Digital Abuse between Intimate Partners: an integrative literature review

: The objective of the current article is to obtain a better understanding about the theme of digital abuse among intimate partners through the analysis of the scientific literature. For this purpose, we carried out an integrative literature review in four databases: SciELO, Virtual Health Library (VHL), Pepsic and Pubmed in the period from 2015 to 2020. After considering the inclusion and exclusion criteria, 33 articles were identified and analyzed. Most of the articles were written in North American English and published in 2018. They were cross-sectional and quantitative studies and made use of standardized instruments. The reviewed studies emphasize the prevalence, consequences, risk factors, the very definition of the phenomenon and the association of digital abuse with beliefs about love and offline violence. According to our findings, investigating the experience of digital abuse is an important task since it is a common phenomenon, especially among young people, and there are many health-affecting consequences. In addition, these findings add to the growing body of evidence on the negative effects of cyber dating abuse, and it is believed that risk determination is useful for clinical and educational interventions.


Introduction
Contemporary social relations have been strongly impacted by the advent of technology and in particular by the influence of digital media (Lemos, 2015). The New Digital Technologies of Information and Communication are techniques and resources used for communication arising from the context of the Information Revolution. These technologies were introduced in the second half of the 1970s, in particular in the 1990s and are responsible for accelerating communicability through digitization and network communications (Velloso, 2014).
The influence of these technologies is so strong that young people are now called "digital natives", and this impacts their shared values and social norms (Giunti et al., 2015). A Digital Native is a concept created by Marc Prensky and refers to those who grew up surrounded by digital information technologies, for example smartphones and wireless internet (Coelho, Costa, & Mattar Neto, 2018), and who perceive technology as a part of their environment (Tapscott, 2010). In comparison, "digital immigrants" are those who started to have access to these technologies after they became adults (Carvalho, Miguel, & Costa, 2020).
A key element of digital culture is the overvaluation of public exposure, which allows for a confused tangling of the boundaries between the public and private (Keen, 2012). Thus, there is a demand from contemporary culture to publish one's private life on social networks (Moreira, Lima, Stengel, Pena, & Salomão, 2017). Digital progress is an important marker in the constitution of individuals, since it produces and conveys information in society. Although these means of communication have their own dynamics, they are not far from the configurations of gender, class and ethnic powers that shape society. We can see that social interactions mediated by digital technologies have begun to create a new context / scenario in which there are also manifestations of discrimination and violence (Flach & Deslandes, 2017). Contextos Clínicos, v. 15, n. 1, jan./abr. 2022 Among couples, for example, changes in the form of communication mediated by the use of new technologies have enabled the emergence of violent behaviors, such as humiliation, threats, control, insults or jealous behavior in order to cause distress and isolation in the partner (Cavalcanti & Coutinho, 2019). This specific form of violence between intimate partners is known as digital abuse (Flach & Deslandes, 2017).
It is important to mention that digital abuse does not happen in isolation.
Scientific findings indicate that those who suffer from violence in a face-to-face context are also most likely to be victimized in the digital sphere . Scales of digital abuse as well as traditional conflict were applied to 1,042 young people in the United States and showed that the two types of violence have a positive correlation (Temple et al., 2016). This finding is congruent with other research that shows that digital abuse occurs concurrently with other forms of violence between intimate partners (Foshee et al., 2015;Marganski & Melander, 2015;Martinez-Pecino & Dúran, 2016;Reed, Tolman, & Ward, 2016;Taylor et al., 2017;Temple et al., 2016;Wright, 2015). However, the same authors emphasize that digital abuse is easier to disseminate, given the characteristics of the internet.
In view of the presented scenario, it is important to observe aspects related to digital abuse, since it is a phenomenon whose frequency has increased among young people. One study pointed out that young people come to experience up to 23 incidents of digital abuse within a six month period . In regard to its prevalence, there is much variation, from 1.1% to 97.7%, in the occurrence of digital abuse, which can be explained by the different definitions of the phenomenon and the instruments and samples used in research (Cavalcanti & Coutinho, 2019), all of which tends to impede an adequate understanding of the phenomenon.
