Intimate Partner Violence

Intimate partner violence (IPV) is a pattern of physical, sexual, psychological, financial, or technology-facilitated abuse by a current or former intimate partner. Coercive control may involve surveillance, isolation, threats, control of money or transportation, and regulation of everyday activities. It can produce profound harm without a bruise; the absence of visible injury does not indicate low risk. An experienced clinician notices the pattern around the injury. The patient may present repeatedly with “accidents,” delay seeking care, describe chronic pain or gastrointestinal and gynaecological symptoms, or have depression, anxiety, post-traumatic stress, substance use, suicidality, or recurrent head trauma. A partner may answer every question, refuse to leave the room, or control the patient's phone, documents, or medications. These observations do not prove IPV, but they do change the next clinical step: create a private opportunity for inquiry. For example, a patient presents after falling down stairs. The bruising is on the upper inner arm, the explanation changes when the partner leaves, and the patient watches the partner before answering. The priority is not to challenge the explanation or confront the partner....