Childhood exposure to domestic violence is a key risk factor for developing life-long deleterious outcomes (Kulkarni, Graham-Bermann, Rauch, & Seng, 2010). Domestic violence can involve physical, sexual, as well as emotional, verbal abuse and witnessing violence. Unfortunately, exposure to domestic violence in childhood is not rare. A 2008 U.S. national survey (National Survey of Children's Exposure to Violence) identified that the prevalence rate of any child maltreatment was as high as 11.1% and witnessing family violence was as high as 5.1% (Turner, Finkelhor, & Ormrod, 2010). In the East Asia and Pacific region also, a similar but growing number of children appear to experience more than one type of domestic violence with almost halt experiencing five or more types (Fry, McCoy, & Swales, 2012).

Exposure to domestic violence can often result in severe and multiple consequences, and they are mostly life-long and complex psychological symptom profiles including depression, anxiety disorders, substance abuse, suicidal attempts, and violence towards others (Agaibi & Wilson, 2005; Runyan et al., 2002). In particular, relational abuse, such as emotional and verbal abuse, has been identified to play a critical role in developing shameproneness and depressive symptoms (Kim & Yoo, 2000; Kulkarni et al., 2010). Critical gaps remain, however, in the understanding of the complex interrelationships between the types of domestic violence experiences in childhood and the psychological consequences in adulthood. Most studies have focused on separate and relatively narrow categories of domestic violence (e.g., sexual or physical abuse), paying less attention to effects of different types of experiences on outcomes in adulthood.

Individuals who grew up in alcoholic households are also more likely to have childhood adverse experiences. Parents' alcohol problems appear to be significantly associated with children's peer bullying and victimization (Eiden et al., 2010). As the number of childhood adverse events increases, the risk of alcoholism and depression in those who grew up in alcoholic families increases (Anda et al., 2002). As reported in our previous studies, however, the negative consequences related to parents' alcohol problems and the number of adverse experiences in ACOAs' childhood have also been found to decrease as resilience and/or sense of belonging increase (Lee & Cranford, 2008; Lee & Williams, 2013). Specifically, resilient ACOAs are more likely to have tolerance of negative effect by developing better problem-solving or coping skills or positive acceptance of change (Lee & Williams, 2013). In addition, feeling valued and connected within a social system can help the individual to recognize more positive aspects in their lives and reduce potential deleterious effects of any sustained stress (Hagerty & Patusky, 1995; Lee & Williams, 2013). Having a cohesive family with supportive relationship and greater satisfaction with life are another protective factors from negative outcomes, in particular for depression (Kim et al., 2010; Lease, 2002).

However, little is known about whether ACOAs would have experienced more distinctive types of domestic violence in their childhood and how those potentially different types of domestic violence in childhood would influence mental health in adulthood. This study therefore aimed to analyze the relationships of different types of childhood domestic violence in relation to parents' alcohol problems with the adult mental health, including resilience, sense of belonging, life satisfaction, and depression, as well as family health, including family functioning and social support. A profile analysis approach (i.e., cluster analysis) was used in this study to provide a unique contribution that identifies different patterns of childhood experiences of domestic violence. We believe that this study can contribute to a better understanding of psychological features and mechanisms in adulthood in relation to childhood adversity, including parental alcoholism and domestic violence.

Studies have reported that childhood experience of domestic violence plays a substantial role in developing deleterious outcomes, even in later life. This study has further expanded those findings, by identifying and comparing specific patterns of domestic violence experiences in childhood between ACOAs and non-ACOAs via a cluster analysis and exploring their relationships with adult mental health as well as family health.

Before the new clusters were identified by domestic violence experiences in childhood, only significant differences between ACOAs and non-ACOAs were in sense of belonging, social support, and depression (Table 1). The unique clusters of ACOAs by their childhood domestic violence experiences, however, identified more variations in those adult mental health as well as family health variables. In particular, ACOAs who were victimized by emotional violence in the family reported the highest depression score as well as the lowest levels of resilience and sense of belonging among the six clusters (p<.05), which include multiple violence-experienced, both ACOAs and non-ACOAs. In addition, the post hoc test revealed that ACOAs who witnessed domestic violence reported much greater resilience, sense of belonging, and lower depression scores compared to the emotional abused ACOAs (p<.05). Statistically not significant, but as Figures 1-a, 1-b, and 1-d illustrate, the multiple violence-experienced ACOAs also appeared better than the emotionally victimized ACOAs in terms of resilience, sense of belonging, and depression.

