Every year, nearly 1.5 million high school students experience physical abuse from a dating partner. One in three adolescents is a victim of physical, sexual or emotional abuse. Alexa Sueda, MD, joins us to talk about what teen dating violence looks like and some of the warning signs parents and friends should be watchful for. We also speak with Nancy Schwartzman, the inventor of the Circle of 6 mobile app, who talks about ways that young women can both prevent and cope with sexual abuse.
About the Guests
Alexa Sueda, MD, is an Ob/Gyn with Kaiser Permanente and a regular lecturer on intimate partner violence. She often focuses on reproductive coercion in abusive relationships.
Nancy Schwartzman is a filmmaker and media strategist. She is the founder of The Line Campaign, a youth-driven transmedia initiative and blog focused on empowering young leaders to end sexual violence. She is also the executive director of Tech 4 Good, which created the Circle of 6 mobile app — the winner of the White House Apps Against Abuse challenge.
Joyce Gottesfeld, MD, is an OB/GYN with Kaiser Permanente Colorado, where she’s worked 17 years. She’s a wife, proud mother of three girls, runner and blogger. Read more about Dr. Gottesfeld.
For more information about preventing and ending domestic abuse and sexual violence, check out the following resources.
- Loveisrespect – a partnership between Break the Cycle and the National Dating Abuse Helpline
- Circle of 6
- National Domestic Violence Abuse Hotline
- Website for Teen Dating Violence Awareness Month (each February)
- Teen Dating Violence Info from the Centers for Disease Control and Prevention (CDC)
- Kaiser Permanente Family Violence Prevention Program
Important Phone Numbers
- National Teen Dating Abuse Helpline at 866-331-9474
- National Domestic Violence Hotline at 800-799-SAFE
DR. GOTTESFELD: Welcome to Total Health Radio. I’m your host, Dr. Joyce Gottesfeld. Here in the U.S., nearly one-and-a-half million high school students experience physical abuse from a dating partner every year. One in three adolescents is a victim of physical, sexual or emotional abuse. Here with us today to talk about teen dating violence is Dr. Alexa Sueda. Dr. Sueda is an OB/GYN physician with Kaiser Permanente and a regular lecturer on intimate partner violence. She joins us to talk about what teen dating violence looks like and some of the warning signs we should be wary of. Thank you for joining us, Dr. Sueda.
DR. SUEDA: Thank you for having me.
DR. GOTTESFELD: Can you tell us what an abusive relationship looks like in a teenager?
DR. SUEDA: Sure. I think one of the misconceptions about abusive relationships is that it’s just physical violence. But we know now that abusive relationships, both in teenagers and adults, includes sexual violence, including sexual coercion. It can include threats. It can include stalking. And now with all the digital media, there’s a huge amount of online bullying and stalking that goes on from one partner to another and all of these things are abusive. All of these behaviors are abusive.
DR. GOTTESFELD: Can you give us an example of what you mean by the work stalking? Like what, I mean as a teenager who’s kind of new to this, tell us exactly what you mean. Like what are some of the specific things a teenager might see from a partner?
DR. SUEDA: Right. So some of the warning signs can look, at first, like a caring partner and sometimes the abusive partners explain their behavior as just caring behavior. So an example of that might be one partner who constantly texts the other partner to find out where they are, what they’re doing, who they’re with, or someone who is always trying to control what their partner is wearing, what kind of decisions that make about their life, including about their reproductive choices. And at first things like constant texting can look like care and love, but in the end, this behavior results in one partner really controlling what the other partner does and making them feel like they don’t really have freedom of choice and that they always have to answer to the abusive partner.
DR. GOTTESFELD: So there may or may not be a physical component to an abusive relationship.
DR. SUEDA: That’s absolutely correct. The definition of abuse is a repetitive pattern of behavior that can be violent, physically violent, but it can also be emotionally coercive, it can be sexually coercive, it can involve just threats, that really is designed for one partner to have control over the other partner.
DR. GOTTESFELD: What might a parent see from their teenager, assuming a parent, you know, is not, they’re not around their teenager all the time, they don’t see how much texting they’re doing, or what their messages are on Facebook. So what are some of the outward signs that a parent might see if a teen is involved in an abusive relationship?
