Family Problems and Family Violence

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2 Family Problems and Family Violence

3 Heather M. Foran, PhD, is the principal investigator of a project on couple functioning and psychopathology funded by the German Research Foundation at the Technical University of Braunschweig in Germany and a part-time consultant for the Walter Reed Army Institute of Research. Her research examines intimate partner violence from a public health perspective with an emphasis on assessment, surveillance, and models of risk and protection. Dr. Foran received her doctorate in clinical psychology from Stony Brook University and is a licensed U.S. psychologist. She has numerous scholarly articles on family-related topics and psychopathology and is chair of the relational processes and ICD-11 working group. Steven R. H. Beach, PhD, is a faculty member in the clinical psychology program at the University of Georgia and a licensed clinical psychologist with over 25 years of experience investigating the role of social relationships in the development and maintenance of psychopathology, particularly depression and substance use disorders. He currently serves as director of the William A. and Barbara R. Owens Institute for Behavioral Research, an interdisciplinary research institute. He is widely recognized as an authority on the link between marital discord and depression and the use of marital interventions in the context of depression. He is also recognized for his research on the role of genetic moderators of intervention response and other contextual variables, and the potential role of epigenetic regulation in accounting for contextual and intervention effects. Amy M. Smith Slep, PhD, is professor of comprehensive care and cariology at New York University. Along with her collaborator Richard E. Heyman, she cofounded and codirects the Family Translational Research Group. Dr. Slep s research focuses on many different aspects of conflict and violence in families: the development of dysfunctional parenting, the connections between parenting and partner conflict, the dynamics of conflict escalation and de-escalation in productive and destructive conflicts, and what facets of exposure to violence impact children s functioning and how these impacts can be buffered. She also focuses on how to best prevent family violence. Her work on definitions of maltreatment has resulted in definitions that are now being used throughout the U.S. military. She has published nearly 100 scientific articles and book chapters and has received nearly 40 federal research grants. She is a licensed clinical psychologist. Richard E. Heyman, PhD, is a professor at New York University. Dr. Heyman codirects the Family Translational Research Group (with Dr. Amy Slep) in the Department of Cariology and Comprehensive Care. He earned a BS from Duke University and a PhD in clinical psychology from the University of Oregon. Dr. Heyman has received 40 grants/contracts from major U.S. funding agencies on a variety of family-related topics, from anger escalation in couples to the impact of family violence on children to community-level prevention of family maltreatment, substance problems, and suicidality. Dr. Heyman has published over 100 scientific articles/chapters focused on couple dysfunction, intimate partner violence, and child maltreatment and their risk factors and consequences. Dr. Heyman is a licensed psychologist and maintains a private practice. Marianne Z. Wamboldt, MD, is professor and vice chair of the Department of Psychiatry at the University of Colorado School of Medicine, as well as chair of Psychiatry and Behavioral Sciences at Children s Hospital Colorado. She is a board-certified child and adolescent psychiatrist, with over 25 years of clinical, teaching, and research experience. Her training included a BS magna cum laude from Marquette University, an MD as well as general psychiatry residency from the University of Wisconsin, a clinical research fellowship at NIMH, and a specialty fellowship in child and adolescent psychiatry at the University of Colorado. Her interests have focused on the role of family relationships in medical (primarily asthma) and psychological outcomes for children and teens, behavioral genetics as a tool to understanding the comorbidity of medical and psychiatric problems, and clinical interventions for children and adolescents with mood and/or anxiety disorders. She has authored over 62 scientific articles/chapters, has been involved as principal investigator or coinvestigator on over 30 grants, and is involved as president of the Board of Family Process; past chair of the Committee on the Physically Ill Child, as well as a member of the Program Committee, within the American Academy of Child and Adolescent Psychiatry; and a member of the Group for Advancement of Psychiatry s Committee on the Family.

4 Family Problems and Family Violence: Reliable Assessment and the ICD-11 Heather M. Foran, PhD Steven R. H. Beach, PhD Amy M. Smith Slep, PhD Richard E. Heyman, PhD Marianne Z. Wamboldt, MD Editors Nadine J. Kaslow, PhD, ABPP David Reiss, MD Associate Editors

