(See also Child Maltreatment Overview of Child Maltreatment Child maltreatment includes all types of abuse and neglect of a child under the age of 18 by a parent, caregiver, or another person in a custodial role (eg, clergy, coach, teacher) that results... read more and Elder Abuse Elder Abuse Elder abuse is physical or psychologic mistreatment, neglect, or financial exploitation of older adults. Common types of elder abuse include physical abuse, psychologic abuse, neglect, and financial... read more .)
Domestic violence occurs among people of all cultures, races, sexual orientations, genders, occupations, income levels, and ages. In the US, more than 10 million adults experience domestic violence every year.
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. Women are more likely to be severely assaulted or killed by a male partner than by anyone else. In the US, 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 (1 General references Domestic violence includes physical, sexual, and psychologic abuse between people who live together including sex partners, parents or guardians and children, children and grandparents, and... read more ).
In the US, 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 (2 General references Domestic violence includes physical, sexual, and psychologic abuse between people who live together including sex partners, parents or guardians and children, children and grandparents, and... read more ).
During the COVID-19 pandemic, domestic violence became more prevalent 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 (3 General references Domestic violence includes physical, sexual, and psychologic abuse between people who live together including sex partners, parents or guardians and children, children and grandparents, and... read more ).
Physical abuse is the most obvious form of domestic violence. It may include hitting, slapping, kicking, punching, breaking bones, pulling hair, pushing, and twisting arms. The victim may be deprived of food or sleep. Weapons, such as a gun or knife, may be used to threaten or cause injury.
Sexual assault is also common; many women who are physically assaulted by their partner are also sexually assaulted by their partner. Sexual assault is any type of sexual activity or contact that a person does not consent to. Sexual assault involves the use of threats or force to coerce sexual contact and includes unwanted touching, grabbing, or kissing, as well as rape Medical Examination of the Rape Victim 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 .
Psychologic abuse may be even more common than physical abuse and may precede it or occur at the same time. 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 victims think they are crazy (gaslighting) or make them feel guilty or responsible, blaming them for the abusive relationship. The perpetrator may also humiliate victims in terms of their 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 direct, written, telephone, or e-mail contact with others. The perpetrator may manipulate the victim into thinking that others cannot or will not help, or use jealousy to justify these actions. The perpetrator may also prevent the victim from accessing medical care.
Often, the perpetrator withholds money to control the victim. The victim may depend on the perpetrator for most or all of their money. The perpetrator may maintain control by preventing the victim from getting a job, by withholding information about their finances, and by taking money.
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.
Perpetrators may use technology (eg, social media web sites, phones) to post videos or stalk the victim and to monitor, isolate, punish, threaten, and/or humiliate victims (4 General references Domestic violence includes physical, sexual, and psychologic abuse between people who live together including sex partners, parents or guardians and children, children and grandparents, and... read more , 5 General references Domestic violence includes physical, sexual, and psychologic abuse between people who live together including sex partners, parents or guardians and children, children and grandparents, and... read more ). Also, perpetrators can monitor the victim's devices, often without the victim's knowing it.
2. Brown TNT,, Herman JL: Intimate partner violence and sexual abuse among LGBT people: A review of existing research. Williams Institute, 2015. Accessed 6/16/22.
3. Noman AHM, Griffiths MD, Pervin S, et al: The detrimental effects of the COVID-19 pandemic on domestic violence against women. J Psychiatr Res 134:111–112, 2021. doi: 10.1016/j.jpsychires.2020.12.057 Epub 2020 Dec 22.
4. Woodlock D: The abuse of technology in domestic violence and stalking. Violence Against Women 23 (5):584–602, 2017. doi: 10.1177/1077801216646277 Epub 2016 Jul 9.
5. Henry N, Powell A: Technology-facilitated sexual violence: A literature review of empirical research. Trauma, Violence, & Abuse 19 (2), 195–208, 2018.
