ec i eness o he in e en ion. Gi en he need o ins umen s o his phenomenon,
Dienemann e al. [
100
] de eloped he DVSA, an ins umen ha p o ides his assessmen ,
ha ing ecognized i s use ulness o he sys ema ic e iew o he di icul ies and dilemmas
by which mos ic ims pass [
101
], and, o his eason, i p o ides g ea suppo in he
in e en ion p ocess.
Au ho Con ibu ions: M.F. and V.S.-G.: s udy concep ion and design, supe ision, and unding
acquisi ion; A.F. and D.M.: me hodology, supe ision; R.O.: li e a u e e iew, w i ing—o iginal d a
p epa a ion; A.D.C. and M.D.L.-F.: supe ision, w i ing— e iewing and edi ing. All au ho s ha e
ead and ag eed o he published e sion o he manusc ip .
Funding: This wo k was suppo ed by he Po uguese Founda ion o Science and Technology (FCT)
unde he Plu iannual Funding P og amme o Resea ch Uni s 2020–2023 (UIDP/00050/2020). The
au ho s ecei ed no inancial suppo o he esea ch, au ho ship, and/o publica ion o his a icle.
Ins i u ional Re iew Boa d S a emen : This s udy was pe o med in line wi h he p inciples o he
Decla a ion o Helsinki and The Eu opean Code o Conduc o Resea ch In eg i y. Howe e , his
s udy did no equi e app o al by he E hics Commi ee o he Uni e si y o Maia.
In o med Consen S a emen : No applicable.
Acknowledgmen s: Two anonymous e iewe s a e hanked o hei use ul commen s and sugges ions.
Con lic s o In e es : The au ho s decla e no con lic s o in e es .
Re e ences
1.
Fishe , D.; Lang, K.; Whea on, J. T aining P o essionals in he P ima y P e en ion o Sexual and In ima e Pa ne Violence; NCIPC:
A lan a, GA, USA, 2010.
2.
Wo ld Heal h O ganiza ion. P e en ion o Sexual Violence and Violence by In ima e Pa ne Agains he Woman: Ac ion and P oduc ion
o E idence; WHO: Gene a, Swi ze land, 2012. A ailable online: h ps://i is.who.in /bi s eam/handle/10665/44350/97892415
64007_eng.pd (accessed on 3 July 2024).
J. Clin. Med. 2025,14, 517 8 o 12
3.
Ca los, D.; Campeiz, A.; Sil a, J.; Fe nandes, M.; Lei ão, M.; Sil a, M.; Fe iani, M. In e enções na escola pa a p e enção da
iolência nas elações de in imidade en e adolescen es: Re isão in eg a i a da li e a u a [In e en ions a school o p e en
iolence in in ima e ela ionships among adolescen s: An in eg a i e li e a u e e iew]. Re . De En e m. Re . 2018,4, 133–146.
[C ossRe ]
4.
B eiding, M.; Basile, K.; Smi h, S.; Black, M.; Mahend a, R. In ima e Pa ne Violence Su eillance: Uni o m De ini ions and
Recommended Da a Elemen s—Ve sion 2.0; Cen e s o Disease Con ol and P e en ion: A lan a, GA, USA, 2015.
5.
Cos a, D.; Soa es, J.; Linde , J.; Ha zidimi iadou, E.; Sundin, O.; To h, O.; Kapolo, E.; Ba os, H. In ima e pa ne iolence:
A s udy in men and women om six Eu opean coun ies. In . J. Public Heal h 2015,60, 467–478. [C ossRe ] [PubMed]
6.
Wo ld Heal h O ganiza ion. Global and Regional Es ima es o Violence Agains Women: P e alence and Heal h E ec s o In ima e Pa ne
Violence and Non-Pa ne Sexual Violence; Wo ld Heal h O ganiza ion: Gene a, Swi ze land, 2013.
7. Nicolson, P. Domes ic Violence and Psychology: A C i ical Pe spec i e; Taylo & F ancis: Abingdon, UK, 2010.
8.
Nicolson, P. Domes ic Violence and Psychology: C i ical Pe spec i es on In ima e Pa ne Violence and Abuse, 2nd ed.; Rou ledge:
London, UK, 2019.
9.
Eu opean Council. Council o Eu ope Con en ion on P e en ing and Comba ing Violence Agains Women and Domes ic Violence; CIG:
Lisbon, Po ugal, 2013.
