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Revista Brasileira de Epidemiologia

Print version ISSN 1415-790X

Rev. bras. epidemiol. vol.17 no.1 São Paulo Jan./Mar. 2014 

Original Articles

Directionality of physical and psychological dating violence among adolescents in Recife, Brazil

Alice Kelly Barreira I  

Maria Luiza Carvalho de Lima II  

Marc Bigras III  

Kathie Njaine IV  

Simone Gonçalves Assis V  

ILaboratório de Estudos em Violência e Saúde; Centro de Pesquisas Aggeu Magalhães da Fundação Oswaldo Cruz - Recife (PE), Brasil

IIDepartamento de Medicina Social da Universidade Federal de Pernambuco - Recife (PE), Brasil

IIIDepartment of Psychology at Université du Québec à Montréal - Montreal, Québec, Canadá

IVDepartamento de Saúde Pública; Centro de Ciências da Saúde da Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil

VCentro Latino-Americano de Estudos de Violência e Saúde Jorge Careli da Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brasil



The aim was to investigate the physical and psychological dating violence among adolescents with respect to the profiles of directionality - only man perpetrates, only woman perpetrates, and bidirectional, ie, both perpetrate violence.


Sample was performed by two-stage cluster selection in public and private school in the city of Recife (PE), Brazil, presenting data on 355 adolescents of both sexes between 15 and 19 years old. Psychological violence was measured in dimensions threat, verbal/emotional, and relational. Statistical analyzes incorporated the sampling weight and the complex sample design.


Violence is bidirectional in most forms studied (83.9%) and girls reported higher levels of perpetration of physical violence, and boys reported more perpetration of relational violence.


It was concluded that adolescent dating violence shows a pattern where partners attack each other, both physically and psychologically. Future research should study the patterns of these acts of violence, keeping the adolescent couple as the unit of analysis and exploring the context in which such violence occurs.

Key words: Adolescents; Violence; Interpersonal relations; Gender identity; Aggression; Prevalence


In Brazil, violence in interpersonal relationships have usually been sistematically banalized in the routine of citizens, by the way it is publicized in some means of communication and because of the way it is handled by social institutions. National studies that investigate violence in the young population group have focused on its most severe form: homicides that occur mostly among Brazilian adolescents and young adults1.

Among the types of violence involving adolescents, interpersonal violence, which occurs in intimate relationships (dating), called dating violence, has been analyzed by researchers from several countries2 - 5. There are few studies about dating violence in Brazil. One of these analyses assessed physical violence among partners in a sample of university students6. Recently, a multicenter study about the theme7, whose data subsidize this article, brought to light the magnitude of the problem in Brazil. It is assumed that, due to the lack of national epidemiological data, actions of prevention and intervention addressed to dating violence among adolescents are also rare. This would lead the existing vulnerability in this population group to increase in relation to several situations, such as psychological disorders, injuries, death by homicide, suicide, use of drugs, teenage pregnancy, sexually transmitted diseases, among others8.

Dating violence includes actions and threats of physical, verbal, sexual and psychological abuse, regardless of the perceived severity9 , 10. Wolfe et al.11 define it as any attempt to control or dominate the other person physically, sexually or psychologically, leading to some kind of damage. Other authors admit a narrower perspective, limited to physical violence, without referring to intention, consequences or context. In fact, most studies are dedicated to the type of physical violence among adolescent partners, to the detriment of other forms of violence, such as the psychological and the sexual ones12.

Another essential aspect of the violence study between intimate partners, which aims at guiding the planning of prevention and treatment programs, is the definition of who is the main perpetrator of violence: the man, the woman, or both3.

In literature about adolescent partners, there is consistent evidence that women are as violent or even more violent than men3 , 4 , 9 , 13 - 16, which leads to the discussion about bidirectional violence, that is, both partners are violent. This is also called reciprocity, mutuality or gender symmetry.

