- Perform complete physical exam (including genitalia) to assess for injuries in patients with suspected IPV (WHO strong recommendation, indirect evidence)
- specific signs of violence may include
- multiple injury sites
- contusions, abrasions, or minor lacerations of
- head/neck and facial area (most common)
- abdominal area
- genital area
- anal area
- injury during pregnancy
- if patient denies IPV
- provide education about effects of IPV (including effects on children in household)
- express availability to discuss any concerns about IPV in future visits
- If patient confirms IPV, SOS-DoC intervention may help guide clinician response.
- S: offer support and assess safety
- O: discuss options, including safety planning and follow-up
- S: validate patient’s strengths
- Do: document observations, assessment, and plans
- C: offer continuity
- Mandatory reporting laws vary by state, mechanism of reporting, and patient age.
- Mental health care provided by clinician with good understanding of violence against women recommended for women with preexisting diagnosis or partner violence-related mental disorder who are experiencing IPV (WHO strong recommendation, indirect evidence)
- CBT for men who physically abuse their female partners might not reduce continued violence
- Counseling intervention in primary care setting may not improve quality of life in women with history of IPV
- Addition of fluoxetine to behavioral and self-help programs may reduce perpetration of IPV in patients with depression and history of alcohol-associated violence
Consultation and referral
- in women with history of IPV
- gynecologic, gastrointestinal, urinary, musculoskeletal, and neurologic symptoms
- sexually transmitted infections
- chronic pain
- elective abortions
- poor pregnancy outcomes
- increased risk for obesity and hypertension
- psychological complications include
- suicide attempts
- misuse of alcohol and/or drugs
- eating disorders
- children exposed to household with IPV may have increased risk for negative outcomes that can persist into adulthood, including
- child abuse (up to 50% of households with IPV)
- behavioral and physical health problems, such as
- violence toward peers
- attempted suicide
- drug and/or alcohol abuse
- running away from home
- risky sexual behaviors
- increased likelihood of committing sexual assault
- increased mortality and morbidity
- About 39% of global homicides with female victim may be committed by intimate partner.
- One in 5 women killed by an intimate partner are reported to receive emergency care in previous year for injuries inflicted by same partner.
- Dating violence during middle or high school is associated with increased risk of young adult intimate partner victimization.
- Cognitive behavioral and empowerment-based interventions may reduce domestic violence during pregnancy.
- Educational or skills-based interventions for preventing relationship and dating violence may not be effective in adolescents and young adults.
- Insufficient evidence to evaluate advocacy interventions for women experiencing IPV
Dr Drabkin is a senior clinical writer for DynaMed, a database of comprehensive updated summaries covering more than 3,200 clinical topics, and assistant clinical professor of population medicine at Harvard Medical School.