APA Citation
Campbell, J., Webster, D., Koziol-McLain, J., Block, C., Campbell, D., Curry, M., Gary, F., Glass, N., McFarlane, J., Sachs, C., Sharps, P., Ulrich, Y., Wilt, S., Manganello, J., Xu, X., Schollenberger, J., Frye, V., & Laughon, K. (2003). Risk Factors for Femicide in Abusive Relationships: Results From a Multisite Case Control Study. *American Journal of Public Health*, 93(7), 1089-1097. https://doi.org/10.2105/AJPH.93.7.1089
Summary
This landmark study analyzed 310 intimate partner femicides across 11 U.S. cities to identify key risk factors for fatal domestic violence. The research found that attempting to leave or recently separating from an abusive partner increased the risk of homicide by 75%. Other critical factors included the abuser's access to firearms, escalating violence patterns, extreme jealousy and control, threats of suicide, and forced sexual violence. The study provides crucial evidence for understanding when intimate partner violence becomes most lethal.
Why This Matters for Survivors
This research validates what many survivors instinctively know - leaving an abusive relationship is the most dangerous time. The findings help survivors understand that their fears about leaving are rational and evidence-based, not paranoia. It emphasizes the critical importance of safety planning and professional support during separation, especially when dealing with narcissistic partners who cannot tolerate loss of control.
What This Research Establishes
Separation is the highest risk period for intimate partner homicide, with attempting to leave increasing the likelihood of being killed by 75% compared to women who remain in abusive relationships.
Specific risk factors significantly predict lethal violence, including the abuser’s access to firearms, history of choking or strangulation, extreme jealousy and stalking behaviors, and threats to kill the victim or themselves.
Escalating patterns of abuse precede most intimate partner femicides, with prior domestic violence incidents, forced sexual violence, and increasing frequency or severity of physical abuse serving as critical warning signs.
Multiple risk factors compound the danger exponentially, with victims facing the highest lethality risk when several factors are present simultaneously, particularly separation attempts combined with weapon access and prior threats.
Why This Matters for Survivors
Your instincts about leaving being dangerous are backed by solid research. This study validates what many survivors already know in their hearts - that the period around separation is when abusive partners are most likely to escalate to lethal violence. Your fears are not paranoia; they are rational responses to real danger.
Understanding these risk factors can help you make informed decisions about your safety. The research doesn’t mean you should never leave, but rather that leaving requires careful planning and professional support. Your safety planning should account for the reality that narcissistic abusers often cannot psychologically tolerate the loss of control that comes with separation.
The findings emphasize that you are not responsible for your abuser’s escalation. When narcissistic partners become violent during separation, it reflects their inability to accept rejection and their desperate attempts to maintain dominance. This violence is about their pathology, not your actions or choices.
This research underscores why rushing into separation without support can be dangerous. Professional domestic violence advocates understand these risks and can help you develop safety strategies that account for your specific situation and your partner’s risk profile.
Clinical Implications
Clinicians must understand that encouraging clients to leave abusive relationships without proper safety planning can inadvertently increase danger. The highest risk period requires the most intensive support and intervention, not abandonment of therapeutic services during separation.
Risk assessment tools based on this research, such as the Danger Assessment, should be standard practice when working with intimate partner violence survivors. Therapists need training to recognize lethality indicators and coordinate with domestic violence specialists when clients are planning to leave.
Mental health professionals working with narcissistic abuse survivors must address the complex trauma bonding that makes leaving psychologically difficult while simultaneously validating the real physical dangers of separation. This requires balancing empowerment with realistic safety concerns.
Therapeutic interventions should include safety planning as a core component, not an afterthought. Clinicians must maintain ongoing risk assessment throughout treatment, as danger levels can change rapidly when abusive partners sense their control is threatened.
How This Research Is Used in the Book
Chapter 12 draws extensively on Campbell’s findings to help survivors understand why leaving feels so dangerous and why their intuitive fears are scientifically validated. The book emphasizes that recognizing these risks is empowering, not discouraging.
“Campbell’s groundbreaking research confirms what survivors have long known: the moment you begin to reclaim your autonomy is often when narcissistic abusers become most dangerous. This isn’t meant to trap you in the relationship, but to ensure you leave with eyes wide open and professional support at your side. Your safety planning must account for the reality that separation represents a narcissistic injury so profound that some abusers escalate to lethal violence rather than accept the loss of control.”
Historical Context
This 2003 study marked a turning point in intimate partner violence research by providing the first large-scale empirical evidence for risk factors that advocates and survivors had long recognized. Published during an era of increased recognition of domestic violence as a public health crisis, it legitimized survivor experiences through rigorous scientific methodology and helped shift the conversation from victim-blaming to perpetrator accountability and systematic risk assessment.
Further Reading
• Stark, Evan. “Coercive Control: How Men Entrap Women in Personal Life” (2007) - Examines the control tactics that often precede lethal violence in intimate relationships.
• Glass, Nancy, et al. “Technology-facilitated stalking: findings from the Boston TechSafety study” (2018) - Updates Campbell’s work by examining how digital tools increase stalking and control in modern abusive relationships.
• Websdale, Neil. “Understanding Domestic Homicide” (1999) - Provides additional context for the patterns and risk factors identified in Campbell’s research through detailed case analysis.
About the Author
Jacquelyn Campbell is the Anna D. Wolf Chair and Professor at Johns Hopkins University School of Nursing, internationally recognized for her research on intimate partner violence and femicide prevention. She developed the Danger Assessment tool used worldwide by advocates and healthcare providers.
Nancy Glass is a Professor at Johns Hopkins School of Nursing and co-director of the Center for Global Health. Her research focuses on technology-facilitated abuse and safety interventions for intimate partner violence survivors.
Historical Context
Published in 2003, this study emerged during increased recognition of intimate partner violence as a public health crisis. It provided the first large-scale, multi-city empirical evidence for risk factors that advocates and survivors had long recognized, legitimizing their experiences through rigorous scientific methodology.
Frequently Asked Questions
Research shows that attempting to leave increases homicide risk by 75% because narcissistic abusers cannot tolerate losing control and may escalate to lethal violence when their dominance is threatened.
Key risk factors include threats to kill, access to firearms, extreme jealousy and stalking, previous choking or strangulation, threats of suicide, and escalating violence patterns.
Safety planning should involve domestic violence professionals, include secure communication methods, financial preparation, legal protection orders when appropriate, and coordination with law enforcement if necessary.
While not all intimate partner homicides involve narcissistic abusers, the risk factors identified - extreme control, inability to accept rejection, and rage at loss of dominance - align closely with narcissistic abuse patterns.
Access to firearms significantly increases lethality risk in domestic violence situations, as abusers with guns are more likely to kill their partners, especially during separation attempts.
Support persons should connect survivors with domestic violence professionals, never pressure them to leave before they're ready, help with safety planning, and understand that leaving is a process, not a single event.
Protection orders can be helpful as part of comprehensive safety planning, but their effectiveness varies and they may escalate danger with some abusers, particularly those with narcissistic traits who view orders as challenges to their authority.
Healthcare providers should be trained to recognize risk factors, use validated screening tools like the Danger Assessment, provide resources without judgment, and understand that patients may not disclose abuse immediately.