10.
Molei o, C.; Pin o, N.; Oli ei a, J.; San os, M. Boas P á icas No Apoio a Ví imas LGBT [Bes P ac ices in Suppo ing LGBT Vic ims];
CIG: Lisbon, Po ugal, 2016.
11.
Mani a, C.; Ribei o, C.; Peixo o, C. Violência Domés ica: Comp eende Pa a In e i , Guia de Boas P á icas Pa a P o issionais de Saúde
[Domes ic Violence: Unde s and o In e ene, a Good P ac ice Guide o Heal h P o essionals], 1s ed.; Comissão pa a a Cidadania e a
Igualdade de Géne o: Lisbon, Po ugal, 2009.
12.
Ak e , S. The link be ween a husband’s us in in o mal ins i u ions and domes ic iolence agains his wi e: E idence om
Pakis an. J. In e pe s. Violence 2020,37, 654–678. [C ossRe ] [PubMed]
13.
Algo ia, E.; Ri e o, E. In ima e pa ne iolence agains women: A s udy on he belie s o ainee eache s in Spain and La in
Ame ica. In . J. Psychol. Res. 2021,14, 18–29. [C ossRe ]
14. DiCola, D.; Spaa , E. In ima e pa ne iolence. Am. Fam. Physician 2016,94, 646–651. [PubMed]
15.
Capaldi, D.; Knoble, N.; Sho , J.; Kim, H. A sys ema ic e iew o isk ac o s o in ima e pa ne iolence. Pa n. Abus. 2012,3,
231–280. [C ossRe ] [PubMed]
16. Mille , E.; McCaw, B. In ima e pa ne iolence. N. Engl. J. Med. 2019,380, 850–857. [C ossRe ] [PubMed]
17.
Dua e, M. Violência domés ica e sua c iminalização em Po ugal: Obs áculos àaplicação da lei [Domes ic iolence and i s
c iminaliza ion in Po ugal: Obs acles o law en o cemen ]. Sis . Penal Violência 2011,3, 1–12.
18.
Paneque, F.; Guima ães, R. Violência domés ica: Uma e lexão sócio-ju ídico- ilosó ica pós COVID-19 [Domes ic iolence:
A social, legal, and philosophical e lec ion in he a e ma h o COVID-19]. Di ei o Negócios Soc. 2022,2, 49–68. [C ossRe ]
19.
Wilcox, T.; G eenwood, M.; Pullen, A.; Kelly, A.; Jones, D. In e aces o domes ic iolence and o ganiza ion: Gende ed iolence
and inequali y. Gend. Wo k O gan. 2020,28, 701–721. [C ossRe ]
20.
Es e es, A.; Cunha, M.; Sá, V.; Panyik, E.; Pon e, F.; Mon ei o, D.; Sil a, C.; Fe nandes, S. Dos Riscos àC iminalidade; UCP: Po o,
Po ugal, 2015.
21.
Bonomi, A.; Ande son, M.; Neme h, J.; Ba le-Ha ing, S.; Bue ne , C.; Schippe , D. Da ing iolence ic imiza ion ac oss he een
yea s: Abuse equency, numbe o abusi e pa ne s, and age a i s occu ence. BMC Public Heal h 2012,12, 637. [C ossRe ]
22.
Ca idade, S.; Saa ed a, R.; Machado, C. P á icas de p e enção da iolência nas elações de in imidade ju enil: O ien ações
ge ais [Violence p e en ion p ac ices in ju enile in ima e ela ionships: Gene al guidelines]. Análise Psicológica 2012,3, 131–142.
[C ossRe ]
23.
Fe nández-Fue es, A.; Fue es, A. Physical and psychological agg ession in da ing ela ionships o Spanish adolescen s: Mo i es
and consequences. Child Abus. Negl. 2010,34, 183–191. [C ossRe ] [PubMed]
24.
Sanz-Ba be o, B.; Pe ei a, P.; Ba i, G.; Vi es-Cases, C. In ima e pa ne iolence agains young women: P e alence and associa ed
ac o s in Eu ope. J. Epidemiol. Communi y Heal h 2018,72, 611–616. [C ossRe ] [PubMed]
25.
Laskey, P.; Ba es, E.; Taylo , J. A sys ema ic li e a u e e iew o in ima e pa ne iolence ic imisa ion: An inclusi e e iew ac oss
gende and sexuali y. Agg ess. Violen Beha . 2019,47, 1–11. [C ossRe ]
26.
