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Intimate partner violence: Epidemiology and health consequences

Amy Weil, MD, FACP
Section Editor
Joann G Elmore, MD, MPH
Deputy Editor
Howard Libman, MD, FACP


Intimate partner violence (IPV) is a serious, preventable public health problem affecting more than 32 million Americans [1]. In countries around the world, 10 to 69 percent of women report physical assault by an intimate partner at some time in their life [2].

The term "intimate partner violence" describes actual or threatened psychological, physical, or sexual harm by a current or former partner or spouse. IPV can occur among heterosexual or same-sex couples and does not require sexual intimacy.

Abusive relationships often begin as verbal and emotional abuse but may become physical. Most women who are victims of physical aggression experience multiple episodes of aggression over time [3]. While "intimate terrorism," in which a passive victim in an abusive relationship lives in constant fear for the next episode of abuse, is the classic IPV paradigm, IPV may be mutual/bidirectional ("situational violence") or may take the form of "violent resistance," in which the identified victim fights back [4].

The underlying psychological dynamic in most types of violence is power and control of the victim by the abuser. The assumption that, within a heterosexual relationship, all violence is initiated by men and directed towards women is not correct, although women are far more likely to experience IPV than men [2].

This topic will review the epidemiology and health consequences of intimate partner violence. Screening and diagnosis of IPV is discussed separately, as is management for patients in whom IPV is diagnosed. (See "Intimate partner violence: Diagnosis and screening" and "Intimate partner violence: Intervention and patient management".)

