Thesis advisor: Lisa A. Goodman / The term “gaslighting” has become increasingly ubiquitous in popular media, from self-help literature to political analysis (Carpenter, 2018; Sarkis, 2018; Stern, 2018). It is also beginning to gain traction in the medical and mental health establishment. For instance, the Centers for Disease Control and Prevention (CDC) now includes gaslighting under its definition of psychological aggression (Breiding, Basile, Smith, Black, & Mahendra, 2015). However, empirical research on this topic lags behind popular discourse. There is desperate need for definition clarity and empirical evidence of this uniquely epistemic form of harm, otherwise the term gaslighting runs the risk of becoming vague, diffuse, and almost meaninglessness. Gaslighting in intimate partner violence (IPV) is the original and paradigmatic case of gaslighting (Cukor, 1944; Hamilton, 2015). A small handful of recent studies have investigated gaslighting in this context, and more general psychological abuse literature has hinted at it by other names (e.g. Bhatti et al., 2021; Ferraro, 2006; Sweet, 2019; Tolman, 1992). However, the present study represents the first systematic, empirical, psychological investigation of gaslighting in IPV. Study aims were to illuminate the tactics, effects, and long-term implications of gaslighting in IPV, as well as ecological factors that may influence survivor experiences. Fifteen IPV survivors were interviewed about their gaslighting experiences, and data were analyzed using qualitative descriptive methods. Three clusters of findings emerged: Survivors described (1) the gaslighting process, (2) their long-term responses to gaslighting, and (3) the influence of ecological factors on self-trust. This study represents a substantial advancement in the literature on gaslighting in IPV, demonstrating the validity of a new two-part model of gaslighting, describing survivors’ subjective experiences of self-doubt, and illuminating how gaslighting fits into broader patterns of power and control in IPV. It also provides the first account of what survivor resistance to gaslighting might look like, and how other factors in survivors’ lives may hinder or promote resistance. Implications for research and practice are discussed in the context of study limitations. / Thesis (PhD) — Boston College, 2023. / Submitted to: Boston College. Lynch School of Education. / Discipline: Counseling, Developmental and Educational Psychology.

In this dissertation, I explore various fundamental challenges of inequality that developing countries continue to grapple with. The first chapter seeks to understand the role of social and cultural norms in explaining the persistent gender gaps in the labor markets. The second chapter studies how schooling decisions are made in the presence of liquidity constraints. Both the above questions are answered in the context of India. The third chapter adds to our understanding of the relationship between decision-making power within households and intimate partner violence in the context of Sub-Saharan Africa. Despite recent gains in women's educational attainment and reproductive agency, substantial gender gaps in the labor market still remain, particularly in developing countries. In my first chapter, I study the impact of culture and social norms in explaining this puzzle in the Indian setting. In particular, I examine the role of the male-breadwinner norm, which dictates that husbands should earn more than their wives. I first establish a sharp discontinuity in the distribution of the share of the wife's income at the point where the wife’s income exceeds the husband's income. I theoretically show that this pattern can be best explained by gender identity norms which make couples averse to a situation where the wife earns more than her husband. I also provide empirical evidence that this aversion has real implications for the labor market outcomes of the wife. First, the wife is less likely to participate in market activities if her potential income is likely to exceed her husband’s. Second, she earns less than her potential if she does work and can potentially out-earn her husband. Evidence from observing couples over time and bunching methods supplement these results. Moreover, these results are more pronounced in couples where the husband is making the labor market decisions of the wife and where other regressive gender norms are prevalent. My second chapter, co-authored with Dhruv Jain, studies the importance of liquidity constraints in determining the schooling decisions of households in developing countries. Evidence across developing countries suggests that parents are often credit-constrained when making schooling decisions for their children. But little is known about the severity of this constraint. In this chapter, we ask if temporary shocks to liquidity affect parents’ decisions regarding the schooling of their children. We use a shock to available cash in the economy induced by India’s 2016 demonetization to identify this effect. The policy made 86% of currency-in-circulation illegal overnight, and individuals could deposit old notes at the bank in exchange for new ones but with significant withdrawal limits. We identify the impacts of demonetization’s severity by leveraging discontinuities in banking access across Indian districts. Difference-in-discontinuity estimates show that districts that experienced more severe liquidity shock saw an increase in dropouts from private schools but no effect in free public schools, consistent with the presence of real credit constraints. Moreover, enrollments in future periods remained unchanged, suggesting a more permanent effect. The third chapter of my dissertation, co-authored with Aletheia Donald, Cheryl Doss and Markus Goldstein, studies the relationship between decision-making within households and its impact on intimate partner violence (IPV) in 12 Sub-Saharan African countries where 36% of women are affected by IPV. Using the wife’s responses to survey questions, we find that compared to joint decision-making, sole decision-making by the husband is associated with a 3.3 percentage point higher incidence of physical IPV in the last year, while sole decision-making by the wife is associated with a 10 percentage point higher incidence. Similar patterns hold for emotional and sexual violence. When we include the combined responses of the husband and wife about decision-making in the analysis, we identify joint decision-making as protective only when spouses agree that decisions are made jointly. Notably, agreement on joint decision-making is associated with lower IPV than agreement on decision-making by the husband. Constructs undergirding common IPV theories, namely attitudes towards violence, similarity of preferences, marital capital, and bargaining, do not explain the relationship. Our results are instead consistent with joint decision-making as a mechanism that allows spouses to share responsibility and mitigate conflict if the decision is later regretted.

