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Intimate partner violence

Background

Overview

Definition
Intimate partner violence is defined as any form of aggression or harmful behavior within a romantic relationship. This can include physical, sexual, or psychological harm, as well as controlling behaviors by a current or former partner.
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Pathophysiology
The pathophysiology of intimate partner violence is complex and multifaceted, involving an interplay of individual, relational, and societal factors. Substance abuse, mental health issues, and societal norms can also contribute to the occurrence of intimate partner violence.
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Epidemiology
Intimate partner violence is a significant global issue and is estimated to affect nearly 1 in 3 women worldwide within their lifetime.
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Disease course
It can manifest in various forms, including physical, sexual, and emotional abuse. Physical abuse often results in injuries, with musculoskeletal injuries being the second most common manifestation. These injuries can range from minor bruises and cuts to severe fractures and burns. It can also lead to sexual violence, which can result in STIs and unintended pregnancies. Emotional abuse, another form of intimate partner violence, can lead to mental health conditions such as depression, PTSD, anxiety disorders, substance abuse, and suicidal behavior.
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Prognosis and risk of recurrence
The prognosis is often characterized by escalating severity and chronicity. The violence can increase in frequency and severity over time, leading to more serious health consequences for the victim. Victims of intimate partner violence are also at an increased risk of future violence.
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Guidelines

Key sources

The following summarized guidelines for the evaluation and management of intimate partner violence are prepared by our editorial team based on guidelines from the U.S. Preventive Services Task Force (USPSTF 2018), the American Academy of Family Physicians (AAFP 2016), and the World Health Organization (WHO 2013). ...
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Screening and diagnosis

Indications for screening
As per USPSTF 2018 guidelines:
Screen for intimate partner violence and abuse in women of reproductive age and provide or refer women with a positive screen to ongoing support services.
B
Insufficient evidence to assess the balance of benefits and harms of screening all older or vulnerable adults for abuse and neglect.
I
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  • Choice of screening tool

Diagnostic investigations

History and physical examination: as per WHO 2013 guidelines, elicit a complete history in female survivors of sexual assault, including time since assault and type of assault, risk of pregnancy, risk of HIV and other STIs, and mental health status, record events to determine what interventions are appropriate, and perform a complete physical examination (head-to-toe including genitalia).
A

Medical management

Emergency contraception: as per WHO 2013 guidelines, offer emergency contraception to survivors of sexual assault presenting within 5 days of sexual assault, ideally as soon as possible after the assault, to maximize effectiveness.
B
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  • Post-exposure STD prophylaxis

Nonpharmacologic interventions

First-line support
As per WHO 2013 guidelines:
Offer immediate support to all females disclosing any form of violence by an intimate partner (or other family member) or sexual assault by any perpetrator. Offer first-line support as a minimum to females disclosing violence, including:
being nonjudgmental and supportive and validating what the woman is saying
providing practical care and support responding to but not intruding on her concerns
asking about her history of violence, listening carefully but not pressuring her to talk (take care when discussing sensitive topics when interpreters are involved)
helping her access information about resources, including legal and other services that she might think helpful
assisting her to increase safety for herself and her children where needed
providing or mobilizing social support
A
Ensure that the consultation is conducted in private and ensure confidentiality while informing females of the limits of confidentiality, such as when there is mandatory reporting.
A

More topics in this section

  • Psychological support

  • Support after sexual assault