Abstract
Intimate partner violence (IPV) is a common and devastating problem affecting the health of women, men, and children. Most health-care research focuses on the effects of IPV on women and children and addressing IPV with women in the health-care setting. Less is known about addressing IPV with men in the health-care setting. This article reviews the challenges in interpreting research on IPV in men, its prevalence and health effects in men, and the arguments for addressing IPV with men in the health-care setting. It introduces pilot guidelines that are based on the existing literature and expert opinion.
Similar content being viewed by others
INTRODUCTION
Intimate partner violence is a devastating epidemic with adverse effects on women, children, and men. The human cost of intimate partner violence (IPV) is staggering. Each year 1.5 million women and 834,732 men are raped and/or physically assaulted by an intimate partner in the US.1 Millions of children are exposed to adult IPV, resulting in lasting psychological and physical damage.2–7 The CDC estimates that IPV results in nearly 2 million injuries and 1,300 deaths nationwide every year.8 Economic costs related to IPV are calculated to exceed 8.3 billion dollars annually.9 Advocates, activists, community leaders, and public health officials have highlighted the preventable nature of this epidemic, set goals for the reduction of IPV, and called on the medical community and others to contribute to ending IPV.10–19
Much of the health-care literature on IPV focuses on women IPV victims, including expert advice and national guidelines on addressing IPV victimization in women in the health-care setting.20–25 Health-care research on IPV and men, though, is quite limited. There are few studies that explore its prevalence in the health-care setting,26–30 the accuracy and efficacy of medical screening,29,31,32 the ability of interview procedures to distinguish victimization from perpetration,32,33 and the efficacy of a health-care responses to men, including of batterer’s treatment programs.34,35 Although published expert experience exists,33,36–39,40–42 there are no comprehensive health-care guidelines on addressing IPV specifically with men. This article will define IPV in men, review dilemmas regarding determining its prevalence and significance, describe its health effects, provide a rationale for addressing IPV with men, and discuss screening challenges. New “pilot” guidelines for addressing IPV victimization and perpetration with men in the health-care setting developed by the Family Violence Prevention Fund (FVPF) are introduced.
DEFINITIONS
Dilemmas in Interpreting IPV Research
Making firm assertions about IPV in men is difficult given the limited, sometimes conflicting research results. Interpretation of research findings is complicated by inherent challenges in the study of a complex behavioral issue including: the inconsistent use of terminology, the “measurement” of behaviors and relationship dynamics, the effects of choice of study population, and the context given for survey questions. Despite suggested standard definitions 43, terminology in IPV research is inconsistent. Often “IPV” refers only to victimization rather than distinguishing between victimization and perpetration. “IPV” may be used to signify individual physical, sexual, or emotional acts of violence regardless of context and, alternatively, to refer to a “power and control” dynamic associated with one’s primary role in a violent relationship. Comprehensive measurements of IPV prevalence necessarily involve self-report or partner report of experiences that are associated with shame, guilt, social stigma, painful emotions, and many adverse consequences that may affect self-report.44,45 The significance of any behavior also depends upon its context. For example, a shove that initiates a sexual assault carries an entirely different meaning than a shove used to defend oneself from a sexual assault. Within the context of a violent and controlling relationship even a stern look may signify grave danger to the victimized partner. A behavior that is considered highly insulting in one culture may not hold the same significance in a different culture.46–48 Thus, similar individual acts may have radically different significance, and how these acts are interpreted can lead to conflicting research results.
Conflicting research findings may also arise from comparing different populations of couples and posing survey questions in different contexts. “Family conflict” research has found a high degree of mutual or “bi-directional” violence perpetrated by women and men in heterosexual relationships.49,50 Other literature has found much higher levels of violence and injurious violence of male perpetrators against female victims than that of female perpetrators against male victims.1,27,51 Most studies find that in heterosexual relationships women are more likely to be seriously injured by a male partner when physical acts of violence exist in the relationship.52–54 Researchers reconciling these findings theorize that survey tools that do not include context, measures of power and control, or injuries underestimate the prevalence and effects of male violence toward their female partners and that different populations of couples, from those with less harmful “situational” or “bidirectional” violence to those experiencing “intimate terrorism,” have been studied.55–58 The clinical interview provides an opportunity for gathering qualitative, contextual history and observing the health effects of relationship dynamics.
