Prevalence Studies from the Nordic Countries

This chapter is based on a review of key Nordic prevalence studies that chart violence against men in intimate relationships, with emphasis on Norwegian studies. In this book we will not go through this work in depth, but give a brief summary of the findings of those studies we have included, with our greatest focus being on the consequences of the violence for men and the kinds of help men seek. In this chapter we also present the part of our study investigating the level of awareness in Norway of the support available through crisis centres, family protection services and centres against incest and sexual abuse, and the awareness that these bodies also offer help to men.

Nordic prevalence studies show that both women and men are exposed to partner violence. However, the statistics vary greatly from one report to another. It is reasonable to assume that this is largely as a result of variations in the definitions that each uses of violence, differences in method and/or bias in samples or, indeed, coincidence. Although in some studies the percentage is low, there are nonetheless many men who have been exposed to violence. A finding that appears regularly is that more women than men are exposed to serious physical partner violence, but in the case of less serious physical violence, gender differences are considerably smaller. In some studies, the proportion of women and men exposed to less serious physical violence is almost equal. Psychological violence is the form of violence to which both women and men are most often subject. However, the statistics vary hugely according to the way the concept of psychological violence is operationalised in the investigations. This is primarily dependent upon the precise range of control strategies included in each study. Both men and women are exposed to various forms of controlling behaviour by partners.
Several of the prevalence studies are designed to capture violence within certain time frames, although these time frames may vary (one year ago, the last five years, earlier in life and/or throughout life). There may also be differences in the diversity of samples, and to what extent all sections of the population are included. It is reasonable to assume that marginalised groups, such as addicts, criminals, the mentally ill and homeless people, may be substantially under-represented in nationwide prevalence studies and other surveys. We know from clinical studies that these groups are particularly vulnerable to violence. Additionally, it is rare in prevalence studies to ask the respondent if they are both a victim and a perpetrator of violence in intimate relationships, although some studies include victims' own violence and can therefore, to some extent, distinguish mutual violence.
The methodological challenges mean it is difficult to make any direct comparison of the findings from these prevalence studies.

