Helen M Farrell M.D.

Frontpage Forensics

Intimate Partner Violence

Health consequences and the importance of screening

Posted Jul 16, 2013

Does your doctor ask you if you feel safe at home? Whether it’s a routine office appointment or a specialty visit, your physician should actively screen for violence.

Intimate partner violence (IPV), is often referred to as domestic violence (DV), intra-familial violence, and family violence. The phrase refers to any assault, sexual assault, or other crime that result in the personal injury or death of one or more family members by another who is or was residing in the same dwelling.

Although men can be victims too, women are beaten, raped and murdered by intimate partners more often than strangers, making intimate partner violence (IPV) a major World Health Organization (WHO) concern. The devastating outcomes experienced by battered women range from mental illness and various health problems to death.

The WHO and Center for Disease Control (CDC) have cited IPV as a major concern. It is no surprise that 10% of all homicides are inter-spousal, given that the US Department of Justice has found that up to 50% of married couples in the US will experience at least one episode of violence during their union. The fact that 1/3 of all homicide victims are slain by a husband or boyfriend is consistent with reports that four million women per year are abused by an intimate partner.

The healthcare system is significantly burdened as a direct result of IPV. Battered women have three times more medical visits per year than all woman and the healthcare system therefore, incurs significantly more costs per year. For example, 35% of female visits to the emergency room per year are a direct result of abuse, while 30% of female visits to a clinic are due to abuse. The physical health consequences of IPV permeate all body systems. Some of the physical consequences to women who suffer abuse from their partners are gynecological diseases, unwanted pregnancies, neurological problems, and gastrointestinal disturbances. Women who are pregnant incur a higher risk for abuse. The prevalence of abuse during gestation in the United States is 8%.

Psychiatric services specifically encounter a significant number of abuse victims. 25% of females who visit a psychiatric emergency room have been abused while over 35% of females who attempt or contemplate suicide have been abused. 64% of female psychiatric in-patients are abused.

Development of a Violent Relationship

Different theories have been proposed as to how battering relationships develop. The original theory developed by Dr. Lenore Walker who coined the phrase “Battered Woman Syndrome” (BWS) followed a three-stage cycle of violence. These stages are tension-building, acute battering, and the honeymoon or contrition phase. Dr. Walker proposed that once a woman experienced the complete cycle at least twice, she then qualified for BWS.

Doctors have expanded on this cycle and formulated a dynamic model of abusive relationships, which follow nine stages. Each stage in this dynamic model builds on the where the perpetrator uses charm to firmly integrate himself into the woman’s life. After the second stage, where the perpetrator has shown control and intolerance, he transitions back into a state of affection and proclamations of love. The result is a commitment to the relationship from both partners. The perpetrator will next begin the battery with verbal insults and physical violence. Such acts are always followed by an apology and a short period of contrition. The female victims are charmed by the apology, and actually internalize blame for their partner’s behaviors. This leads to isolation and confusion. Finally, the perpetrator exhibits dominance over his victim and she perceives that it is safer to stay in the relationship rather than leave.

Physicians have a duty to protect their patients from the consequences of abusive relationships. It is imperative that women be screened for violence and the American Medical Association has recommended that routine screening for domestic violence occur at every single physician visit.

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  1. World Health Organization Official Website
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  4.  Federal Bureau of Investigations.  Hate Crime Statistics.  Washington, DC: US Department of Justice, Federal Bureau of Investigations.  2001
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  8. American College of Physicians.  Domestic Violence: Position Paper of the American College of Physicians Philadelphia: American College of Physicians, 1986. 
  9. Walker, L.  The Battered Woman Syndrome.  New York: Springer.  1984
  10. Muer, T., et al.  US Department of Justice Domestic Violence.  National Victim Assistance Academy Textbook.  Washington, DC, 2002

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