Intimate partner violence (IPV), is defined as any intentional, controlling behavior consisting of physical, sexual, or psychological assaults in the context of an intimate relationship. The data on IPV underscore the magnitude of the problem. In a landmark study, 28% of a random nationwide sample of couples reported violence at some point in their history; almost 4% of the women reported severe violence. If these figures are extrapolated to the general population, it is estimated that about 4 million women are subjected to violence each year in the United States with about 500,000 women requiring medical treatment. 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 their complaints are frequently misdiagnosed, they may return time and time again, often with increasingly severe trauma.
Despite its magnitude in society and in medical settings, until recently IPV could be described as a "silent epidemic." Considered a private, family problem by the government, and a social problem by the medical establishment, victims often had nowhere to turn. This predicament has gradually improved. IPV is now acknowledged to be an important public health problem, and medical practitioners have a variety of diagnostic and treatment guidelines available to them (see "Suggested Readings," at the end of the chapter). All practitioners must be knowledgeable about and comfortable with the evaluation and care of patients who are subjected to IPV.
Research conducted in a variety of medical settings has reported on the prevalence of IPV. Cross-sectional studies from outpatient primary care clinics and ED settings have found the prevalence of IPV among women to be from 6 to 28%; lifetime prevalence rates up to 50% have been reported. Similar rates have been reported by studies conducted in obstetric/gynecologic outpatient clinics. In fact, pregnancy may double the risk of IPV. Differences in prevalence of IPV among various studies can be explained, in part, by their use of different definitions of IPV.
Most studies ask about violence exclusively in the context of heterosexual relationships. However, a similar prevalence of IPV appears to exist in gay and lesbian relationships, with the same physical and emotional consequences. Primary care providers should be aware that it may be more difficult for gay and lesbian patients to disclose that they are in an abusive relationship. In addition, the commonly held bias that violence does not occur in these relationships ("women can't hurt women") further lowers detection rates.
Men report being physically abused by their female partners at rates just below those reported by women. The injuries inflicted by women on men, however, are generally insignificant when compared with same-sex or male-on-female violence.
Many battered women seek medical care both for the direct and indirect consequences of IPV. Yet only a small percentage of them are diagnosed and treated appropriately. The following case is illustrative of the type ...