Physical

  • 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)
      • torso
      • abdominal area
      • genital area
      • anal area
    • burns
    • fractures
    • sprains
    • injury during pregnancy

General management strategies

  • 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.

Counseling


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  • 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

Medications

  • 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

  • Refer patients exposed to IPV to community-based treatment and advocacy programs.

Follow-up

  • Offer follow-up appointment and assess barriers to follow-up.

Complications

  • 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
    • PTSD
    • depression
    • 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
        • depression
        • anxiety
        • 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
  • HIV infection

Prognosis

  • mortality
    • 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.

Prevention

  • 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.