This article includes discussion of intimate partner violence that may be challenging for some readers.
December 9, 2021
By Anna Owen, MS4, Drexel University College of Medicine
Intimate partner violence (IPV) has many definitions. For this discussion, consider the website Medscape’s definition: victimization of a person with whom the abuser has or has had an intimate, romantic or spousal relationship. Forms of violence are varied and can include physical assault, psychological abuse, stalking, cyberstalking, financial and sexual abuse. The violence is repetitive and escalates in frequency and severity over time. IPV often also involves physical and social isolation of the victim from supports outside the relationship including friends, family, finances and medical care. Overall, IPV is underreported but highly prevalent worldwide. It is more common for women to be victims than men. It can occur in any intimate relationship regardless of the couple’s genders. According to a study done by Doctors Daniel Dicola and Elizabeth Spaar, a conservative estimate suggests 20-30% of women in the US experience IPV in their lifetime, but this estimate is likely low due to underreporting. More than 1,000 deaths a year in the U.S. are homicides that result from intimate partner violence. IPV is a crime.
Often there is a “cycle of violence” pattern that accompanies episodes of IPV. During the first phase of the cycle, tension builds as the abuser increases frequency and intensity of threats and the victim attempts to avoid the violence. Then, the tension breaks with an act of acute abuse. Following this outburst, in the third phase the abuser becomes apologetic and expresses guilt and shame. During this time, there may be promises that the violence will end, or the violence may be blamed on the victim. Non-physical forms of abuse (control, isolation, cruelty) can be more subtle, but are also abuse.
Women will stay in these relationships for a multitude of valid reasons including but not limited to love, hope, dependence, fear and learned helplessness. The “cycle of violence” pattern and the isolation (from work, finances, support system) help to create a dynamic that can make it extremely difficult for people to leave their abuser.
Breaking the pattern of violence is difficult and daunting for patients and their physicians. The first step is simply telling someone else. According to the American College of Obstetricians and Gynecologists, “many abused women feel a great sense of relief – and some sense of safety – once they have told someone outside the home.” To stay safe, it helps to make plans. Safety planning includes making copies of personal documents and keys, securing money, packing essentials (including extra medications), having a place to go, and using code words with trusted confidants. Victims of IPV should also safely research local laws and resources available (some national and Philadelphia-specific resources are provided below). Document any evidence, write down dates and stories, take pictures, and go to the ER for any injuries. Setting aside money with friends or family can provide a safety net for crises. When deciding to leave, it is necessary to plan a safe, quick escape utilizing the police and having an established place to go. Examples of safety planning lists and a safety planning online tool are available at the links below.
IPV causes not only acute physical and psychologic harm but also chronic health problems. This includes chronic abdominal pain, irritable bowel syndrome, pelvic pain, sexually transmitted infections, unintended pregnancy, chronic pain, migraines, anxiety, depression, PTSD, sleep disorders, substance use, preterm birth and low-birth-weight infants.
Health care providers should make people feel comfortable and safe to disclose abuse and should trust and support their patients. In addition, screening of all childbearing age patients for IPV is recommended by the USPSTF to decrease abuse and harm to patients. Few negative effects of screening have been noted. If IPV is noted, patients should safely receive information on resources, safety planning and local shelters.
Drexel's Employee Assistance Program is available to help employees in need of support through confidential, 24/7 counseling at 888.628.4824. This is offered at no cost to benefits-eligible faculty and professional staff, their family members, and Drexel graduate students. More information is available on the Human Resources website. Students can reach out for support via Student Wellbeing.
National Intimate Partner Violence Resources:
- Futures Without Violence - futureswithoutviolence.org
Posters, brochures and safety planning cards
- National Coalition Against Domestic Violence - ncadv.org
Online tool for creating a safety plan
- National Domestic Violence Hotline - 1-800-799-SAFE or ndvh.org
Help with safety planning and crisis interventions
Philadelphia Specific Intimate Partner Violence Resources:
Resources:
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