Intimate partner violence (IPV) is a distressing reality that affects many individuals in intimate relationships, manifesting as behaviors that inflict physical, psychological, or sexual harm. Often perpetrated by someone with a current, past, or desired relationship with the victim, these actions aim to exert control and dominance.
IPV knows no boundaries. It can impact anyone, regardless of gender, economic status, age, ethnicity, sexual orientation, religion, or education level. While IPV occurs in both heterosexual and same-sex relationships, it is notably more prevalent among low-income, undereducated, rural, and pregnant individuals.
Startling statistics from the Centers for Disease Control and Prevention (CDC) reveal that one in three women and one in four men in the United States have faced severe physical violence during their lives. Shockingly, between 2003 and 2012, IPV accounted for 15% of all violent crimes. However, the true prevalence of IPV is likely underreported, as many fear seeking help due to potential repercussions from their abuser.
Related: Intimate Partner Violence: Compassionate Care, Effective Assessment
Consequences of intimate partner violence
Intimate Partner Violence poses a significant risk to women’s health. Women can present to the emergency room with acute injuries such as bruises and cuts on their heads, faces, breasts, and other sensitive areas, while others bear the invisible scars of abuse. They may struggle with chronic headaches, sleep disturbances, appetite changes, anxiety, and even pelvic pain. These non-acute symptoms often stem from internalized stress, spiraling into conditions like post-traumatic stress disorder (PTSD). PTSD frequently coexists with depression and anxiety, potentially leading to substance abuse and suicidal thoughts.
IPV can have a negative impact on pregnancy outcomes, leading to poor weight gain, infections, anemia, or even stillbirth. The severity of violence often escalates during pregnancy and postpartum periods. Homicide tragically ranks as a leading cause of maternal mortality, with many cases linked to current or former partners.
The societal and economic implications of IPV are significant. Each year, around a quarter of a million emergency room visits are prompted by IPV. The staggering cost of intimate partner rape, physical assault, and stalking exceeds $8.3 billion annually, factoring in direct medical care, mental health services, and lost productivity.
Importance of physician involvement
Physicians play an important role in recognizing and addressing IPV, a crucial step in breaking the cycle of abuse. Through effective screening, ongoing support, and connecting patients with prevention and referral resources, healthcare providers can make a significant impact. Often, medical professionals are the first to offer help to women facing abuse, underscoring the importance of their role in this sensitive area.
IPV screening and counseling should be standard at every female patient’s health visit. Many will be reluctant to disclose their situation at first. During obstetric care, screenings should happen at the initial prenatal visit, at least once each trimester, and during postpartum checkups.
The clinician should evaluate the possibility of IPV when patients present with new-onset depression, substance abuse, mental health issues, repeat requests for pregnancy tests despite not wanting to be pregnant, new or recurrent sexually transmitted diseases, or if express fear about negotiating safe sex practices with their partner.
Strategies for effective IPV screening
Privacy is paramount when screening patients and it is essential to avoid stigmatizing language like “abuse” or “battered.” Instead, healthcare providers should use respectful, non-judgmental language and approaches.
The screening should occur in private spaces away from partners or family members. When needed, clinicians should use professional language interpreters instead of someone close to the patient. Introduce screening as a routing practice and clarifying confidentiality and state disclosure laws can help improve screening effectiveness.
Keep printed resources such as safety procedures, hotline numbers, and referral information in private areas of the office, like restrooms or exam rooms. This allows patients to obtain information without the presence of a partner.
Finally, ensure that all staff members receive ongoing training about IPV to create a knowledgeable and supportive environment.
Even when abuse isn’t openly discussed, engaging in conversations about IPV with genuine care can be immensely beneficial. By providing educational materials to all patients, healthcare professionals can create a safe space for women to take information without feeling pressured to disclose their experiences. This approach helps normalize the conversation around IPV, making it a topic that women can explore when they are ready.
Identifying IPV with effective screening tools
The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics advocate for regular and frequent screening for IPV. To accomplish this, a variety of validated screening tools are available to help healthcare providers screen for IPV.
- Hurt, Insult, Threaten, and Scream (HITS) questionnaire. Introduced in 1998, this powerful four-question screening can be administered by either a clinician or completed by patients themselves. Respondents evaluate their experiences on a 5-point scale, resulting in a total score ranging from 4 to 20. Using a cut-off point of 10 for women and 11 for men, HITS helps identify individuals who may be at risk.
- Women Abuse Screening Tool (WAST). This tool is available in a seven-question format. There is also a condensed version known as the WAST-Short, featuring just two key questions. Women responding positively to these two questions should be considered at high risk, prompting further inquiry into their situation.
Research has shown that both self-administered and clinician-administered screening tools are equally effective in uncovering instances of IPV. In addition, innovative approaches like computer-assisted screenings are gaining traction in healthcare settings. These methods not only encourage open discussions about IPV but also enhance confidentiality and safety during the screening process, ultimately helping to uncover and support those who may be suffering in silence.
Key elements of a safety plan
Creating a safety plan is a vital step in navigating the complexities of IPV. It not only enhances awareness of risk factors but also equips survivors with the skills to prioritize their safety. Recognizing that leaving an abusive relationship isn’t always an option, effective safety planning provides survivors with the knowledge and tools they need to protect themselves and minimize harm.
Safety planning for those in an abusive relationship
- Build your support network: Discussing abuse can feel daunting, but identifying a trusted friend or family member who can be relied upon in a crisis is crucial. Having someone to turn to can greatly enhance safety and facilitate recovery.
- Identify safe places: Know where you can go if you need to escape quickly. This could be a local domestic violence shelter or a trusted family member’s home. Map out the safest routes to these locations to give yourself options in dangerous situations.
- Establish a code word: Develop a discreet code word with your children or trusted allies. This word can signal when it is time to leave or when you need help without alerting the abuser.
- Prepare an emergency bag: Pack a bag with essential items you may need upon leaving, such as clothing, toiletries, and any necessary medications. Having this ready can save precious time when you need to act quickly.
- Plan your escape route: Stay aware of your surroundings and avoid rooms with only one exit, such as bathrooms or bedrooms, where you could feel trapped. Instead, position yourself near doors and windows for a quick escape if needed.
Safety planning for those ready to leave an abusive relationship
- Open a personal savings account: Start a savings account in your name and contribute to it whenever possible. This will provide you with financial independence and security as you prepare to make your next move.
- Copy important documents: Secure copies of crucial documents such as your social security card and birth certificate and store these in your emergency bag or safely with a trusted relative.
- Keep your emergency bag ready: Make sure your emergency bag is packed with cash, spare keys, important documents, and a list of important contacts.
- Create a clear escape route: Design a detailed escape plan that includes where to go, the route to take, and memorize it.
As healthcare professionals, our role is crucial in supporting IPV survivors. By staying informed on the latest research and implementing effective strategies, we can significantly enhance the care we provide—and potentially save lives in the process. Your awareness and proactive approach can make a world of difference for those in need.