Prevalence Estimates of IPV Victimization in Men
In the “National Violence Against Women Study” (NVAWS), a national random-digit-dial telephone survey of 8,005 women and 8,001 men in the United States, 24.8% of women and 7.6% of men reported having been physically and/or sexually abused by an intimate partner at some point in their adult lives. This extrapolates to a yearly prevalence of 1.5 million women and 834,700 men raped or physically assaulted by an intimate partner.1
Men with a history of same-sex cohabitation were at higher risk of IPV victimization. Of same-sex cohabitants, 23.1% were raped and/or physically assaulted by a spouse or cohabiting partner (15.4% of these assaults were by a same-sex male partner and 10.8% of these assaults were by an opposite-sex female partner), and 7.7% of the opposite-sex cohabitants were physically assaulted by a female intimate partner.59
In the health-care setting, there are a few estimates of IPV victimization in men. Recent studies in emergency departments have found a prevalence of IPV victimization of men from 6%-20% for current physical IPV26–28,60 and 11%-32% for current non-physical IPV.27,28 In a retrospective case-control ED study of men who were given ICD-9 assault code diagnoses and reported being assaulted by a female partner, 51% of the males who reported being assaulted by their partner had also been arrested for IPV in the past.32
Prevalence Estimates of IPV Perpetration in Men
There are few prevalence estimates of male IPV perpetration done in the health-care setting. In an anonymous written survey addressing IPV perpetration by male patients in a health-care clinic, 13.5% of the respondents reported perpetration of minor violence in past year, and 4.2% reported using severe violence against their partner in past year.29 In an ED study asking about perpetration of violence against “someone close to you” using a computer touch screen tool, 14% of men reported having ever “physically hurt someone close to you” and 9% of men reported being “worried that you might physically hurt someone close to you.”27 A study examining IPV and sexual risk behaviors in young men found that 27.6% of the men reported physical IPV perpetration, 28.3% reported sexual IPV perpetration, and 13.8% reported IPV perpetration that resulted in injury or the need for medical services in the past year.61 Descriptive studies of health-care use by male perpetrators have found that between 42% and 63% of the participants have seen a health-care provider in the past 6 months.62
Health Effects Associated with IPV Victimization of Men
There are scant studies on health problems associated with IPV victimization in men. A recent study on deaths from violence in North Carolina and the different epidemiologic patterns of death for males and females revealed that approximated 13% of all male homicides involved IPV in some way and that 4% of men killed were directly killed by an intimate partner.63,64 Men also sustain injuries inflicted by their intimate partners, but these injury patterns have not been well studied.65
Coker et al. re-examined the NVAWS data to determine the physical and mental health effects of both physical and psychological IPV victimization on men and women. Both physical and the power and control forms of psychological abuse were associated with overall current self report of “poor” health in men. All IPV victimization was associated with depressive symptoms, heavy alcohol use, “therapeutic” drug use, recreational drug use, and a history of being injured in men. Physical IPV victimization was associated with developing an injury and a chronic disease in men. Psychological power and control abuse in men was associated with developing a chronic mental illness.66 There has been little study of the health effects of IPV victimization in gay men. Studies report on HIV seroconversion resulting from IPV victimization,67 review the scant data pertinent to HIV and IPV victimization in gay men,68 and demonstrate an association between IPV victimization and increased physical and mental health problems in gay and bisexual men.69
Health Effects Associated with IPV Perpetration by Men
