**1. Introduction**

*"Unhealthy relationships can start early and last a lifetime" – Centers for Disease Control and Prevention*

In the wake of the #MeToo movement, the call for more awareness of sexual abuse and its effects on victims spread across the world. Survivors of sexual assault who were previously silenced have gathered the courage to come forward to tell their stories. Perpetrators of such unspeakable acts are now being held accountable for their heinous deeds. Victims are now being heard and societies are learning of the role they played in their normalization of such behaviors. Despite these positive movements,

more is still needed to learn about the effects of sexual abuse. The most effective way to prevent a behavior is to understand its nature. Therefore, it must be understood that sexual abuse may not necessarily occur in isolation from other acts of violence.

As described by the Centers for Disease Control and Prevention [1, 2], intimate partner violence (IPV; also referred to as dating abuse, dating aggression, or dating violence in the adolescent development literature) consists of aggressive or abusive behaviors expressed or experienced within romantic relationships. Such behaviors can be expressed/experienced through means of psychological (i.e., verbal or emotional), physical, and/or sexual abuse. The co-occurrence and progression of these various forms of abuse is well-documented in the literature [3–11]. Using a biopsychosocial framework (see **Figure 1**), we argue that sexual abuse must be studied as an integration with other forms of abuse (see **Figure 2**) and potentially as a development from other forms of aggression, particularly psychological aggression (see **Figure 3**). Understanding the integration of these behaviors will be beneficial for researchers, practitioners, and interventionists in the attempts to reach survivors of sexual abuse.

Moreover, to prevent a behavior, it is also best to address it during its origin. The CDC quote noted above implies that without intervention or preventive methods, the effects and continuation of unhealthy behaviors can progress over time. Surprisingly, adolescent romantic relationships were once deemed as shallow and frivolous given the transient nature of these relationships, particularly among early adolescents [12]. However, research within the past two decades argue that the formation of romantic relationships is critical to adolescent development [12, 13]. For instance, dating partners become a critical source for identity development during adolescence [14–16]. Data from the National Longitudinal Study of Adolescent Health (Add Health) indicated that 55% of adolescents reported to have been in a romantic relationship. Also, from this dataset, 69% of males and 76% of females indicated to have been romantically involved within the 18 months prior to data collection [17]. Additionally, romantic experiences during adolescence can influence

**Figure 1.** *An integration of abuse via a biopsychosocial framework.*

*An Integrative Exploration of Sexual, Physical, Psychological, and Cyber-Digital Relationship… DOI: http://dx.doi.org/10.5772/intechopen.98233*

**Figure 2.**

*An integrative illustration of sexual, physical, psychological, and cyber abuse in adolescent and young adult relationships.*

well-being and later romantic experiences during young adulthood [18–20]. Such is also the case for adolescents who experience some form of dating violence/IPV in their romantic relationships. The view that the formation of romantic relationships plays an insignificant role on adolescent development can be dismissed for the additional reason that many adolescents who are romantically involved experience abuse in their relationships [2]. Notably, many individuals first experiences of dating violence happen before the age of 18 making youth and young adulthood a critical time for addressing and preventing this public health concern [2, 21–23]. Studies have also shown that the perpetration and victimization of IPV behaviors can extend beyond adolescence up until young adulthood [2, 10, 21, 22, 24–26].

Rates of experiencing some form of IPV in the United States (USA) are approximately 25% for women and 10% for men. Also, approximately 11 million women and five million men experienced some type of IPV before the age of 18 [1]. Furthermore, over three million Canadians aged 15 and older reported to have been victimized by psychological, physical, and/or sexual IPV within the past five years [27]. Rates of experiencing and/or perpetrating specific forms of IPV across various parts of the globe are reported below within their respective sections. Consequences from involvement in an abusive relationship among adolescents and young adults include reports of depression, anxiety, suicide ideation, interpersonal problems, and posttraumatic stress disorder [2, 28–32]. Reports of IPV within these populations have also been associated with unhealthy behaviors ranging from substance use, unhealthy weight control behaviors, sexual risk behaviors, and teenage pregnancy [2, 31, 33–37]. Lastly, victimization from teen dating violence is related to antisocial behaviors (e.g., lying, stealing, bullying, hitting, or engaging in criminal activities) [2, 30, 31, 38, 39].

Additionally, the social and digital age of our current times has given rise to a new form of psychological dating aggression expressed/experienced through means of technology. We term such behaviors as cyber-digital relationship abuse (CDRA). CDRA is also considered to be a new form of psychological dating aggression [40] that may also co-occur and even progress to physical and/or sexual abuse [41].

