Key Points

• The American Association of Family Physicians estimates that one third of patients cared for by family physicians are affected by family violence.

Box 45-1 Common Symptoms Associated with a Crisis or Trauma

• Children are adversely affected by intimate partner violence and may need a referral to child-focused treatment.

• Family violence leads to 39,000 physician visits and 73,000 hospitalizations annually.

Intimate partner violence (IPV) is a specific type of crisis requiring some special consideration; we use this term throughout this chapter to account for diverse populations and types of abuse. The Family Violence Prevention Fund (FVPF, 2004) defines intimate partner violence 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 perpetrated by someone who is, was, or wishes to be involved in an intimate or dating relationship with an adult or adolescent, and are aimed at establishing control by one partner over the other."

Worldwide, at least 10% to 50% of women have been physically or sexually abused in their lifetime (WHO, 2001). Annually, 2 to 4 million women and 835,000 men are assaulted by intimate partners in the United States (National Institute of Justice). Lifetime prevalence of physical or sexual abuse by an intimate partner of U.S. women is 20% to 30%, and for men, 7.5% (FVPF, 2004). From 22% to 46% of gays and lesbians have been victims of physical IPV (AAFP, 2000). Between 2000 and 4000 U.S. women die from these injuries each year. Up to one in six pregnant women is abused during pregnancy (AAFP, 2000). One study showed that IPV increased health care costs in affected women by 92% (Ramsay et al., 2009). Family violence leads to 39,000 physician visits and 73,000 hospitalizations annually (Kass-Bartelmes and Rutherford, 2004).

A common and costly problem, IPV is receiving increased attention. Several professional organizations and other groups have made policy statements and recommendations; some mandate screening. The majority of IVP research is about violence committed by men against women, although recent epidemiologic studies show that IPV remains a significant problem in male homosexual relationships and occurs in all types of relationships (FVPF, 2004). The previous statistics on IPV are even more striking when considering that IPV is almost universally underreported (Watts and Zimmerman, 2002). Many studies assess only physical violence, not accounting for the psychological, economic, and emotional abuse that may exist alone or with other forms of violence.

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