Descriptive studies of the health of male IPV perpetrators show high rates of: injuries related to IPV, psychiatric and substance use diagnoses, and sexually risky behavior. In a study of men in a batterer’s treatment program in the VA, 23% of the perpetrators reported having injured themselves and having received health care for injuries related to their IPV perpetrator conduct. Fifty-five percent of these men had a psychiatric diagnosis and 45% had a substance abuse diagnosis.70 IPV perpetrating men in a methadone clinic had an increased number of partners, rates of anal intercourse, and higher risk of having a partner with IV drug use history compared to non-perpetrators.71 Male IPV perpetrators in an urban health center were less likely to use condoms during vaginal and anal sexual intercourse and more likely to have forced sexual intercourse without a condom and more female partners than non-perpetrators.61
Controversy over IPV “Screening” and Rationale for Addressing IPV with Men
Many of the arguments about screening and addressing IPV in women can be applied to men. Due to the high prevalence of IPV, the adverse health consequences and suffering of adult IPV victims and children exposed to IPV, as well as the intergenerational transmission of IPV,72–74 advocates and health-care providers began experimenting with routinely inquiring about IPV with women in the 1980s.75–77 Many health-care settings now have well-established, successful programs to address IPV in their patient population. Multiple professional organizations recommend “screening” all women for IPV,2,78–84 and more recent guidelines suggest providers should screen men for victimization as well.78 JCAHO requires that hospitals assess patients “who may be victims of abuse, neglect, or exploitation.”85 In 2004, though, the USPSTF recommended that “there is insufficient evidence to recommend for or against routine screening of …women for intimate partner violence” due to a lack of study of “the harms of screening” and of randomized, controlled trial evidence that health-care interventions following screening have been proven effective.86 The USPHTF guidelines have been criticized on multiple methodological, ethical, and practical grounds.17,18,87
Those advocating routine IPV screening of women cite qualitative studies demonstrating patient approval of routine inquiry, the harm of “not knowing” about IPV, and our ethical duty to address and possibly prevent the suffering of IPV victimization. Some suggest using the term “routine inquiry” rather than “screening” to accentuate that the goal “is not identification of disease but the provision of information, support, and a safe atmosphere for discussing abuse….”16 Direct inquiry about IPV victimization to an entire population of patients (all women or all women and men) dramatically increases identification of patients exposed to IPV(88,89–95) over the prevalence found with screening only those patients the health-care provider “suspects” are IPV exposed. Studies of different screening methods from the use of patient questionnaires to computer touch screens yield differing rates of IPV prevalence.91,96–98
Despite the dearth of published information on routine IPV victimization inquiry with male patients, the rationale for addressing this problem in men and women is similar. Although the prevalence of highly injurious IPV victimization of men by women is low, there are men who are victimized by their female partners and suffer ill effects of IPV victimization. Men in relationships with men are also at risk for IPV victimization and the adverse health consequences of victimization.
There are multiple reasons experts have begun to advocate for addressing IPV perpetration with men in the health-care setting. Childhood exposure to IPV is known to increase the risk of violence in later adult intimate relationships,72,74 and in 30 to 60% of families affected by IPV, children are also directly abused.99 To “break the cycle” of transmission of IPV, experts hypothesize that intervening with male IPV perpetrators in contact with children might reduce child exposure to IPV and direct child abuse. Even in the absence of direct physical or sexual abuse of the child, exposure to IPV can have lifelong physical, psychological, and behavioral effects.2,100 Anecdotal evidence suggests that “responsible fatherhood” programs may influence men who are perpetrating IPV to change in order to be better role models.101
While creating behavior change in men who have long-established patterns of abusive behavior is extraordinarily challenging even in court-mandated programs, reaching men who are less controlling, have more insight and motivation to change, or are very early in the development of abusive behavior may be possible.102,103 Identifying IPV perpetration as a health-care issue, modeling respectful behavior, and expressing concern for the health and well-being of a perpetrator allow providers to encourage men to change in a non-judgmental manner.
