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
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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
