Intimate partner violence

Intimate partner violence (IPV) is domestic violence by a current or former spouse or partner in an intimate relationship against the other spouse or partner. IPV can take a number of forms, including physical, verbal, emotional, economic and sexual abuse. The World Health Organization (WHO) defines IPV as "any behavior within an intimate relationship that causes physical, psychological or sexual harm to those in the relationship, including acts of physical aggression, sexual coercion, psychological abuse and controlling behaviors." IPV is sometimes referred to simply as battery, or as spouse or partner abuse. The most extreme form of IPV is termed intimate terrorism, coercive controlling violence, or simply coercive control. In such situations, one partner is systematically violent and controlling. This is generally perpetrated by men against women, and is the most likely of the types to require medical services and the use of a women's shelter. Resistance to intimate terrorism, which is a form of self-defense, and is termed violent resistance, is usually conducted by women. Studies on domestic violence against men suggest that men are less likely to report domestic violence perpetrated by their female intimate partners. Conversely, men are more likely to commit acts of severe domestic battery, and women are more likely to suffer serious injury as a result. The most common but less injurious form of intimate partner violence is situational couple violence (also known as situational violence), which is conducted by men and women nearly equally, and is more likely to occur among younger couples, including adolescents (see teen dating violence) and those of college age.

Background

Intimate partner violence occurs between two people in an intimate relationship or former relationship. It may occur between heterosexual or homosexual couples and victims can be male or female. Couples may be dating, cohabiting or married and violence can occur in or outside of the home. Studies in the 1990s showed that both men and women could be abusers or victims of domestic violence. Women are more likely to act violently in retaliation or self-defense and tend to engage in less severe forms of violence than men whereas men are more likely to commit long-term cycles of abuse than women. The World Health Organization (WHO) defines intimate partner violence as "any behavior within an intimate relationship that causes physical, psychological or sexual harm to those in the relationship". The WHO also adds controlling behaviors as a form of abuse. According to a study conducted in 2010, 30% of women globally aged 15 and older have experienced physical and/or sexual intimate partner violence. Global estimates by WHO calculated that the incidence of women who had experienced physical or sexual abuse from an intimate partner in their lifetime was 1 in 3. The complications from intimate partner violence are profound. Intimate partner violence is associated with increased rates of substance abuse amongst the victims, including tobacco use. Those who are victims of intimate partner violence are also more likely to experience depression, PTSD, anxiety and suicidality. Women who experience intimate partner violence have a higher risk of unintended pregnancies and sexually transmitted infection, including HIV. This is thought to be due to forced or coerced sex and reproductive coercion (ie. removing a condom during sex or blocking the woman's access to contraception). Children whose parent experiences intimate partner violence are more likely to become victims of IPV themselves or become perpetrators of violence later in life. Injuries that are frequently seen in victims of IPV include contusions, lacerations, fractures (especially of the head, neck and face), strangulation injuries (a strong predictor of future serious injury or death), concussions and traumatic brain injuries.

Assessment

Screening tools The U.S. Preventive Services Task Force (USPSTF) recommends screening women of reproductive age for intimate partner violence, and provide information or referral to social services for those who screen positive. Some of the most studied IPV screening tools were the Hurt, Insult, Threaten, and Scream (HITS), the Woman Abuse Screening Tool/Woman Abuse Screening Tool-Short Form (WAST/WAST-SF), the Partner Violence Screen (PVS), and the Abuse Assessment Screen (AAS). The HITS is a four-item scale rated on a 5-point Likert scale from 1 (never) to 5 (frequently). This tool was initially developed and tested among family physicians and family practice offices, and since then has been evaluated in diverse outpatient settings. Internal reliability and concurrent validity are acceptable. Generally, sensitivity of this measure has found to be lower among men than among women. The WAST is an eight-item measure (there is a short form of the WAST that consists of the first two items only). It was originally developed for family physicians, but subsequently has been tested in the emergency department. It has been found to have good internal reliability and acceptable concurrent validity. The PVS is a three-item measure scored on a yes/no scale, with positive responses to any question denoting abuse. It was developed as a brief instrument for the emergency department. The AAS is a five-item measure scored on a yes/no scale, with positive responses to any question denoting abuse. It was created to detect abuse perpetrated against pregnant women. The screening tool has been tested predominantly with young, poor women. It has acceptable test retest reliability. The Danger Assessment-5 screening tool can assess for risk of severe injury or homicide due to intimate partner violence. A "yes" response to two or more questions suggests a high risk of severe injury or death in women experiencing intimate partner violence. The five questions ask about an increasing frequency of abuse over the past year, use of weapons during the abuse, if the victim believes their partner is capable of killing them, the occurrence of choking during the abuse, and if the abuser is violently and constantly jealous of the victim.

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