Addressing Intimate Partner Violence in Primary Care Practice

Leigh Kimberg, MD

Disclosures
In This Article

Prevalence of Intimate Partner Violence

Intimate partner violence is exceedingly common in the United States and the world. In a national telephone survey sponsored by the National Institute of Justice and the Centers for Disease Control and Prevention (NIJ/CDC), 24.8% of women reported rape and/or physical assault by an intimate partner in their lifetime. Furthermore, 1.5% of all women in this study reported rape and/or physical assault by an intimate partner in the past 12 months.[1] Violence against women is largely perpetrated by their intimate partners; 76% of women who reported having been raped and/or assaulted as adults were assaulted by an intimate partner.[1] As disturbing as these data are, experts have proposed that data from national surveys probably underestimate the true prevalence, because these surveys do not include "'the very poor' (without telephones), those who do not speak English fluently, or individuals who are institutionalized, hospitalized, homeless, or incarcerated at the time of the survey."[2]

The prevalence of intimate partner violence specifically has not been studied as extensively in adolescent girls as in adult women. In the NIJ/CDC study, rape was predominantly perpetrated on girls; 54% of all women reporting rape stated that their first rape occurred before the age of 18.[1] Data suggest that adolescents are at high risk for interpersonal violence (even higher than for adults) from various family members, intimate partners, and others.[3,4]

A recent comprehensive review[5] of the worldwide data on violence against girls and women revealed the ubiquitous nature of intimate partner violence in the world.Intimate partner violence against girls and women is perpetrated, almost exclusively, by men and boys.[1,5] Intimate partner violence in lesbian relationships exists, but data on the prevalence of abuse in lesbian relationships are scarce.[6]

Whereas abuse of women and girls by a male intimate partner or ex-partner is of epidemic proportions, a far smaller proportion of men experience violence in their intimate relationships. In the NIJ/CDC study, 7.8% of men reported physical assault and/or rape by an intimate partner during their lifetime (0.9 % during the past 12 months).[1] Men experience extremely high levels of violence in US society, yet this violence is far less likely to occur in the context of an intimate relationship. Of the men who report being raped and/or physically assaulted as adults, 82% are assaulted by someone other than an intimate partner.[1] In intimate heterosexual relationships, when men are the victims of violence they are much less likely to be severely injured than women in violent relationships.[1] Men in violent heterosexual relationships, also, are unlikely to be victims of a "battering syndrome" in which a female partner exerts power and control over her male partner.[7] Violence against men is largely perpetrated by other men; 86% of men raped and/or physically assaulted were assaulted by other men who were strangers or acquaintances.[1]

Homosexual men, also, are at risk of abuse by their male partners. Again, there is a dearth of studies done in homosexual male populations. The little data that exist suggest that the prevalence of abuse in male homosexual relationships may be at least equivalent to the prevalence of abuse in women and girls by men in heterosexual relationships[6] (Kaplan B, Personal communication - San Francisco General Hospital, UCSF; 2000).

In the healthcare setting, women who have been or are being abused are over-represented as compared with the prevalence determined by community surveys. In large prospective emergency department studies, 37% to 54% of women seen in the emergency department have been abused by an intimate partner at some point in their lives.[8.9] In one of these studies, 11% of the women seen in an emergency department presented as a result of acute abuse.[8]

In studies of pregnant women, estimates of prevalence of abuse during pregnancy range from 0.9% to 20.1% (with most studies finding 4% to 8%).[10] The study that reported the highest prevalence was one in which trained nurses asked patients in public health prenatal clinics about intimate partner violence at every prenatal visit.[11,12] In this study, pregnant teens were at even higher risk than adult women for interpersonal violence: 21.7% had been physically or sexually abused during the pregnancy, as compared with 15.9% of adult pregnant women attending the same clinic; 68% of the physical and/or sexual abuse of these pregnant teens was reported as being perpetrated by an intimate partner. Pregnant adolescents are also at risk of physical and sexual assault by other family members, acquaintances, and strangers.[11,12,13]

Studies (cross-sectional surveys) done in primary care settings also reveal a high prevalence for intimate partner violence: 5.5% to 22.7% for current or recent (past year) intimate partner violence and 28% to 66% for lifetime intimate partner violence.[14,15,16,17,18,19,20,21] These studies used different screening methods (including different definitions of intimate partner violence, with some including prevalence of emotional or psychological intimate partner violence[16,17,18,20] and others referring strictly to physical and/or sexual assault[14,15,21]) and studied different populations of patients.

Sexual assault in intimate partner violence has not been extensively studied but is probably quite common. In a shelter-based study,[22] sexual assault was estimated to have occurred in 40% of violent relationships, to cause severe physical and psychological effects, and to remain hidden without direct inquiry.Clinic-based studies have found that 33%[17] to 43%[18] of all intimate partner violence victims have experienced sexual intimate partner violence.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....