Physical injuries, psychologic problems, social isolation, loss of a job, financial difficulties, and even death can result.
Doctors may suspect domestic violence based on injuries, inconsistent or puzzling symptoms, or the behavior of the victim and/or the victim's partner.
Keeping safe—for example, having a plan of escape—is the most important consideration.
Domestic violence can occur between children and parents or guardians, grandparents, or siblings, as well as intimate partners. It occurs among people of all cultures, races, sexual orientations, genders, occupations, income levels, educational levels, religious backgrounds, and ages.
Women are more commonly victims of domestic violence than are men. About 95% of people who seek medical attention as a result of domestic violence are women.
About 1 in 4 women and nearly 1 in 10 men have experienced sexual violence, physical violence, and/or stalking by an intimate partner during their lifetime. Women are more likely to be severely assaulted or killed by a male partner than by anyone else. Each year in the United States, experts estimate that about 2 million women are severely beaten by their partner.
In the United States, domestic violence is as prevalent (or more prevalent) among lesbian and bisexual women, gay and bisexual men, and transgender people as among the general population.
During the COVID-19 pandemic, domestic violence became more common in many countries. Reasons probably include stress due to loss of income and loss of contact with other people. Also, people who were abused often could not escape to a shelter or another safe place.
Did You Know...
Physical abuse is the most obvious form of domestic violence. It may include hitting, slapping, kicking, punching, breaking bones, pulling hair, pushing, twisting arms, slamming against something, choking, suffocating, beating, and burning. The victim may be deprived of food or sleep. Weapons, such as a gun or knife, may be used to threaten or cause injury.
Many people who are physically assaulted by their partner are also sexually assaulted by their partner (see Rape and Sexual Assault Sexual Assault and Rape Sexual assault is any type of sexual activity or contact that a person does not consent to. Sexual assault, including rape, may cause physical injury or illness or psychologic trauma. Survivors... read more ). Sexual assault is any type of sexual activity or contact that a person does not consent to, including unwanted touching, grabbing, kissing, and rape Sexual Assault and Rape Sexual assault is any type of sexual activity or contact that a person does not consent to. Sexual assault, including rape, may cause physical injury or illness or psychologic trauma. Survivors... read more . If sexual activity occurs without consent, it is considered sexual assault, even it occurs between people who have had consensual sex at other times before or after the assault. Sexual assault may involve the use of threats or force to coerce sexual contact, or the perpetrator may give the victim alcohol or drugs. It may cause physical injury or illness or psychologic trauma.
Psychologic abuse is very common. It may start before or at the same time as physical or sexual abuse. Psychologic abuse involves any nonphysical behavior that undermines or belittles the victim or that enables the perpetrator to control the victim. Psychologic abuse can include
Usually, the perpetrator uses language to demean, degrade, humiliate, intimidate, or threaten the victim in private or in public. The perpetrator may make the victim think that her perceptions of reality are wrong and that she is crazy (called gaslighting) or guilty or responsible for the abusive relationship. The perpetrator may also humiliate the victim in terms of sexual performance, physical appearance, or both.
The perpetrator may try to partly or completely isolate the victim by controlling the victim’s access to friends, relatives, and other people. Control may include forbidding contact with others—directly or through writing, telephone, e-mail, texting, or social media. The perpetrator may use jealousy to justify these actions. The perpetrator may convince the victim that family members and friends cannot or will not help and thus further isolate the victim.
Often, the perpetrator withholds money to control the victim. The victim may depend on the perpetrator for money (most or all). The perpetrator may maintain control by preventing the victim from getting a job, by keeping information about their finances secret, and by taking money from the victim.
The perpetrator may also prevent the victim from getting medical care.
Abuse using technology
Perpetrators may use technology (such as social media) to post videos of, stalk, monitor, isolate, punish, threaten, and/or humiliate the victim. Also, perpetrators often monitor the victim's devices, often without the victim's knowing it.
The perpetrator's behavior after abuse
After an incident of abuse, the perpetrator may beg for forgiveness and promise to change and stop the abusive behavior. However, typically, the abuse continues and often escalates.
The perpetrator's outbursts of violence tend to be episodic and unpredictable. Thus, victims may live in near-constant fear of the next outburst.
Reasons victims remain in an abusive relationship
Often, victims do not leave the abusive relationship. Reasons may include
Feeling dependent on the perpetrator for money
Feeling alone, with no one to help
Being afraid that planning or trying to leave will trigger more intense violence
Being afraid of what the perpetrator will do after they leave (for example, stalk them or hurt their children, another family member, or a pet)
Believing that the abuser will change (for example, because of promises to do so)
Still loving the abuser
Believing that abuse may be normal (for example, because of previous experiences)
Effects of Domestic Violence
Victims of domestic violence may be physically injured. Physical injuries can include bruises, black eyes, cuts, scratches, broken bones, lost teeth, and burns. Injuries may interfere with the victim's ability to work. As a result, income may be lost. Injuries, as well as the abusive situation, may cause embarrassment, causing victims to isolate themselves from family and friends.
