Men and women in same sex and heterosexual relationships are at risk, and actual intimacy is not required to establish the diagnosis (ergo, the term “domestic violence” is sometimes used). The lifetime risk for IPV in different clinical settings worldwide ranges from 5% to 44% within the past year and 10% to 60% over a lifetime. All ages and sociodemographic groups are affected, but risk is increased in reproductive age women, patient and partner abuse of alcohol and/or drugs, marital troubles, lower academic achievement, poor self-esteem, and financial difficulties. In one study, the prevalence of IPV in women who smoked and engaged in problem drinking more than doubled, from 10% to 27% in the previous year; lifetime prevalence of IPV in this population increased from 27% to 54%. Pregnancy seems to be a particularly common time for IPV, with one in six women reporting physical or sexual assault during pregnancy. Additional risk factors include marital instability (divorces, separations), other unhealthy family relationships, and traditional views of gender roles. Being single, separated, or divorced and living with a male friend or family members other than a husband were associated with higher rates of violence.

Victims of IPV are at risk for injury, sexually transmitted infections, unintended pregnancies, pregnancy coercion, and death surrounding the acts of violence. The long-term consequences of gynecologic disorders, chronic pain, gastrointestinal disorders, and neurologic disorders are 50% to 70% more prevalent in this population than in nonabused women. Consequently, a wide range of office presentations is possible. Unexplained migraine headache, hypertension, recurrent urinary infections, pelvic pain, back pain, abdominal pain, and dyspareunia are significantly more common among abused women than among those who have never been abused. Other manifestations include worsening symptoms of a chronic condition, depression, anxiety, dizziness, fainting, seizures, severe premenstrual symptoms, irritable bowel symptoms, and alcohol abuse, which may be among the presenting manifestations. Patients are at increased risk for somatization disorders, complications of pregnancy, sexually transmitted diseases, eating disorders, substance abuse, and nonadherence with medical regimens.

Repeated visits to the emergency room for “falls” or forearm injuries sustained during attempts at self-defense are characteristic, as are findings such as multiple ecchymoses in various stages of healing. Other characteristics of trauma include a central distribution of injuries, involvement of the head and face, and hearing loss. Suspicion should also be raised with any injury to the head, neck, teeth, or genitals that does not have an adequate explanation, and when these patients are frequently accompanied to the office or emergency room by an overly aggressive partner.