Intimate Partner Violence


  • Intimate partner violence (IPV) is a serious, preventable public health problem that affects millions of Americans.  The term "intimate partner violence" describes physical, sexual, or psychological harm by a current or former partner or spouse.  It also includes stalking and intimidation that increases the risk of unplanned pregnancy.  This type of violence can occur among heterosexual or same-sex couples and does not require sexual intimacy.

    The goal is to stop IPV before it begins.  There is a lot to learn about how to prevent IPV.  We do know that strategies that promote healthy behaviors in relationships are important.  Programs that teach young people skills for dating can prevent violence.  These programs can stop violence in dating relationships before it occurs.  (The Centers for Disease Control and Prevention, http://www.cdc.gov/violenceprevention/intimatepartnerviolence/index.html)

  • Intimate partner violence (IPV) is a major public health concern. Recent national media attention has increased discussion regarding this significant health care issue.

    Definition and Background

    The Futures Without Violence Association (FWV) defines intimate partner violence (IPV) as “A pattern of assaultive and coercive behaviors that may include inflicted physical injury, psychological abuse, sexual assault, progressive social isolation, stalking, deprivation, intimidation and threats. These behaviors are perpetuated by someone who is, was, or wishes to be involved in an intimate or dating relationship with an adult or adolescent, and one aimed at establishing control by one partner over the other.”

    Substance abuse has been found to co-occur in 40-60% of IPV incidents across various studies. Several lines of evidence suggest that substance use/abuse plays a facilitative role in IPV by precipitating or exacerbating violence

    Spousal abuse has been identified as a predictor of developing a substance abuse problem and/or addiction. Additionally, women in abusive relationships have often reported being coerced into using alcohol and/or drugs by their partners. Substance abuse and high-risk alcohol use/abuse are more prevalent among women who experience IPV compared to a cohort with no IPV experience. In a study of prenatal patients in North Carolina, victims of violence were significantly more likely to use multiple substances before and during pregnancy than those who had no experience of IPV (American Journal of Public Health).

    Many episodes of IPV involve alcohol and/or illicit drug consumption. Research has found that on days of heavy drug and/or alcohol use, physical violence was 11 times more likely among IPV batterers and victims.

    Health Consequences of IPV

    “IPV is the leading cause of female homicides and injury-related deaths during pregnancy, and accounts for significant preventable injuries and ED visits by women,” (Intimate Partner Violence and Healthy People 2010 Fact Sheet). A 2002 study by the US Department of Justice found that most victims injured by an intimate partner did not report seeking professional medical treatment for their injuries.

    Victims of IPV are at increased risk for suffering serious mental health problems; 56% of women who experience IPV are diagnosed with a psychiatric problem, and victims of IPV are more likely to use tobacco and marijuana. Several studies suggest a significant correlation between IPV, morbid obesity and disturbed eating behaviors. Victims of IPV are 70 percent more likely to drink alcohol heavily than the non-experienced IPV cohort. IPV is also linked to a variety of reproductive health issues.

    The American College of Obstetrics and Gynecology Committee on Health Care for Underserved Women recommends with “clinical signs of depression, substance abuse, mental health problems, requests for repeat pregnancy tests when the patient does not wish to be pregnant, new or recurrent STIs, asking to be tested for an STI, or expressing fear when negotiating condom use with a partner,” that the physical assess the patient for IPV.

    Conclusions

    Although intimate partner violence remains a public health concern, there have been advances in our basic understanding of how to treat perpetrators with co-occurring substance abuse and addiction. “For example, when substance use and IPV co-occur, research suggests that substance use plays a facilitative role in IPV by precipitating or exacerbating violence,” (Psychiatric Times – The Role of Substance Abuse in Intimate Partner Violence).  

    Hence, it is imperative to treat the substance abuse/addiction.  The United States is making progress in addressing this violence. Standard IPV interventions have shown to be ineffective, so referrals to substance abuse or mental health treatment are necessary (Psychiatric Times – The Role of Substance Abuse in Intimate Partner Violence).

    (Source:  Intimate Partner Violence and Co-Occurring Substance Abuse/Addiction, by Richard G. Soper, MD, JD, MS, FASAM, DABAM, Editor-in-Chief | October 6, 2014, ASAM (American Society of Addiction Medicine), http://www.asam.org/magazine/read/article/2014/10/06/intimate-partner-violence-and-co-occurring-substance-abuse-addiction)

Statistics
  • Nearly 31% of women and 26% of men have experienced intimate partner violence in their lifetimes.  (The Centers for Disease Control and Prevention, January 2013) 

  • Greater than 20% of male perpetrators report using alcohol and/or illicit drugs prior to the most recent and severe acts of violence.

    The U.S. Bureau of Justice Statistics report on intimate violence found that 85% of victims are female.

    Women are five to eight times more likely than men to be victimized by an intimate partner. Seventy-five percent of perpetrators are males. Of note, IPV also occurs in lesbian, gay, bisexual and transgender (LGBT) relationships.

    “On average, more than three women a day are murdered by their intimate partner in the United States,” and “Nearly one in four women in the United States report experiencing violence by a current or from a former spouse or boyfriend at some point in their life,” according to Futures Without Violence.  The most current data available from Centers for Disease Control and Prevention finds women experience over 2,000,000 injuries from intimate partner perpetrators. In the United States, the vast majority of nonfatal intimate partner victimizations of women (66%) occur in the home.

    “15.5 million children in the U.S. live in families in which partner violence occurred at least once in the past year,” (Futures Without Violence), and young women who were in shelters as children are now seeking protection from domestic violence situations themselves, according to the 2013 Mary Kay Truth about Abuse Survey.

    Nearly 50% of Native American women experience IPV in their life, the highest rate among US population groups.  (Source:  Intimate Partner Violence and Co-Occurring Substance Abuse/Addiction, by Richard G. Soper, MD, JD, MS, FASAM, DABAM, Editor-in-Chief | October 6, 2014, ASAM (American Society of Addictin Medicine),
    http://www.asam.org/magazine/read/article/2014/10/06/intimate-partner-violence-and-co-occurring-substance-abuse-addiction)

What You Can Do

  • Treat Addiction - Save Lives.  Addiction Medicine specialists can use therapeutic relationships with patients to: “identify intimate partner violence, make brief office interventions, offer continuity of care, and refer them for subspecialty and community-based evaluation, treatment, and advocacy,” (American Family Physician - Intimate Partner Violence).   
  • Centers of higher educations can develop a stronger role in prevention, training students to intervene on behalf of one another and assist victims.