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Intimate Partner Violence
Contents of this page:
Definition of Intimate Partner Violence IPV is a pattern of assaultive and coercive behaviors, including physical, sexual, and psychological attacks, as well as economic coercion, that adults or adolescents use against their intimate partners. Key elements of Intimate Partner Violence:
IPV is a combination of physical attacks, terrorist acts, and controlling tactics used by perpetrators that result in fear as well as physical and psychological harm to victims and their children, usually in repeated episodes. It is important to realize that your patient is trying to survive a complex, long-term pattern of abusive tactics by their partner. Most of the health effects you will see are not injuries from acute abusive incidents but rather the effects of prolonged exposure to severe stress and fear, as well as the effects of controlling behaviors interfering with self-care and management of chronic conditions. Abuse in relationships is intentional and is perpetrated to maintain power and control over the victim. Individual acts of violence may occur impulsively or under chemical influence, but this is not the cause of the behavior. (Therefore perpetrator treatment for anger management or substance abuse is not effective in ending intimate partner violence see also Health Care Responses to Perpetrators of Intimate Partner Violence) Calm periods may alternate with periods of escalation. After violent incidents perpetrators may express regrets and make promises. Some battered victims report that their batterers shower them with gift, cards and flowers during such periods. Although batterers often insist that their violence is directly caused by their partners’ behaviors or shortcomings, experience shows that batterers will abuse their victims regardless of the victim’s behaviors. As a survival strategy, victims usually focus intensely on the needs and moods of their violent partners in order to avoid violent incidents and keep themselves and their children as safe as possible. This may make it harder for them to reach out for help. It may also interfere with their ability to take care of themselves. Together with controlling behavior by the batterer, this pattern can make it hard for a patient who is trying to survive to comply with treatment protocols prescribed by their health care provider. In domestic violence, perpetrators have on-going access to their victims, know their daily routines and vulnerabilities, and can continue after violent episodes to exercise considerable physical and emotional control over their daily lives. In addition, these perpetrators have knowledge of their victims (e.g., prior medical conditions, allegiance to their children) which they use to target their assaults (e.g., withholding medications, grabbing victims from behind, threatening to harm the children), increasing the victims' trauma and fear. Physical Assault Physical abuse may include spitting, scratching, biting, grabbing, shaking, shoving, pushing, restraining, throwing, twisting, slapping (with open or closed hand), punching, choking, burning, and/or use of weapons (e.g., household objects, knives, guns) against the victim. Sexual Assault Some perpetrators sexually batter their victims. Sexual battering consists of a wide range of conduct that may include pressured sex when the victim does not want sex, coerced sex by manipulation or threat, physically forced sex, or sexual assault accompanied by violence. Victims may be coerced or forced to perform a kind of sex they do not want (e.g., sex with third parties, physically painful sex, sexual activity they find offensive, verbal degradation during sex, viewing sexually violent material) or at a time they do not want it (e.g., when exhausted, when ill, in front of children, after a physical assault, when asleep). Some perpetrators attack their victims' genitals with blows or weapons. Frequently perpetrators deny victims contraception or protection against sexually transmitted diseases. Sexual violence can result in a range of gynecological and mental health effects. Attacks Against Property or Pets and Other Acts of Intimidation Attacks against property and pets are not random acts. It is the wall near which the victims are standing near that gets hit, or the door they are hiding behind that gets torn off of its hinges; the victims' favorite china is smashed or their pet cat that is strangled in front of them; the table at which they are sitting that gets pounded or one of the perpetrators' favorite objects that gets smashed while he or she says, "Look what you made me do." The message to the victim is always, "You can be next."
Isolation The perpetrator isolates the victim by acting jealous and interrupting social/support networks. Some perpetrators are very possessive about their victims' time and attention. They often accuse them of sexual infidelity and of other supposed infidelities, such as spending too much time with children, the extended family, at work or with friends. They claim that family or friends are trying to turn their relationship. This jealousy about alleged lovers, friends or family is a tactic of control. The erosion of the victim’s social network removes support and increases the perpetrator’s control. It is an important intervention strategy for health care practitioners to assess the patient’s support network and make referrals that can increase available supports. If a health care practitioner becomes part of a social support systems for the victim, the perpetrator may try to destroy this relationship by preventing the victim from seeing this health care practitioner. Other isolations strategies include denying or sabotaging use of cars or other transportation, controlling or denying access to phones, moving victim into isolated places (house in the country, off the grid), away from friends and family, or moving often to prevent the victim to build relationships. Isolation strategies are particularly destructive for victims who have increased barriers to reaching out for help (see “marginalized status” in “Leaving, Staying, Keeping Safe”, below) Use of Economics Perpetrators control victims by controlling their access to all of the family resources: time, transportation, food, clothing, shelter, insurance, and money. It does not matter who the primary provider is or if both partners contribute. The perpetrator is the one who controls how the finances are spent. He or she may actively resist the victim becoming financially self-sufficient as a way to maintain power and control. Trying to escape a controlling and violent partner can result in retaliatory violence. Many battered victims have been seriously injured or killed when they were trying to leave or had left. When victims manages to escape from the battering relationship, perpetrators may use economics as a way to maintain control or force them to return: refusing to pay bills, ruining their credit, instituting legal procedures costly to the victim, destroying assets in which they have a share or refusing to work "on the books" where there would be legal access to the perpetrator’s income. All of these tactics may be used regardless of the economic class of the family. Use of children is another strategy batterers often employ to maintain control over their victims even after the victim leaves.