Consequences of Violence Towards Men in Intimate Relationships
Most studies investigate the consequences of violence in general. Few of the prevalence studies we have looked at deal with the consequences of partner violence and the help that men seek.
In the prevalence study Vold og voldtekt i Norge (Violence and Rape in Norway; Thoresen and Hjemdal 2014), it was found that men who are exposed to physical violence in general (not exclusively in intimate relationships) often suffer from physical damage in the form of scarring and bruising, internal injuries or fractures. In this study, 53.1 per cent of men and 55.7 per cent of women who answered that they had been exposed to serious violence reported that they had suffered injuries (p. 77); 31.6 per cent of men and 49.6 per cent of women answered that they had been afraid that they might be seriously injured or killed when the violence was taking place. Most of the men were exposed to violence from unknown persons (72.1 per cent). The majority of women were exposed to serious violence by partners (40.9 per cent). The study found an increased risk of mental health problems in both men and women who had been subjected to violence and rape compared to those who had not (p. 98).
In the Stockholms-undersøkelsen (Stockholm survey; Bååk 2013), 15 per cent of men and 39 per cent of women who had been exposed to serious violence reported that one or more of the incidents of violence in the previous year had resulted in injuries that led to, or should have led to, their visiting a doctor, nurse or dentist (p. 34). In Brottförebyggande rådets undersøkelse fra 2012 (Swedish National Council for Crime Prevention study 2012; Frenzel 2014), 2.4 per cent of men and 29.1 per cent of women who were exposed to serious violence reported that they visited or should have visited a doctor, nurse or dentist (p. 49).
In the study Vold i parforhold-ulike perspectiver (Violence in Partner Relationships-Various Perspectives), Haaland and his fellow researchers found that many of those exposed to violence reported that they had been unable to protect themselves from that violence, and 2.2 per cent of the men and 8.4 per cent of the women stated that they were exposed to violence with a "very high potential for injury" (Haaland et al. 2005, p. 60). One in ten men reported serious physical injuries as a direct consequence of the partner violence which they had experienced (p. 108).
The Swedish study "Self-Reported Exposure to Intimate Partner Violence Among Women and Men in Sweden: Results from a Population-Based Survey" (Nybergh et al. 2013) measured the social consequences of partner violence. The study found that men reported varying social consequences of partner violence, but here N is very small: 26 men and 58 women. A larger proportion of women than men left the family home and divorced as a result of the violence. A larger proportion of men worked longer hours to get away from home.
In the 2005 Danske kjaerestevoldundersøkelsen (Danish Violence between Couples Survey), almost half of the young men who had suffered physical violence from a partner reported that this violence had not affected them. However, one in three young men stated that they had experienced feelings of guilt at being the victim of partner violence, and 22 per cent of men had felt hatred or hopelessness as a result of violence (Schütt et al. 2008, p. 66). Additionally, a significant correlation between sexual assault and suicide attempts was demonstrated in men, although the data material was thin.
In the 2005 Danish health survey SUSY, it was found that men who have experienced violence report low moods and suicide attempts more often than those who have not, but also that male victims report better health than female victims (Helweg-Larsen and Frederiksen 2008, p. 6).
In the Swedish study "Men's and Women's Exposure and Perpetration of Partner Violence" (Lövestad and Krantz 2012), men who were exposed to mental partner violence reported having suicidal thoughts. No men exposed to physical partner violence reported the same.
In the 2009 Finske studien om vold mot menn i naere relasjoner (Finnish Study of Violence against Men in Close Relationships; Heiskanen and Ruuskanen 2011), 9.7 per cent of men and 35.2 per cent of women reported that they had suffered psychological problems as a result of partner violence from their current partner (N = 203 men and 138 women); 21 per cent of men and 60.6 per cent of women reported that they had suffered psychological problems as a result of partner violence from former partners (N = 221 men and 300 women; p. 22). The psychological problems most frequently experienced by women included fear, hatred and low self-esteem/feelings of vulnerability. Those most usual among men included depression, shock and hatred.
Consistent in many studies is the fact that women report greater psychological problems as a result of partner violence. However, Norwegian interview studies with men at crisis centres (Grøvdal and Jonassen 2015;Danielsen 2013) find that men who experience serious and systematic partner violence have many of the same psychological responses as women: social isolation, anxiety and fear of further violence. Another consistent finding in interview studies of women exposed to serious partner violence is that many find psychological violence the most difficult to recover from (Grøvdal and Jonassen 2015;Danielsen 2013;Bjerkeseth 2010;Storberget et al. 2007).

