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Intimate partner violence (IPV) is a pattern of abusive behavior by a current or former intimate partner. The abuse can be physical, sexual, or emotional and can include economic deprivation. Although anyone can experience IPV, women are more likely than men to be impacted by IPV; lesbian, gay, bisexual, transgender, and questioning persons experience higher rates of IPV than other groups. Regardless of the type of abuse, the goal of the abuser is to gain control over the victim. IPV is common but is often not diagnosed.

The prevalence estimate of IPV varies depending on the setting. Rates are higher when measured in emergency departments than when measured in the general population. In a randomized controlled trial of IPV screening in emergency departments, the prevalence over 12 months ranged from 4% to 18%.

While IPV occurs in all locations, cultural backgrounds, and socioeconomic groups, prevalence estimates can vary by certain demographic characteristics. Specific risk factors include being young (age 18–24 years); being pregnant; being single, divorced, or separated; self-identifying among specific ethnic minority groups such as Native American, multiracial, or non-Hispanic Black; or having coexisting mental illness.

EVALUATION

Since patients often do not volunteer that they have been abused, clinicians must seek 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 using nonjudgmental language in the event that there are 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 those who experience IPV. Somatization is also common.

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 ...

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