Description

  • Intimate partner violence (IPV) is physical, sexual, or psychological harm perpetrated by a current or former intimate partner, such as a spouse, cohabitating partner, or dating relationship.

Who is most affected

  • Women are more affected than men (often with male perpetrator).
  • Women and men in all types of relationships may be affected regardless of race, sexual orientation, or economic status.

Incidence/prevalence in US

  • 1.5 million women and 834,700 men report rape and/or physical assault by an intimate partner annually
  • 30% to 33% lifetime prevalence of IPV reported among female psychiatric patients

Likely risk factors

  • victim-related risk factors
    • preexisting mental health and/or substance abuse
    • history of traumatic events, such as
      • sexual abuse in childhood
      • prior IPV
      • war-related trauma
    • unmarried status
    • family history of abuse
  • perpetrator-related risk factors
    • men with exposure to parental violence or who have experienced physical abuse during childhood
    • preteen alcohol use
  • exposure to political violence

Screening questions and resources

  • Start with generalized statement, such as “many people experience problems at home or in their relationships that can affect their health, so I have started to ask all my patients about any issues at home.”
  • ask about
    • current violence
      • Have you been hit, kicked, punched, or otherwise hurt by an intimate partner within the past year, and if so, by whom?
      • Do you feel safe in your current relationship?
      • Is someone from a previous relationship making you feel unsafe now?
      • Is anyone forcing you to do something sexual that you do not want to do?
      • Is anyone in the community following or harassing you?
    • history of violence
      • Have you ever been in a relationship in which you were frightened or hurt by your partner?
      • Did anyone ever physically hurt you, force you to do something sexual, or hurt you psychologically (such as telling you that you were worthless or unwanted) when you were a child?
      • As an adult, have you ever been physically hurt or forced to do something sexual you did not want to do?
    • aggressive behavior in partner such as
      • jealousy
      • exhibiting controlling behavior
      • anger with patient or children
      • controlling conversations
      • canceling appointments for patient or insisting on being present during appointments with patient
  • screening questionnaires include
    • Hurt, Insult, Threaten, and Scream (HITS)
    • Woman Abuse Screening Tool (WAST) and WAST-short form (WAST-SF)
    • Partner Violence Screen (PVS)
    • Humiliation, Afraid, Rape, Kick (HARK)

Efficacy of screening

  • Screening instruments might accurately identify IPV toward women.
  • HITS reported to have 88% sensitivity and 97% specificity for identification of male victims of IPV.
  • Screening for IPV in healthcare setting may improve identification in women but does not appear to reduce recurrence.

History

  • Ask about current assault, including (WHO strong recommendation, indirect evidence)
    • type of assault
    • when the assault took place
    • risk of pregnancy
    • risk for HIV infection and other sexually transmitted infections
    • mental health status
  • ask about general signs and symptoms of distress, including
    • fatigue
    • headache
    • gastrointestinal symptoms
    • cardiac symptoms
    • pelvic pain
    • sexual dysfunction
    • chronic pain
    • description of frequent or vague symptoms
    • substance abuse
    • anxiety or depression
    • PTSD
    • missed appointments
    • social isolation
  • repeated injury, delay in seeking care, or reported etiology inconsistent with injury findings may each be signs associated with violence