Intimate Partner Violence: The Silent Epidemic
Primary Care Update
Brief Summaries for Clinical Practice
Although the prevalence of intimate partner violence in the United States is arousing increased alarm, its importance as a medical issue is less acknowledged. Recently, however, in a consensus report on women’s health, the Institute of Medicine recommended screening and counseling all women and adolescent girls for interpersonal and domestic violence as part of preventive health services.1
THE SCOPE OF THE PROBLEM
Consider the following statistics from the CDC’s National Intimate Partner and Sexual Violence Survey2:
•One in 4 women has been a victim of severe physical violence by an intimate partner in her lifetime (Table). The injuries resulting from intimate partner violence can be serious; in one study of 218 women who presented to a metropolitan emergency department with such injuries, 28% required hospitalization and 13% required major surgical treatment. One third of the cases involved the use of a weapon, such as a knife, club, or gun.3
•About 1 in 10 women has been raped by an intimate partner during her lifetime.
•Almost 70% of female victims experienced some form of intimate partner violence for the first time before the age of 25.
•Female victims of intimate partner violence were significantly more likely to have physical and mental health problems than non-victimized women and girls.
Women who experienced physical violence by an intimate partner in their lifetime were more likely to report frequent headaches, chronic pain, difficulty in sleeping, activity limitations, poor physical health, and poor mental health. They were also more likely to report having asthma, irritable bowel syndrome, and diabetes than women who did not experience intimate partner violence.2
Unfortunately, many women are too frightened or too embarrassed to reveal that they are victims of intimate partner violence. Most abused women do not disclose incidents of domestic violence to their health care providers; more than half do not tell anyone about such incidents.2
Primary care clinicians are ideally placed to identify and counsel women who have suffered intimate partner violence. They are usually the health care providers of first resort who are most likely to encounter abused women in the course of their practice. Moreover, because they may see such patients on a regular basis, they are more likely to establish a relationship of mutual trust that can encourage women to disclose incidents of intimate partner violence.
TRAINING FOR HEALTH CARE PROVIDERS
It is essential to provide patients with an opportunity to discuss their experiences or concerns about intimate partner violence. Clinicians must also be aware of the steps necessary to ensure the safety and autonomy of abused patients. This includes both information about legal options available to patients and knowledge of their own legal responsibilities for reporting intimate partner violence and/or sexual assault; these vary from state to state. The CDC publishes an extensive guide to training materials and programs dealing with intimate partner violence.4
1. Institute of Medicine of the National Academies. Clinical Preventive Services for Women: Closing the Gaps. Released July 19, 2011. Available at: http://www.iom.edu/Reports/2011/Clinical-Preventive-Services-for-Women-Closing-the-Gaps.aspx. Accessed December 28, 2011.
2. Black MC, Basile KC, Breiding MJ, et al. The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 Summary Report. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. 2011. Available at: http://www.cdc.gov/violenceprevention/nisvs/. Accessed December 28, 2011.
3. Berrios DC, Grady D. Domestic violence: risk factors and outcome. West J Med. 1991;155:133-135.
4. Fisher D, Lang KS, Wheaton J. Training Professionals in the Primary Prevention of Sexual and Intimate Partner Violence: A Planning Guide. Atlanta, GA: Centers for Disease Control and Prevention; 2010. Available at: http://www.cdc.gov/ViolencePrevention/pub/training_guide.html. Accessed December 28, 2011.