What Help Do Male Victims of Violence Seek?
The prevalence studies we have reviewed all, to a limited degree, investigate the help sought by men who experience violence. To the extent that these studies deal with this subject, the focus is purely on the care available after physical violence. The studies indicate that many male victims of violence conceal incidents of violence from others and do not contact any support services or report the violence to the police.
In the prevalence study of violence and rape in Norway (Thoresen and Hjemdal 2014), fully 59.1 per cent of the men who had experienced minor violence from a partner reported that they had never spoken to anyone about this violence. Less than a fifth of the men had talked to health professionals about their experiences of serious physical violence (p. 124). Most of the women who had experienced minor violence had talked to others about the violence; only 21.9 per cent of the women had never spoken to others about the violence (p. 79).
In the same study, 24 men reported that they had been raped. None said that they had undergone any medical examination or treatment in the days or weeks following the rape (p. 88). Out of the 24 men, 4 (16.7 per cent) had reported the rape.
In the study Vold i parforhold-ulike perspektiver (Violence in Partner Relationships-Alternative Perspectives), Haaland et al. (2005) found that only one in ten men who were exposed to partner violence, who had stayed in the relationship, had talked to someone about the violence. Of those who had split up from their partners, little more than 10 per cent had sought help from one or more support agencies (p. 151). In comparison, nearly a third of women who had split up with their partners had sought help from support agencies.
The Oslo survey (Pape and Stefansen 2004) showed that only one in four men and one in three women subjected to partner violence had contacted the police, or other professionals or support agencies. These findings are confirmed by the Violence and Rape Study from 2014.
In the survey Våldsamt lika och ulika-Om vold i samkönade parrelationer (Violence Equal and Unequal-Violence in Cohabiting Couples; Holmberg et al. 2005), it was found that only 6 per cent of men who had experienced violence had reported it to the police.
In the 2009 Finnish study of violence against men in intimate relationships (Heiskanen and Ruuskanen 2011), only 0.5 per cent of the men who had suffered violence from their current partner reported that they had contacted the police, and 1.9 per cent of the men who were victims of violence from a former partner reported that they had been in contact with the police (p. 36).
In Denmark, of the 14,753 cases of violence against men reported to the police in the period 2008-2009, only 1 per cent were defined as partner violence. This corresponds to a figure of 2 men per 100,000 men aged 16-79 who reported partner violence to the police (Plauborg and Helweg-Larsen 2012, p. 10). Between 2008 and 2010, each Danish police district received an average of 1-2 inquiries from men exposed to sexual violence (p. 70). The Danish Accident Register shows that about 300 men per year contact emergency services due to partner violence (p. 11). If we see this in the light of the 2010 Danish SUSY survey, which estimates that 8000 men are the subject of physical partner violence annually, this implies that very few men report the violence or seek emergency medical assistance. Table 3.1 summarises the main findings in the surveys on the numbers of men exposed to partner violence. In the case of both physical and psychological violence, there are major differences between countries, and occasionally between the various studies within each country.
Both women and men are exposed to partner violence. However, the results showing its prevalence in the various studies can vary enormously. It is reasonable to assume that this is largely a consequence of differences in the definition of violence, variations in method and/or coincidences/bias in sample groups. In the case of physical violence, the studies from Denmark show a much lower proportion than other countries. With the exception of one Swedish study with a very high proportion of physical violence once in the last year, the figures for Norway and Sweden are at approximately the same level. There is only one Finnish study, and it shows that a high proportion of people have experienced violence. In the case of psychological violence, there is only one Danish study, and in this area that study again shows the lowest proportion of victims of violence. With the exception of one Swedish study whose figures are high, there is again a reasonable correlation between studies from Norway and Sweden. Once more, the Finnish study shows a higher incidence than those from elsewhere.
All the studies demonstrate that partner violence also affects men. Although the percentage shown in some of the studies is low, there are nonetheless many men who have been exposed to violence. Psychological violence is a form of violence that particularly affects men. It is therefore important that studies that identify the presence of violence against men in intimate relationships include psychological violence.

Prevalence Studies from the Nordic Countries
The statistical findings of these surveys differ greatly, but nonetheless certain trends emerge. More women than men experience serious physical partner violence. Women also report more significant psychological difficulties as a result of partner violence in general. In the case of less serious physical violence, the disparity between genders is considerably smaller; in some studies the percentage of women and men exposed to less severe physical violence is almost equal. Men are rarely exposed to sexual partner violence. Psychological violence is the form of violence to which the majority of both women and men are exposed. The gender difference in the proportion of women to men who are exposed to psychological violence also varies greatly between studies. Some studies show that the proportion of men exposed to psychological violence is almost as high as the proportion of women; others show a significantly higher incidence among women than among men. Psychological violence is defined very differently in the studies, depending primarily on the extent to which different forms of control strategies are included. We see that both women and men experience controlling behaviour from partners. Several of the surveys also show that the majority of those subjected to serious partner violence are also subjected to controlling behaviour.
Violence research finds that both men and women are exposed more often to psychological violence than physical violence, and that this applies even more to men than to women. Both Nordic and international research has shown that both men and women feel that psychological violence has major consequences for their mental health and quality of life. In order to capture the types of violence to which men are most often exposed, it is essential to have a deeper understanding of the ways in which psychological violence operates.

Norwegian Survey
The last part of this chapter deals with that part of the study which investigates the level of awareness in Norway of the support available through crisis centres, family protection services and centres against incest and sexual abuse, and the awareness that these bodies also offer help to men. We conducted a survey to find out the level of awareness about these services (1) in the general population; (2) among staff of support agencies; and (3) among those who have been victims of violence in intimate relationships.
Our survey shows that crisis centres are the service best known about, with 81 per cent of respondents saying they are aware of what these centres offer; 56 per cent record that they are aware of the family protection office and 50 per cent that they know about the centres against incest and sexual abuse. The family protection office is a low-threshold service offered to families experiencing problems, and offers mandatory mediation in the case of separation and relationship breakdown between parents with children under the age of 16. Despite the fact that this is a service with a broad target group, the family protection office is a littleknown organisation. Crisis centres and the centres against incest and sexual abuse by contrast have a far more limited target group, but are as well known as the family protection office.
A positive finding is that respondents who, based on their field of work/employment, can be described as health workers show a greater awareness of all three services than the general public. These services are also better known among men who have been victims of violence than among respondents in general (Fig. 3.1).