In the present chapter, we argue that sexual abuse ought not to be examined in isolation as such behaviors may intertwine with psychological and physical abuse. We also argue that both sexual and physical abuse can progress from psychological abuse. Additionally, we focus on the prevalence of these behaviors during the period of adolescence and young adulthood as this is when abusive behaviors within romantic relationships may first originate. We later argue on the implications for researchers, practitioners, interventionists, and high school and college counselors for examining these various forms of abuse from an integrative approach.

## **2. Sexual abuse**

Defining sexual abuse has been challenging among researchers. Particularly because such behaviors can be perpetrated by a stranger, acquaintance, or romantic partner [42–45]. For our purpose, sexual abuse is described as forced sexual activities/sexual contact expressed towards a romantic partner. Additionally, sexual abuse has been defined differently throughout the literature. Some researchers have defined such behaviors based on forced penetrative acts (e.g., "Using force (like hitting, holding down, or using a weapon) to make one's partner have sex"; "unwanted penetration when a victim/survivor is unable to consent or is "unaware", i.e., asleep or under the influence of alcohol") ([42], p. 323; [44], p. 309). Non-physical acts expressed with the intention of forcing one's partner to have sex is also a common form of sexual abuse (e.g., "insisting on sex when one's partner doesn't want to without using physical force"; "the use of nonphysical, controlling, degrading, and manipulative tactics to obtain, or attempt to obtain unwanted oral, vaginal, or anal intercourse, including forced penetration and sex with objects") ([42], p. 323; [44]). Sexual abuse has also been defined as non-penetrative sexual acts expressed physically and/or verbally (e.g., kissing or touching one's partner sexually without their approval; "the use of manipulative, psychologically abusive tactics to keep an intimate partner in submissive positions of power; strategies include sexual degradation, non-contact unwanted sexual experiences, and reproductive and sexual control") ([42], p. 323; [46, 47]).

#### *An Integrative Exploration of Sexual, Physical, Psychological, and Cyber-Digital Relationship… DOI: http://dx.doi.org/10.5772/intechopen.98233*

Other forms of sexual abuse include "exposing sexual body parts, being made to look at or participate in sexual photos or movies, harassed in a public place in a way that felt unsafe" ([46], p. 17). In summary, sexual abuse consists of aggressive behaviors expressed either physically and/or psychologically. These behaviors entail more than just rape/forced sexual intercourse and they can be expressed with the intention to control and/or intimidate one's romantic partner. Moreover, the expression of sexual abuse via psychological and physical means further supports the notion of integrating all three types of abuse.

According to findings from the *National Intimate Partner and Sexual Violence Survey* (NISVS), one out of 10 women indicated to have been sexually assaulted by a romantic partner. Findings from their survey also showed that 19 million women were victimized by some form of psychological and/or physical sexual abuse [46]. Similar rates were also shown outside of the USA. For instance, Painter and Farrington [48] indicated that 13% of participants from 10 regions of Great Britain experienced some form of sexual abuse. Also, Fanslow, Robinson, Crengle, and Perese [49] found that 29.1% of Maori women, 14.9% of Pacific women, 3.8% of Asian women, and 16% of European women in Auckland, New Zealand were sexually abused. Among youth and young adults in the USA, rates of having experienced sexual abuse from a romantic partner have ranged from 4–25% [2, 25, 37, 39, 50]. Rates of adolescents perpetrating some type of sexual abuse towards their romantic partner range from 2–21% [39, 47]. Thompson et al. [26] indicated that 8.6% of undergraduate male students consistently perpetrated sexual abuse towards their sexual partners throughout all four academic years. Furthermore, Brownridge [51] indicated that 36.4% of young adult college women in Manitoba (Canadian province) experienced sexual abuse from a dating partner at least once in their lifetime.

Unlike other types of abuse, there is less co-occurrence between perpetration and victimization in reports of sexual abuse among youth and young adults. Primarily because such behaviors are generally perpetrated by men [52]. However, reports of sexual abuse expressed towards men should not be undermined. NISVS findings indicated that approximately nine million men experienced unwanted sexual contact, nonphysical unwanted sexual experiences, were forced to receive oral sex from a male or female, were forced to engage in sexual intercourse with a woman, and/or were forced to penetrate a male or female anally [46]. Furthermore, 12.5% of high school females and 3.8% of high school males were victimized by some form of sexual abuse [2].

