Intimate Partner Violence: A Primer for Emergency Medicine Practitioners

/

National Domestic Violence Hotline Number: 800-799-7233

OVERVIEW & EPIDEMIOLOGY

Intimate partner violence (IPV) is a widespread public health problem. By definition, IPV refers to actual or threatened psychological, physical, or sexual harm by a current or former partner or spouse. The exact scope of the issue is difficult to ascertain given that a large proportion of incidents go unreported but is estimated to affect over 12 million people in the United States every year (1).

 The 2011 National Intimate Partner and Sexual Violence Survey, an anonymous telephone survey, revealed that 32% of females and 28% of males had experienced physical violence, rape, and/or stalking by an intimate partner in their lifetime (2). There is a relative paucity of data regarding intimate partner violence in non-heterosexual relationships, though recent studies have demonstrated that individuals who identify as sexual and gender minorities likely experience similar or increased rates of IPV (3,4). The risk of IPV also increases with pregnancy and during the postpartum period, with at least one incident reported in 4-8% of pregnancies in one national survey (5). Other risk factors include young age (with rates peaking in late adolescence and early adulthood), low socioeconomic status, minority race, and exposure to violence during childhood (6). However, it is important to note that anyone can be a victim of intimate partner violence – absence of risk factors should not preclude consideration of IPV in the appropriate clinical context.

Besides injuries sustained directly from abuse, intimate partner violence has been shown to be associated with several chronic symptoms and medical conditions including headaches, musculoskeletal pain, chest pain, sexually transmitted infections, and urinary tract infections among several others (7). Increased rates of depression, anxiety, post-traumatic stress disorder, and suicide have also been observed (8-10). In females, IPV is associated with type 2 diabetes, cardiovascular disease, and increased all-cause mortality (11).

SCREENING FOR IPV IN THE EMERGENCY DEPARTMENT

The Emergency Department often serves as a first point of contact for survivors of intimate partner violence. Studies have shown that women experiencing intimate partner violence are more likely to seek medical care than to seek assistance from social services or criminal justice agencies (12), and it is estimated that approximately 6% of patients presenting to the Emergency Department have experienced IPV within the past year (13).

With its unique ability to reach patients isolated from the rest of the healthcare system, the Emergency Department has an important opportunity to provide screening for intimate partner violence.  In 2024, the U.S. Preventive Services Task Force (USPSTF) released their recommendation that all pregnant/postpartum persons and women of reproductive age be screened routinely for intimate partner violence. There is no established gold-standard screening tool, so IPV screening protocols vary greatly amongst individual Emergency Departments (14) and are often integrated into nursing triage protocols. It is important for providers to familiarize themselves with the screening protocols in place at their institutions, and to consider IPV in patients that may not undergo screening. Screening should be performed in private, and questions should be posed in a nonjudgemental, open-ended fashion.

MANAGEMENT CONSIDERATIONS

Once intimate partner violence has been identified, providers should follow the principles of trauma-informed care to build a therapeutic alliance and prevent retraumatization. Any disclosure by the patient should be met with empathy and validation of their experience. During history taking, providers should use active listening techniques and avoid excessive questioning regarding the details of the abuse. The approach to the physical exam should prioritize patient autonomy. If the exam requires the patient to undress, the patient should be given the opportunity to do this themselves, in private if possible, and they should be provided with a gown/drape. Each component of the exam should be explained to the patient ahead of time, and the patient should have the opportunity to ask questions and give permission for the exam (15).

All patients that have disclosed IPV should undergo a basic safety assessment while in the Emergency Department. If the patient is to be discharged from the Emergency Department, providers should inquire whether the patient feels safe leaving. If not, alternative arrangements should be discussed, such as staying at a domestic violence shelter, or with a friend or family member. A safety plan should also be discussed. The National Domestic Violence Hotline website has an interactive tool to assist in the creation of a personalized safety plan. If available, a social worker or representative from a local organization can often assist with these conversations and with potential placement (15).

Documentation of the patient encounter should be carefully considered. It is important to note that perpetrators may have access to the patient’s medical records, and patients have the right to request that information regarding IPV be left out of their medical chart. Similar logic should be applied when providing patients with physical resources pertaining to IPV, such as discharge paperwork. However, thorough documentation can alert future providers to the issue for follow-up purposes and can be important if the patient seeks legal action.  