5 Copyright 2013 Springer Publishing Company, LLC All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Springer Publishing Company, LLC, or authorization through payment of the appropriate fees to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, , fax , info@copyright.com or on the Web at Springer Publishing Company, LLC 11 West 42nd Street New York, NY Acquisitions Editor: Nancy S. Hale Associate Editor: Kathryn Corasaniti Composition: Newgen Imaging ISBN: e-book ISBN: / The author and the publisher of this Work have made every effort to use sources believed to be reliable to provide information that is accurate and compatible with the standards generally accepted at the time of publication. The author and publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers use of, or reliance on, the information contained in this book. The publisher has no responsibility for the persistence or accuracy of URLs for external or third-party Internet websites referred to in this publication and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. Library of Congress Cataloging-in-Publication Data Family problems and family violence : reliable assessment and the ICD-11 / edited by Heather M. Foran... [et al.]. p. cm. Includes index. ISBN Family violence. 2. Spousal abuse. I. Foran, Heather M. RC569.5.F3F dc Special discounts on bulk quantities of our books are available to corporations, professional associations, pharmaceutical companies, health care organizations, and other qualifying groups. If you are interested in a custom book, including chapters from more than one of our titles, we can provide that service as well. For details, please contact: Special Sales Department, Springer Publishing Company, LLC 11 West 42nd Street, 15th Floor, New York, NY Phone: or ; Fax: sales@springerpub.com Printed in the United States of America by Gasch Printing.

6 Contents Contributors vii Foreword by David Addiss, MD, MPH Preface xi Acknowledgments xix ix I: PARTNER MALTREATMENT 1. Intimate Partner Maltreatment: Definitions, Prevalence, and Implications for Diagnosis 1 Richard E. Heyman, Amy M. Smith Slep, Ann C. Eckardt Erlanger, and Heather M. Foran 2. Intimate Partner Violence and Its Measurement: Global Considerations 15 Christina Pallitto and Claudia García-Moreno 3. Psychological, Physical, and Economic Consequences of Intimate Partner Violence 33 Heather M. Foran and Ryan Phelps 4. Practical Tools for Assessing Partner Maltreatment in Clinical Practice and Public Health Settings 43 Richard E. Heyman, Amy M. Smith Slep, Jeffery D. Snarr, and Heather M. Foran II: PARTNER RELATIONAL PROBLEMS 5. Relationship Distress: Assessment, Definition, and Implications for Mental Health Diagnosis 71 Mark A. Whisman and Steven R. H. Beach 6. Defining Partner Relational Problems in the Arab Region 79 Brigitte Khoury and Yasmine Fayad 7. Relationship Distress: Impact on Mental Illness, Physical Health, Children, and Family Economics 91 Steven R. H. Beach and Mark A. Whisman v

7 vi Contents 8. Practical Tools for Assessing Marital or Intimate Partner Relational Problems in Clinical Practice and Public Health Settings 101 Steven R. H. Beach, Mark A. Whisman, Douglas K. Snyder, and Richard E. Heyman III: CHILD MALTREATMENT 9. Child Maltreatment: Definitions, Prevalence, and Implications for Diagnosis 111 Amy M. Smith Slep, Richard E. Heyman, and Jill Malik 10. Child Maltreatment Relational Diagnosis Using ICD Codes: Considerations for Low- and Middle-Income Settings 131 Mokhantšo G. Makoae 11. Psychological, Physical, and Economic Consequences of Child Maltreatment 149 Tamara Del Vecchio, Amy M. Smith Slep, and Richard E. Heyman 12. Practical Tools for Assessing Child Maltreatment in Clinical Practice and Public Health Settings 159 Amy M. Smith Slep, Richard E. Heyman, Jeffery D. Snarr, and Heather M. Foran IV: CAREGIVER CHILD RELATIONAL PROBLEMS 13. Caregiver Child Relational Problems: Definitions and Implications for Diagnosis 185 Amy M. Smith Slep and Tuula Tamminen 14. Applicability, Generalizability, and Considerations in China 197 Wenhong Cheng 15. Parent Child Relational Problems: The Psychological, Physical, and Economic Consequences 203 Kurt Hahlweg 16. Practical Tools for Assessing Caregiver Child Relationship Problems 217 Marianne Z. Wamboldt and Anthony R. Cordaro, Jr. V: CURRENT STATE OF PUBLIC HEALTH RESPONSE AND FUTURE DIRECTIONS 17. Prevention and Reduction of Parent Child Relationship Difficulties 229 Ron Prinz 18. Current State of the Global Public Health Response to Child Maltreatment and Intimate Partner Violence 237 Christopher Mikton and Alexander Butchart 19. Relational Problems Co-Occurring With Medical Problems: The Conceptual Basis of Cross-Coding 251 David Reiss 20. Future Directions for Science and Public Health 269 Steven R. H. Beach, Nadine J. Kaslow, Heather M. Foran, Richard E. Heyman, and Claudia García-Moreno Index 277