The health-care setting also presents an opportunity to participate in primary prevention by counseling boys (and girls) on “healthy relationships” in order to help change societal norms.14 It presents a confidential setting to discuss healthy relationships, identify young men at risk for perpetration, and provide tools such as preventive counseling models to help them learn constructive ways of interacting and disagreeing in intimate relationships.104–106 Health-care providers can also advocate for schools and school-based health clinics to adopt evidence-based, effective “Safe Date” programs.107
New Pilot Guidelines on Addressing IPV Victimization and Perpetration with Men
There are sources of expert opinion, but no comprehensive national guidelines on addressing male IPV victimization and perpetration in the health-care setting.24,29,33,36,37,39,108,109 The attached pilot guidelines were written in response to requests by health-care providers for guidance in addressing IPV with male patients and the realization that, even in the absence of extensive research, providers are already addressing IPV with men. The FVPF convened a national committee to craft “Pilot Guidelines on Identifying and Responding to Male Intimate Partner Violence Victimization and Perpetration in the Health-Care Setting”, based on existing data and expert experience. Due to the lack of data, these guidelines are not meant to represent standard of care, but, instead, to share expert opinion with those who are familiar with addressing IPV in women or working with men around violence and would like to expand their experience. The pilot guidelines can be found along with the electronic version of this article.
These guidelines present a multi-step process for health-care providers who have been trained in the dynamics of IPV, understand the potentially life-threatening risks of IPV, and how to promote safety and autonomy for IPV victims, and are competent in addressing the intersection of culture and abuse. First, the guidelines share recommended questions for inquiring about both IPV victimization and perpetration using a general question like, “Are you, or have you ever been, in a relationship where your arguments ever become/became physical?” More direct, behavioral, non-judgmental questions like, “Have you ever been hit, hurt, or threatened by your partner?” And “Have you ever hit, hurt, or threatened your partner?” are also recommended to determine whether any IPV exists in the relationship.
The guidelines, then, delineate an assessment process that may be used to distinguish IPV victimization from IPV perpetration. This determination requires a higher level of experience with addressing IPV than that required to determine whether any IPV exists in a relationship. In some health-care institutions, experienced providers may develop the expertise necessary to do a complete assessment. In other health-care settings, patients may be referred to a knowledgeable social worker or IPV advocate on-site or at a community-based collaborating agency to do a full assessment. The guidelines provide a practical series of questions to help one determine whether a particular patient is an IPV victim, perpetrator, or that the patient’s primary role in the relationship is “indeterminate.” Finally, the guidelines describe an intervention process based upon the suspected role the patient plays in the violent relationship.
Distinguishing IPV Victimization from IPV Perpetration in Male Patients: Challenges and Importance
When a provider inquires about both IPV victimization and perpetration with a male patient and identifies violence, it can be challenging to distinguish the patient’s role in the violence. One may have a clinical suspicion that a male patient is being victimized based on witnessing that the patient consistently defers to his partner, seems frightened of his partner, or repeatedly asks for his partner’s permission before making decisions. Or, one may suspect that a male patient is perpetrating violence against his partner if the patient is always present at appointments, highly controlling, manipulative, derogatory, or aggressive (or if this male patient’s partner is also a patient and exhibits the above behaviors that could signify being victimized). Ironically, IPV victims often express shame and self-criticism, while IPV perpetrators may present themselves as victims even while they are highly violent and dangerous to their partner and family. Research and detailed observation of male perpetrators have demonstrated that they routinely deny their violent behavior, minimize the severity of their violent actions and the effects of their violence, and blame the violence on others.103,110 Perpetrators of IPV may be so manipulative and present themselves so convincingly as victims that it is extremely challenging for health-care providers (or other such as judges, law enforcement officers, etc.) to suspect or understand the extent of their abusive behaviors.110,111
Making a determination as to whether a patient is primarily being victimized or primarily perpetrating IPV can be extremely helpful in establishing the appropriate treatment plan. Interventions for IPV victimization focus on the empowerment of the victim through the direct provision of a safer environment (shelter, restraining orders, police assistance, the arrest of the perpetrator), safety counseling, and empowering independent decision-making skills. In responding to IPV perpetration, accepted interventions include: holding a perpetrator legally and practically accountable for his actions, attempting to help the perpetrator understand how unacceptable his behavior is and truly empathize with his victims, and promoting new paradigms of non-coercive, equitable, respectful ways of relating through batterer’s treatment programs, usually lasting a year or more.110,112 Misidentifying an IPV victim as a perpetrator could have quite negative consequences in that a male patient who is already suffering from poor self-esteem and lack of safety due to the perpetrator’s abusive treatment would be made to feel as if he were responsible for the abuse — the exact opposite message one would need to convey to improve his health and safety. Misidentifying an IPV perpetrator as a victim could exacerbate the perpetrator’s sense of entitlement and create worsening danger for the victim.