Effects of Domestic Violence (Intimate Partner Violence)
A victim of domestic violence may be physically injured. Physical injuries can include bruises, black eyes, cuts, scratches, broken bones, lost teeth, and burns. Injuries may negatively affect the victim's ability to work, possibly leading to loss of income. Injuries, as well as the abusive situation, may embarrass the victim, causing them to isolate from family and friends. The victim may also have to move often—a financial burden—to escape the perpetrator. Sometimes the perpetrator kills the victim.
As a result of domestic violence, many victims have psychologic problems. Such problems include posttraumatic stress disorder Posttraumatic Stress Disorder (PTSD) Posttraumatic stress disorder (PTSD) is recurring, intrusive recollections of an overwhelming traumatic event; recollections last > 1 month and begin within 6 months of the event. The pathophysiology... read more (PTSD), substance abuse Substance Use Disorders Substance use disorders involve a pathologic pattern of behaviors in which patients continue to use a substance despite experiencing significant problems related to its use. Diagnosis of substance... read more , anxiety Overview of Anxiety Disorders Everyone periodically experiences fear and anxiety. Fear is an emotional, physical, and behavioral response to an immediately recognizable external threat (eg, an intruder, a car spinning on... read more , and depression Depressive Disorders Depressive disorders are characterized by sadness severe enough or persistent enough to interfere with function and often by decreased interest or pleasure in activities. Exact cause is unknown... read more . More severe physical abuse is usually related to more severe psychologic problems. Even when physical abuse decreases, psychologic abuse often continues, reminding victims that they can be physically abused at any time. Abused people may feel that psychologic abuse is more damaging than physical abuse.
Evaluation of Domestic Violence (Intimate Partner Violence)
Clinicians may suspect domestic violence based on injuries, inconsistent or puzzling symptoms, and/or behavior of the victim and/or partner (eg, a partner is reluctant to leave the victim alone with the clinician). Or a victim may report the abuse.
If clinicians suspect domestic violence, they may gently ask patients about their relationship with their partner or with other people living in their home. Many experts recommend that clinicians screen all patients for domestic violence by asking specific questions.
Clinicians also 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, clinicians 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. Laws about reporting domestic violence vary by state and sometimes by type of clinician.
Management of Domestic Violence (Intimate Partner Violence)
(See also Responding to Intimate Partner Violence and Sexual Violence Against Women: WHO Clinical and Policy Guidelines.)
In cases of domestic violence, the most important consideration is safety. 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 the kitchen, although doing so may not be possible. If they can, victims should promptly call 911 or the police and leave the house. Victims should have any injuries treated and documented with photographs. They 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 important. It should include where to go for help, how to get away, and how to access money. 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 in case they need to leave quickly.
Sometimes the only solution is to leave the abusive relationship permanently because domestic violence continues, especially among very aggressive perpetrators. Also, even when physical abuse decreases, psychologic abuse may persist. The decision to leave is not simple or easy. Victims often feel unable to leave an abusive relationship for multiple reasons, including fear of retaliation and economic dependence on the abuser.
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, by obtaining a restraining or protection order (although such an order does not guarantee safety).
Help is available through shelters for domestic violence survivors (including those in LGBTQ+ communities), 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 make a voice call.
Domestic violence includes physical, sexual, and psychologic abuse between people who live together including sex partners, parents or guardians and children, and siblings.
Physical injuries, psychologic problems, social isolation, loss of a job, financial difficulties, and even death can result.
Keeping safe—for example, having a plan of escape—is the most important consideration.
Because domestic violence tends to continue, sometimes the only solution is to leave the abusive relationship permanently, which requires preparation and extra precautions to ensure safety.
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.
The National Intimate Partner and Sexual Violence Survey: This web site provides the most current and comprehensive national and state data from the Centers for Disease Control and Prevention on the national prevalence of intimate partner violence, sexual violence, and stalking among women and men in the United States and tracks trends over time; special reports provide more information or in-depth analyses on a specific topic.
National Domestic Violence Helpline: Information about the domestic violence hotline and live, online chat service available for victims, survivors, and friends and family members who are concerned about a loved one's safety