In the Brazilian context only four studies were found on the subject, two of which were literature reviews. The first, published in 2017, sought to understand the phenomenon and its health problems (Flach & Deslandes, 2017); the second, from 2019, carried out a study on the prevalence, assessment tools and risk factors of digital abuse (Cavalcanti & Coutinho, 2019). With regard to empirical research, mobile phone applications designed to control and monitor partners were analyzed (Flach & Deslandes, 2019); and another study aimed to understand the social representations about digital abuse among young Brazilian university students (Cavalcanti et al., 2020).
However, studies are beginning on digital abuse in Brazil, as well as there being a predominance of the same researchers studying the subject. This article aims to carry out an integrative review of the literature (national and international) on the topic of digital abuse in the period from 2015 to 2020 with a view to investigating the state of the art on the subject. This article will specifically look at the similarities and differences that the authors point out in the prevalence, consequences, risk factors, the very definition of the phenomenon, and the association of digital abuse with beliefs about love and offline violence. It is hoped that the realization of this integrative review may shed light on the theme and motivate the development of empirical studies in the national scenario since it may indicate important gaps to be filled.

Method
We performed an integrative literature review which sought to describe the scientific production on digital abuse among intimate partners. This type of study aims to organize, integrate and critically evaluate the material already published on a given Contextos Clínicos, v. 15, n. 1, jan./abr. 2022 topic. To guide the execution of the study, the following steps were taken: definition and delimitation of the theme; definition of descriptors and databases for the search; conducting the search and organization of materials; attentive reading of the titles and abstracts of the materials found; elaboration of the review script; and writing of the review (Von Hohendorff, 2014).
For the research we used the databases SciELO, Virtual Health Library (VHL), Pepsic and Pubmed, with the descriptors "digital abuse" and "cyber dating abuse". The inclusion criteria we used were: articles published in the period from 2015 to 2020 that dealt with digital abuse between intimate partners. After reading the titles and abstracts we excluded duplicate articles from the sample as well as those that did not portray research involving digital abuse. Those that dealt with literature reviews were also excluded. The chosen works were accessed in full and read during the month of November 2020.
First, we carried out a quantitative analysis, in which we sought to characterize scientific production by considering issues such as: year of publication, nationality of researchers, method, samples / participants, and instruments. Subsequently, we analysed the qualitative nature of the studies in an attempt to synthesize the thematic contents (Bardin, 1995). This generated five categories of analysis: 1) empirical evidence about prevalence, types and dissemination; 2) consequences of digital abuse for victims; 3) digital abuse and beliefs about love; 4) risk factors for digital abuse; and 5) relationship between digital abuse and offline violence.

Results
With this investigation into the scientific literature, we found a total of 42 studies on the subject in focus, five in Scielo, 30 in VHL and seven in Pubmed. The search in Pepsic did not result in any scientific research relating to digital abuse. After applying the inclusion and exclusion criteria, a total of 33 studies were found. Regarding the method adopted all articles were empirical studies, with only one of them having a longitudinal design, evaluating the participants at different times. The other works were transversal, that is evaluations made at a specific moment, one of which was a study of control and monitoring applications, which did not involve participants.
In relation to the samples used in these studies we found that the main sources of recruitment were schools and universities, given that the character of digital abuse is more common in adolescents and young adults. The samples comprised numbers above 50 adolescents / young adults. However, most studies (63.8%) involved more than 400 young people.
The study that had the lowest number of participants among those analyzed was transversal and involved the realization of a focus group (Stonard, Bowen, Walker, & Price, 2017). In this work, 52 adolescents were evaluated in eight focus groups to identify the role of electronic communication technologies within romantic relationships and in abusive behaviors. The study that reached the largest number of participants was carried out with a sample from the United States (Yahner, Dank, Zweig, & Lachman, 2015) and which included a total of 5,647 adolescents from 10 schools and examined the digital perpetration of dating violence.
With regard to data collection procedures it was found that in most cases (86.6%) there was the use of standardized assessment instruments (scales, inventories, questionnaires), with a great variability in the materials used. In particular, the Cyber Dating Abuse Questionnaire  was the most cited instrument among the evaluated studies (26.6%) as a way of assessing the perpetration and victimization of digital abuse and is subdivided into the types of direct aggression and control / monitoring. Contextos Clínicos, v. 15, n. 1, jan./abr. 2022 There was also the frequent use of certain standardized instruments (26.6%) related to the acceptance of violence in dating (for example: Acceptance of couple violence - Sezer, 2008), instruments to evaluate myths about love and abuse (for example: Myths of Romantic Love Scale - Bosch et al., 2007), and instruments that examined different forms of violence in adolescent couples (for example: Conflict in Adolescent Dating Relationships Inventory - Wolfe et al., 2001).

