Intimate Partner Violence Can Exacerbate Medical Problems

Comment: As the article notes, intimate partner violence (IPV) is more prevalent during a woman’s lifetime than diabetes, depression, or breast cancer. However, it is often not recognized by health professionals. Of course, men are not immune to intimate partner violence. This review focuses on women, because the prevalence is much higher and serious injury is more common for women. The review presents three clinical cases, any of which could be seen as part of an otolaryngologist’s practice (asthma, throat pain, chronic headaches). In each case, the care team interacts with and, ultimately, helps support the patient. In the era of #MeToo, patients may feel safer to disclose issues like IPV. To me, this reinforces the importance of truly forming therapeutic relationships with our patients that are built on a foundation of trust and respect. This is true whether we’re seeing someone for the first time or over the course of many years. Adequately screening for, and supporting those dealing with, IPV is not something that can be done via another EMR series of survey click boxes and templated dot phrases. —Jennifer A. Villwock, MD

Given the prevalence of intimate partner violence and its effects on women’s health, what is the best response for effective interventions to be appropriately incorporated into clinical settings?

Bottom Line: Current or past intimate partner violence may be included in the differential diagnosis of many medical and behavioral health conditions, particularly in women. A missed or delayed diagnosis may lead to unnecessary or incorrect tests, procedures, and treatments, and to increased morbidity or mortality.

Background: Intimate partner violence is common, costly, and associated with increased morbidity and mortality. Such violence is more prevalent during a woman’s lifetime than conditions such as diabetes, depression, or breast cancer, yet it often remains unrecognized by health professionals.

Study design: Literature review.

Synopsis: Routine inquiry about partner violence in general medical settings can expose abusive behavior directed toward the patient. The abuse may underlie deterioration in the patient’s health and impair chronic condition management. Women experiencing intimate partner violence have more medical, gynecologic, and stress-related symptoms than non-abused women, and persons who have experienced partner violence are at increased risk of chronic conditions such as asthma, arthritis, stroke, and cardiovascular disease. Chronic stress associated with partner violence may also increase the risk of behavioral coping strategies, such as smoking and other substance use, that contribute to poor health. Particular physical injuries in women (contusions, lacerations, and fractures, especially in the head, neck, and face) are recognized indicators of intimate partner violence. Strangulation, a common but frequently unrecognized form of assault, can have long-term neurologic sequelae due to anoxia. Beneficial clinical programs for addressing intimate partner violence use a multicomponent approach that includes staff training, clinical tools, and connections to follow-up social services.

Citation: Miller E, McCaw B. Intimate partner violence. N Engl J Med. 2019;380:850–857.