Connecting the dots to break chain of violence: Victims of violence more likely to suffer, perpetuate violence
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* Michele Late

A girl who is bullied gets into fights. A boy who is neglected tries to end his own life. A teen who was sexually abused becomes a victim of intimate partner violence.

From child maltreatment and bullying to suicidal behavior and elder abuse and neglect, research shows that violence is interconnected.

Most victims of violence do not act violently, according to “Connecting the Dots: An Overview of the Links Among Multiple Forms of Violence,” a 2014 report from the Prevention Institute and the Centers for Disease Control and Prevention. But people who have experienced violence — who can suffer from physical, mental and or emotional health problems — are at increased risk of being victims of more violence and of behaving violently themselves.

“Gang violence is connected to bullying is connected to school violence is connected to intimate partner violence is connected to child abuse is connected to elder abuse,” Deborah Prothrow-Stith, MD, dean and professor at Charles R. Drew University College of Medicine, said in the report. “It’s all connected.”

Violence affects people of all ages. As many as 10 percent of seniors have experienced elder abuse. Annually, 10 million women and men experience intimate partner violence. And 1 in 5 U.S. women experience rape or attempted rape during their lifetimes.

In many cases, violence is first experienced in childhood, potentially leading to lifelong repercussions. Children who have adverse childhood experiences — such as abuse, neglect or other traumatic stressors — are at higher risk for health issues such as alcohol abuse, depression and intimate partner violence, according to CDC.

People who have six or more adverse childhood experiences live 20 years less than those with no such experiences, research shows.

“There are experiences, particularly early in childhood, that make it extremely predictable that individuals are at substantially higher risk for involvement with violence,” wrote APHA member Howard Spivak, MD, former director of CDC’s Division of Violence Prevention, in the report.

![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/48/2/S3.1/F1.medium.gif)

[Figure1](http://www.thenationshealth.org/content/48/2/S3.1/F1)

Healthy family dynamics help reduce the risk of kids being victims of violence, according to a CDC report.

Photo by Sladic, courtesy iStockphoto

Such connections can also be found in the aftermath of sexual violence, the report found. For example, girls who are sexually abused are more likely to suffer physical violence, harm themselves and experience intimate partner violence as adults.

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[Figure2](http://www.thenationshealth.org/content/48/2/S3.1/F2)

Kids’ experiences shape their physical and mental health as adults, according to CDC.

Photo by Steve Debenport, courtesy iStockphoto

Researchers have worked to identify known risk factors for violence as well as those that can be protective. In the case of sexual violence, risk factors include a family environment with physical violence, a childhood history of abuse and poor parent-child relationships, according to CDC. Protective factors that can reduce the likelihood of sexual violence perpetration include connectedness, academic achievement and family conflict resolution.

Some states are using a shared risk and protective factor approach in their violence prevention work. In Wyoming, officials are promoting youth development to help communities make the link between healthy relationships and healthy sexuality. In Maryland, which has one of the highest violent crime rates in the U.S., officials conducted a statewide scan to identify violence prevention programs and held a summit with partners to determine how local agencies can work together.

The approach is one that holds promise, as health workers, social services and community organizations can collaborate to break the chain of violence, the “Connecting the Dots” report said.

“For example, practitioners working with survivors of intimate partner violence may recognize that children in families experiencing conflict and violence are at higher risk of being victims of bullying, or becoming bullies themselves, and coordinate with schools to ensure that all members of the family are receiving the help and support they need to prevent future violence,” the report said.

Through its Veto Violence program, CDC offers a guided online training that highlights ways that shared risk and protective factors can prevent violence. To take part, visit [bit.ly/dotstraining](http://bit.ly/dotstraining).

For the “Connecting the Dots” report, visit [bit.ly/connectingthedotscdc](http://bit.ly/connectingthedotscdc).

*   Copyright The Nation’s Health, American Public Health Association