Written by Beth Kaplan, MD, Senior Medical Advisor at Nurx, with Josephine Brenner and Nico Dezerega
Domestic violence is a severe, direly under-addressed epidemic in our society; a problem that I have witnessed countless times, firsthand, as an Emergency Department doctor. The complexities of the issue and unique aspects of each situation mean there is no single solution — but there are solutions.
At Nurx we strive to provide you with choices to take care of a broad range of your personal and sexual health needs. We want to provide access to the resources, tools, and assistance that can help you or someone you care about; so if you or somebody you know is in a relationship that is not healthy or safe, know that you have options. With the power of information and support, one can move forward to a healthier life.
It’s important to know the facts about domestic violence, and set aside stereotypes to understand the realities. Here are 9 things you may not know about abusive relationships—but should:
Domestic violence doesn’t only affect married couples.
The type of abuse usually called “domestic” violence is more accurately called intimate partner violence, because the relationship can be with an intimate, dating, romantic, or spousal partner. Intimate partner violence can occur when living together or not, whether the relationship is ongoing or ended.
The Centers for Disease Control and Prevention (CDC) defines intimate partner violence as physical violence, sexual violence, stalking, or psychological aggression (including coercive acts) by a current or former intimate partner. It describes a systematic pattern of power and control used by one intimate partner against the other.
Abuse isn’t only bruises and broken bones.
Many people only think of intimate partner violence as one partner beating the other up, but there are many other tactics that qualify as abuse, even if they don’t rise to the level of violence that results in injury. Any type of physical violence or threat of violence, as well as psychological abuse and patterns of manipulation and control, all fall into the category of intimate partner abuse. Abuse that is purely psychological and emotional in nature can have significant impact on health, whether or not violence occurs, and is often a precursor to physical violence. Here are some insidious forms of intimate partner abuse other than physical violence:
- Verbal and emotional abuse: Name calling, constant insults, putting one down, humiliation of any kind
- Economic or financial control and abuse
- Intimidation or scary words or behaviors; threatening to hurt you, your children, or pets
- Pressured or forced sex
- Interference in medical care
- Isolation from support such as from friends, family, or work colleagues
- Damaging your property when they’re angry (throwing objects, punching walls, kicking doors)
- Driving recklessly or dangerously when you are in the car
- Forcing you to use drugs or alcohol (especially if you’ve had a substance abuse problem in the past)
- Trapping you in your home, or preventing you from leaving or entering
- Persistent or extreme jealousy; monitoring where you go, who you call and who you spend time with
- Monitoring you online or on social media
Experiencing even one or two of these behaviors in a relationship is a red flag that abuse may be present. Remember, each type of abuse is serious, and no one deserves to experience abuse of any kind, for any reason.
It’s more common than you realize.
More than 12 million people in the US are victims of physical violence, rape, or stalking by a partner each year — 24 people per minute. 1/4 women and 1/7 men experience physical violence by a partner in their lifetime. Almost half of women and men experience psychological aggression by a partner at some point.
It can happen to anybody.
The idea of domestic violence might call to mind a “wife beater” man and an abused woman, but the truth is that victims can be men as well as women, and domestic violence is also present in LGBTQ+ relationships and happens to people of all ages: adults, teens and even the elderly. Domestic violence affects millions of people across the globe, impacting all cultures and socio-economic backgrounds. Domestic violence is a violation of human rights and a public health epidemic.
But some groups are more at risk.
Although intimate partner violence does not discriminate, some demographic groups are particularly vulnerable.
Young people: Young people, and young women specifically, are the demographic that experiences the most abuse. Women ages 18-34 experience the highest rates of partner violence. Physical abuse is also common during the teen years: Nearly 1.5 million high school students nationwide experience physical abuse from a dating partner each year, and one out of four high school dating relationships is violent. One in 10 high school students has been purposefully hit, slapped or physically hurt by a boyfriend or girlfriend. High school is a time of growth and self-discovery, and experiencing domestic violence at this age is likely to have long-lasting effects.
LGBTQ+ people: When we think of intimate partner violence we might think about heterosexual relationships, and that is a problem. These issues are also huge problems in the LGBTQ+ community, but are talked about much less. According to the CDC, 26% of gay men and 37.3% of bisexual men have experienced rape, physical violence, and/or stalking by an intimate partner in their lifetime. 43.8% of lesbian women and 61.1% of bisexual women have experienced rape, physical violence, and/or stalking by an intimate partner at some point in their lifetime. In 2012, fewer than 5% of LGBTQ survivors of intimate partner violence sought orders of protection.
