An elevator security camera captures Baltimore Ravens running back Ray Rice delivering a punch seen around the world. Carolina Panthers player Greg Hardy is convicted of assaulting and threatening to kill his then-girlfriend. Arizona Cardinals running back Jonathan Dwyer is accused of breaking his wife’s nose with a head-butt. And the list goes on and on.

It’s tempting to write off the recent flurry of domestic abuse allegations against NFL players as a phenomenon unique to the violent world of football. But the truth is, these cases came to the public’s attention simply because of the high profiles of those involved; they could just as easily have featured a businessman, an electrician or a teacher.

If we broaden our camera angle from the inside of the elevator to the nation as a whole, we’ll see that domestic violence is not just an NFL problem, it’s one that cuts across every economic strata, every race, and every demographic in the U.S.

According to a University of Michigan study, one in five American men admit to hurting their spouse or partner. It’s a grim indicator that we still have far to go in our understanding of domestic violence and what a healthy relationship is. Wife beating has been illegal in this country since the 1920s, but one look at the comments accompanying Ray Rice stories shows that the "keep your woman in line" mindset is alive and well.

The Link to Future Abuse

So what fuels domestic violence? In the case of the athlete, it might seem natural to look for at least a partial explanation in alcohol and drugs. After all, these have been known to be a problem in professional sports, especially stimulants such as amphetamine and cocaine and performance-enhancing drugs such as testosterone and steroids. While we can’t say whether substances were involved in any of the recent NFL incidents, we do know they can escalate agitation and aggressive behavior.

However, no matter the profession, the single biggest predictor of who will commit violence against a spouse or partner is this: experiencing abuse as a child or witnessing it against a parent. In fact, those who witness domestic violence as boys are twice as likely to grow up to abuse their partners. This, in turn, makes it more likely that their own children will continue the pattern.

From Charm to Violence

From the outside, those with professional sports careers seem to have it all—wealth, fame, adulation. Why would they hurt those they love and risk their careers, some ask, by giving in to a moment of anger?

The reality is that few domestic abusers start a relationship thinking they will become violent. Instead, they tend to start by feeling insecure and wanting to have the partner’s exclusive attention. They’ll often turn on the charm while simultaneously starting to isolate the woman from her friends and family.

This infatuation stage of the relationship can be very seductive to the woman. She may feel more understood and more loved than she ever has. So it’s a bitter blow when the very person who once made her feel so special progresses from verbal abuse and sarcasm to physical violence.

So Leave Already

Why don’t they just leave? It’s a question asked often of women in abusive relationships, and it has no easy answers. There are multiple factors at play. Among them:

* It’s hard to give up on someone once loved so deeply and on a relationship once thought of as perfect.

* The abuser will often reveal a traumatic history of his own abuse or of witnessing domestic abuse. This can lead the woman to think of her abuser as damaged or a victim in need of her help and sympathy.

* Because the woman has been encouraged to break connections with family and friends, it can seem as though there is no one to turn to for help.

* Even in wealthy households, the money needed to leave may be hard to access. Domestic shelters are often run with public funds, and those who are not low income may not be eligible for their emergency services.

* The woman may fear for her safety. More than half of the violence against victims and their children occurs after leaving the perpetrator. Restraining orders are hard to obtain and even harder to enforce.

Offering Support and Compassion

The public responses to the NFL incidents make it abundantly clear that there are many people who are still happy to blame the woman in domestic violence situations and to see nefarious motives in an inability to separate from the abuser.

While it can be frustrating to see someone seemingly unable to take steps to help herself, it’s important to realize that the process takes time. First, the woman must overcome very real feelings of shame and grief at finding herself no longer beloved, but berated and beaten. She must also come to accept that nothing she did created the abusive situation, but she is probably the only one who can fix it. And for that to be possible, she needs our support and compassion.

David Sack, MD, is board certified in psychiatry, addiction psychiatry and addiction medicine. He is CEO of Elements Behavioral Health, a family of addiction and mental health treatment programs that includes Promises Treatment Centers, Lucida Treatment Center in Florida, and Malibu Vista women’s mental health center.