Intimate Partner Violence (IPV) Key Considerations

Defined by the World Health Organization as behavior by an intimate partner that causes physical, sexual, or psychological harm, including acts of physical aggression, sexual coercion, psychological abuse, and controlling behaviors. The definition applies to violence by both current as well as former spouses and other intimate partners.1

Scope of the problem:2

  • Between 13% and 61% of women 15-49 years old report that an intimate partner has physically abused them at least once in their lifetime.
  • Between 6% and 59% of women report forced sexual intercourse, or an attempt at it, by an intimate partner in their lifetime.
  • From 1% to 28% of women report they were physically abused during pregnancy, by an intimate partner.

Consequences of Intimate Partner Violence:3

  • perception of overall poor health
  • Gynecologic Conditions-premenstrual syndrome, sexually transmitted diseases, unintended pregnancies, and chronic pelvic pain
  • Psychological Conditions-depression, anxiety, panic disorders, substance use, posttraumatic stress disorder
  • Somatic Complaints-chronic pain, irritable bowel syndrome, headaches

 

Screening Recommendations

Group Recommendation Reference
World Health Organization Advises against IPV screening or routine inquiry about exposures to IPV.  They recommend clinicians ask about IPV when assessing conditions that may be caused or complicated by IPV. 1
Canadian Task Force on Prevention Health Care Insufficient evidence to recommend for or against routine universal screening for violence against either pregnant or non-pregnant women, but recommends that clinicians be alert to signs and symptoms of abuse. 4
US Preventive Services Task Force (USPSTF) Clinicians should screen women of childbearing age (14 to 46 years old) for IPV, and provide or refer women to intervention services when appropriate. 5
American College of Obstetricians and Gynecologists (ACOG) All women should be screened for IPV at periodic intervals, including obstetric care (at first prenatal visit, at least once a trimester, at the post partum checkup). 6
Institute of Medicine All women and girls be screened for IPV due to the magnitude of potential IPV harms. 7

 

Screening Tools - Example:

HITS scale8

Hurt: How often does your partner physically hurt you?
Insult: How often does your partner insult or talk down to you?
Threaten: How often does your partner threaten you with physical harm?
Scream: How often does your partner scream or curse at you?

Each question is answered on a 5 point scale:

1 2 3 4 5
Never Rarely Sometimes Fairly Often Frequently

The score ranges from 4 to a maximum of 20. A score >10 is considered diagnostic of abuse.

 


References

  1. Responding to intimate partner violence and sexual violence against women.  WHO Clinical and Policy Guidelines
  2. Garcia-Moreno C et al. WHO multi-country study on women's health and domestic violence against women: initial results on prevalence, health outcomes, and women's responses. Geneva, World Health organization, 2005.
  3. Ellsberg M, Jansen HA, Heise L, et al.  Intimate partner violence and women's physical and mental health in the WHO multi-country study on women's health and domestic violence: an observational study. Lancet 2008; 371: 1165.
  4. Wathen CN, MacMillan HL, Canadian Task Force on Preventive Health Care. Prevention of violence against women:  recommendation statement from the Canadian Task Force on Preventive Health Care. CMAJ 2003; 169: 582.
  5. Moyer VA, U.S. Preventive Task Force. 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: 478.
  6. ACOG Committee Opinion No. 518: Intimate partner violence. Obstet Gynecol 2012; 119: 412.
  7. Institute of Medicine. Clinical Preventive Services for Women: closing the gaps. July 2011. 
  8. Sherin KM, Sinacore JM, Li XQ, Zitter RE, Shakil A. HITS: a short domestic violence screening tool for use in a family practice setting. Fam Med 1998;30(7):508-512.