Perpetrators of sexual abuse are more likely to report high engagement in alcohol use, high levels of delinquent behaviors, and to report more sexual partners [11]. Victims of sexual abuse are also likely to engage in risky sexual behaviors, experience teenage pregnancy, engage in risky health behaviors to lose weight (excessive use of diet pills, laxative, and excessive vomiting), and experience suicide ideation [37]. Katz et al. [5] indicated that undergraduate female students who experienced both physical and sexual abuse reported less general and sexual satisfaction in their romantic relationship.

### **3. Physical abuse**

Physical abuse consists of aggressive behaviors perpetrated with the intention to harm one's romantic partner. Rates of experiencing physical abuse from a dating partner have ranged between 7–30% among adolescents and young adults in the USA [2, 37, 53]. Concerns relating to physical abuse are not limited to the USA, as according to the Women's National Institute, 66.5% of Mexican adolescents

reported being victims of some type of physical abuse in their relationships. Moreover, it was found that only 10% of these victims were likely to report the abuse [54]. Data collected from Spain by the Government Delegation of Gender Violence [55] revealed that adolescents under the age of 18 who were victims of physical abuse remained in such relationships for an average of 3.5 years; in some cases, relationship lasted up to eight years. Also, recently Exner-Cortens, Baker, and Craig [56] found that 11.8% of Canadian youth (grades 9 & 10) were victimized by physical aggression and that 7.3% of Canadian youth perpetrated acts of physical aggression. These findings suggest that physical abuse is a worldwide health problem among adolescents and young adults.

Rates of physical abuse among adolescents and young adults can also vary based on the severity of the aggression. Specifically, behaviors deemed as minor or moderate (e.g., throwing, grabbing, slapping, and/or twisting a partner's fingers, arm, or hair) are more likely to be experienced/expressed relative to severe forms of aggression (e.g., choking, beating up, burning, and/or using a knife/gun on one's partner) [44, 57]. For instance, among a sample of rural adolescents in North Carolina (13–19 years old), Foshee et al. [57] found that rates of perpetrating minor/moderate forms of physical abuse ranged between 13–21% whereas rates of perpetrating severe forms of physical abuse ranged between 5–9% across five waves of data. Among a community sample of young adults (18–25 years old), Saint-Eloi Cadely et al. [10] found that across eight waves of data, between 21–65% of participants reported to have perpetrated minor forms of physical abuse, whereas between 3–38% of participants indicated to have perpetrated severe forms of physical abuse. Furthermore, among a sample of Latinx adolescents (12–17 years old) whom all experienced physical abuse, Munoz-Rivas, Ronzon-Tirado, Redondo, & Cassinello [58] indicated that between 24–72% of adolescents were victimized by what was defined as mild forms of physical abuse (i.e., being punched or held tightly by a partner, being kicked or bitten, or having been hit or slapped) whereas only 1–2% of adolescents experienced more severe forms of aggression (i.e., being beaten, strangled, or attacked with a knife or weapon).

Importantly, many adolescents and young adults who are victims of physical abuse also report to have perpetrated such behaviors [7, 56, 59, 60]. The cooccurrence between reports of perpetration and victimization may explain the similarity in the reports of these behaviors across sexes. Although often debated, gender symmetry in physical abuse (similar reports across sexes in the perpetration of physical abuse) is largely supported in the literature [52] and is more commonly found among samples of adolescents and young adults [61]. Studies within these populations also found that at times higher rates of perpetrating physical aggression are reported by females relative to males [61–64]. However, adolescent and young adult women are more likely to be injured by physical aggression [61], partially due to adolescent and young adult males being more likely to engage in more severe forms of physical aggression [29, 57, 65, 66].

The effects of physical abuse among adolescents are detrimental. For instance, adolescents who perpetrate physical abuse are more likely to exhibit externalizing and/or internalizing behaviors [31]. Victims of physical abuse are likely to engage in risky sexual behaviors (e.g., lack of condom use and having sex at a young age) [33], drop out of high school [28], and experience mental health disorders such as dissociation, posttraumatic stress, and depression [28, 29]. Even more troubling, many adolescents have trouble leaving a physically abusive relationship. This was found due to the satisfaction and commitment to the relationship, justification for the aggression as joking/playing around, and psychological coercion (e.g., feeling forced to remain in an abusive relationship) [58].

*An Integrative Exploration of Sexual, Physical, Psychological, and Cyber-Digital Relationship… DOI: http://dx.doi.org/10.5772/intechopen.98233*
