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Intimate Partner Violence (IPV)

BASICS

  • Abuse/aggression in a current or former romantic relationship
  • Types: Physical, sexual, emotional, psychological, economic, stalking, threats
  • Occurs across all: genders, races, sexual orientations, socioeconomic classes, religions
  • Synonyms: Domestic violence, partner abuse, spousal abuse, family violence

EPIDEMIOLOGY

  • USA: 4.8 million women report physical/sexual assault annually
  • Lifetime prevalence:
  • 1 in 4 women
  • 1 in 10 men
  • Cost: >$10.4 billion/year to U.S. economy
  • COVID-19: Exacerbated IPV risk
  • Geriatric: 1–2 million >65 yrs mistreated or injured by caregivers
  • Adolescents (Teen Dating Violence):
  • ~1 in 5 high school females report abuse
  • Highest vulnerability: ages 16–24
  • 11 million women and 5 million men experience IPV <18 yrs

RISK FACTORS

Victim Risk Factors

  • Substance abuse, poverty, low education
  • Social isolation, lack of support
  • Past abuse, mental illness/disability
  • Pregnancy, transgender identity
  • Attempting to leave abusive partner

Perpetrator Risk Factors

  • Substance use, depression, personality disorders
  • Low education, job loss, witnessed childhood abuse
  • Threats, owning weapons, control behaviors

Relational Risk Factors

  • Marital conflict, poor communication
  • Economic stress, gender role norms

PREGNANCY CONSIDERATIONS

  • ↑ Risk of:
  • Unintended pregnancy
  • Induced abortion
  • Miscarriage
  • Stillbirth
  • Preterm birth
  • STIs

PEDIATRIC IMPLICATIONS

  • Children in IPV homes: ↑ risk of physical/sexual/emotional abuse
  • Adverse effects:
  • Anxiety, depression
  • Developmental & behavioral issues
  • Long-term poor health

DIAGNOSIS & SCREENING

General Guidelines

  • USPSTF: Screen all women of reproductive age
  • ACOG: Screen at each prenatal visit, every trimester, postpartum

Screening Tools

  • HITS: Score >10 indicates likely IPV
  • Hurt
  • Insult
  • Threaten
  • Scream
  • Partner Violence Scale
  • SAFE Questions:
  • Stress/Safety
  • Afraid/Abused
  • Friends/Family support
  • Emergency plan

History Clues

  • Delay in seeking treatment
  • Inconsistent/incongruent injury explanations
  • Frequent ER visits, missed appointments
  • Chronic pelvic/head pain, STIs, substance use, poor prenatal care
  • Mental health symptoms: depression, anxiety, eating disorders

PHYSICAL EXAM

  • Signs:
  • Multiple injuries in different healing stages
  • Tympanic rupture, genital/rectal trauma
  • Facial fractures, bite marks, burns
  • PTSD signs: flat affect, hypervigilance
  • Red Flags:
  • Partner refuses to leave room
  • Malnutrition/bedsores in elderly

DIAGNOSTIC TESTS

  • Trauma suspected: CBC, LFTs, amylase, lipase, pregnancy test
  • Sexual abuse: STI panel (HIV, syphilis, GC/CT, trichomonas)
  • Fractures: X-ray
  • Child <2 yrs: Skeletal survey

TREATMENT

SOS-DoC Approach

S – Support & assess Safety - “You are not to blame.” - “Do you feel safe going home?”

O – Discuss Options - Safety plan - IPV shelter/hotline referral - Offer police support if desired

S – Validate Strength - “You showed strength in coming forward.”

Do – Document - Use exact patient language (“patient reports…”) - Map injuries, take photos with consent - Create emergency kit checklist

C – Ensure Continuity - Offer follow-up; identify barriers

GENERAL MEASURES

  • Mandatory reporting:
  • Child/elder abuse – in all states
  • IPV – varies by state
  • Display resource posters in clinic (exam rooms, restrooms)
  • Train staff on trauma-informed communication

ADDITIONAL THERAPIES & RESOURCES

FOLLOW-UP RECOMMENDATIONS

  • Schedule prompt revisit
  • Ask what occurred since last visit
  • Provide repeated interventions
  • Offer long-term mental health support

PROGNOSIS

  • Long-term consequences: PTSD, depression, anxiety
  • Support, therapy, and safe housing improve outcomes

ICD-10 CODES

Type of Abuse Code
Adult physical abuse T74.11XA
Adult psychological abuse T74.31XA
Adult maltreatment, unspecified T74.91XA

CLINICAL PEARLS

  • Always screen in private without partner present
  • Offer resources and follow-up even if screening is negative
  • Validate with: “You are not alone” / “Help is available”
  • Place multilingual posters in clinic areas
  • Maintain nonjudgmental, supportive tone