Prevalence Studies from the Nordic Countries
What is interesting is that the proportion is halved when we ask if respondents know that the crisis centres also offer their services to men who are subjected to violence. Only 41 per cent of respondents know that crisis centres offer help to men exposed to violence in intimate relationships. This is considerably fewer than those who know about crisis centres in general. Of those aware of the family protection office and centres against incest and sexual abuse, the proportions are 32 per cent and 27 per cent, respectively. Men who have been the victims of violence in intimate relationships differ to a small extent from other respondents in their response to this question.
Those we define as health workers show a greater awareness that these services are available to men. However, even among this group only around 50 per cent know that male victims of violence can use the services of crisis centres, and this figure drops to 40 per cent in the case of family protection offices and centres against incest and sexual abuse. These figures are somewhat surprising and indicate that awareness of the needs of men is very low, not only in the general population, but among those who are employed to offer such help. Figure 3.2 shows the response distribution among the various groups of respondents.
Of the respondents who have been exposed to violence in intimate relationships, 35 per cent state that they could have benefited from or that they needed assistance in relation to these events; 46 per cent say they have not needed help, and 19 per cent do not know.
We asked those men who had been exposed to violence if they had been in contact with any organisations offering help as a result of these incidents. Only 2 per cent responded that they had been in contact with a crisis centre, 2 per cent that they had been in contact with family protection and 4 per cent that they had been in contact with a centre against incest and sexual abuse.
Moreover, 21 per cent responded that they had been in contact with other services. We asked an open question about which services they had been in contact with. Several men reported that they had been in contact with a doctor, others with the police.
We asked those men who had not sought help (N = 43) about their reasons for not doing so. Respondents could tick multiple response options. The most common reason selected is that the victim "wanted to handle it" on their own. Among those who have not sought help, over 60 per cent give this as their reason. A larger proportion of those who have been subjected to physical violence express that they would rather deal with it on their own (62 per cent) than those subjected to psychological violence (48 per cent). Many men responded that they do not generally seek help when they have problems and/or that they experience it as shameful to do so. Other respondents indicated that they feared the potential reaction of their partner or further abuse.
Just over 20 per cent responded that they did not know that the support agencies (crisis centres, family protection office and centres against incest and sexual abuse) offer their services to men.
Of the 700 men who responded to our survey, 9 per cent stated that they have been victims of violence from people with whom they have an intimate relationship, after the age of 18.
In the questionnaire we asked about the following forms of violence: • Physical violence: kicking, hitting, pulling hair, biting, the use of weapons or other objects, or other forms of physical violence.  Of the respondents, 6.6 per cent indicated that they have been subjected to physical violence, 5.4 per cent that they have been subjected to psychological violence and 1.4 per cent that they have been subjected to sexual violence.
Of those who have been subjected to physical violence, 35 per cent reported that they have experienced such violence on 2-4 occasions, and 20 per cent that they have experienced it five times or more. Among those who have been subjected to psychological violence, 45 per cent said that they have experienced this form of violence five times or more.
Among those who have been victims of violence (N = 60), over half have been subjected to both physical and psychological violence. Just over 15 per cent have been experienced incidents of a physical and sexual nature, while around 15 per cent have been subjected to both psychological and sexual violence.
Of the 57 men who responded to the question about the gender of the perpetrator, 51 per cent reported that women perpetrated the violence and 39 per cent that men perpetrated the violence.
We asked the victims of violence what relationship they have/had to the person who perpetrated the violence: 54 per cent answered that it was a wife/partner/girlfriend, 26 per cent that it was a member of their close family, 7 per cent that it was someone from the wider family, while 11 per cent answered that it was someone else to whom they were close. The respondents could answer several categories.