Intimate Partner Violence

Intimate partner violence (IPV) is a public health crisis that knows no boundaries; it affects people from all walks of life of any age, gender, sexuality, ability, race, and social standing. Acts of IPV can be committed by a current or former spouse or romantic partner and may or may not include sexual violence. It impacts at least tens of millions of people in the U.S. annually.

What is Intimate Partner Violence (IPV)?

Any behavior meant to cause psychological, physical, or sexual harm within a personal relationship is defined as IPV. The exact type of behaviors, the rate at which they occur, and their impact are all variables. Statistically, within IPV, various types of abuse are intertwined and can lead to many economic, physical, and psychological consequences. 

Types of Abuse

IPV is typically connected to other forms of abuse. Most cases of abuse don’t even begin with violence but with other behaviors present in the relationship.  Common abusive behaviors exhibited in intimate partner relationships may include:
  • Psychological abuse — Often termed verbal or emotional abuse, the abuser may use verbal or nonverbal means to isolate, frighten, or exhibit control over the abused. This is often done with gaslighting, saying, and doing things to harm the other person emotionally or mentally through manipulation. 
  • Sexual violence  This is the attempt or act of touching, non-physical communication or attempting to force someone into taking part in any sexual acts against their will. 
  • Physical aggression/violence — This is often not the first type of violence or abuse to be noticed, but it may be the first type of abuse the victim notices. Behaviors may include throwing items, punching walls, breaking things, hitting, kicking, or any other form of physical force against another person. 
  • Stalking —  This describes repeated unwanted attention by someone that causes one to feel fearful or question their safety.



More than 60 million women and 50 million men in the U.S. have reported psychological aggression by a partner. Worldwide, approximately 38 percent of murders are committed by a male partner, and up to 852 million women report being abused. Of the nearly 5,000 female victims of murder and non-negligent manslaughter in 2021, 34 percent were killed by an intimate partner.
Other consequences of IPV include:

Mental Health
  • Anxiety
  • Depression
  • PTSD
  • Insomnia/sleep difficulties
  • Suicidal ideation
  • Dizziness
  • Headaches
  • Stroke
  • Traumatic brain injury
  • Arterial dissection
  Substance Abuse
  • Higher incidences of alcohol consumption, smoking, intravenous drugs or generalized substance use
  • Chest pain
  • Hypertension
  • Hyperlipidemia
  • Heart disease
  • Diabetes
  • Pelvic pain
  • Dyspareunia
  • Vaginal infections (recurrent)
  • Pregnancy (unintended/unwanted)
  • Higher risk of labor and birth adverse outcomes, such as preterm birth or low birth weight
  • Cervical cancer
  • Increased risk of sexually transmitted infections (STIs)
  • Human immunodeficiency virus (HIV)
  Chronic Diseases
  • Chronic pain
  • Liver failure
  • Musculoskeletal problems
  • Kidney and/or urinary problems
  • Respiratory illnesses
  • Gastrointestinal conditions
  • Fibromyalgia
Many behavioral and mental health issues may follow if children are in a home where violence occurs. According to experts, more than two-thirds of adolescents have reported being exposed to violence, both indirectly and directly. This exposure can occur when one parent is seen being abused by another parent, partner, family member, or other close individual. The actual abuse can also carry over to the children. The overall number of U.S. children who have lived in homes where violence occurs is more than 15 million. Children who are exposed to IPV are at a much higher risk of being abused or being an abuser themselves.  The high occurrence of this exposure places adolescents at risk for mismanagement of their emotions, mental health conditions (such as anxiety, depression, PTSD), and poor coping behaviors (such as impulsiveness, unsafe sexual activity, and substance abuse).   


Healthcare Response

The needs of the patient experiencing IPV will vary from patient to patient. This may differ from what a clinician may expect to see or be prepared to offer during the patient encounter. Healthcare professionals, however, must educate themselves on IPV, their state-specific laws regarding IPV, mandated reporting requirements, and available resources to provide to patients that choose to accept them when they come through the doors of a clinical setting.   

National Protocol 

Clinicians will encounter patients experiencing IPV in all clinical settings. The National Protocol for Intimate Partner Violence Medical Forensic Examinations provides guidance and tools for all clinicians when caring for patients that disclose experiencing intimate partner violence. The U.S. Department of Justice Office on Violence Against Women (OVW), in partnership with the International Association of Forensic Nurses (IAFN), recently released the landmark National Protocol for Intimate Partner Violence Medical Forensic Examinations. This is the first evidence-based guidance with best practice recommendations for clinicians in various settings. It can be used to develop policies and procedures regarding intimate partner violence medical forensic examinations. An interactive version of the protocol, with ready-to-use tools and expanded resources, is available here.

A Medical forensic examination should be offered to all patients experiencing IPV, not limiting the exam to only those that experience sexual assault or strangulation as an incident of their abuse. The medical forensic examination is a  comprehensive assessment that prioritizes the patient’s health and well-being while planning for or preserving information for potential use by the legal system. Components of a medical forensic examination include:
  • Gather a forensic medical history
  • Complete physical assessment
  • Treatment of injuries
  • If there are other healthcare concerns, be sure to address each and provide the necessary care
  • Gather samples for evidence
  • Photo Documentation of findings 
  • Written documentation of the patient’s encounter 
  • Safety planning, discharge instructions that include targeted referrals tailored to meet the patient’s needs
It is essential that all healthcare professionals understand the broad specifics of IPV and that there is no one-size-fits-all approach. A clinician is responsible for providing patients with healthcare, support, and resources while ensuring they have been informed of their options to make the necessary decisions regardless of the patient’s choice to leave their abuser and/or report their abuse to local law enforcement.  It is also important to note that healthcare clinicians should educate themselves on their state laws regarding what does and does not fall under the mandatory reporting umbrella. For example, if an adult seeking medical abuse treatment does not wish to report it to law enforcement, clinicians may not be mandated to report it. However, if there is a child involved, and there is suspicion that the child is also being abused, which would meet the requirements for mandated reporting to child protective services. 

Final Thoughts

As a clinician, how can you help? Seek educational opportunities to learn more about IPV and expand your nursing skills. IAFN offers an IPV nurse examiner certificate program. This 100% virtual certificate course is for any nurse who wishes to obtain the education to correctly identify, assess, and provide comprehensive care to patients experiencing IPV.  This virtual certificate course is open to anyone with at least an RN license. It includes interactive online modules, handouts, articles, and video simulations with patients who have experienced intimate partner violence. It provides 15 contact hours in nursing upon completion. Additionally, you can learn more about the resources and available IPV-specific victim services providers in your local area to familiarize yourselves with what is available for the patients you care for.    References: Spivak, H., et al (2014). CDC Grand Rounds: A Public Health Approach to Prevention of Intimate Partner Violence. MMWR.  The International Association of Forensic Nursing (IAFN).(2023).  National Protocol for Intimate Partner Violence Medical Forensic Examinations Centers for Disease Control and Prevention (CDC). (2022). Fast Facts: Preventing Intimate Partner Violence International Association of Forensic Nurses (IAFN). (2020). Intimate Partner Violence Nurse Examiner Heinze, J. et al. (2021). Adolescent Exposure to Violence and Intimate-Partner Violence Mediated by Mental Distress. Journal of Applied Developmental Psychology.  Office on Women’s Health. (2021). Effects of domestic violence on children

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