Chapter 294: Intimate Partner Violence and Abuse

INTRODUCTION AND EPIDEMIOLOGY

Intimate partner violence is defined as a pattern of assaultive, coercive behaviors that may include inflicted physical injury, psychological abuse, sexual assault, progressive social isolation, stalking, deprivation, intimidation, and threats. Such behaviors are perpetrated by someone who is, was, or wishes to be involved in an intimate or dating relationship with an adult or adolescent individual and are aimed at establishing control by one partner over the other.¹

Intimate partner violence and abuse is the preferred alternative for previously used terms such as spousal abuse, wife battering, and domestic violence. This term more accurately reflects the fact that this type of abuse occurs not only in adult heterosexual married relationships but also in relationships between cohabiting, separated, gay and lesbian, bisexual, and transgendered individuals as well as in adolescent dating relationships.^2,3

Intimate partner violence and abuse occurs in every racial, ethnic, cultural, geographic, and religious group, and it affects individuals of all socioeconomic and educational backgrounds worldwide. Men are affected, but the overwhelming burden of victimization from intimate partner violence is borne by women.^2,4,5 Risk factors for intimate partner violence and abuse include female sex, age between 18 and 24 years, low income level of the household, and relationship status of separated rather than divorced or married.² Sexual and/or physical abuse during childhood and adolescence is a frequent predictor of future victimization.^2,6 Presence of weapons in the home and threats of murder are associated with increased risk of homicide.

Effects extend to family members, friends, coworkers, other witnesses, and the community at large.² Children who grow up in violent homes may be physically or emotionally abused or neglected, and witnessing violence can have short- and long-term adverse health consequences.⁷ In families in which either child maltreatment or spousal abuse is identified, it is likely that both forms of abuse exist. Children may be incidentally injured or killed when they try to intervene in a struggle.⁷ Children exposed to violence in the home may develop behavioral difficulties, including depression, abusive behaviors, and drug abuse. Frequent exposure to violence in the home may teach children that violence is a normal way of life. Perpetrators of violence, in particular severe violence, may be at risk for suicide, committing murder, or being murdered by a family member.^7,8

Ask about a history of intimate partner violence or abuse during healthcare encounters. Failure to recognize and intervene in situations of intimate partner violence may have serious consequences for the survivor and family. Such consequences may include continued violence, physical and psychological health problems, and injury or even death.^2,9,10

CLINICAL FEATURES

Intimate partner violence is most often cyclical in nature. The cycle begins with a period of tension building, ...