Intimate partner violence is physical, sexual or emotional abuse or controlling behavior by a current or former partner. It is common and often hidden, so clinicians screen women of reproductive age in private and offer support, safety planning and resources without judging.
Key symptoms
- Injuries with an explanation that does not fit
- Chronic pain, headaches, stomach or pelvic complaints
- Anxiety, depression, PTSD, substance use
- Partner who answers for the patient or will not leave the room
- Missed appointments, delay in care, unplanned pregnancy
What you find on exam
- Interview the patient alone, with a professional interpreter if needed
- Injuries to the head, face, neck, chest, breasts or abdomen
- Bruises of different ages or defensive injuries on the forearms
- Signs of strangulation: neck marks, hoarse voice, eye hemorrhages
Tests
- Screening with a validated tool such as HITS
- Imaging for injuries as needed
- Pregnancy test and STI testing when relevant
- Danger assessment for lethality risk
Treatment basics
- Listen, believe and tell the patient it is not their fault
- Treat injuries and document carefully, with photos if the patient agrees
- Safety planning and referral to advocates and the national hotline
- Follow state reporting laws, respecting the patient's choices
- Follow up visits and mental health care
Red flags
- History of strangulation or threats with a weapon
- Violence increasing in frequency or severity, or during pregnancy
- Patient fears for their life or for their children
Practice it in Making Synapses
Making Synapses cases
Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.