Fá e o, M.; C uz, N.; Mo ei a, D.; Del Campo, A.; Sousa-Gomes, V. Violence in in ima e ela ionships: Symp oma ology and
mo i a ion o change. Psychol. T auma Theo y Res. P ac . Policy 2024,16, 462–469. [C ossRe ]
27.
Ali, P.A.; Dhing a, K.; McGa y, J. A li e a u e e iew o in ima e pa ne iolence and i s classi ica ions. Agg ess. Violen Beha .
2016,31, 16–25. [C ossRe ]
28.
Fe a esso, R. Risk and p o ec i e ac o s associa ed wi h in ima e pa ne iolence in a na ionally ep esen a i e sample o
Ko ean men. J. P e . Med. Public Heal h 2020,53, 135–142. [C ossRe ]
29.
Backes, B.L.; Fedina, L.; Holmes, J.L. The c iminal jus ice sys em esponse o in ima e pa ne s alking: A sys ema ic e iew o
quan i a i e and quali a i e esea ch. J. Fam. Viol. 2020,35, 665–678. [C ossRe ]
J. Clin. Med. 2025,14, 517 9 o 12
30.
Mo ei a, D.; Mo ei a, D.S.; Ba bosa, F.; Sousa-Gomes, V.; Fá e o, M. Childhood auma ic expe iences and psychopa hy:
A comp ehensi e e iew. Psychol. T auma Theo y Res. P ac . Policy 2021,14, 1281–1287. [C ossRe ] [PubMed]
31.
Bo h, L.; Fa a e o, T.; F ei as, L. Cycle o iolence in women ic ims o domes ic iolence. B ain Beha . 2019,9, 18–29. [C ossRe ]
32.
G ego y, A.; Fede , G.; Take , A.; Williamson, E. Quali a i e s udy o explo e he heal h and well-being impac s on adul s
p o iding in o mal suppo o emale domes ic iolence su i o s. BMJ Open 2017,7, e014511. [C ossRe ]
33.
Magalhães, T. Violência e Abuso: Respos as Simples Pa a Ques ões Complexas [Violence and Abuse: Simple Answe s o Complex Ques ions],
1s ed.; Imp ensa da Uni e sidade de Coimb a: Coimb a, Po ugal, 2010. [C ossRe ]
34.
Sil a, S.A.; Lucena, K.D.T.; Deininge , L.S.C.; Coelho, H.F.C.; Vianna, R.P.T.; Anjos, U.U. Análise da iolência domés ica na saúde
das mulhe es. J. Hum. G ow h De . 2015,25, 182–186. [C ossRe ]
35.
Soleymani, S.; B i , E.; Wallace-Bell, M. Mo i a ional in e iewing o enhancing engagemen in in ima e pa ne iolence (IPV)
ea men : A e iew o he li e a u e. Agg ess. Violen Beha . 2018,40, 119–127. [C ossRe ]
36. Ba oso, Z. Violência nas Relações Amo osas [Violence in Lo e Rela ionships], 1s ed.; Edições Colib i: Famões, Po ugal, 2007.
37.
Paglia o, S.; Ca azza, N.; Paolini, D.; Te esi, M.; Johnson, J.; Pacilli, M. Adding insul o inju y: The e ec s o in ima e pa ne
iolence spillo e on he ic im’s epu a ion. Violence Agains Women 2021,28, 1523–1541. [C ossRe ]
38.
Pa k, S.; Bang, S.; Jeon, J. “This socie y igno es ou ic imiza ion”: Unde s anding he expe iences o Ko ean male ic ims o
in ima e pa ne iolence. J. In e pe s. Violence 2020,36, 11658–11680. [C ossRe ] [PubMed]
39.
Al es, M.J.V.; Mani a, C.; Caldas, I.M.; Fe nández-Ma inez, E.; Sil a, A.G.; Magalhães, T. E olu ion and analysis o cul u al and
cogni i e ac o s ela ed wi h domes ic iolence agains women. J. In e pe s. Violence 2016,34, 621–641. [C ossRe ] [PubMed]
40.
E ans, M.; Fede , G. Help-seeking amongs women su i o s o domes ic iolence: A quali a i e s udy o pa hways owa ds
o mal and in o mal suppo . Heal h Expec . 2014,19, 62–73. [C ossRe ] [PubMed]
41.