In this study, the term types of directionality will be used to nominate the perpetration of violence that can be performed only by the woman, only by the man or by both (bidirectional). For Harned17, the use of the term bidirectional does not presuppose that both partners are equally or mutually violent. Even in relationships in which violence is bidirectional, it may not be symmetric when reasons and consequences are taken into account18.

Therefore, the observance that bidirectional dating violence among adolescents is superposed to violence that is perpetrated only by men or only by women does not put an end to this discussion. On the contrary, there are basic problems to state there is gender equality with regard to dating violence19, and many issues should be clarified, including the type of investigated violence.

The objective of this study was to investigate the prevalence of physical and psychological violence and its directionality pattern (only perpetration, only victimization, both are victims and perpetrators) according to sex, among teenage partners in Recife, capital of Pernambuco, Brazil. In this study, sexual violence was not investigated, since its dynamics is different from physical and psychological violence4 , 20 , 21. The intention is that the results in this study can contribute with the awareness about the problem in our population, as well as with the perception of the need for further national studies and more integrating prevention measures in relation to violence among teenage partners.


The reference population was composed of 408 adolescents in the sophomore year of high school in state public and private schools of Recife (PE). A two-stage cluster selection was used: 1st stage - choice of schools, with probability of proportional selection in relation to the number of students (systematic probability proportional to size) of the sophomore year in public and private schools; 2nd stage - one group randomly selected in each school for the application of the questionnaire with all of the present students. The data presented in this article refers to 355 adolescents, and 53 of them were excluded due to the lack of information concerning age (all of the interviewees were aged between 15 and 19 years old), or because they had never dated, which was an essential subject for the investigated theme. The sample was measured in order to obtain estimates of proportion, with 0.10 absolute error, 95% confidence interval (95%CI) and Proportion (P) of the occurrence of victimization among partners equals to 70%. No students refused to participate in the study.

Information concerning the city of Recife integrate the data base of another study conducted under the same epidemiological assumptions in the public and private schools of nine Brazilian capitals: Manaus (AM), Porto Velho (RO), Recife (PE), Teresina (PI), Brasília (DF), Cuiabá (MT), Rio de Janeiro (RJ), Belo Horizonte (MG), Florianópolis (SC) and Porto Alegre (RS), which were selected by convenience among the ones with the highest violence rates among adolescents, in 20077.

The instrument consisted of a closed self-applied questionnaire composed of several questions, including sociodemographic characteristics and questions about the acceptance of violence in the relationship. In order to evaluate violence in intimate relationships between adolescents, the Conflict in Adolescent Dating Relationship Inventory (CADRI)23 was used, since this scale was specifically created for the universe of adolescents and adapted to Portuguese7. Answers concerned perpetrated and suffered acts of violence in a relationships established in the past 12 months.

The items of the scale that measure physical violence ("throwing something on the partner", "hitting, kicking or punching", "slapping/pulling hair", "pushing or shaking") and psychological violence, which was discriminated in three subtypes: emotional/verbal, threats and relational. Emotional/verbal violence is measured by the items: "doing something to cause jealousy", "mentioning something bad the boyfriend/girlfriend did", "saying things only to make him(her) angry", "speaking in a hostile tone of voice", "insulting with depreciation", "mock or tease the boyfriend/girlfriend in front of others", "keeping track of who the boyfriend/girlfriend is with and where", "blaming the boyfriend/girlfriend for the problem", "accusing the boyfriend/girlfriend of flirting with someone else", "threatening to end the relationship". The threatening behavior is represented by the following questions: "destroying or threatening to destroy something valuable", "trying to frighten on purpose", "threatening to hurt him/her", "threatening to hit or through something". Relational violence concerns the actions of psychological violence that involve the relationship with others, such as friends and acquaintances, and it is still little studied. In CADRI, it is measured by the items: "trying to turn friends against the boyfriend/girlfriend", "saying things about the boyfriend/girlfriend to your friends to turn them against him/her", "spread rumors about the boyfriend/girlfriend". The authors of the scale23 suggest that the use of relational violence would reflect the relative immaturity to deal with conflicts in the relationship, but they also concluded that a restricted scale model, which excludes relational violence, is the most reliable form of the instrument.