The tactics of the abusers in heterosexual relationships and LGBTQ+ relationships hold the same goal: to suppress and manipulate the partner or ex. However, in LGBTQ+ relationships the abuser may use specific tactics such as outing or threatening to out their partner to their families or colleagues. Stigma and barriers to support may contribute to greater isolation for the victim.
People with HIV: Living with HIV presents additional challenges when combined with a domestic violence relationship. Social stigma and lack of legal support may lead to isolation and lack of resources. An abusive partner may employ tactics such as disclosing (or threatening to disclose) the victim’s HIV-positive status to others or online, or interference in medical care and medications. If the abuser is HIV-positive and the victim is HIV-negative, the abusive partner may interfere in PrEP medications, refuse to use condoms or practice safe sex, or refuse to take their own HIV medications.
Reproductive coercion is abuse.
One form that abuse often takes place in heterosexual relationships is reproductive coercion — pressuring a woman to become pregnant against her wishes or sabotaging contraception, for example by tampering, discarding, or interfering with birth control, or breaking or removing condoms during sex. In 2011 The National Domestic Violence Hotline conducted a survey to learn the extent of reproductive coercion in the US and found that 1 in 4 callers reported that they had experienced this type of abuse.
Domestic abuse is a health problem.
Intimate partner violence isn’t a relationship or “personal” problem — it is truly a health problem with wide-ranging consequences for the victim. Being in a relationship marked by violence, threats, sexual coercion, or psychological abuse is detrimental to a person’s physical and mental health in many ways.
About 15% women and 4% men experience a physical injury, such as bruises, pain, broken bones, lacerations, or sexual assault, as a result of domestic violence. While those injuries are what we think of when we think of domestic violence, other health effects may be just as serious but are less well-known. These include:
Mental health problems: Partner violence has been associated with depression, post-traumatic stress disorder, anxiety, suicidal behavior, and substance mis-use.
Medical conditions: Health problems including asthma, diabetes, high blood pressure and chronic pain can be related to or worsened by domestic abuse. Some abusers interfere with healthcare appointments or medication as part of the pattern of control. Emotional abuse can lead to stress that causes or worsens multiple medical conditions. Women experiencing intimate partner violence have more medical, gynecologic, and stress-related symptoms than non- abused women. Headaches, abdominal problems, pelvic pain, fibromyalgia, and difficulty sleeping are all common.
Reproductive health consequences: In part because of reproductive coercion, Intimate partner violence is associated with poor reproductive and sexual health, including unintended pregnancies, sexually transmitted infections (STIs), and HIV. If a woman in an abusive relationship gets pregnant, that is a very vulnerable time for her and her unborn baby, when abuse can leave both emotional and physical trauma and lead to miscarriage, injury, hypertension, childbirth complications, and low-birth rate, and is a risk factor for maternal depression and substance mis-use. Along with motor vehicle accidents, intimate partner violence is the most common type of traumatic injury during pregnancy. Because an abusive partner may see the unpredictability of pregnancy as an opportunity to increase power and control, it’s extra important that pregnant women in these relationships explore options to enhance their physical, emotional, financial, and legal safety.
Effects on children: Children with a parent in an abusive relationship also suffer health consequences, including physical and mental health conditions and an increased risk of being a victim or perpetrator of intimate partner violence later in life.
Domestic violence can be deadly.
Intimate partner violence can lead to murder. More than half of women murdered in the United States are killed by a current or former intimate partner. 72% of all murder-suicides involve intimate partner violence, and in 94% of these the murder victim is female. The abused member of the couple is not the only one at risk: 20% of victims in intimate partner homicides were family members, friends, neighbors, persons who intervened, law enforcement responders, or bystanders.
Although anybody in an abusive relationship is at risk, one important red flag to know about is choking. An abuser who attempts to strangle or choke a partner is more likely to be increasingly violent and commit homicide later. Another danger sign: When an abuser threatens the victim with a gun. The use of a gun to threaten or intimidate a partner is seen as a predictor of homicide, and when an abuser has access to a gun it is 500% more likely that a victim will be killed.
Help is available!
If you are involved in an abusive relationship, or think you may be, know that you are not alone! Help is available, 24 hours a day. Reach out to the National Domestic Violence Hotline at 800−799−7233 or by visiting https://www.thehotline.org/, where you can confidentially chat with a trained expert.
About the Author
Beth Kaplan, MD, is an Emergency Medicine physician in the San Francisco Bay Area and a Senior Medical Advisor at Nurx.
This blog provides information about telemedicine, health and related subjects. The blog content and any linked materials herein are not intended to be, and should not be construed as a substitute for, medical or healthcare advice, diagnosis or treatment. Any reader or person with a medical concern should consult with an appropriately-licensed physician or other healthcare provider. This blog is provided purely for informational purposes. The views expressed herein are not sponsored by and do not represent the opinions of Nurx™.