Rai, A.; Choi, Y.J. Socio-cul u al isk ac o s impac ing domes ic iolence among Sou h Asian immig an women: A scoping
e iew. Agg ess. Violen Beha . 2018,38, 76–85. [C ossRe ]
42.
Shin, N.; Pa k, E. The in luence o in o mal suppo on ba e ed women’s use o o mal se ices. J. Agg ess. Mal ea men T auma
2020,30, 1203–1219. [C ossRe ]
43.
Du a, M.; P a es, P.; Nakamu a, E.; Villela, W. A con igu ação da ede social de mulhe es em si uação de iolência domés ica [The
con igu a ion o he social ne wo k o women li ing in domes ic iolence si ua ions]. Ciênc. Saúde Cole i a 2013,18, 1293–1304.
[C ossRe ]
44.
Machisa, M.T.; Ch is o ides, N.; Jewkes, R. Social suppo ac o s associa ed wi h psychological esilience among women su i o s
o in ima e pa ne iolence in Gau eng, Sou h A ica. Glob. Heal h Ac ion 2018,11, 1491114. [C ossRe ] [PubMed]
45.
Pa k, S.; Ko, Y. Vic ims o in ima e pa ne iolence in Sou h Ko ea: Expe iences in seeking help based on suppo selec ion.
Violence Agains Women 2020,27, 320–338. [C ossRe ] [PubMed]
46.
San oniccolo, F.; T ombe a, T.; Rollè, L. The help-seeking p ocess in same-sex in ima e pa ne iolence: A sys ema ic e iew. Sex.
Res. Soc. Policy 2023,20, 391–411. [C ossRe ]
47.
Ba e , B.J.; Pei one, A.; Cheung, C.H. Help seeking expe iences o su i o s o in ima e pa ne iolence in Canada: The ole o
gende , iolence se e i y, and social belonging. J. Fam. Viol. 2020,35, 15–28. [C ossRe ]
48.
Ceza io, A.; Ca alho, L.; Lopes, N.; Lou enço, L. A iolência en e pa cei os ín imos sob a pe spec i a de homens í imas de
suas pa cei as no B asil [Violence be ween in ima e pa ne s om he pe spec i e o male ic ims o hei pa ne s in B azil].
Pe spec . En Psicol. 2015,12, 41–49.
49.
Ped o, I.; Rocha, S.; Nascimen o, L. Social suppo and social ne wo k in amily nu sing: Re iewing concep s. Re . LA En e m.
2008,16, 324–327. [C ossRe ]
50.
Duns , C.; T i e e, C. Assessmen o social suppo in ea ly in e en ion p og ams. In Handbook o Ea ly Childhood In e en ion;
Meisels, S., Shonko , J., Eds.; Camb idge Uni e si y P ess: Camb idge, UK, 1990; pp. 326–349.
51.
Coke , A.; Smi h, P.; Thompson, M.; McKeown, R.; Be hea, L.; Da is, K. Social suppo p o ec s agains he nega i e e ec s o
pa ne iolence on men al heal h. Women’s Heal h Gend.-Based Med. 2002,11, 465–476. [C ossRe ]
52.
Fe a i, G.; Da ies, R.; Bailey, J.; Howa d, L.; Howa h, E.; Pe e s, T.; Sa dinha, L.; Fede , G. Domes ic iolence and men al heal h:
A c oss-sec ional su ey o women seeking help om domes ic iolence suppo se ices. Global Heal h Ac ion 2016,9, 29890.
[C ossRe ]
53.
Ha andi, T.; Taghinasab, M.; Naye i, T. The co ela ion o social suppo wi h men al heal h. Elec on. Physician 2017,9, 5212–5222.
[C ossRe ] [PubMed]
54.
Mahapa o, M.; P asad, M.; Singh, S. Role o social suppo in women acing domes ic iolence du ing lockdown o COVID-19
while cohabi ing wi h he abuse s: Analysis o cases egis e ed wi h he amily counselling cen e, Alwa , India. J. Fam. Issues
2021,42, 2609–2624. [C ossRe ] [PubMed]
55.
Panaghi, L.; Ahmadabi, Z.; Ghaha i, S.; Mohammadi, S. Social suppo , coping mechanisms, and men al heal h o women
su e ing om spouse abuse. P ac . Clin. Psychol. 2013,1, 9–15.