A dichotomous variable was created for each type of violence (general, physical, verbal/emotional, threat and relational), being considered case the teenager who reported having having suffered (victimization) or perpetrated (perpetration) at least one act of violence in the scale. The concept of bidirectional violence was used when the adolescent reported having perpetrated and suffered violence in the same relationship, thus suggesting that both partners acted violently.

For the descriptive analysis, data were analyzed through the indicator of prevalence (number of cases of perpetration and/or victimization divided by the total sample of the study), according to sex. The χ2 test was used to compare between groups (very severe/severe in the analysis of violence acceptance; and female/male gender in the analysis of perpetration and/or victimization by violence). All of the statistical analyses incorporated: sampling weight, in order to correct punctual estimation (such as percentages), and sampling design, aiming to correct the estimation of variance. This option was due to the lower estimation of variance, which is a characteristic of cluster sampling designs, when compared to statistical tests that are normally used in a simple random sample.

The study was approved by the Research Ethics Committee of the National School of Public Health Sergio Arouca. The authorization for the research was also given by the State Secretariat of Education of Pernambuco. The board of the involved schools and students who participated in the investigation signed an informed consent form, as indicated by resolution n. 196/96, from the National Health Council, which normalizes studies with humans.


Out of the 302 analyzed adolescents, 56.3% were females and most considered themselves to be white (41.7%) or brown (37.3%). A little more than half of the sample (56.0%) was composed of students from private schools, and 54.1% represented the social strata A and B. A minimum percentage of illiteracy from father and mother was observed (0.7 and 2.4%, respectively), and 45.6% of fathers and 39.7% of the mothers had completed high school. As to religion, 74.0% claimed to have one.

As to the acceptance of dating violence, the investigated adolescents considered more severe for a "boyfriend to humiliate a girlfriend" (64.1% considered it to be very serious; 31.8% thought it was serious" than for a "girlfriend to humiliate a boyfriend" (56.7% considered it to be very serious; 39.4% thought it was serious) (p < 0.000). Likewise, they consider it is more severe that a boyfriend "assaults a girlfriend" (88.8% consider it to be very serious; 10.6% think it is serious) than that a "girlfriend assaults a boyfriend" (70.2% consider it to be very serious; 25.5% think it is serious) (p < 0,000).

Most adolescents (83.9%) claimed to have perpetrated and suffered physical and/or psychological dating violence. Only 2.5% perpetrated it, but did not suffer it, and 2.8% suffered it, but did not perpetrate it. The prevalence of adolescents who reported not having experienced violence in the relationship was of 10.8%. The comparison of such data between sexes did not show statistically significant differences, being p = 0.498 (Graph 1).

Graphic 1 Directionality of physical/psychological adolescent dating violence. Recife, Brazil, 2008. 

At analyzing physical violence exclusively, in 14.2% of the relationships both partners were violent (bidirectional). In the comparison between sexes, girls presented higher percentage in the only perpetration profile (10.0%) than boys (1.5%). Boys presented higher only victimization profile (11.0%) than girls (1.1%), with p = 0.001 (Table 1).

Table 1 Directionality of physical adolescent dating violence. Recife, Brazil, 2008. 

Physical violence Sex Total p-value*
Male Female
% % %
Perpetrated and suffered it 17.1 12.0 14.2
Perpetrated it, but did not suffer it 1.5 10.0 6.3
Suffered it, but did not perpetrate it 11.0 1.1 5.3
Did not suffer nor perpetrate it 70.4 76.9 74.1
Total 100.0 100.0 100.0 0.001

* ÷2 test.

Table 2 shows the prevalence of psychological violence in the verbal/emotional, threats and relational aspects. Verbal/emotional violence was the most prevalent one (87.9%), followed by threats (36.1%), and, finally, relational violence (24.5%).

Table 2 Directionality of psychological adolescent dating violence. Recife, Brazil, 2008. 