8 Contributors Steven R. H. Beach, PhD University of Georgia Athens, GA Alexander Butchart, PhD World Health Organization Geneva, Switzerland Wenhong Cheng, MD Shanghai Jiaotong University Medical Center Shanghai, China Anthony R. Cordaro, Jr. MD University of Colorado School of Medicine Aurora, CO Ann C. Eckardt Erlanger, PsyD New York University New York, NY Tamara Del Vecchio, PhD St. John s University Queens, NY Yasmine Fayad, MA American University of Beirut Medical Center Beirut, Lebanon Heather M. Foran, PhD Technical University of Braunschweig Braunschweig, Germany Claudia García-Moreno, MD World Health Organization Geneva, Switzerland Kurt Hahlweg, PhD Technical University of Braunschweig Braunschweig, Germany Richard E. Heyman, PhD New York University New York, NY Nadine J. Kaslow, PhD, ABPP Emory University Atlanta, GA Brigitte Khoury, PhD American University of Beirut Medical Center Beirut, Lebanon Jill Malik, MA Stony Brook University Stony Brook, NY Christopher Mikton, PhD World Health Organization Geneva, Switzerland Mokhantšo G. Makoae, PhD Human Sciences Research Council Cape Town, South Africa Christina Pallitto, PhD World Health Organization Geneva, Switzerland Ryan Phelps, PhD Stephen F. Austin State University Nacogdoches, TX vii

9 viii Contributors Ron Prinz, PhD, ABPP University of South Carolina Columbia, SC David Reiss, MD Yale Child Study Center New Haven, CT Amy M. Smith Slep, PhD New York University New York, NY Jeffery D. Snarr, PhD The College at Brockport Brockport, NY Douglas K. Snyder, PhD Texas A&M University College Station, TX Tuula Tamminen, MD University of Tampere Medical School Tempere, Finland Marianne Z. Wamboldt, MD University of Colorado School of Medicine Aurora, CO Mark A. Whisman, PhD University of Colorado at Boulder Boulder, CO

10 Foreword A t its core, human life is relational. For centuries, poets, mystics, and all great spiritual traditions have testified to humanity s deep need and yearning for relationship. The African concept of Ubuntu bears witness to the critical importance of relationships for human flourishing. As described by Archbishop Desmond Tutu, We believe that a person is a person through another person, that my humanity is caught up, bound up, inextricably, with yours. Or, in the words of the poet ee cummings, I am through you so I. As relational beings, then, we humans live in an intensely relational world. Unfortunately, not all human relationships are life-giving. Rather than nurturing our individual and collective flourishing, some relationships are devastatingly harmful. Instead of being enriching and meaningful, they can be terrifying and disabling. The magnitude of human suffering caused by unhealthy relationships can scarcely be imagined. Primary relationships those between intimate partners or between parent and child are particularly important. Recent scientific studies have shown that the quality of our primary relationships can have profound effects on health, wound healing, immune function, and responses to treatment for a variety of mental and physical illnesses. Given the overwhelming importance of family relationships for human health and well-being, it is surprising and unfortunate that in busy clinical settings, they often are not adequately considered in the assessment and treatment of individual patients. As a consequence, the tremendous healing power of relationship goes untapped and responses to treatment remain unsatisfactory. For the past 10 years, a small group of family researchers, primarily psychologists, and psychiatrists in North America has been amassing the scientific evidence and articulating the conceptual and practical frameworks necessary to bring greater attention to relationships in clinical practice. This groundbreaking work, focused primarily on mental and relational health, is summarized in their recent book, Relational Processes and DSM-V: Neuroscience, Assessment, Prevention, and Intervention. To build on this seminal effort and to explore how relational processes might be accorded greater prominence on a global scale, a meeting was held at Eranos, in Ascona, Switzerland on October 14 15, The intent of the meeting was to foster greater cross-cultural and interdisciplinary understanding of the challenges to primary relationships faced by humans around the globe. The meeting was supported by the ix