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Literature review current through: Nov 2017. | This topic last updated: Sep 26, 2017.
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  1. Tjaden P, Thoennes N. Extent, nature, and consequences of intimate partner violence: findings from the National Violence Against Women Survey. Publication No. NCJ-181867, US Department of Justice, Washington, DC 2000.
  2. The World Health Organization. World report on violence and health. Chapter 4. Violence by intimate partners. http://www.who.int/violence_injury_prevention/violence/global_campaign/en/chap4.pdf (Accessed on August 07, 2011).
  3. Heise L, Garcia-Moreno C. Violence by intimate partners. In: World report on violence and health, Krug E, Dahlberg LL, Mercy JA, et al (Eds), World Health Organization, Geneva 2002.
  4. Intimate Partner Violence in Practical Gynecology: A Guide for the Primary Care Physician, 2nd ed, Ryden J, Blumenthal PD, Charney P (Eds), American College of Physicans, 2009.
  5. Saltzman LE, Fanslow JL, McMahon PM, Shelley GA. Intimate Partner Violence Surveillance: Uniform Definitions and Recommended Data Elements (Version 1.0). Centers for Disease Control and Prevention. National Center for Injury Prevention and Control, Atlanta 2002. Available at: http://www.cdc.gov/ncipc/pub-res/ipv_surveillance/intimate.htm#Read (Accessed on June 20, 2012).
  6. Intimate Partner Violence. Masachusetts Medical Society Committee on Violence Intervention and Prevention. 5th Edition. http://www.massmed.org/AM/Template.cfm?Section=Home6&CONTENTID=36015&TEMPLATE=/CM/ContentDisplay.cfm (Accessed on August 08, 2012).
  7. McFarlane J, Malecha A, Watson K, et al. Intimate partner sexual assault against women: frequency, health consequences, and treatment outcomes. Obstet Gynecol 2005; 105:99.
  8. Ellsberg, M, Heise, L. Researching Violence Against Women: A Practical Guide for Researchers and Activists. World Health Organization/PATH, Washington, DC 2005. Available at: http://www.who.int/reproductivehealth/publications/violence/9241546476/en/ (Accessed on June 22, 2012).
  9. Sumner SA, Mercy JA, Dahlberg LL, et al. Violence in the United States: Status, Challenges, and Opportunities. JAMA 2015; 314:478.
  10. 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.
  11. Kimerling R, Iverson KM, Dichter ME, et al. Prevalence of Intimate Partner Violence among Women Veterans who Utilize Veterans Health Administration Primary Care. J Gen Intern Med 2016; 31:888.
  12. Bureau of Justice Statistics; Intimate Partner Violence 1993 to 2010 http://www.bjs.gov/index.cfm?ty=pbdetail&iid=4536 (Accessed on January 31, 2016).
  13. Finneran C, Stephenson R. Intimate partner violence among men who have sex with men: a systematic review. Trauma Violence Abuse 2013; 14:168.
  14. Nasrullah, Oraka, Chavez, et al. Nonvolitional sex and HIV-related sexual risk behaviours among MSM in the United States. AIDS 2015; 29:1673.
  15. http://bjs.ojp.usdoj.gov/index.cfm?ty=tp&tid=971#summary (Accessed on April 22, 2011).
  16. Crandall ML, Nathens AB, Kernic MA, et al. Predicting future injury among women in abusive relationships. J Trauma 2004; 56:906.
  17. Garcia-Moreno C, Jansen HA, Ellsberg M, et al. Prevalence of intimate partner violence: findings from the WHO multi-country study on women's health and domestic violence. Lancet 2006; 368:1260.
  18. Stöckl H, Devries K, Rotstein A, et al. The global prevalence of intimate partner homicide: a systematic review. Lancet 2013; 382:859.
  19. Hillard PJ. Physical abuse in pregnancy. Obstet Gynecol 1985; 66:185.
  20. Stewart DE. Incidence of postpartum abuse in women with a history of abuse during pregnancy. CMAJ 1994; 151:1601.
  21. Gazmararian JA, Lazorick S, Spitz AM, et al. Prevalence of violence against pregnant women. JAMA 1996; 275:1915.
  22. 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.
  23. Goodwin MM, Gazmararian JA, Johnson CH, et al. Pregnancy intendedness and physical abuse around the time of pregnancy: findings from the pregnancy risk assessment monitoring system, 1996-1997. PRAMS Working Group. Pregnancy Risk Assessment Monitoring System. Matern Child Health J 2000; 4:85.
  24. Finer LB, Zolna MR. Unintended pregnancy in the United States: incidence and disparities, 2006. Contraception 2011; 84:478.
  25. McFarlane J, Campbell JC, Sharps P, Watson K. Abuse during pregnancy and femicide: urgent implications for women's health. Obstet Gynecol 2002; 100:27.
  26. Wallace ME, Hoyert D, Williams C, Mendola P. Pregnancy-associated homicide and suicide in 37 US states with enhanced pregnancy surveillance. Am J Obstet Gynecol 2016; 215:364.e1.
  27. Silverman JG, Raj A. Intimate partner violence and reproductive coercion: global barriers to women's reproductive control. PLoS Med 2014; 11:e1001723.