More than 324,000 women each year are estimated as having experienced intimate partner violence (IPV) during pregnancy. Correctly identifying women experiencing all forms and severity of IPV is necessary to inform the implementation of interventions to prevent and treat IPV. This can optimally be accomplished with data from accurate screening instruments. The United States Preventative Services Task force has recently recommended that all women who are pregnant should be screened for IPV over the course of their pregnancy and postnatal visits. Currently, clinical practice and research are hindered by the lack of validated IPV screening measurements for a pregnant population. The current review examined accuracy measures of empirically tested IPV screening measures, and evaluated them for use in prenatal health care settings. Based on the information collected and presented, recommendations regarding which screens are, and are not, appropriate to use in prenatal care settings to identify IPV were presented. Further rigorous studies are needed to identify and evaluate screening measurements and procedures to increase sensitivity and suitability for use in a variety of clinical settings for pregnant women.

The public is often surprised by the high prevalence of relationship violence. With more than 50% of adults experiencing some form of physical or psychological violence in their intimate relationships during their lifetime, IPV is a public health crisis that particularly affects marginalized communities (Breiding et al., 2015; Johns et al., 2019, 2020; Stockman et al., 2015). The variable results of perpetrator and victim treatments make prevention particularly important if it is effective (Anderson & Van Ee, 2018; Babcock et al., 2004; Cheng et al., 2021; Karakurt et al., 2019; Maguire, 2018; Stith, Rosen, et al., 2004; Stover et al., 2009). Thus, researchers are interested in developing empirically tested programs that reduce IPV (Jennings et al., 2017; Niolon et al., 2017). The current meta-analysis builds on the existing literature by analyzing the broad effectiveness of IPV primary prevention in adolescence and young adulthood while specifically analyzing the moderator of novel intervention methods (e.g., online, mobile app, or mailed interventions). Additional moderators included age; gender; at-risk populations; intervention type, whether focused on IPV or relationship health; setting, whether school or community; and length of the intervention. Looking at the included studies as a whole, the aggregate of the intervention outcomes indicates that there is a small but significant positive effect from primary prevention programs (d = 0.175, k = 47, p < 0.001). As broad categories, attitudes (d = 0.166, k = 29, p < 0.001), knowledge (d = 0.212, k = 12, p < 0.001), and behaviors (d = 0.160, k = 36, p < 0.001) had small, significant effect sizes. Taken together, IPV primary prevention programs were able to successfully address their targeted outcomes in these domains. There was not a significant difference between facilitated and self-directed prevention programs (dF = 0.177, k = 39, p < 0.001; dSD = 0.160, k= 8, p = 0.132; Q = 0.023, p = 0.878). These findings have important implications for IPV prevention strategies and interventions. Although the effect size is described as small, even small reductions in IPV can have a significant impact on behavior that impacts millions of people and is costly economically and socially. Future research should further explore self-directed programs and extend our work to LGBTQ+ populations.

