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INTRODUCTION

Intimate partner violence (IPV) is defined as any intentional, controlling behavior consisting of physical, sexual, or psychological assault, or stalking by a current or former intimate partner. IPV affects men and women from all socioeconomic strata, professions, locations, and cultural backgrounds. Women visiting outpatient medical and obstetric/gynecologic clinics as well as the emergency department (ED) are often there for complaints directly attributable to IPV. Because they are frequently misdiagnosed, they may return time and time again, often with increasingly severe trauma. In addition to increased morbidity and mortality of victims, IPV confers a tremendous financial burden in the United States. The total annual costs related to IPV are estimated to be between $2 and $7 billion, and the CDC estimates that the lifetime costs are up to $36 trillion, including medical expenditures, lost productivity among victims and perpetrators, criminal justice costs, and property loss or other damage.

Despite its magnitude in society and in medical settings, IPV is sometimes described as a “silent epidemic.” Considered a private family problem by the government, and a social problem by the medical establishment, victims often have nowhere to turn. This predicament has gradually improved. Intimate partner violence is now acknowledged to be an important public health problem, and medical practitioners have a variety of diagnostic and treatment guidelines available to them. All clinicians must be knowledgeable about and comfortable with the evaluation and care of patients who are subjected to IPV (also see Chapter 41).

EPIDEMIOLOGY

Recent information from the CDC-sponsored National Intimate Partner and Sexual Violence Survey (NIPSVS) found that 37% of women have experienced sexual or physical violence or stalking by an intimate partner in their lifetime, with up to 23% of women and 14% of men reporting severe physical violence by an intimate partner (including acts such as being hit with something hard, being kicked or beaten, or being burned on purpose). This type of violence is more prevalent during a woman’s lifetime than diabetes, depression, or breast cancer. In addition, an estimated 19.3% of women and 1.7% of men in the United States reported having been raped, and cross-sectional studies from outpatient primary care clinics and ED settings have found even higher rates in primary care, emergency departments, obstetrics and gynecology clinics, and mental health and addiction practices. Pregnancy has been found to double the risk of IPV. IPV accounts for more than half the murders of women in the United States every year. Unfortunately, prevalence rates have remained essentially unchanged since 2010.

Most studies ask about violence exclusively in the context of heterosexual relationships. However, a similar prevalence of IPV appears to exist in LGBT (Lesbian, Gay, Bisexual, Transgender) relationships, with the same physical and emotional consequences. In fact, the NIPSVS shows that the highest prevalence of lifetime physical violence, rape, and stalking is among bisexual women (61%). Most bisexual women report having only male perpetrators ...

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