DR. SUEDA: Well, I mean I think one of the things that they can look for is if their teen is withdrawing from all the other activities they used to enjoy. If they’re withdrawing from spending time or hanging out with other friends, especially if they never really go anywhere without their partner. Those are all subtle signs that can definitely be signs that their partner is not really allowing them to have a life outside their relationship. So that’s one of the early signs.
DR. GOTTESFELD: For a teen who’s involved in an abusive relationship, that can have an effect on them in other areas of their life. Is that correct?
DR. SUEDA: That’s absolutely correct. And there is a lot of evidence coming out now about the connection between abusive relationships and general health of the person who is in an abusive relationship. And one of the things that I really like to talk to and am sensitive to as an OB/GYN, and you probably are, too, is the effect this has on particularly a woman’s choices around their reproduction and birth control methods. Oftentimes controlling the choice about whether or not to prevent a pregnancy is used by an abuser to gain more power and control over the partner and they may not have a choice to use birth control or have a choice around whether or not to initiate sexual activity at all.
DR. GOTTESFELD: So now we’re talking about a girl, a woman in an abusive relationship and the man wants to control her reproductive choice. Why would he want to do that? I mean then there’s going to be a child. Does this person want a child, or what’s behind that?
DR. SUEDA: Right. I mean usually it’s not about starting a family. It’s about using a powerful method of controlling their partner. When a woman becomes pregnant, even the decision of whether or not to continue that pregnancy is an incredible tool that an abusive partner can use to have control over their partner. And then if they do decide to continue the pregnancy and have a baby, that also is an incredible way for an abusive partner to maintain control over that woman’s life. Now he’s the father of her child and it’s much harder for her to find a way to escape that relationship.
DR. GOTTESFELD: So hearing something like, I don’t want to use condoms because it doesn’t feel as good, or I don’t think you should use the pill, or judgment statements like that, those should be warning signs to a young woman.
DR. SUEDA: That’s correct. And actually it can be even more subtle than that. So, you know, we like to think of it as sort of coercion, which is more obvious statements about not wanting her to use birth control, or not wanting to use condoms. But birth control sabotage is actually quite common, too. Birth control sabotage would include things like condoms that constantly seem to break, or a partner taking a condom off in the middle of sex without her permission, or hiding her birth control pills, or throwing away her birth control pills. You know, these are all other techniques that can be used to cause a pregnancy against her will. They found that about a quarter of teens report that their abusive partners were trying to get them pregnant without them wanting to get pregnant. So this is a huge problem and it’s something we’re just starting to acknowledge.
I think that we’re just now starting to recognize the link between unplanned pregnancies and abusive relationships. Women who have unplanned pregnancies are four times as likely to have experienced some sort of violence in their relationship, so it is a huge red flag.
DR. GOTTESFELD: And then if someone’s involved in an abusive relationship in their teenage years, they are at risk for, we talked about some of the behavioral health issues, depression or something they may experience in their teens are at increased risk for attempted suicide and I would suspect getting involved in more abusive relationships as an adult. So this is a big deal to identify this and address it.
DR. SUEDA: And I think a lot of people have a hard time knowing how to address it, because they don’t want to make things worse. Also, because it’s hard to know, really, what to do to help. So those are some of the questions that many friends and parents and providers have, is that are we opening up a whole can of worms if we’re asking these questions. But unfortunately, only about a third of teenagers who are in abusive relationships will
DR. GOTTESFELD: And what do you think a parent can do if they see some of those signs we talked about, to try and open up this dialogue with their teen?
DR. SUEDA: I think the most important thing is to provide emotional support and an open, supportive environment. It’s completely appropriate and necessary to express concerns about some of the signs they are seeing in a non-judgmental way. You know, very commonly the teen won’t be seeing these signs with the same concern their parent or their friend might. So to open that conversation with love and concern and just say, “I’m worried about your safety and I’m worried that these can be some signs of an unhealthy relationship.” But to not come at it judgmentally or with blame. It’s really important to tell the person in an abusive relationship that it’s not their fault. And then to realize that they may not see it the same way and they may not be at a point where they’re willing to do anything about it. But you’ve set the stage and you’ve planted a seed and made yourself available, so that if down the road they’re feeling like they do want to talk about their concerns about the relationship, they can come to the parent.