Sex Total p-value*
Male Female
% % %
Verbal/emotional violence
Perpetrated and suffered it 86.1 77.4 81.1
Perpetrated it, but did not suffer it 2.5 3.7 3.2
Suffered it, but did not perpetrate it 2.1 4.7 3.6
Did not suffer nor perpetrate it 9.3 14.2 12.1
Total 100.0 100.0 100.0 0.331
Perpetrated and suffered it 20.2 24.1 21.9
Perpetrated it, but did not suffer it 10.1 9.9 9.9
Suffered it, but did not perpetrate it 2.3 5.5 4.3
Did not suffer nor perpetrate it 67.4 60.5 63.9
Total 100.0 100.0 100.0 0.523
Relational violence
Perpetrated and suffered it 15.1 5.0 9.3
Perpetrated it, but did not suffer it 2.9 3.5 3.2
Suffered it, but did not perpetrate it 16.8 8.1 11.9
Did not suffer nor perpetrate it 65.2 83.5 75.5
Total 100.0 100.0 100.0% 0.009

*÷2 test.

Verbal/emotional violence and threatening behavior did not show statistically significant differences between sexes. However, boys confirmed relational violence much more, both perpetrated and suffered ones (34.8%), in comparison to girls (16.6%), with p = 0.009. Relational violence also stands out for more reports of victimization than perpetration (Table 2).

In all of the psychological types of violence, the bidirectional pattern (perpetrated and suffered it) was the most prevalent one when compared to categories "only the woman perpetrates it" and "only the man perpetrates it" (Table 2).


The results in this study demonstrate that dating violence among teenage students is, in most cases (83.9%), bidirectional, that is: both partners are perpetrators of the physical and the psychological violence. The bidirectional pattern of physical dating violence among adolescents is the most common one, which is widely accepted in international literature2 , 24 - 26. However, very few studies include psychological violence. The results found by Sherer and Sherer4, Fernández-Fuertes and Fuertes5 and O'Leary et al.27 in samples of teenage students, in spite of not presenting systematic data for the analysis of directionality, they suggest that physical and/or psychological violence is also, in most cases, bidirectional.

The comparison between sexes showed no significant difference in the combined analysis of physical and psychological violence, which reinforces the idea that violence in intimate relationships between teenagers seems to be inserted in a context of negative exchange, thus creating a violent dynamics of relations.

When only the physical violence is analyzed the bidirectional category is most prevalent (14.2%), followed by perpetration by the girls (10.0%), and with perpetration only by the boys at a much lower percentage (1.5%). The results corroborate data found in international studies that assess directionality both in college students and3 , 25 , 26and high school students24.

The high level of perpetration found among girls seems to be confirmed when data concerning only victimization are analyzed : 11.0% of the boys suffer physical violence even when they do not perpetrate it, while a small number of girls (1.1%) suffers physical violence without perpetrating it. The results by Straus and Ramirez26 also demonstrated that teenage female students are more likely to be the only violent partner int he relationship. Foshee28 observed that they perpetrated more mild, moderate and severe violence, even by controlling for the perpetrated violence in self-defense.

A possible explanation pointed out in the two mentioned studies refers to the better social acceptance of violence perpetrated by women26 , 28. When a man assaults a woman, this act is usually considered to be less acceptable than when a women attacks a man violently13 , 29. The results presented here reinforce this hypothesis, once the participating adolescents stated that the humiliation or aggression performed by the man is more serous than the one performed by the woman in romantic relationships.

For Jackson12, instruments that use self-report are subjected to answers according to what is socially accepted, and not to the truth. However, further studies are necessary to clarify to what extent female acceptance results in the actual higher prevalence of female violence, and how much it influences only the reports, which would lead to unreal values of prevalence concerning violence between teenage boyfriends and girlfriends. This is because women are more prone to revealing the practiced violence, while boys would omit violence because it is not accepted.

Out of the three dimensions of psychological violence that were analyzed, verbal or emotional violence was prevalent both for perpetration and victimization, which was also demonstrated by Foshee28 in a sample of teenage students. Jourilles et al.30 and Fernandez-Fuertes and Fuertez5 also used CADRI and observed that more than 90% of the analyzed teenage students had been victims of verbal or emotional violence; the second study found similar values also for perpetration.