Bakgrund: Våld i nära relationer är ett globalt hälsoproblem. Kvinnor som söker vård för sina skador känner sig ofta missförstådda av sjukvården och har skam-och skuldkänslor. Sjuksköterskor spelar en viktig roll i omvårdnaden av kvinnor som blir utsatta för våld i nära relationer. Syfte: Studiens syfte är att beskriva sjuksköterskors erfarenheter av att möta kvinnor som utsätts för våld i nära relationer. Metod: Studien genomfördes med en kvalitativ induktiv design där åtta artiklar från databaserna Pubmed, Cinahl och PsycInfo analyserades med Fribergs femstegsmodell. Resultat: Tre kategorier och nio subkategorier togs fram efter analysen. Kategorierna var; behov av verktyg i mötet, hantera egna känslomässiga reaktioner, bemästra professionellt ansvar. Konklusion: Det är en utmaning att möta kvinnor som är utsatta för våld i nära relationer. Sjuksköterskor förväntas vara objektiva och ge god omvårdnad trots ämnets komplexitet. För att sjuksköterskor ska kunna bedriva god omvårdnad till våldsutsatta kvinnor behövs tillgång till verktyg, möjlighet att förstå egna känslor och att bemästra sin yrkesroll. / Background: Intimate partner violence is a global health problem. When women seek health care because of injures they often feel misunderstood and carries feelings of shame and guilt. Nurses play an important role in taking care of women who are exposed to intimate partner violence. Aim: The aim of this study is to describe nurses´ experience when meeting women that are exposed to intimate partner violence. Methods: The study was conducted with a qualitative inductive design where eight  articles from Pubmed, Cinahl and PsycInfo were analyzed with Friberg's five-step model. Results: Three categories and nine subcategories were highlighted after the analysis. The categories were; the need for tools in the meeting, nurses emotional reactions, master professional responsibility. Conclusion: It is a challenge to meet women exposed to intimate partner violence. Nurses are expected to be objective and provide good care even if the subject is complicated. To make sure that nurses are able to provide good care to abused women it is necessary that they have access to tools, understanding of their own feelings and to be able to master the professional responsibility.

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The current study was undertaken to explore the relationship between self-esteem, narcissism, and empathy with intimate partner violence perpetration among men in 2 samples: college students and inmates. The sample was analyzed both as an aggregate and separately. A negative relationship was hypothesized between intimate violence perpetration and both self-esteem and empathy. A positive relationship was expected between intimate violence perpetration and narcissism. A 2-way interaction was examined between self-esteem and narcissism as a test of threatened egotism, defined as high self-esteem coupled with high narcissism, which was not expected in the current study. Empathy was hypothesized to moderate the relationship between intimate violence perpetration and threatened egotism, such that low empathy coupled with high narcissism and high self-esteem was expected to result in increased intimate violence perpetration. Participants were 488 men (249 college students; 239 inmates). Surveys consisted of a demographic questionnaire, CTS2 for participants’ relationships, CTS for their parents’ relationship, Rosenberg Self-Esteem Scale, entitlement and exploitative subscales of the NPI, and the IRI. Independent samples t-tests were used to explore differences in the 2 samples. Hierarchical multiple regression was undertaken in the aggregate sample as well as the college sample and inmate sample separately. For the aggregate sample significant main effects emerged for family violence, self-esteem, narcissism, and cognitive and affective empathy, as well as the 2-way interaction between self-esteem and narcissism. Results were similar for the college sample with the exception that affective empathy was not significant. For the inmate sample main effects emerged for family violence, narcissism, and affective empathy as well as the 2-way interaction between self-esteem and narcissism. The results appear to support the theory of threatened egotism, though further analysis indicates the findings are not so clear. Empathy did not moderate the 2-way interaction between self-esteem and narcissism.

Intimate Partner Violence (IPV) is a major problem in the United States. There are many health concerns associated with IPV (e.g. chronic pain, gynecological problems), leading researchers to examine the detection and management of IPV in primary care settings. However, a disproportionate amount of this research has focused on the detection and management of IPV in urban primary care clinics, with the detection and management of IPV in rural primary care being largely understudied. The current study addresses this gap in the literature by describing the screening practices and barriers to screening reported by rural providers as well as differences in rural and urban providers in regards to amount and type of barriers reported. Eighty-seven primary care providers (47=Rural) were surveyed about IPV screening practices and barriers to screening. Providers identified barriers related to both professional issues and personal beliefs. There were no significant differences in rural and urban providers in regards to number and type of reported barriers. Implications for the management of IPV in rural primary care settings are discussed.