Chapter 294: Intimate Partner Violence and Abuse

INTRODUCTION AND EPIDEMIOLOGY

Intimate partner violence includes physical violence, sexual violence, threats of physical or sexual violence, stalking, progressive social isolation, and psychological aggression perpetrated by someone who is, was, or wishes to be involved in an intimate or dating relationship with an adult or adolescent individual. These actions are aimed at establishing control by one partner over the other.^1-3

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 transgender individuals as well as in adolescent dating relationships.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.^1,4 Intimate partner violence occurs in both opposite sex and same sex relationships.³ Risk factors for intimate partner violence and abuse include female sex, age between 18 and 24 years, low income level of the household, black or multiracial race/ethnicity, bisexual sexual orientation, and relationship status of separated rather than divorced or married.¹ 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.¹ In families in which either child maltreatment or spousal abuse is identified, it is likely that both forms of abuse exist.⁵ Children exposed to violence in the home have higher rates of behavioral difficulties; mental and health problems including depression, anxiety, abusive behaviors, and drug abuse; and eating, sleeping, and pain problems.⁵ Frequent exposure to violence in the home may normalize violence for children, resulting in higher rates of victimization and perpetration later in life.^1,5

Providers should 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 behavioral health problems, and injury or even death.^1,6,7

CLINICAL FEATURES

Intimate partner violence is often cyclical in nature. The cycle begins with a period of tension building, which may include arguing, blaming, or controlling behaviors or jealousy. The next phase is escalation and may include verbal threats, physical and sexual abuse, or assault. Weapons may be used at this point. Sometimes there may be a “honeymoon” phase in which the perpetrator may apologize or make excuses for inappropriate behavior. Over time, the abusive behavior ...