Intimate Partner Violence

Authors: Trevor Wilson, MD, Beth Kaplan, MD
Updated: 7/31/2013

Intimate Partner Violence (IPV)

Definition: Physical, sexual, or psychological harm by a current or former partner or spouse; occurs among heterosexual and same-sex couples

Epidemiology: Lifetime estimates for IPV in women= 22-39%

Sequelae: Untreated IPV results in many physical and psychological morbidities.

Pearl: Physicians should screen, document,intervene, and provide resources.

Screening

  • U.S. Preventive Services Task Force: Level B recommendation for screening women of child-bearing age
    • High certainty that the net benefit is moderate.
    • Costs and potential harms of screening appear to be outweighed by potential for early intervention with screening.
  • Interview patient alone. Frame: “Because violence is so common, we’re routinely asking our patients about their safety in their relationships.”
  • Increase suspicion of abuse when overly protective partner, history inconsistent with injury, vague complaints, or pregnancy.

SAFE Questions

Topic Question
Stress/Safety Do you feel safe in your relationship?
Afraid/Abused Have you ever been in a relationship where you were threatened, hurt, or afraid?
Friend/Family Are your friends aware you have been hurt?
Emergency Plan Do you have a safe place to go and the resources you need in an emergency?

Document

Convey constructive messages:

  • “Nobody deserves to be treated this way. You are not alone.”
  • “I am concerned about your safety and health. There is help. I’d like you to speak with an advocate/counselor.”

Assess immediate safety for patient in ED.

Involve social work. Provide list of shelters, resources, and hotline.

Define safety plan for discharge.

Resources

References

  • Ashur ML. Asking about domestic violence: SAFE questions. JAMA. 1993;269(18):2367. [PubMed]
  • Moyer VA. Screening for intimate partner violence and abuse of elderly and vulnerable adults: U.S. preventive services task force recommendation statement. Ann Intern Med. 2013;158(6):478-86. [PubMed]