DR. GOTTESFELD: Dr. Sueda, tell us what we can to do help a girl, or someone who finds themselves in this kind of relationship.
DR. SUEDA: Sure. You know, the first thing is to just express concern and if they’re open to a discussion about their concerns about their relationship, there’s lots of wonderful resources and organizations out there that can help. It is important to realize that when a person is leaving their abusive relationship, that’s sometimes the most dangerous time for them. And so one of the things that’s important to talk through is a safety plan. You know, how to keep them safe at school, at their job, at home. And there are actually some really good resources on-line for this. I do want to say a word before I share those resources, that some women and men who are in abusive relationships can’t really take home written information. Safety cards are wonderful if it’s safe for them to take home, but if it’s not safe for them to take home, it may actually get them in more trouble if their abusive partner finds a card about intimate partner violence in their wallet, for instance. Similarly, if we refer to web sites, they should be aware of how to erase the browser history, or to make sure that they’re going to these web sites on private computers that their partner won’t be able to look and investigate and see what kind of sites they are going to, because again, this can cause more danger if their partner feels that they are about to leave them.
DR. GOTTESFELD: What are some of the suggestions you’ve seen for staying safe in school? That sounds like it could be a real vulnerable situation.
DR. SUEDA: It is. And I think, you know, if the teen is comfortable talking to a trustworthy adult, it’s very important to inform the school authorities at what’s going on, so they can help the teen stay safe. You know, oftentimes it’s the unsupervised time that’s most dangerous and so making sure they’re always in a group of people where they can stay safe and that they have a safe plan for getting to and from school. And then again, to understand the impact that cyber bullying and digital media can create, that, you know, a partner texting their partner during class constantly can create this feeling of fear and an atmosphere of fear and so just awareness on the adult’s part of how this can impact the students.
DR. GOTTESFELD: Why do you think people are vulnerable to these kinds of dangerous relationships?
DR. SUEDA: You know, they are scary. Because they don’t start out abusive. Most abusive relationships start out really good, otherwise why would they, you know, most of the time, why would they ever start?
DR. SUEDA: No one deserves to be abused. You know, and one of the tactics that abusers will often use is they will blame the person who’s being abused for the abuse. Well, if you just didn’t do this, if you just didn’t do that, then I wouldn’t feel like I needed to call you names. But I would encourage all women and men not to buy into that. That it’s not their fault and it’s nothing that they should be ashamed of, either. And then that also means that for those who are family members and friends, they need to be supportive and not buy into the habit of blaming the person who is being abused, for the abuse. We all need to be educated on this, so that we can change the culture around it.
DR. GOTTESFELD: Well Dr. Sueda, thank you very much for talking to us about this difficult subject. Is there anything else you want to add before we wrap it up?
DR. SUEDA: Just to say that, you know, the more that we talk about this topic, the more that acknowledge this a problem for our young teens, as well as adults, the better we’re going to be able to address the problems just in general. So thank you so much for having me on to talk about it.
DR. GOTTESFELD: Have a great day in Hawaii.
DR. SUEDA: Yeah, thank you so much.
Part II: NANCY SCHWARTZMAN
DR. GOTTESFELD: We are joined now by filmmaker and media strategist, Nancy Schwartzman. Nancy is the founder of The Line Campaign, which is dedicated to ending sexual violence. She is also the mind behind the Circle of 6, which is a mobile App, and it allows users to contact help in dangerous situations. Welcome to the show, Nancy. It is great to have you on today.
SCHWARTZMAN: Hi. Thanks for having me.
DR. GOTTESFELD: Can you tell us a little bit about this App?
