Chapter 110: Intimate parter violence and sexual assault

INTRODUCTION

Intimate partner violence (IPV) is defined by the World Health Organization as ‘any behaviour within an intimate relationship that causes physical, psychological or sexual harm to those in the relationship’. Domestic violence emphasises the setting of the violence, whereas family violence is a broader term that includes any violence or abuse that occurs in a family, e.g. elder abuse and adolescent violence against parents.¹

There is a strong gender bias in IPV. We describe the gender bias in other conditions like rheumatoid arthritis where the majority of people affected are women. In IPV, it is mainly women and children who are subjected to IPV, and it is mainly men who perpetrate IPV. Of course, not all men are violent, and some women can be violent too. However, it is important to be aware of this strong gender bias. IPV occurs in both heterosexual and same sex relationships. Due to space limitations, this chapter will focus on IPV in heterosexual relationships perpetrated by men against women and children.

IPV is the most common form of violence against women. The most common form of violence against men is perpetrated by other men, usually by strangers.

GPs often say we do not see many women that have experienced IPV. However, it has been estimated that full-time GPs are seeing up to five women per week who have experienced some form of IPV in the past 12 months.²

A major problem in dealing with IPV is that it is hidden and women are reluctant to disclose IPV when visiting medical practitioners. Another complicating factor is the fact that many women experiencing IPV may not even be aware that this is the case. Women who have been subjected to IPV stress the importance of a trusting doctor–patient relationship, including confidentiality and a non-judgmental attitude.

We usually think of IPV in terms of physical violence but it can take many forms.³ These include:

• acts of physical violence, such as slapping, hitting, kicking and beating

• sexual violence, including forced sexual intercourse and other forms of sexual coercion

• emotional (psychological) abuse, such as insults, belittling, constant humiliation, intimidation (e.g. destroying things), threats of harm, threats to take away children

• controlling behaviours, including isolating a person from family and friends; monitoring their movements; and restricting access to financial resources, employment, education or medical care