• Nearly 5.3 million incidents of IPV occur each year among U.S. women ages 18 and older, and 3.2 million occur among men. Most assaults are relatively minor and consist of pushing, grabbing, shoving, slapping, and hitting (Tjaden and Thoennes 2000a).
• In the United States every year, about 1.5 million women and more than 800,000 men are raped or physically assaulted by an intimate partner. This translates into about 47 IPV assaults per 1,000 women and 32 assaults per 1,000 men (Tjaden and Thoennes 2000a).
• IPV results in nearly 2 million injuries and 1,300 deaths nationwide every year (CDC 2003).
• Estimates indicate more than 1 million women and 371,000 men are stalked by intimate partners each year (Tjaden and Thoennes 2000a).
• IPV accounted for 20% of nonfatal violence against women in 2001 and 3% against men (Rennison 2003).
• From 1976 to 2002, about 11% of homicide victims were killed by an intimate partner (Fox and Zawitz 2004).
• In 2002, 76% of IPV homicide victims were female; 24% were male (Fox and Zawitz 2004).
• The number of intimate partner homicides decreased 14% overall for men and women in the span of about 20 years, with a 67% decrease for men (from 1,357 to 388) vs. 25% for women (from 1,600 to 1,202; Fox and Zawitz 2004).
• One study found that 44% of women murdered by their intimate partner had visited an emergency department within 2 years of the homicide. Of these women, 93% had at least one injury visit (Crandall et al. 2004).
• Previous literature suggests that women who have separated from their abusive partners often remain at risk of violence (Campbell et al. 2003; Fleury, Sullivan and Bybee 2000).
• Firearms were the major weapon type used in intimate partner homicides from 1981 to 1998 (Paulozzi et al. 2001).
• A national study found that 29% of women and 22% of men had experienced physical, sexual, or psychological IPV during their lifetime (Coker et al. 2002).
• Between 4% and 8% of pregnant women are abused at least once during the pregnancy (Gazmararian et al. 2000).

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Consequences

In general, victims of repeated violence over time experience more serious consequences than victims of one-time incidents (Johnson and Leone 2005). The following list describes just some of the consequences of IPV.

Physical

At least 42% of women and 20% of men who were physically assaulted since age 18 sustained injuries during their most recent victimization. Most injuries were minor such as scratches, bruises, and welts (Tjaden and Thoennes 2000a).

More severe physical consequences of IPV may occur depending on severity and frequency of abuse (Campbell et al. 2002; Heise and Garcia-Moreno 2002; Plichta 2004; Tjaden and Thoennes 2000a). These include:

• Bruises
• Knife wounds
• Pelvic pain
• Headaches
• Back pain
• Broken bones
• Gynecological disorders
• Pregnancy difficulties like low birth weight babies and perinatal deaths
• Sexually transmitted diseases including HIV/AIDS
• Central nervous system disorders
• Gastrointestinal disorders
• Symptoms of post-traumatic stress disorder
  • Emotional detachment
  • Sleep disturbances
  • Flashbacks
  • Replaying assault in mind
• Heart or circulatory conditions

Children may become injured during IPV incidents between their parents. A large overlap exists between IPV and child maltreatment (Appel and Holden 1998). One study found that children of abused mothers were 57 times more likely to have been harmed because of IPV between their parents, compared with children of non-abused mothers (Parkinson et al. 2001).

Psychological

Physical violence is typically accompanied by emotional or psychological abuse (Tjaden and Thoennes 2000a). IPV—whether sexual, physical, or psychological—can lead to various psychological consequences for victims (Bergen 1996; Coker et al. 2002; Heise and Garcia-Moreno 2002; Roberts, Klein, and Fisher 2003):

• Depression
• Antisocial behavior
• Suicidal behavior in females
• Anxiety
• Low self-esteem
• Inability to trust men
• Fear of intimacy

Social

Victims of IPV sometimes face the following social consequences (Heise and Garcia-Moreno 2002; Plichta 2004):

• Restricted access to services
• Strained relationships with health providers and employers
• Isolation from social networks

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Health Behaviors

Women with a history of IPV are more likely to display behaviors that present further health risks (e.g., substance abuse, alcoholism, suicide attempts).

IPV is associated with a variety of negative health behaviors (Heise and Garcia-Moreno 2002; Plichta 2004; Roberts, Auinger, and Klein 2005; Silverman et al. 2001). Studies show that the more severe the violence, the stronger its relationship to negative health behaviors by victims.