Among various types of violence, emotional abuse is one of the most common types in alcoholic families (Verduyn & Calam, 1999). In our study, the cluster size of emotional violence group was not much different from the other clusters' in ACOAs, but its associations to adult mental health (i.e., depression, resilience and sense of belonging) were significant. More severe levels of depression in the emotionally abused victims have also been found in other studies. Compared to other types of violence, emotional abuse in the family showed a stronger association with depression as well as other emotional difficulties, including aggression, instability, or dependency (Nicholas & Rasmussen, 2006; Verduyn & Calam, 1999). Because domestic violence is passed from one generation to the next, it has been thought that domestic violence affects not only the victim but also the psychological states of the witnesses and especially the psychosocial development of children. However, in the current study findings indicate that ACOAs who witnessed domestic violence experienced better mental health than the emotionally victimized group, possibly due to the fact that emotional violence can be a more direct victimization that involves more intense feelings than just witnessing (Kulkarni et al., 2010).

The significant differences between the emotionally victimized and the multiple violence-experienced ACOAs remained at the familial level as well, but in the opposite direction. The Multiple Violence-experienced ACOA group showed the lowest overall and subscale scores of family functioning as well as social support (p<.05), which is not surprising. Experiencing multiple incidents of domestic violence, including physical and emotional ones, can be more likely to create constant fear for every family member and to make it difficult for family members to build a cohesive, adaptable, and supportive family environment. Traumatic childhood experiences are also more likely to correspond to reduced opportunities to build attachment within the family (i.e., having insecure attachments) or reduced feelings of trust within interpersonal relationships (Agaibi & Wilson, 2005).

Interestingly though, except for the Multiple Violence-experienced cluster, most of the ACOA participating in this study seem to have a similar level of family functioning to that of non-ACOAs with no violence experiences. However, these associations at the familial level should be interpreted carefully. It may be difficult to make a direct relationship between family functioning and psychological outcomes in the context of domestic violence. When considering what family cohesion and family adaptability refers to, however, we can make a possible interpretation of the double-sidedness of both family cohesion and adaptability in the alcoholic families. Family cohesion means the emotional intimacy in a family, and family adaptability means the changeable range of a family system (Olson et al., 1985). The closed system of alcoholic families (Lease, 2002; Lee & Williams, 2013) is high likely to hinder potential, healthy support from outside the family, but because the family as a whole has been through the very same adversities, unless their domestic violence experience becomes fatal (i.e., multiple types of violence occurring), they could develop intimate relationships within the family that they could lean on as well as more flexible coping strategies than the other families would do. Family focused-intervention, thus, can bring the greatest potential for success with alcoholic families by producing significant improvements, for instance, in positive parenting styles and child behaviors. Nonetheless, further studies are required to decipher the details behind such a relationship between certain types of domestic violence and family functioning in alcoholic families.

Nevertheless, childhood exposure to domestic violence, in general., increases the risk of experiencing negative mental health consequences, physical health sequelae, and high-risk sexual behaviors (Fry et al., 2012). Particularly, depression and anger have been found to be more prevalent in ACOAs who lived through traumatic experiences such as emotional, physical, and sexual abuse during childhood. In addition, those who have been the victim of violence during their childhood will use violence to a greater extent as adults, such as intimate partner violence. Therefore, family violence offenders should be included in any clinical approach to intervene in family violence, and their past experience and psychological consequences need to be carefully assessed and addressed. Practical barriers though exist that impede the identification of individuals early on the initial risk. Children may be mostly perceived as "belonging to" and "in debt toward" their parents and caretakers. In addition, victims of violence are discouraged from speaking out and obtaining external support and discussing or reporting violence publicly, thus often remain invisible (Runyan et al., 2002).

This study has limitations. The data were from a web-based survey that only certain participants could access, so the results may not be generalizable. In addition, the measure of violence did not specify the exact nature, frequency, or severity of the violence experiences. All violence experienced was assessed retrospectively and current adulthood experience was not includeed. Lastly, given the relatively small proportion of ACOAs in the current study (~15%), no further multivariate analyses could be conducted to explore causal., underlying relationships among the variables.

However, there also are important strengths. We were able to identify unique patterns of childhood domestic violence experiences in ACOAs that are significantly associated with adult psychological features and family health. Thus, the data fill gaps in our understanding of how domestic violence and parental alcoholism in childhood influence later mental health, with addressing differences by the type of domestic violence.

This study identified unique patterns of childhood experience of domestic violence among ACOAs and compared them to those in non-ACOAs. Those who were victims of emotional violence showed negative psychological features at the individual level and those exposed to multiple incidents of domestic violence were shown to have lower levels of family functioning than others. The findings suggest that ACOAs and non-ACOAs may have experienced very different patterns of childhood domestic violence which are associated with distinct psychological entities in their adulthood. On the basis of these results, comprehensive clinical approach to alcoholic families is encouraged to prevent negative health outcomes, by assessing and identifying the different types of domestic violence experiences and family functioning.