Intimate Partner Violence

Three-part cycle:  Honeymoon –> Tension –> Violence –>
25% of women report being victims of IPV in their lifetimes (ED patients: 14-35%, primary care 12-23% in the last year).
8% of men report being victims of IPV
– interestingly, women and men have approximately equal rates of reported violent behaviors, but the outcomes for women (hospitalization, death) are more often much worse.
Women are at highest risk for homicide when they leave the relationship
IPV = physical violence, sexual violence, stalking or psychological aggression (including coercion) by a current or former intimate partner.
Physical violence:  includes preventing escape or restraining, along with throwing, pushing, punching, slapping, etc.
Emotional violence:  shaming, humiliating, isolating, controlling.
One of the more helpful phrases:  “Tell me more about that…,” “help me understand why that won’t work…,” etc.
Health consequences to victims:
– CAD, chronic pain, headaches, chronic pelvic pain, recurrent infections, etc.
– depression, anxiety, PTSD, suicide attempts
– poor management of chronic health conditions
** important to remember these consequences can persist for 15 years after the cessation of IPV!  (“Have you EVER been exposed to IPV…”)
Health consequences of perpetration (Singh, 2014):  (not a cause-effect, but may be a sign of risk factors present)
– IBS
– insomnia
– substance abuse
– experiencing or witnessing violence as a child
Terroristic violence = unidirectional, used as means of control, fear/control tactics
Situational/Common Couple violence = bidirectional, not used as means of control, induced by distress in relationship.
Screening for IPV:
When to screen:  WWEs, on the OB deck, in the ED.
Best to separate the couple when you’re asking the questions (prep from beginning of the appointment, ask during the pelvic exam, can be a written screen).
The best single question:  Do you feel safe? (sens 10%, spec 99%)
HITS written screen:  over the last 12 mos, how often has your partner HURT, INSULTED, THREATENED to harm, SCREAMED or cursed at you?
Other questions (verbal inquiry with funneling):
 – What does conflict look like in your relationship?  If I were a fly on the wall, what would I see?
 – Follow-up with more specific questions re: hitting, punching, slapping, etc.
Ask about bidirectional, parallel violence.
1800-779-SAFE – National Domestic Violence Hotline
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