SCHWARTZMAN: Absolutely. Circle of 6 were born from the very simple idea of you have kind of a buddy system. The user chooses six people they trust. It can be less. If they want to choose three, that’s fine, too. They choose people they trust, and there are three preprogrammed messages that get sent out. It’s very user-friendly. You join someone’s circle, and then with two taps, it’s very user friendly/ With two taps an alert goes out by S&S, one says come and get me, I need help getting home, and it will send your GPS location to your friends. The second one, we kind of joke, it’s the bad date button. If you want to get out of the situation, someone is not taking your verbal cues and you want your phone to ring, it’s two taps, and it will say, call and pretend you need me, I need an interruption. And a third one is a resource around dating violence and domestic violence. And it’s a chat bubble. And it says I then need to talk, I’m looking up information, and it sends out resources to The Circle. The other, the last feature, is an emergency button, and two national hotlines are preprogrammed in. And then the user if given a third option. So if you’re on a campus in Colorado for example, and you want campus security plugged in, that’s great. If you want 911 plugged in, you can do that. If you want something else, it’s the user’s choice. The app is really designed not to replace police, not to replace kind of an urgent emergency. It’s really trying to be preventative. The App is designed with this baseline understanding that people are partying on the weekends, and we are not making judgments about that. We know that young people are consuming alcohol on Friday nights on college campuses, so the text in the phone is already written for that, right? So it already says get me home, I need help. Here is where I am. It already has your friends programmed in when you’re sober, or when you’re really, you know, thinking, “Who do I trust?” You’ve already done that. You’re not fumbling with your phone at two o’clock in the morning.
DR. GOTTESFELD: Let’s talk a little bit about teen dating violence. How do girls in particular get into these situations?
SCHWARTZMAN: You know, part of the problem is you have these high profile celebrity couples that are in abusive relationships that are normalized. We have Chris Brown and Rihanna, a terribly abusive relationship. They are back together, they’re apart, they’re back together, they’re apart. Rihanna is blamed for her bad choices. It’s called “drama.” You know, “Oh, there just have a really dramatic relationship.” Kids kind of get confused, and I would say adults get confused, too. You know, what, it’s important to tease out what is the difference between drama and danger, and young people don’t like to use the words “abusive relationship” or “bullied.” You know, they call it drama, right? So there is a lot of confusion about romance and possessiveness. If you look at Twilight, Edward is incredibly abusive towards Bella. If you did a checklist of is this a healthy or unhealthy relationship, it almost meets all of the unhealthy requirements. He stalks her, he has physically harms her. I mean, it’s really bad. He is in her room while she is sleeping. And Twilight is a huge hit, and everyone thinks it is so romantic.
DR. GOTTESFELD: And it’s been normalized. His bad behavior has been normalized as if, well, it’s science fictional that he is standing in your bedroom watching you sleep. But, I mean, it’s never called out as overtly creepy behavior.
SCHWARTZMAN: I know. Like, oh, that’s great that’s normal. No! It’s totally creepy. The third one that I know she goes through incredible physical pain and violence, and so it is a lot of really bad messages about sex and violence, really couched in terms of romance.
DR. GOTTESFELD: I think teenage girls try to develop an understanding of violence and relationships and that evolves over time. And that is hard enough, but what about boys and men? I mean, what should we be teaching? What should they know about this? What should they say, what should they do, what are some of the things they can look for, how can they help? What are your thoughts on that?
SCHWARTZMAN: I think it’s as confusing and upsetting for young men who are raised in a culture where this term is being thrown around, “toxic masculinity.” That is kind of hyper-masculine, unfeeling, borderline violent kind of masculinity that’s really celebrated that you have men feel they have to aspire to. So the problem is, if they want to step in, and they want to call something out, they will face a backlash. They might get bullied, they might be called slurs about their sexuality, you know. If they choose to go against the status quo, they’re taking a really big risk. I hope moving forward those are the risks that we can start rewarding. We can say look at that guy, he’s an up-stander. He didn’t just bystand while someone was being assaulted at a party, or while someone was being physically abused. He stood up for it and he blew the whistle. We have to work to really rewards whistle-blowing behavior so that it becomes more normalized. There is this whole other element of like the digital aspect where you shouldn’t be obliged to give out your password to your boyfriend or your girlfriend. That’s your business. That’s your privacy. I think what happens, especially with young people, is that, you know, “You don’t love me if you don’t share your Facebook account with me,” or “If I can’t read your texts,” you have something to hide, and like we should all know that we have our bodily boundaries, and our technical boundaries.