The high prevalence of verbal/emotional violence is comparable to the levels of psychological violence reported by other studies (which use several scales and questoinnaires17 , 27) with teenage students. This is possibly because this dimension has more items, which are similar to psychological violence items that are mostly found in other studies and scales17 , 27 , 31 , 32.

The prevalence of victimization due to threatening behavior (26.2%) was similar to that found by Jourilles et al.33 in cross-sectional evaluations, using CADRI, with teenage students.

The only dimension of psychological violence that presented significant difference between sexes was relational violence, since boys presented higher rates, both for perpetration and victimization. Such results were also observed by Schiff and Zeira21among teenage students at risk (with behavioral issues or poor school performance), and they presuppose boys are more sensitive to notice relational violence. Other authors have observed differences between violence perception between sexes23 , 29.

In all of the analyzed psychological violence dimensions, the bidirectional pattern was the most prevalent one when compared to the categories "only the woman perpetrates it" and "only the man perpetrates it". These data confirm that psychological violence between partners is perpetrated by both sexes, which can also be concluded from the data presented by Sherer and Sherer4, Fernandez-Fuertes and Fuertez5, O'Leary et al.27and O'Leary and Smith Slep34 in samples with the same characteristis of this study.

Some authors defend that the pattern of bidirectionality followed by the higher perpetration of women, which was observed in most studies, is the result of current methodological limitations12. Therefore, it would be necessary to extend the research parameters beyond the measurement of violent acts in order to investigate the consequences, context, motivation and meaning of violence for men and for women, as observed by Straus and Ramirez26.

It is true that the bidirectional dynamics of dating violence among teenagers should be further explored, especially because it is opposed to data regarding violence against the frown woman in intimate relationships1. However, empirical evidence that dating violence among adolescents is performed by both partners is consistent for physical violence3 , 24 - 26, and studies that include psychological violence point out to the same direction4 , 5 , 27 , 34. Another evidence lies on the observance that dating violence perpetrated by one of the partners is determinant for the perpetration of the other17, including in the long term34.

The study presents limitations, such as the use of self-report, information about the couple obtained from only one of the partners and absence of data concerning motives, context and consequences of physical and psychological aggression between teenage partners.

In spite of the presented limitations, the study has Strong points, such as the use of a broad definition of violence, which includes psychological violence, and not only the physical one. Besides, the use of a representative sample, unlike many studies about the theme, which use convenience samples3 , 18 , 26 , 32 , 34, and the absence refusals to participate, are strong points, while international studies also present with compromised participation rate17 , 28 , 32 , 33, of up to 50%24, and these aspects minimize the possibility of selection bias.

The findings in this study seem to be similar to those found in nine Brazilian cities investigated in the study by Minayo et al.7, and there were similarities between the adolescents in Recife in relation to the ones in other locations, with regard to demographic and cultural characteristics and also to the context of violence experienced by this population group. The performance of similar studies in the future in the country should be a goal for research groups addressed to teenagers.


Violence performed in romantic/loving relationships between teenagers presents one pattern: partners assault each other mutually, both physically and psychologically, which reveals that in order to break this relational dynamics it is necessary to intervene, and not only with the male or female adolescent. The reciprocity of dating violence found at this age group presupposes that cultural patterns of sexism are not well structured in this stage of life, and that is why the group needs intervention measures. Considering this dynamics, in which there is a mixture of love and violence, at this point in life it means to prevent future acts of violence between adult partners, when relationship patterns learned in the past are established, with possible serious consequences for the couple and their children.


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Financial support: Ford Foundation (Processo nº 1075-1257).

Received: February 18, 2013; Revised: September 05, 2013; Accepted: November 13, 2013

Corresponding author: Alice Kelly Barreira. Rua Meiguice, 270, Dois Irmaõs CEP: 52171-060, Recife, PE, Brasil E-mail:

Conflict of interests: nothing to declare

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