Since patients often do not volunteer that they have been abused, clinicians must be alert to clues that suggest abuse, including an explanation of the injuries that does not fit with what is being seen; frequent visits to the emergency department; and somatic complaints such as chronic headache, abdominal pain, and fatigue. The patient may be vague about some of her symptoms and may avoid eye contact. If the abusing partner is present, he or she may answer all the questions or may decline to leave the room. It is critical that the patient has the opportunity to speak with the clinician alone. The patient's description of the events should be carefully detailed in case there are any subsequent legal issues.
Physical examination often reveals injuries in the central area of the body. There may be injuries on the forearms as well if the patient tried to defend herself. As with any situation of expected abuse, bruises that are in various stages of healing may be an important clue. All physical examination findings should be well documented.
In addition to the physical consequences, abuse can have psychological consequences. Posttraumatic stress disorder, depression, anxiety, and alcohol or other substance abuse can develop in victims. Somatization is also common among victims.
Several instruments have been developed to screen for IPV. These include the HITS (Hurt, Insult, Threaten, Screamed at) tool, the Women Abuse Screening Tool (WAST), the Partner Violence Screen (PVS), the Abuse Assessment Screen (AAS), and the Women's Experience with Battering (WEB) scale. A systematic review of these screening tools showed that most tools only had been evaluated in a relatively small number of studies and the sensitivities and specificities varied widely within and between the tools.
Many studies have addressed how the questions about IPV are asked. Inclusion of one question in the context of the medical history, "Have you ever been hit, kicked, punched, or otherwise hurt by someone within the past year? If so, by whom?" has been shown to increase identification of IPV. The SAFE questions are also useful. Stress/Safety: Do you feel safe in your relationship? Afraid/Abused: Have you ever been in a relationship where you were threatened, hurt, or afraid? Friend/Family: Are your friends aware you have been hurt? Emergency Plan: Do you have a safe place to go and the resources you need in an emergency? In one randomized trial, women preferred written questionnaires over face-to-face interviewing. The USPSTF recommends that clinicians screen women of childbearing age for IPV, including domestic violence and provide or refer women who screen positive to intervention services.