• Engaging in high-risk sexual behavior
  • Unprotected sex
  • Decreased condom use
  • Early sexual initiation
  • Choosing unhealthy sexual partners
  • Having multiple sex partners
  • Trading sex for food, money, or other items
• Using or abusing harmful substances
  • Smoking cigarettes
  • Drinking alcohol
  • Driving after drinking alcohol
  • Taking drugs
• Unhealthy diet-related behaviors
  • Fasting
  • Vomiting
  • Abusing diet pills
  • Overeating
• Overuse of health services

Economic

• Costs of IPV against women in 1995 exceed an estimated $5.8 billion. These costs include nearly $4.1 billion in the direct costs of medical and mental health care and nearly $1.8 billion in the indirect costs of lost productivity (CDC 2003).
• When updated to 2003 dollars, IPV costs exceed $8.3 billion, which includes $460 million for rape, $6.2 billion for physical assault, $461 million for stalking, and $1.2 billion in the value of lost lives (Max et al. 2004).
• Victims of severe IPV lose nearly 8 million days of paid work—the equivalent of more than 32,000 full-time jobs—and almost 5.6 million days of household productivity each year (CDC 2003).
• Women who experience severe aggression by men (e.g., not being allowed to go to work or school, or having their lives or their children’s lives threatened) are more likely to have been unemployed in the past, have health problems, and be receiving public assistance (Lloyd and Taluc 1999).

Groups at Risk

Certain groups are at greater risk for IPV victimization or perpetration.

Victimization

• The National Crime Victimization Survey found that 85% of IPV victims were women (Rennison 2003).
• Prevalence of IPV varies among race. Among the ethnic groups most at risk are American Indian/Alaskan Native women and men, African-American women, and Hispanic women (Tjaden and Thoennes 2000b).
• Young women and those below the poverty line are disproportionately victims of IPV (Tjaden and Thoennes 2000b).

Perpetration

• Studies show that for low levels of physical violence, men and women self-report perpetrating physical IPV at about the same rate. However, a common criticism of these studies is that they are generally lacking information on the context of the violence (e.g., whether self-defense is the reason for the violence) (Archer 2000).

Risk Factors for Victimization and Perpetration

Risk factors are associated with a greater likelihood of IPV victimization or perpetration. Risk factors are not necessarily direct causes of IPV—these may be contributing factors to IPV (Heise and Garcia-Moreno 2002). Not everyone who is identified as "at risk" becomes involved in violence.

Some risk factors for IPV victimization and perpetration are the same. In addition, some risk factors for victimization and perpetration are associated with one another; for example, childhood physical or sexual victimization is a risk factor for future IPV perpetration and victimization.

The public health approach aims to moderate and mediate those contributing factors that are preventable, and to identify protective factors which can reduce the risk of victimization and perpetration.

A combination of individual, relational, community, and societal factors contribute to the risk of being a victim or perpetrator of IPV. Understanding these multilevel factors can help identify various points of prevention intervention.

Risk Factors for Victimization

Individual Factors

• Prior history of IPV
• Being female
• Young age
• Heavy alcohol and drug use
• High-risk sexual behavior
• Witnessing or experiencing violence as a child
• Being less educated
• Unemployment
• For men, having a different ethnicity from their partner’s
• For women, having a greater education level than their partner’s
• For women, being American Indian/Alaska Native or African American
• For women, having a verbally abusive, jealous, or possessive partner

Relationship Factors

• Couples with income, educational, or job status disparities
• Dominance and control of the relationship by the male

Community Factors

• Poverty and associated factors (e.g., overcrowding)
• Low social capital—lack of institutions, relationships, and norms that shape the quality and quantity of a community’s social interactions
• Weak community sanctions against IPV (e.g., police unwilling to intervene)

Societal Factors

• Traditional gender norms (e.g., women should stay at home and not enter workforce, should be submissive)

(Crandall et al. 2004; Heise and Garcia-Moreno 2002; Stith et al. 2004; Tjaden and Thoennes 2000a)


Risk Factors for Perpetration

Individual Factors

• Low self-esteem
• Low income
• Low academic achievement
• Involvement in aggressive or delinquent behavior as a youth
• Heavy alcohol and drug use
• Depression
• Anger and hostility
• Personality disorders
• Prior history of being physically abusive
• Having few friends and being isolated from other people
• Unemployment
• Economic stress
• Emotional dependence and insecurity
• Belief in strict gender roles (e.g., male dominance and aggression in relationships)
• Desire for power and control in relationships
• Being a victim of physical or psychological abuse (consistently one of the strongest predictors of perpetration)

Relationship Factors

• Marital conflict—fights, tension, and other struggles
• Marital instability—divorces and separations
• Dominance and control of the relationship by the male
• Economic stress
• Unhealthy family relationships and interactions

Community Factors

• Poverty and associated factors (e.g., overcrowding)
• Low social capital—lack of institutions, relationships, and norms that shape the quality and quantity of a community’s social interactions
• Weak community sanctions against IPV (e.g., unwillingness of neighbors to intervene in situations where they witness violence)

Societal Factors

• Traditional gender norms (e.g., women should stay at home and not enter workforce, should be submissive)

(Black et al. 1999; Heise and Garcia-Moreno 2002; Kantor and Jasinski 1998; Stith et al. 2004; Tjaden and Thoennes 2000a)