11 x Foreword Eranos Foundation and the Fetzer Institute. Participants included clinical psychologists, psychiatrists, and researchers from the United States, China, South Africa, Lebanon, Finland, and Australia, as well as officials from the World Health Organization (WHO) specializing in mental health, external causes of injury, violence prevention, and reproductive health. Fields of expertise included parent child relationships, child maltreatment, intimate partner relationships and intimate partner violence genetics, health systems research, and disease classification. The timing of this meeting coincided with a major revision of the International Classification of Diseases (ICD). The ICD, published by WHO, is the global standard for classifying diseases and related health problems. Its importance for diagnosis and treatment of physical and mental illness, and for understanding global disease trends, cannot be overstated. It is used by physicians, other health workers, hospitals, ministries of health, and health information systems around the world. The 11th revision of the ICD will reflect the many scientific and conceptual advances in medicine and health since the last major revision in Thus, the Eranos meeting provided the first opportunity for psychologists, psychiatrists, and other mental health professionals from a variety of cultural settings to explore how relational processes might be more fully incorporated into the ICD-11. Participants first reviewed the data on the massive public health and economic toll of relational problems. They then focused their attention on four specific categories of family relational problems: partner relational problems (which do not necessarily involve maltreatment or abuse), partner maltreatment, parent child relational problems, and child maltreatment. They also developed criteria and made recommendations for greater incorporation of relational processes into the ICD-11. The Eranos meeting marked the beginning of an expanded collaboration that has culminated in this remarkable volume, which is both conceptually robust and highly practical. For each of the four major categories of relational problems, the distinguished authors have addressed (a) definitions, prevalence, and implications for diagnosis; (b) psychological, physical, and economic impact; (c) global considerations for assessment; and (d) practical tools for clinical practice and public health. A final section describes the public health response to relational problems and outlines future directions for addressing them. This book should be of interest to clinicians and family therapists, especially those who seek to understand the impact of family relationships from the broad perspective of global health. It will also serve as a valuable resource for public health officials involved in violence prevention, maternal child health, and mental health, among other fields. The book promises to heighten awareness among clinicians around the world about the diagnostic and therapeutic importance of family relationships in human health and disease. It also will serve as a roadmap for the critically important work that lies ahead. David Addiss, MD, MPH Task Force for Global Health Decatur, Georgia

12 Preface Relational problems (intimate partner violence, partner relationship distress, child maltreatment, and parent child relational problems) are major global concerns having vast impacts on psychological health, physical health, and economic well-being. Prevention and public health interventions for relational problems have been constrained by lack of universal definitions and assessment of these problems globally. The purpose of this book is to address this need by providing a comprehensive and concise review of the public health impact of relational problems, innovations in definitional systems for relational problems, and recommendations for improving surveillance worldwide. THE ICD The International Classification of Diseases (ICD) is the most widely used physical and mental health classification system. The ICD, originating as a system to classify causes of death in the 19th century, is currently used for coding of mortality and morbidity in more than 110 countries and 60% of the world s population (WHO, 2010a). The ICD is also used for national and international epidemiology, patient records, health care reimbursement and financing, referencing for treatment and research, and quality assessment of health care systems (WHO, 2010a). It may be of surprise to many mental health professionals in the United States and Canada that the ICD is the primary system used for medical coding and health care reimbursement of both mental and physical health conditions in North America, as well. Although the Diagnostic Statistical Manual for Mental Disorders (DSM-IV; American Psychiatric Association, 1994) is used for training mental health providers, the use of ICD codes is widespread. For example, in the largest integrated health system in the United States, the Veterans Affairs medical centers, the ICD is used for all coding of mental and physical conditions within their electronic patient record system. In fact, more than 70% of the world s health expenditures are allocated using the ICD (WHO, 2010a). The current version of the ICD, the ICD-10, was published in Revision for the next edition, the ICD-11, is underway and scheduled for full release in 2015 with the beta version available in 2012 (WHO, 2011). The ICD-11 revision steering committee has set forth priorities for the revision (WHO, 2007). Most importantly, revisions should be based on new scientific evidence, clinical utility and health system utility, and public xi

