Chapter 50 Intimate Partner Violence
Intimate partner violence (IPV), also known as domestic violence, is defined as a pattern of assaultive and coercive behavior by an individual against a current or former intimate partner. Intimate partners may be heterosexual or homosexual. Eighty-five percent of the time, IPV involves a woman being abused by a male partner.1 However, violence against men by women and violence against a partner in a same-sex relationship also occur. IPV may also extend to dating violence.
Intimate partner violence is a global health problem. It is estimated that, one in every five women worldwide has been abused physically by a current or former partner.2 Numerous studies report that American women experience a similar incidence of physical or sexual abuse.3
• Women account for 85% of the victims of IPV; men account for approximately 15%.4
• Women are much more likely than men to be killed by an intimate partner. IPV accounts for 33.5% of murders of women, but less than 4% of murders of men.5
• For many complex reasons, including embarrassment and fear, IPV is underreported. Underreporting is especially prevalent in same-sex relationships and among abused men.
The emergency nurse must understand that IPV can be found in all economic, racial, religious, educational, and age groups. Victims have no specific personality type, occupation, or sexual orientation profile. Factors that place women at increased risk for IPV include the following6:
In the United States, African-Americans experience IPV at rates higher than those of other racial groups.1 Nearly one third of black American women experience IPV in their lifetimes compared with one quarter of white American women.7 Most victims are not identified unless a health care provider directly and sensitively asks about the possibility of IPV.
Types of Intimate Partner Violence
Intimate partner violence takes many forms, including physical abuse, emotional abuse, psychological abuse, and sexual abuse and economic control. Although it is possible to experience only a single type of abuse, those in IPV situations commonly report multiple categories of abuse over time, particularly if the relationship remains unchanged. Table 50-1 summarizes common manifestations of IPV.
TABLE 50-1 MANIFESTATIONS OF INTIMATE PARTNER VIOLENCE
| Physical | |
| Emotional | |
| Sexual | |
| Economic |
Teen Dating Violence
According to the Centers for Disease Control and Prevention (CDC), dating violence is a type of IPV. The underpinnings of this power and control relationship are similar to those that occur with adults.8 Research by the Liz Claiborne Corporation9 showed the following astonishing IPV facts:
• One in five teens who have been in a serious relationship have been hit, slapped, or pushed by their partner.
• One in three girls expressed concern for physical harm from their partner.
• One in four teens in a serious relationship have experienced a situation in which their partner (both boys and girls) tried to keep them from spending time with friends or family.
• One in four girls in a relationship reported sexual activity as a result of pressure.
A 2006 CDC survey confirms that both males and females may be victims of physical dating violence.10 Of the 14,956 students surveyed, prevalence was 8.9% for males and 8.8% for females.10 Teenagers at risk for dating violence include those whose partner is depressed and known to have aggressive behaviors.
Same-Sex Intimate Partner Abuse
In 2008 Brown11 reported on same-sex IPV, which led to changes in how IPV is assessed in the emergency care setting. Studies have found the following11:
• IPV is the third largest problem facing gay men.
• IPV occurs at similar and possibly higher frequency in the gay, lesbian, bisexual, and transgender community.
Although many elements of IPV are similar for same-sex relationships as for heterosexual relationships, some key differences exist including the following12:
• Same-sex victims have more difficulty finding support because of their sexual orientation.
• Making use of resources and services for help may involve the victim revealing his or her sexual orientation to others who may not have been aware of it.
• The silence about domestic violence in this community further isolates the victim.
• The risk of losing children to another party is higher for lesbian and gay couples.
Facts Related to Same-Sex Intimate Partner Violence12
• Incidence of domestic violence is 25% to 33%.
• Many shelters and safe houses for battered women deny services to same-sex victims.
• Only seven states define domestic violence to include same-sex victims.
• Perpetrators use the threat of “outing” their partner to family and friends as a means of control and power.
• One in eight rape victims is male.
• Eighty-one percent of male victims had their protection order violated.
Identifying Intimate Partner Violence
Victims of IPV present to emergency departments (EDs) with a multitude of complaints ranging from multiple trauma to milder physical and mental health symptoms. Chronic medical and psychological conditions, minor and serious injuries, depression, suicidal behavior, sexually transmitted infections, substance abuse, and even death are only a few of the health consequences of IPV. In addition to physical injuries, a number of stress-related conditions have been linked to IPV, such as chronic neck and back pain, recurrent headaches, chronic pelvic pain, indigestion, diarrhea, constipation, gastritis, and spastic colon. Overall, victims of IPV have more surgeries, medical visits, and hospitalizations than persons without a history of abuse.13
Signs and Symptoms Suggestive of Abuse
The following signs and symptoms potentially suggest IPV as the cause:
• The patient describes the alleged “accident” in a hesitant, embarrassed, or evasive manner, or avoids eye contact.
• The extent or type of injury is inconsistent with the explanation offered by the patient.
• The victim has a history of traumatic injuries or frequent ED visits.
• The patient denies physical abuse but has unexplained bruises; areas of erythema or bruises in the shape of a hand or other object; lacerations, burns, scars, fractures, or multiple injuries in various stages; mandibular fractures; or a perforated tympanic membrane.
• The patient expresses a fear of returning home or concern for the safety of his or her children.
• Injuries are in areas hidden by clothing or hair (e.g., head, chest, breasts, abdomen, genitals). Unintentional trauma generally involves injuries to the extremities, whereas IPV often involves truncal, head, and neck injuries.
• The partner (or suspected abuser) accompanies the patient, insists on staying close to the patient, and tries to answer all questions directed to the patient.
• The patient admits to past or present physical or emotional abuse as a victim or as a child witness.
• The woman is pregnant. Homicide is the leading cause of death for pregnant women, and intimate partners are the most common perpetrators.14
• The victim shows evidence of sexual assault.
• The patient is the caregiver of an abused child.
• A substantial delay occurred between the time of injury and presentation for treatment. The patient may have been prevented from seeking medical attention sooner or may have had to wait for the batterer to leave.
• The patient has psychosomatic complaints such as panic attacks, anxiety, a choking sensation, or depression.
• A complaint of chronic pain (especially back or pelvic pain), with no substantiating physical evidence, often signifies fear of impending or actual physical abuse.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