Qualitative Analysis
The qualitative analysis of the studies generated the definition of five categories of analysis according to thematic similarities worked on by the authors, namely: 1) empirical evidence about prevalence, types and dissemination (n = 11); 2) the consequences of digital abuse for victims (n = 9); 3) digital abuse and beliefs about love (n = 6); 4) risk factors for digital abuse (n = 4); and 5) relationship between digital abuse and offline violence (n = 3). The articles were classified by the main themes they addressed (main objectives and results), although in many cases it was found that the articles touched on more than one of the created categories of analysis.
The simultaneous occurrence of victimization and perpetration also appears in the literature with a prevalence of 27.2% (Smith et al., 2018) highlighting the bidirectionality of the phenomenon.
We identified direct aggression and control as different types of digital abuse, these can be threats, dissemination of private information and monitoring motivated by suspicions of infidelity, such as frequently visiting the victim's social network profile, Contextos Clínicos, v. 15, n. 1, jan./abr. 2022 using personal passwords to read partner's messages, or making repeated calls Temple et al., 2016;Marganski & Melander, 2015;Reed et al., 2016;Borrajo, Gámez-Guadix, Pereda, & Calvete, 2015). In addition, it is important to differentiate digital abuse from cyberbullying, as the aforementioned behavior is limited to peers and usually happens between partners or ex-affective-sexual partners, and does not need an audience, as is the case in cyberbullying (Cavalcanti & Coutinho, 2019).
Regarding the dissemination tools, we estimate that more than 50% of the reported cases of digital abuse that occurred in affective-sexual relationships were practiced through messaging services or messaging applications such as Whatsapp, 40% via social networking, such as Facebook, and about 7% via e-mail, which is in line with preferences for certain social media platforms .
Studies show the high prevalence of digital abuse among adolescents and young people as well as the naturalization of the phenomenon, which can sometimes be recognized as proof of love, causing the situation to be romanticized .
As for the prevalence between genders studies show that there is no consensus, however, one study indicated that women suffer more digital abuse than men and that they are less likely to commit such aggression (Deans & Bhogal, 2017), whereas other research shows that both sexes exhibit this type of behavior. Nevertheless, there is a consensus that what changes is the type of aggression and the intensity  as women tend to perpetrate digital abuse more frequently in a non-sexual way, while men tend to perpetrate digital abuse sexually, such as sending photos or videos of a sexual nature (Reed et al., 2016) Control and jealousy are more frequent among women since they tend not to perceive them as abuse but as a way of protection, corroborating the idea of romanticization mentioned previously (Lucero, Weisz, Smith-Darden, & Lucero, 2014).
It is also noteworthy that the violence can be reciprocal (bidirectional), with both (men and women) acting as victims and perpetrators Reed et al., 2016). The feeling of shame is also associated with digital abuse, which can lead to worrying moods and feelings such as anxiety and risk of suicide (Cavalcanti et al., 2020).
The victim behaves in a detached and isolated way, which cause difficulty in establishing quality relationships based on trust and communication and hinders the possibility of seeking help when necessary, which can contribute to a separation from family and peers, increasing depressive thoughts (Gracia-Leiva et al., 2020).
With regard to suicidal ideation, we found that 22.75% of girls who suffered some type of violence in dating had already thought about suicide and 8% attempted suicide after the episode of violence (Gracia-Leiva et al., 2020). Specifically, we noticed that women who suffered both forms of violence (offline violence and digital abuse) are between two and three times more likely to have suicidal ideation. If the violence occurs together this number rises to four. In addition, suicide attempts occur 3.5 times more in girls who have suffered digital abuse (Gracia-Leiva et al., 2020). This data corroborates other studies which demonstrate the increased risk of suicide after exposure to dating violence (Ely, Nugent, & Flaherty, 2009;Miranda-Mendizabal et al., 2019).
With the help of electronic resources, jealousy can be expressed through abusive acts, such as invading the privacy of others and stalking among other forms (Cavalcanti et al., 2020). Online control, for example, appears as the most common form of digital abuse Caridade, Ataíde, & Dinis, 2020).