Victims may develop symptoms that have no obvious physical cause. These symptoms can include headaches, abdominal or pelvic pain, and fatigue.
Many victims also get sexually transmitted infections Overview of Sexually Transmitted Infections (STIs) Sexually transmitted infection (STI) refers to an infection that is passed through blood, semen, vaginal fluids, or other body fluids during oral, anal, or genital sex with an infected partner... read more and have problems during pregnancy.
Victims may have to move often—a financial burden—to escape the perpetrator.
Sometimes the perpetrator kills the victim.
Did You Know...
As a result of domestic violence, many victims have psychologic problems, such as depression Depression A short discussion of prolonged grief disorder. Depression is a feeling of sadness and/or a decreased interest or pleasure in activities that becomes a disorder when it is intense enough to... read more , posttraumatic stress disorder Posttraumatic Stress Disorder (PTSD) Posttraumatic stress disorder (PTSD) involves intense, unpleasant, and dysfunctional reactions beginning after an overwhelming traumatic event. Events that threaten death or serious injury can... read more (PTSD), eating disorders Overview of Eating Disorders Eating disorders involve a disturbance of eating or of behavior related to eating, typically including Changes in what or how much people eat Measures people take to prevent food from being... read more and/or substance abuse Substance Use Disorders Substance use disorders generally involve behavior patterns in which people continue to use a substance (for example, a recreational drug) despite having problems caused by its use. The substances... read more . More severe physical abuse is usually related to more severe psychologic problems. Domestic violence may also worsen symptoms of preexisting mental disorders.
Even when physical abuse decreases, psychologic abuse often continues, reminding victims that they can be physically abused at any time. Psychologic abuse can be more damaging than physical abuse. Psychologic abuse increases the risk of depression and substance abuse.
Evaluation of Domestic Violence
A doctor's evaluation
Doctors may suspect domestic violence based on injuries, inconsistent or puzzling symptoms, and/or the behavior of the victim and/or partner. Or a victim may report the abuse.
If doctors suspect domestic violence, they may ask the person if they feel safe in their relationship and in their home. Many experts recommend that health care practitioners ask all people questions about domestic violence.
If domestic violence is suspected, doctors try to determine whether the victim can safely return home before leaving the health care facility. Safety is in doubt in the following circumstances:
The victim has threatened to leave the relationship.
Violence has been increasing.
The partner has access to weapons.
The partner has threatened to kill or injure the victim.
If domestic violence is confirmed, doctors are required to document the evidence of abuse, often by photographing the injuries. This documentation can be used to support a legal case against the perpetrator.
Management of Domestic Violence
Developing a safety plan
Seeking help when needed
Abuse is never justified. Support is available whether victims decide to stay in or leave the abusive relationship.
In cases of domestic violence, the most important consideration is safety. If possible, during a violent incident, victims should try to move away from areas in which they can be trapped or in which the perpetrator can obtain weapons, such as knives in the kitchen. If possible, victims should promptly call 911 or the police and leave the residence.
Victims should have any injuries treated and documented with photographs. Victims should teach their children not to get in the middle of a fight and when and how to call for help.
Developing a safety plan is extremely important. It should include
Where to go for help (victims should have several possible places to go and people who can be called)
How to get away (often including appearing to do a routine task that involves leaving the house, such as going on an errand or walking the dog)
How to access money (including hiding money away and obtaining a separate bank account and, if possible, credit card)
Victims should also make and hide copies of official documents (such as children’s birth certificates, social security cards, insurance cards, and bank account numbers). They should keep an overnight bag packed and hidden in case they need to leave quickly.
Sometimes the only solution is to leave the abusive relationship permanently because domestic violence tends to continue, especially among very aggressive perpetrators. Also, even when physical abuse decreases, psychologic abuse may persist.
The decision to leave is not simple or easy. Often, victims feel unable to leave an abusive relationship for many reasons, including being afraid of what the perpetrator will do after they leave and being dependent on the perpetrator for money.
After the perpetrator knows the victim has decided to leave, the victim’s risk of serious harm and death may be greatest. At this time, victims should take additional steps to protect themselves and their children. For example, they can obtain a restraining or protection order, although such an order does not guarantee safety.
Help is available through shelters for battered women, support groups, the courts, and a national hotline (1-800-799-SAFE or, for TTY, 1-800-787-3224). The National Domestic Violence Helpline also has chat options if the victim is unable to speak safely. Victims should seek such help even if abuse is not severe. Seeking such help does not necessarily cause trouble for the partner. Information about using technology safely is available online.
The following are some English-language resources that may be useful. Please note that THE MANUAL is not responsible for the content of these resources.
Centers for Disease Control and Prevention (CDC): Intimate Partner Violence. This web site provides links to fast facts, prevention strategies, dating, risk and protective factors, and the National Intimate Partner and Sexual Violence Survey, which is an ongoing survey that collects the most current and comprehensive national and state data on intimate partner violence, sexual violence and stalking victimization in the United States.
Centers for Disease Control and Prevention (CDC): Sexual Violence Resources. Resources include links to the CDC's publications about sexual violence, related issues such as mental health after a disaster, rape prevention, and sex trafficking.