Domestic Violence (Intimate Partner Violence)

Introduction

• Description: Domestic violence (domestic abuse) is a pattern of behavior that involves violence or other abuse by one person against another in a home or family setting. It may include physical, verbal, emotional, economic, and sexual abuse, which can range from subtle, coercive forms, to overt acts (see Chapter 19 , Abuse: Physical and Sexual).

• Prevalence: Over 32 million women in the United States have experienced intimate partner violence (IPV) and 43 million women have experienced psychologic aggression by an intimate partner in their lifetime. Approximately 1 in 3 women have experienced some form of physical violence by an intimate partner, including a range of behaviors (eg, slapping, shoving, pushing). Roughly 1 in 4 women have been victims of severe physical violence (eg, beating, burning, strangling) by an intimate partner in their lifetime. Lifetime estimates for IPV involving women in the United States range from 22% to 39%. IPV accounts for 15% of all violent crime.

• Predominant Age: Most common during the early reproductive years, though elder abuse constitutes a special case.

• Genetics: Male-to-female ratio is 1:5+. A wife or female partner is more commonly the victim of such violence.

Etiology and Pathogenesis

• Causes: Unknown

• Risk Factors: Childhood physical or sexual victimization, prior history of IPV, alcohol or drug use, lower socioeconomic status, unemployment. Women with an unintended pregnancy have a higher risk (3-fold greater in one study).

Signs and Symptoms

• Direct signs of physical violence, often inconsistently or inconsistently explained

• Delay in seeking treatment

• Frequent emergency room visits

• Vague somatic complaints (“hidden agenda”)

• Inappropriate affect/poor eye contact

• Overly attentive or verbally abusive partner

• Social withdrawal

• Anxiety or depression

Diagnostic Approach