In regard to the practice of control / monitoring, the use of tracking applications is common. We searched for applications that offered services of controlling, monitoring and tracking of intimate partners and found 40 applications made available by the Android system. These applications are able to remotely monitor the partner's mobile device, control personal passwords, provide real-time location, even allow access to messages posted and received on social networks and messaging applications (Flach & Deslandes, 2017).
In a study of the myths that justify the realization of digital abuse we found that abuse appears to be normalized in the relationships of young people with an average age of 22 years. The belief in myths about love is related to the perpetuation of control on the internet, for example behavior from partners who constantly check where and with whom the partner is can be interpreted as attitudes of concern and care . Another important finding is that the myths about love have a stronger influence on the intimate relationships of younger people, which can be explained by having an unrealistic view on relationships, generating controlling behaviors. For example, one of the most common behaviors among teenagers that can facilitate digital abuse is the practice of sharing passwords on cell phones and social networks as a sign of love and trust .
There are also conservative beliefs about traditional roles and sexist models that justify violence, such as benevolent sexism. This appears disguised as a false concern of affection and maintains the woman in the place of one who must be cared for, allowing Contextos Clínicos, v. 15, n. 1, jan./abr. 2022 the victim to remain in an abusive relationship (González-Ortega, Echeburúa, & Corral, 2008).
Scientific findings point out that violation happens in a context of games, strengthening the understanding that digital abuse is not important or is something that is part of a relationship. This may explain why the perpetrators favor sexting, while victims often indicate the feeling of being targets of sexting (Peskin et al., 2017).

Risk factors for digital abuse
It is noticed that engagement of people in the virtual network can be considered risky behavior as well as the act of sexting with a partner, so that the greater its use, the greater the possibility of becoming a victim or aggressor of this type of abuse.
( Manchibarrena et al., 2018;Reed et al., 2016). The use of social networks and the internet also has a positive correlation with other types of virtual aggressions, such as cyberbullying (Twyman, Saylor, Taylor, & Comeaux, 2010), which corroborates the previous statement. Together these data explain the fact that young people are the biggest targets of this type of violence in addition to being less aware of the importance of protecting their profiles on the internet, which can create opportunities for perpetrators to access personal information (Baker & Carreño, 2016;Marganski & Melander, 2015;Van Ouytsel, 2016).
Another study also found a correlation between the time that young people spend on social networks and the likelihood of becoming victims of controlling behaviors. This can be explained by the fact that perpetrators are provided with more opportunities (Reed et al., 2016). Jealous behavior can also be understood as a feeling that predicts conflict in romantic relationships and that can provoke partner monitoring and controlling behaviors (Deans & Bhogal, 2017). The use of social networks contributes to the development or increase of reactions and jealous thoughts since the sharing of photos and personal information occurs (Miller, Denes, Diaz, & Buck, 2014). Contextos Clínicos, v. 15, n. 1, jan./abr. 2022 Given this scenario the importance of educational initiatives on digital abuse becomes apparent, with a focus on providing information on the safe use of the internet, problematizing for example the sharing of passwords and discussing privacy and limits (Reed et al., 2016).
The consumption of alcohol was also pointed out as something common in victims and perpetrators (Machibarrena et al., 2018;Reed et al., 2016). The difference is in the use of other narcotic substances, which is more associated with the victims (Machibarrena et al., 2018) and the use of cigarettes, which tends to be stronger in perpetrators (Reed et al., 2016).
There is a predictive relationship between problems with alcohol and abusive behaviors in dating, however, no evidence was found that problems with alcohol could predict the perpetration of digital abuse, despite being positively correlated (Brem et al., 2019). A predictor for digital abuse pointed out in the literature is cyberbullying and bullying, with participation in bullying positively correlating with the perpetration of digital abuse (Peskin et al., 2017). This is justified by the way these particular young people relate to their peers through the use of power and aggression being transferred to their romantic and virtual relationships (Cavalcanti & Coutinho, 2019).

Relationship between digital abuse and offline violence
Digital abuse can also be associated with other traditional types of violence between intimate partners and interact with other forms of digital abuse in affectivesexual relationships, examples being revenge porn -threats to release embarrassing information -and coercive sexting -pressuring the partner to take pictures or videos of a sexual nature (Reed et al., 2016).