DR. GOTTESFELD: So I am thinking for myself and my family, like a dinner table discussion using a story, and saying, “Oh, I heard about this girl and her boyfriend wanted all her passwords and stuff,” and trying to use that as a jumping off point to have that conversation as a family, and sort of highlight the fact that, you know, if somebody feels like they’re being controlled, that you’ve got to listen to that feeling, that’s a legitimate feeling.
SCHWARTZMAN: Uh huh. I think there is also—I think that is a great idea, kind of bring that up as a story—that women and young girls are allowed their privacy. That you’re allowed to have that privacy. That doesn’t mean this person loves you more because they read all your emails. You know, you have a right, you’re not hiding anything. You’re just allowed your secrets and your privacy. I think that came up just in a small way, when Jada Pinkett Smith’s daughter, Willow, cut off her hair. And she was eight or nine years old I think, and parents were saying how dare that mom let her daughter do that! And Jada said that’s my daughter. It’s her autonomy. That’s her body. That’s her right. And I think just in a very basic way, young people don’t understand, especially young girls, that their body is their own.
DR. GOTTESFELD: So do you have any data on how many times this App has been downloaded or used?
SCHWARTZMAN: Yeah. We have some very basic data that, right now, we know that 55,000 people are using the App, which is really exciting.
DR. GOTTESFELD: Wow. That’s a lot.
SCHWARTZMAN: So it’s a very wide adaptation for us, and the other cool thing is that it is being used in 26 countries.
DR. GOTTESFELD: Have you gotten any feedback from users or stories about what happened, or prevented something horrible from happening? Have you . . .
SCHWARTZMAN: Yeah. I mean the key thing with prevention is hard to measure because, again, we don’t recommend this App – this is not the App you use if you are being attacked necessarily. You know, what we really want to happen is that you don’t have to make those hard decisions. So a young woman does not have to say, do I walk across this dark campus by myself? Or do I let someone I don’t really know walk me home? We don’t want someone to have to make that choice. Because the other piece, too, and this might be less relevant for young people, is that in some ways going to the police is very scary, and acknowledging that there is a big problem in going to the authorities is very scary, and there is something very gentle and protective about having your own network. If you’re a teenager, a lot of teenager girls I met in New York, said, “Oh yeah, I put my mom on my Circle.” And I thought that was really cool. I think that’s a great way for mom to have a very no-judgment approach to being there for their kids. So if I’m 15 and everyone is drinking at this party, and it’s really late and I don’t want to get in that car, I can, I can send this out to my mom. And I’ve heard parents say I’ve done that for my kid, and I’ve said we will not talk about it tonight. I’m going to come get you, make sure you’re safe, and we’ll talk about it tomorrow.
DR. GOTTESFELD: Nancy, you’ve given us a lot to digest here today. I know I have a lot to think about. So can you just remind us how people can access this information?
SCHWARTZMAN: Absolutely. Yeah. The App can be found and downloaded at circleof6app.com, and you can get the video there. There is a resources page that has links out to other organizations that talk about dating violence, sexual education, healthy relationships. And our Toolkit is really fantastic. It’s under the Materials page. It is free. It is being used in some middle schools and high schools already. So take your time and we hope that what we have created and built is valuable for working with young people.
DR. GOTTESFELD: Thank you so much Nancy. Really great information that I think will be really helpful for so many people, and I think the work you’re doing is going to do a lot of good.
SCHWARTZMAN: Oh, thank you. Thanks for having me.
DR. GOTTESFELD: Take care.
DR. GOTTESFELD: Thanks so much for joining me today on Total Health Radio. I welcome any thoughts or comments or feedback on this so please feel free to e-mail me at email@example.com. That’s all we have for you today on Total Health Radio. I’m your host, Dr. Joyce Gottesfeld and we’ll see you next time.
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