13 xii Preface health usefulness. In this book, we address these priorities as they apply to revisions to the relational problem categories; namely, intimate partner violence, partner relationship distress, child maltreatment, and caregiver child relational problems. THE ICD-11 AND RELATIONAL PROCESSES Since the last edition of the ICD in 1992, there has been significant progress in understanding relational problems and their impact on physical and mental health (see Beach, Wamboldt, Kaslow, Heyman, & Reiss, 2006a; Schmaling & Sher, 2000). A series of studies examining immune function, cardiovascular response, and other biological processes have demonstrated that unhealthy relationships in childhood and adulthood are associated with higher morbidity and mortality (e.g., Eaker, Sullivan, Kelly- Hayes, D Agostino, & Benjamin, 2007; Fagundes, Bennett, Derry, & Kiecolt-Glaser, 2011; Kiecolt-Glaser, Gouin, & Hantsoo, 2009; Wolf, Miller, & Chen, 2008). In addition, the importance of relational problems for treatment, clinical course, and health care utilization of a variety of physical and mental health conditions has been more thoroughly documented (e.g., Bell, 2009; Denton et al., 2010; Miklowitz, Wisniewski, Miyahara, Otto, & Sachs, 2005; Nemeroff et al., 2003; Schonbrun & Whisman, 2010; F. S. Wamboldt, M. Z. Wamboldt, Gavin, Roesler, & Brugman, 1995). Simultaneously, there has been significant innovations in assessment of key relational processes. As reviewed in this book, reliable and valid definitions for intimate partner violence, child maltreatment, relationship distress, and caregiver child relational problems are now available and have potential to improve the surveillance and treatment of these problems by inclusion in the ICD-11. These definitions improve existing categories used in the ICD-10 in many ways. First, there are no valid definitions for relational processes in the ICD-10. Second, the ICD-10 includes a large number of names for relational categories, but there is a lack of scientific evidence for including so many separate codes. This is illustrated below with a list of some of the codes for family problems and family violence used in the ICD-10 (WHO, 2010b): Z60 Problems related to social environment Z60.1 Atypical parenting situation Z61 Problems related to negative life events in childhood Z61.2 Altered pattern of family relationships in childhood Z61.4 Problems related to alleged sexual abuse of child by person within primary support group Z61.6 Problems related to alleged physical abuse of child Z62 Other problems related to upbringing Z62.0 Inadequate parental supervision and control Z62.1 Parental overprotection Z62.3 Hostility toward and scapegoating of child Z62.4 Emotional neglect of child Z62.5 Other problems related to neglect in upbringing Z62.6 Inappropriate parental pressure and other abnormal qualities of upbringing Z62.8 Other specified problems related to upbringing Z62.9 Problems related to upbringing, unspecified Z63 Other problems related to primary support group, including family circumstances Z63.0 Problems in relationship with spouse or partner Z63.1 Problems in relationship with parents and in-laws

14 Preface xiii Z63.2 Inadequate family support Y05 Sexual assault by bodily force Y06 Neglect and abandonment Y06.0 By spouse or partner Y06.1 By parent Y07 Other maltreatment Y07.0 By spouse or partner Y07.1 By parent T74 Maltreatment syndromes T4.0 Neglect or abandonment T74.1 Physical abuse T74.2 Sexual abuse T74.3 Psychological abuse T74.8 Other maltreatment syndromes T74.9 Maltreatment syndrome, unspecified Third, there are no reliable tools for assessing the dozens of codes, and the complexity of the current system limits clinical utility. The large number of codes, with no definitions or tools to assess them, also makes the current system cumbersome for use in many low-resource settings. This book consolidates these codes into four scientifically based categories that have validated definitions and brief screening tools that can be easily implemented across a range of settings. Thus, it directly addresses the primary goals of the ICD-11 revisions improvements based on science, clinical utility, and public health usefulness and is organized accordingly. HISTORICAL CONTEXT FOR THE CURRENT VOLUME This book is the result of a conference attended by worldwide scholars and representatives of the World Health Organization (WHO) held October 14 15, 2010 in Ascona, Switzerland. The conference, funded by the Fetzer Institute, provided a forum to discuss specific recommendations for reliable, valid international definitions to be incorporated into the new version of the International Classification of Diseases (ICD-11). The foundation of this book is also based on more than a decade of scholarly activities by the Relational Processes Working Group initially founded by David Reiss, Steven Beach, Nadine Kaslow, Marianne Wamboldt, and Richard Heyman in There have been two previous expert meetings on the topic of relational assessment (Relational Processes and Mental Health, Washington, DC, 2005 and Relational Processes and the DSM-V: Revising Current Nosology and Improving Assessment, San Diego, CA, 2007) and several other publications related to this topic (e.g., Beach et al., 2006a; Beach,Wamboldt, Kaslow, Heyman & Reiss, 2006b; Heyman et al., 2009; Wamboldt et al., 2010). Over the past decade, numerous experts from a range of fields relevant to relational processes (e.g., public health, epidemiology, clinical and social psychology, psychiatry, economics, neuroscience) have contributed to the conversation on this topic. SUMMARY OF CHAPTER CONTENTS The first four sections of the book each describe one relational problem: (a) partner maltreatment, (b) partner relational problems, (c) child maltreatment, and (d) caregiver child relational problems. These four categories were selected above the smaller delineations currently found in the ICD-10, as they compose parsimonious categories with the most scientific basis for reliable and valid coding.