Similarly there is the relationship between digital abuse and offline aggression in dating, mainly in types of psychological aggression. Thus, we believe that violence on the internet tends to coexist with violence outside the internet. The specificity in the first Contextos Clínicos, v. 15, n. 1, jan./abr. 2022 case is the absence of geographical and temporal boundaries, providing a greater opportunity for contact via the internet Dick et al., 2014;Margasnki & Melander, 2015;Reed et al., 2016). In a sample of adolescent girls and young women in Spain, the prevalence of both modes of violence is high but face-to-face violence is highlighted more, reaching a rate of 76%, against 68.8% with online violence (Gracia-Leiva, 2020).
The family also appears as a significant element in digital abuse behaviors. It is well known that the way in which parents relate to each other and to their offspring influences the way in which children will manifest these behaviors with peers, since people raised in violent family environments tend to resolve their conflicts in a similar way (Cavalcanti & Coutinho, 2019).
A substantial amount of research on forms of offline dating violence demonstrates that witnessing intrafamily violence and interparental conflicts can increase the likelihood of engaging in some form of dating violence (Arriaga & Foshee, 2004;Borges & Dell'Aglio, 2020;Murta et al., 2016). In the context of digital abuse, it has also been shown that exposure to this type of scenario is related to greater perpetration (Ramos, Miller, Moss, & Margolin, 2017). A study found that young people who observed parents with a higher level of intrusive behavior were more likely to be involved in digital abuse than those who did not have access to this behavior (Van Ouytsel, 2016).
It appears among the studies reviewed that little is considered about the influence of the family on digital abuse. Based on this, it is important to conduct new empirical studies that seek to understand the relevance of the family on those who experience digital abuse, especially with regard to how perceived family support, parenting skills and practices influence the phenomenon.

Final considerations
The study aimed to present an overview of national and international scientific production about digital abuse, with a view to investigating the state of the art, specifically with regard to the similarities and differences that the authors point out in relation to the prevalence, consequences, risk factors, the very definition of the phenomenon, and the association of digital abuse with beliefs about love and offline violence.
According to what we observed in the quantitative analysis, publications on digital abuse grew significantly in 2018, and it was only after that year that research was found in the Brazilian context. Thus, it is evident how recent the discussion on the topic is, especially in Brazil. Moreover, the analysis showed the predominance of North American, cross-sectional, quantitative studies that use a variety of standardized instruments such as scales, lists and questionnaires.
The qualitative analysis of the studies identified the predominance of studies on the prevalence, types and spread of abuse, followed by studies focusing on the consequences of digital abuse, the relationship between this type of abuse and beliefs about "love", as well as the risk factors for digital abuse and its relationship to offline violence. Therefore, we found that there is an attempt by researchers to obtain an overview of the phenomenon. In this process, we perceived that there are a set of instruments and forms of investigation which generate dissonance in the information obtained, with there being no consensus in the literature on some aspects (prevalence, gender etc.) It is understood that investigating the experience of digital abuse is an important task, since it is a common phenomenon especially among adolescents and young people and its possible consequences should be taken into account. What is also noteworthy is its association with traditional violence, which can aggravate its effects. However, it is a Contextos Clínicos, v. 15, n. 1, jan./abr. 2022 subject that still faces many prejudices as beliefs about love and the feeling of jealousy often endorse practices of sexist values which strengthen violence.
Some limits were imposed on this review, namely: the non inclusion of other databases such as PsycINFO for example, which could expand the articles included in the analysis; and the non-use of other descriptors such as digital violence and virtual aggression, which could also generate a greater number of studies. Despite these limitations we hope that the content treated here can be useful for research and interventions on digital abuse.
In terms of future studies, we suggest carrying out empirical research in Brazil that replicates studies already carried out on the subject, in addition to more research with a longitudinal design and also using qualitative designs. It is important that future studies quantitatively analyze the prevalence of abuse (including the type), its association with other types of violence experienced, as well as the impact on mental health. Moreover, it is suggested that studies in the future prioritize the use of qualitative Based on these points related to the scenario of scientific publications in the area, we are able to conclude that, as with other forms of violence, digital abuse is shown to be a relevant phenomenon in the sexual-affective relationships of young people. Thus urgency is emphasized so that interventions are developed in schools and universities with the objective of preventing this violence and / or reducing the harm caused. There needs to be initiatives in creating an awareness of healthy use of the internet and of behaviors associated with abusive relationships, as well as the creation of an adequate welcoming space for those who have already experienced this violence in order to prevent re-victimization.