Normalizing Screening for Intimate Partner Violence

Intimate partner violence (IPV), also known as domestic violence, is a serious issue for millions of people in the US. 

The Centers for Disease Control (CDC) reports that 1 in 4 women and 1 in 9 men will experience severe physical violence, sexual violence, or stalking. As many as 43 million women and 38 million men have experienced emotional abuse.

This type of trauma has wide-ranging emotional and physical effects on the health of millions. And it has deadly consequences. Data from U.S. crime reports shows that almost 1 in 5 homicides are committed by intimate partners, and more than half of female murder victims are killed by former or current partners.

We can do a better job of identifying signs of intimate partner violence.

What Is Domestic Violence?

Domestic violence is a pattern of abusive behavior in an intimate relationship where one partner tries to control and dominate the other. The behavior may be verbally, psychologically, physically, sexually, financially, technologically, or legally abusive. The victim is left feeling scared, confused, dependent, and insecure. 

In Connecticut, it is a crime to assault, threaten, harass, strangle, or stalk an intimate partner.

4 Main Types of Abuse

It’s important for behavioral health professionals to recognize the warning signs of abuse, use screening tools to identify potentially abusive situations, and to help connect people with resources that can help them escape dangerous situations and access resources for healing.

There are four main categories of abuse, although not every experience fits neatly into a category.

1. Physical violence is hitting, kicking, or using some kind of physical force.

2. Sexual violence is forcing or attempting to force a partner to take part in non-consensual physical or non-physical (e.g., sexting) sexual activity.

3. Stalking is repeatedly contacting or following someone, causing concern or fear for their own safety, or that of someone close to them. 

4. Psychological aggression is verbal and non-verbal communication meant to harm someone mentally or emotionally — or to control them. 

Physical and Emotional Warning Signs 

Because of the control abusers often exert over their partners, people experiencing abuse are not always forthcoming about what is going on in their lives. Some might try to mask physical or emotional signs of abuse, and they might not have a good explanation for what happened. 

Behavioral health professionals and community members can be on the lookout for physical and emotional signs that someone might be experiencing intimate partner violence.

Physical Signs of Intimate Partner Violence

• Bruises or physical injuries on arms
• Black eyes
• Torn lips
• Marks on their neck
• Wrist sprains
• Wearing heavy makeup to mask injuries
• Wearing clothing (like scarves or long sleeves) to cover injuries

Emotional Signs of Abuse

When people are living in fear of a partner, they might begin to act differently as a result of their trauma response. The following are some emotional signs that may signal intimate partner violence.

• Constant worry, anxiety, or agitation
• Sleeping more or not enough
• Problems with substance use
• Lack of self-confidence or self-esteem
• Loss of interest in activities
• Fear
• Depression
• Talking about suicide, or attempting suicide 

Screening for Intimate Partner Violence

The Connecticut Women’s Consortium Training Intimate Partner Violence: Screening and Interventions for Health Professionals and Community Providers discusses the reasons that clinicians may be hesitant to ask about intimate partner violence or to offer screening. They may feel uncomfortable initiating a conversation, or they might not know what to do if someone reveals they are being abused and are worried about mandatory reporting. Some might feel frustrated if patients do not follow a plan of care. 

But most research shows that patients support IPV assessments, and there is much more benefit for health and safety than harm. If clinicians don’t screen, patients can slip through the cracks and suffer greater injury—or even death. That’s why major organizations like the American Medical Association, the American Academy of Pediatrics, and the American Nursing Association all recommend screening for intimate partner violence—even when clients or patients don’t show signs or symptoms of abuse. 

The Most Important Question

There is one universal screening question that all behavioral health professionals should be asking for IPV: “Is there anyone in your life who is hurting or threatening you in any way?”

If they answer “yes,” a number of follow up questions should be asked. An IPV questionnaire includes questions such as the following: 

Does your partner

• Physically hurt you?
• Insult or talk down to you?
• Threaten you with harm?
• Scream or curse at you?
• Make you do things sexually you’re not comfortable with?

The Screening Process

There are a number of best practices that will help one screen for IPV more effectively.

1. Confidentiality. Establish a policy where each client spends time alone for some part of their visit. Know and establish confidentiality boundaries by telling clients what mandatory reporting opportunities are in your state.

2. Universal education. Incorporate IPV questions into your social history or intake process. You can use language like, “We’ve started talking with all of our clients about safe and healthy relationships because it can have such a large impact on your health.”

3. Empowerment. Provide everyone with information on healthy relationships and resources like hotline numbers. In Connecticut, we have a universal 24/7 IPV hotline called SafeConnect: 1-888-774-2900.

4. Support. If someone discloses that they are experiencing IPV, clinicians can follow these steps:

5. Validate: “I am sorry this is happening to you. Help is available.”

6. Educate on how relationships affect health and explain resources.

7. Refer them—immediately—to SafeConnect or another resource in your area.

8. Treat for specific concerns and follow up.

Screening Works

We look forward to living in a society with fewer violent and controlling relationships and more healthy ones. By making screening a regular part of our professional conversations, we are doing our part to reduce the pain and trauma of abuse.

Screening is effective. One study showed that women who talked to a health provider about abuse were 4 times more likely to use an intervention and almost 3 times as likely to exit an abusive relationship. 

When we normalize talking about intimate partner violence in our communities and trauma-informed practices, we encourage individuals to take action to stop violence or exit dangerous relationships.

That’s a healthier world.