15 xiv Preface Each section comprises four chapters. The first chapter within each section provides definitional information, prevalences, and implications for diagnosis (see Chapters 1, 5, 9, and 13). The second chapter within each section addresses cultural issues in the assessment of relationship problems (see Chapters 2, 6, 10, and 14). The section on partner maltreatment includes global considerations in assessment of violence against women around the world (Chapter 2, Pallitto and García-Moreno). In the section on partner relational problems, assessment issues of relational problems in the Arab world are described (Chapter 6, Khoury and Fayad). In the section on child maltreatment, issues in application of newly developing surveillance systems in South Africa, as an example, are reviewed (Chapter 10, Makoae). In the section on caregiver child relationships, implications of the rapid development on families in China and parent child relationships are discussed (Chapter 14, Cheng). The third chapter in each section provides evidence for the public health importance of relational problems by reviewing the psychological, physical, and economic impacts of each relationship problem (see Chapters 3, 7, 11, and 15). The last chapter in each section provides measures for screening each of the four relational problems and recommendations for use in applied settings (see Chapters 4, 8, 12, and 16). We expect these chapters will be of particular use to health providers seeking tools for reliable assessment and diagnosis of relational problems in hospitals, clinics, or research settings. The aforementioned sections are supplemented by a final section that describes public health programs to address relational problems and future directions (see Chapters 17 20). Within this section, the first chapter describes the Triple P program as an example of a success story in terms of public health prevention to address caregiver child relational problems (Chapter 17, Prinz). The second chapter discusses public health programming to address child and partner maltreatment from a World Health Organization perspective (Chapter 18, Mikton and Butchart). The last two chapters provide recommendations for public health surveillance and future directions for science and public policy (Chapter 19, Reiss; Chapter 20, Beach, Kaslow et al.). The chapter by David Reiss reviews the evidence for co-occurrence of medical problems with relational problems and implications of cross-coding conditions for treatment and service provision. As persuasively argued in David Reiss s chapter, the value of cross-coding for diagnosis and treatment planning is apparent, but implementation has been constrained by practical issues. The ICD-11 offers a unique opportunity to overcome past constraints in cross-coding through its online format in which codes can be easily linked. Further, one of the goals of the ICD-11 is to make use of the advantages of electronic record systems in coding of mental and physical health conditions (WHO, 2007). Electronic record systems offer several advantages, including improving surveillance and monitoring, clinical care, and cost effectiveness. In particular, electronic record systems allow for programming of decision trees that have been documented to improve assessment and subsequent treatment recommendations. For example, when a child presents to a pediatrician with lacerations on the back or a woman presents with bruises to her face, maltreatment should be assessed. The use of an electronic record system could trigger the provider when entering these injury codes to assess for maltreatment. This could lead to improvements in care for victims who were previously underdetected. In addition, for disorders in which couple or family problems influence clinical course, prompting to assess for these relationship problems may help improve treatment outcomes.

16 Preface xv A NOTE ABOUT OUR APPROACH Clearly, there are many causes for relational problems and they may differ by region, culture, or nation. In the case of intimate partner violence and child maltreatment, prevalence of violence against women and children differ drastically from one country to another and within countries (e.g., rural and urban areas) (García-Moreno et al., 2005) and are influenced by macro-level factors such as cultural norms toward violence, availability of victim resources, and laws in a particular region or country. By providing valid definitions and tools to assess violence, our aim is explicitly not to pathologize the victim or frame these conditions as individual disorders. Rather, our goal is to improve surveillance of family problems and family violence that are often rooted in societal or community factors mentioned above. This in turn may impact treatment, prevention, policy decisions, and resource allocation for these problems. Our perspective is thus similar to an epidemiological or public health approach adopted by the Centers for Disease Control and Prevention (CDC) and WHO in which an integrated community response is necessary for maximally effective prevention. As the ICD is used to inform health care resource allocation decisions for 70% of expenditures (WHO, 2011), better surveillance of these types of problems can lead to changes in violence prevention efforts and resources for victims. An excellent review of some of the efforts related to child and partner maltreatment prevention globally is described in Chapter 18 (Mikton and Butchart). WHO SHOULD READ THIS BOOK? A Tool for Practitioners Assessing Relationship Problems This volume includes several new state-of-the art assessment instruments. Copies of these structured diagnostic interviews and brief screening instruments for relationship problems are included in each of the Practical Tools chapters (see Chapters 4, 8, 12, and 16). Assessment of relational problems, such as maltreatment, is a concern that intersects with a large range of professions in diverse settings, including emergency rooms, social service agencies, primary care offices, schools, psychotherapy clinics, marital therapy clinics, psychiatry offices, and forensic settings. Hence, this volume may be a useful reference for a wide range of practitioners assessing relationship problems. A Text for Training We anticipate this volume will be an attractive classroom text for graduate training programs. Social workers, psychologists, marriage and family therapists, and psychiatric nurses all encounter relational problems in practice. Training in proper assessment of family maltreatment, parent child problems, and relationship discord are components in many graduate program courses across disciplines. A Wide Scholarly Audience Because this volume examines a critical public health issue from a multidisciplinary perspective, we expect that it is of interest to a wide audience including clinicians, epidemiologists, prevention program developers, researchers, psychologists, physicians, cultural anthropologists, public policy makers, and advocates. Past volumes about relationship problems typically neglect global perspectives and only focus on a specific type of relationship problem (e.g., childhood dysfunctions). The focus of the current volume