REFERENCES

  1. Centers for Disease Control and Prevention. The National Intimate Partner and Sexual Violence Survey (NISVS). Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 2001.

  2. Breiding MJ, Smith SG, Basile KC, et al. Prevalence and characteristics of sexual violence, stalking, and intimate partner violence victimization--national intimate partner and sexual violence survey, United States, 2011. MMWR Surveill Summ 2014; 63:1.

  3. Valentine SE, Peitzmeier SM, King DS, et al. Disparities in Exposure to Intimate Partner Violence Among Transgender/Gender Nonconforming and Sexual Minority Primary Care Patients. LGBT Health 2017; 4:260.

  4. Bermea AM, Slakoff DC, Goldberg AE. Intimate Partner Violence in the LGBTQ+ Community: Experiences, Outcomes, and Implications for Primary Care. Prim Care 2021; 48:329.

  5. Tjaden P, Thoennes N. Full report of the prevalence, incidence, and consequences of violence against women: findings from the National Violence Against Women Survey. Publication no. NCJ-183781, US Department of Justice, Washington, DC 2005.

  6. Capaldi, Deborah M., et al. "A systematic review of risk factors for intimate partner violence." Partner abuse 3.2 (2012): 231-280.

  7. Bonomi AE, Anderson ML, Reid RJ, et al. Medical and psychosocial diagnoses in women with a history of intimate partner violence. Arch Intern Med 2009; 169:1692.\

  8. Heise L, Garcia-Moreno C. Violence by intimate partners. In: Krug E, Dahlberg LL, Mercy JA, et al., editors. World Report on Violence and Health. Geneva, Switzerland: World Health Organization; 2002. p. 87-121.

  9. Silverman JG, Decker MR, Reed E, Raj A. Intimate partner violence victimization prior to and during pregnancy in U.S. women: associations with maternal and neonatal health. Am J Obstet Gynecol. 2006;195:140-8.

  10. Devries KM, Mak JY, Bacchus LJ, et al. Intimate partner violence and incident depressive symptoms and suicide attempts: a systematic review of longitudinal studies. PLoS Med. 2013;10:e1001439.

  11. Chandan JS, Thomas T, Bradbury-Jones C, et al. Risk of Cardiometabolic Disease and All-Cause Mortality in Female Survivors of Domestic Abuse. J Am Heart Assoc 2020; 9:e014580.

  12. Dawson, Angela J., et al. “The emergency department response to women experiencing intimate partner violence: Insights from interviews with clinicians in Australia.” Academic Emergency Medicine, vol. 26, no. 9, 25 Mar. 2019, pp. 1052–1062, https://doi.org/10.1111/acem.13721.

  13. Reisenhofer, Sonia, and Carmel Seibold. “Emergency healthcare experiences of women living with intimate partner violence.” Journal of Clinical Nursing, vol. 22, no. 15–16, 2 Nov. 2012, pp. 2253–2263, https://doi.org/10.1111/j.1365-2702.2012.04311.x.

  14. Choo, Esther K., and Debra E. Houry. “Managing intimate partner violence in the emergency department.” Annals of Emergency Medicine, vol. 65, no. 4, Apr. 2015, https://doi.org/10.1016/j.annemergmed.2014.11.004.

  15. Weil, Amy. “Intimate Partner Violence: Intervention and Patient Management.” UpToDate,www.uptodate.com/contents/intimate-partner-violence-intervention-and-patient-management. Accessed 23 May 2025.

Authorship

Written by Colleen Arnold, MD, PGY-3, University of Cincinnati Department of Emergency Medicine

Peer Review and Editing by Kelli Jarrell, MD, Associate Professor, University of Cincinnati Department of Emergency Medicine

Cite As: Arnold, C. Jarrell, K. Intimate Partner Violence: A Primer for Emergency Medicine Practitioners. TamingtheSRU.com. www.tamingthesru.com/blog/electives/intimate-partner-violence-a-primer-for-emergency-providers. 6/20/2025