For an in-depth discussion about Batterers’ strategies and effects, consult the book Why Does He Doe That? Inside the Minds of Violent and Controlling Men, by Lundy Bancroft (Putnam 2002). The author is a national expert on batterer rehabilitation. Also available by the same author: Lundy Bancroft and Jay Silverman, The Batterer as Parent. Addressing the Impact of Domestic Violence on Family Dynamics, Sage 2002. It is important that health care practitioners and other helpers do not blame the victim for the abuse and do not expect her or him to stop it. Only the perpetrator can stop the abuse. A victim may not be able to stop the abuse, not even by leaving the relationship. Some victims are hurt or killed when they try to leave, others are stalked and threatened for years after separating from the abuser, others are financially ruined or harassed for many years through the ongoing custody arrangements. A coordinated community response is necessary to hold perpetrators accountable and keep victims and their children safe. Some communities have better resources and better coordination of responses than others. Many Vermont victims of intimate partner violence succeed in regaining safety every year, always through their own courage and persistence and often with the help of supportive services and communities. Leaving, staying, keeping safe – Typical Considerations of Victims It is important that health care practitioners and any helpers understand that victims of intimate partner violence have many difficult things to consider as they are trying to find the best way to keep themselves and their families safe. Effective collaboration, referrals and attention to safety planning (Interventions) can support victims in this process.
Fear. Fear of injury or death for victim, children or family members. Fear of losing the children. Fear of ongoing harassment. Fear of being without resources. Fear of being alone. Finances. Victims may not be able to support themselves and their children without the income of the perpetrator. They may never have worked or never have been involved in financial planning and management for the family. A livable income for an adult and two children in most Vermont communities exceeds by far the average income of female workers in Vermont. Other Resources. Housing, transportation, child care, and health insurance are some of the major resource needs that victims have to consider. Waiting lists for section 8 (low income) housing can take more than a year. Some waiting lists in Vermont have been closed. A woman trying to leave an abusive partner may have a job that would allow to support herself but may lack the transportation or the child care that would enable her to keep this job. Many women and children receive health insurance through the male partner’s job. Victims with chronic health problems may find themselves without the care they need when they lose their batterer’s health insurance. Family Values/ Cultural Values/ Religious Beliefs A victim’s family, cultural context or faith community may not be supportive. They may discourage separation or divorce. They may be concerned about children growing up in single parent families. They may believe in gender roles that encourage subservience in female victims. Hope Victims often hope that the abuse may end if they can avoid certain behaviors, if the violent partner stops drinking, if financial pressures in the family cease etc. These hopes are sometimes encouraged by the violent partner by justifying their violence as caused by external circumstances (the victim’s behavior, alcohol, stress) and by making promises and acting kind and loving after violent incidents. Marginalized status Some victims have higher barrier to reaching out and escaping due to their own marginalized status which increases their isolation and limited access to resources. Examples include people with disabilities, immigrants (especially non-English speaking or without permanent resident status), gay, lesbian and trans people, people engaged in illegal activities (drugs, prostitution – which both may be a result of the abuse and coercion), HIV positive people. Exhaustion and
mental health
Years of
struggling to survive in an |
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perpetrator. For more information on same-sex intimate
partner violence go to 
Some abusive acts are directed against or
involve the children in order to control or punish the adult victim (e.g.,
physical attacks against a child, sexual use of the children, forcing children
to watch the abuse of the victim). A perpetrator may use children to maintain
control over his partner by not paying child support, requiring the children to
spy, requiring that at least one child always be in the company of the victim,
threatening to take children away from her, involving her in long legal fights
over custody, or kidnapping or taking children hostage as a way to force the
victims' compliance. 
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