17 xvi Preface should be of interest to an international audience as well as readers interested in the spectrum of relational problems across childhood and adulthood. CONCLUDING SUMMARY The purpose of this book is to provide clinicians, scholars, students, and policy makers with (a) a comprehensive and concise review of recent innovations in defining and assessing couple and family problems and family violence; (b) global considerations of cross-cultural relationship assessment and recommendation for modifications and cross-cultural validation; (c) a review of the impact of couple and family problems and family violence on worldwide psychological health, physical health, and economic wellbeing; (d) an overview of practical clinical and public health tools for defining, screening, and assessing clinically significant couple and family problems and family violence; and (e) copies of the tools. In this book, we have provided an up-to-date review of the public health impacts of relational problems and scientifically based tools for improving surveillance of these problems; we hope this will help move the field toward universal definitions and assessment of these problems and lead to improvements in treatment, prevention, and public health decisions. REFERENCES American Psychiatric Association. (1994). Diagnostic and statistical manual for mental disorders (4th ed.). Washington, DC: Author. Beach, S. R. H., Wamboldt, M., Kaslow, N. J., Heyman, R. E., & Reiss, D. (2006a). Relational processes and mental health: A bench to bedside dialogue to guide the DSM-V. In S. R. H. Beach, M. Wamboldt, N. Kaslow, R. E. Heyman, M. First, L. G. Underwood, & D. Reiss (Eds.) Relational processes and DSM-V: Neuroscience, assessment, prevention, and treatment (pp. 1 20). Washington, DC: American Psychiatric Press. Beach, S. R. H., Wamboldt, M., Kaslow, N. J., Heyman, R. E., & Reiss, D. (2006b). Describing relationship problems in DSM-V: Toward better guidance for research and clinical practice. Journal of Family Psychology, 20, Bell, N. S. (2009). Health and occupational consequences of spouse abuse victimization among male U.S. Army soldiers. Journal of Interpersonal Violence, 24, Denton, W. H., Carmody, T. J., Rush, A. J., Thase, M. E., Trivedi, M. H., Arnow, B. A.,... Keller, M. B. (2010). Dyadic discord at baseline is associated with lack of remission in the acute treatment of chronic depression. Psychological Medicine, 40, García-Moreno, C., Jansen, H. A, Ellsberg, M., Heise, L., Watts, C. (2005). WHO multi-country study on women s health and domestic violence against women. Geneva, World Health Organization. Eaker, E. D., Sullivan, L. M., Kelly-Hayes, M., D Agostino, R. B., & Benjamin, E. J. (2007). Marital status, marital strain, and risk of coronary heart disease or total mortality: The Framingham offspring study. Psychosomatic Medicine, 69(6), Fagundes, C. P., Bennett, J. M., Derry, H. M., & Kiecolt-Glaser, J. K. (2011). Relationships and inflammation across the lifespan: Social developmental pathways to disease. Social and Personality Psychology Compass, 5, Heyman R. E., Slep, A. M. S., Beach, S. R. H., Wamboldt, M., Kaslow, N. J., & Reiss, D. (2009). Relationship problems and the DSM: Needed improvements and suggested solutions. World Psychiatry, 8, Kiecolt-Glaser, J. K., Gouin, J. -P., & Hantsoo, L. (2009). Close relationships, inflammation, and health. Neuroscience and Biobehavioral Reviews, 35, Miklowitz, D. J., Wisniewski, S. R., Miyahara, S., Otto, M. W., & Sachs, G. S. (2005). Perceived criticism from family members as a predictor of the 1-year course of bipolar disorder. Psychiatry Research, 136, Nemeroff, C. B., Heim, C. M., Thase, M. E., Klein, D. N., Rush, A. J., Schatzberg, A. F.,... Keller, M. B. (2003). Differential responses to psychotherapy versus pharmacotherapy in patients with