  28. Miller E, Decker MR, McCauley HL, et al. Pregnancy coercion, intimate partner violence and unintended pregnancy. Contraception 2010; 81:316.
  29. Rennison C. Intimate partner violence 1993-2001. Publication no. NCJ-197838, Bureau of Justice Statistics; US Department of Justice, Washington, DC 2003.
  30. McCloskey LA, Lichter E, Ganz ML, et al. Intimate partner violence and patient screening across medical specialties. Acad Emerg Med 2005; 12:712.
  31. Renner LM, Whitney SD. Risk factors for unidirectional and bidirectional intimate partner violence among young adults. Child Abuse Negl 2012; 36:40.
  32. Lehrer JA, Buka S, Gortmaker S, Shrier LA. Depressive symptomatology as a predictor of exposure to intimate partner violence among US female adolescents and young adults. Arch Pediatr Adolesc Med 2006; 160:270.
  33. Khalifeh H, Oram S, Trevillion K, et al. Recent intimate partner violence among people with chronic mental illness: findings from a national cross-sectional survey. Br J Psychiatry 2015; 207:207.
  34. Gracia E, López-Quílez A, Marco M, et al. The Spatial Epidemiology of Intimate Partner Violence: Do Neighborhoods Matter? Am J Epidemiol 2015; 182:58.
  35. Marshall AD, Panuzio J, Taft CT. Intimate partner violence among military veterans and active duty servicemen. Clin Psychol Rev 2005; 25:862.
  36. Mechem CC, Shofer FS, Reinhard SS, et al. History of domestic violence among male patients presenting to an urban emergency department. Acad Emerg Med 1999; 6:786.
  37. Centers for Disease Control and Prevention (CDC). Adverse health conditions and health risk behaviors associated with intimate partner violence--United States, 2005. MMWR Morb Mortal Wkly Rep 2008; 57:113.
  38. Blosnich JR, Bossarte RM. Comparisons of intimate partner violence among partners in same-sex and opposite-sex relationships in the United States. Am J Public Health 2009; 99:2182.
  39. 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.
  40. Plichta SB. Intimate partner violence and physical health consequences: policy and practice implications. J Interpers Violence 2004; 19:1296.
  41. Rees S, Silove D, Chey T, et al. Lifetime prevalence of gender-based violence in women and the relationship with mental disorders and psychosocial function. JAMA 2011; 306:513.
  42. 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.
  43. Sugg N. Intimate partner violence: prevalence, health consequences, and intervention. Med Clin North Am 2015; 99:629.
  44. Buller AM, Devries KM, Howard LM, Bacchus LJ. Associations between intimate partner violence and health among men who have sex with men: a systematic review and meta-analysis. PLoS Med 2014; 11:e1001609.
  45. Nixon RD, Resick PA, Nishith P. An exploration of comorbid depression among female victims of intimate partner violence with posttraumatic stress disorder. J Affect Disord 2004; 82:315.
  46. Dutton MA, Green BL, Kaltman SI, et al. Intimate partner violence, PTSD, and adverse health outcomes. J Interpers Violence 2006; 21:955.
  47. Dube SR, Anda RF, Felitti VJ, et al. Exposure to abuse, neglect, and household dysfunction among adults who witnessed intimate partner violence as children: implications for health and social services. Violence Vict 2002; 17:3.
  48. Silverman JG, Decker MR, Reed E, Raj A. Intimate partner violence victimization prior to and during pregnancy among women residing in 26 U.S. states: associations with maternal and neonatal health. Am J Obstet Gynecol 2006; 195:140.
  49. Ludermir AB, Lewis G, Valongueiro SA, et al. Violence against women by their intimate partner during pregnancy and postnatal depression: a prospective cohort study. Lancet 2010; 376:903.
  50. Appel AE, Holden GW. The co-occurrence of spouse and physical child abuse: a review and appraisal. J Fam Psychology 1998; 12:578.
  51. Taylor CA, Guterman NB, Lee SJ, Rathouz PJ. Intimate partner violence, maternal stress, nativity, and risk for maternal maltreatment of young children. Am J Public Health 2009; 99:175.
  52. Parkinson GW, Adams RC, Emerling FG. Maternal domestic violence screening in an office-based pediatric practice. Pediatrics 2001; 108:E43.
  53. McAllister TW, Stein MB. Effects of psychological and biomechanical trauma on brain and behavior. Ann N Y Acad Sci 2010; 1208:46.
  54. Yehuda R. Post-traumatic stress disorder. N Engl J Med 2002; 346:108.
  55. Coker AL, Smith PH, Fadden MK. Intimate partner violence and disabilities among women attending family practice clinics. J Womens Health (Larchmt) 2005; 14:829.
  56. Hughes K, Bellis MA, Jones L, et al. Prevalence and risk of violence against adults with disabilities: a systematic review and meta-analysis of observational studies. Lancet 2012; 379:1621.
  57. Roberts TA, Klein JD, Fisher S. Longitudinal effect of intimate partner abuse on high-risk behavior among adolescents. Arch Pediatr Adolesc Med 2003; 157:875.