18 Preface xvii chronic forms of major depression and childhood trauma. Proceedings of the National Academy of Sciences of the United States of America, 100, Schmaling, K. B., & Sher, T. G. (2000). The Psychology of Couples and Illness: Theory, Research, and Practice. Washington, DC: American Psychological Association. Schonbrun, Y. C., & Whisman, M. A. (2010). Marital distress and mental health care service utilization among married adults. Journal of Consulting and Clinical Psychology, 78, Wamboldt, F. S., Wamboldt, M. Z., Gavin, L. A., Roesler, T. A., & Brugman, S. M. (1995). Parental criticism and treatment outcome in adolescents hospitalized for severe, chronic asthma. Journal of Psychosomatic Research, 39, Wamboldt, M. Z., Beach, S. R. H., Kaslow, N. J., Heyman, R. E., First, M. B. & Reiss, D. (2010). Describing relationship patterns in DSM-V: A preliminary proposal. In T. Millon, R. R. Krueger, & E. Simonsen (Eds.), Contemporary Directions in Psychopathology: Scientific Foundations of the DSM-V and ICD-11 (pp ). New York, NY: Guilford Press. Wolf, J., Miller, G., & Chen, E. (2008). Parent psychological states predict changes in inflammatory markers in children with asthma and healthy children. Brain, Behavior, and Immunity, 22, World Health Organization (WHO). (2007). Production of the ICD-11. Geneva, Switzerland: Author. World Health Organization (WHO). (2010a). ICD-11 revision project plan Draft 2.0. Geneva, Switzerland: Author. World Health Organization (WHO). (2010b). ICD-10 Version: Geneva, Switzerland: Author. Retrieved from World Health Organization (WHO). (2011). Classifications: ICD revision timelines. Retrieved December, 2011, from

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20 Acknowledgments We would like to thank the many contributors without whom this volume would not have been possible. First and foremost, much credit is owed to the joint efforts of the relational processes working group assembled in 2001 by David Reiss, including (in alphabetical order) Steven Beach, Richard Heyman, Nadine Kaslow, and Marianne Wamboldt, and later joined by Heather Foran and Amy M. Smith Slep. Three past conferences on assessment of relational processes (in 2005, 2007, and 2010) and several publications on the topic (e.g., Beach, Wamboldt, Kaslow, Heyman, First, Underwood, & Reiss, 2006) serve as foundational building blocks for the current volume.the perseverance of the group along with the network of experts on relationship processes from psychology, psychiatry, public health, epidemiology, and neuroscience laid the necessary scientific groundwork. We are grateful to the Fetzer Institute for their generous support over the years, including funding of the very fruitful 2010 conference on relational processes and the ICD-11 in Ascona, Switzerland, on which this book was based. Notably, we are thankful to Heidi Ihrig for her indispensable assistance in the organization of the Ascona conference and the Ascona Foundation for hosting us in such a beautiful location. We are also deeply indebted to the efforts of David Addiss, former Fetzer Institute program manager. His engagement and hard work stimulated international discussions and collaborations necessary for this project to be a success. There are many individuals from the World Health Organization who deserve recognition for their contributions as well. They include Claudia García-Moreno, Christopher Mikton, James Harrison, Alexander Butchart, and Geoffrey Reed, who have provided critical insights into relational processes from a global perspective and how these problems are handled in the ICD. We owe a special thanks to Geoffrey Reed for his guidance on the ICD-11 revision process and continued assistance along the way. Finally, we would like to thank the many experts from Africa, Europe, North America, South America, and Asia who contributed to this volume and the development of the proposals for revisions to the ICD-11. We are grateful to William Bernet and the parental alienation group for the helpful feedback provided on the proposal forms for child maltreatment and caregiver child relational problems. We are also grateful to all the Ascona conference participants who were instrumental in formulating the current revision proposals for the ICD-11: David Addiss, Wenhong Cheng, Claudia García-Moreno, Kurt Hahlweg, James Harrison, Nadine Kaslow, Brigitte Khoury, Christopher Mikton, xix

21 xx Acknowledgments Mokhantso Makoae, Ron Prinz, Geoffrey Reed, David Reiss, Tuula Tamminen, Mark Whisman, and Frederick Wamboldt. In recognition of the long-term contributions of the relational processes working group members instrumental to development of this book, the citation for this book should include all editors and associate editors: Foran, H. M., Beach, S. R. H., Slep, A. M. S., Heyman, R. E., Wamboldt, M. Z., Kaslow, N. J., & Reiss D., Eds (2012). Family violence and family problems: Reliable assessment and the ICD-11. New York, NY: Springer Publishing.