Safety Concerns When Both Members of a Couple Are Patients in the Same Health-care Setting
Inquiry about IPV victimization and perpetration when both members of a couple are seen in the same medical practice is fraught with potential difficulty and danger. There is some evidence to support the safety of addressing IPV in this situation,113 but experience suggests challenges. An IPV victim whose abusive partner is cared for in the same practice may feel unsafe revealing IPV victimization and may not trust that the confidentiality safeguards are sufficient to protect her/him. If the IPV perpetrator suspects that he has been asked about IPV due to a disclosure by the victim, he may retaliate with worsening abuse. The perpetrator may try to limit his partner’s access to care, sabotage his partner’s medical care, and manipulate the health-care provider in order to hurt the intended intimate partner victim.114–116 Holding such a controlling and manipulative perpetrator accountable for his behavior can be challenging. There are published guidelines on working with couples experiencing IPV in both medical and mental health practices (108,113,117). The attached guidelines suggest ways to mitigate potential risks to patients when both members of a couple are cared for in the same practice.
Other Challenges in Addressing IPV Victimization in Male Patients
To address the USPHTF finding of insufficient study on the potential harms of screening for IPV victimization, researchers recently evaluated the safety of IPV victimization screening and found no significant adverse outcomes.30 Theoretical risks of IPV victimization screening of men include a risk of shame and embarrassment, misidentification of a perpetrator as a victim, and patient and provider dismay over the lack of services available to male IPV victims.
Other Challenges in Addressing IPV Perpetration in Male Patients
Identifying IPV perpetration may challenge a provider’s ability to sustain a compassionate focus on the perpetrator’s health problems. As discussed above, the misidentification of a perpetrator as a victim may further endanger the victim. After identifying IPV perpetration, the provider may be unsure of the potential for serious harm or lethality.33,118–120 Understanding one’s ethical and/or legal obligation of a “duty to warn” intended victim(s) and the police of danger to intended victim(s) 121,122 may be difficult. Legal precedents vary from state to state, and there is no national legislation establishing a “duty to warn.” The guidelines summarize helpful information on lethality risk and the provider’s “duty to warn.”
References
Tjaden P, Thoennes N. (Department of Justice). Extent, Nature, and Consequences of Intimate Partner Violence: Findings from the National Violence Against Women Survey. 2000. http://www.ojp.usdoj.gov/nij/pubs-sum/181867.htm. Accessed July 20, 2008.
The Family Violence Prevention Fund. Identifying and Responding to Domestic Violence: Consensus Recommendations for Child and Adolescent Health. 2002. http://endabuse.org/programs/healthcare/files/Pediatric.pdf. Accessed July 20, 2008.
Osofsky J, ed. Young Children and Trauma: Intervention and Treatment. New York: The Guilford Press; 2004.
Geffner R, Jaffe P, Sudermann M, eds. Children Exposed to Domestic Violence: Current Issues in Research, Prevention, and Policy Development. New York: The Haworth Maltreatment and Trauma Press; 2000.
Edleson JL. Children’s witnessing of adult domestic violence. J Interpers Violence. 1999;14(8):839–870.
Fantuzzo J, Boruch R, Beriama A, Atkins M, Marcus S. Domestic violence and children: Prevalence and risk in five major cities. J Am Child Adolesc Psychiatry. 1997;36(1):116–22. January.
Groves BM. Children Who See too Much: Lessons from the Child Witness to Violence Project. Boston: Beacon Press; 2002.
Centers for Disease Control. Intimate Partner Violence Factsheet. 2006. http://www.cdc.gov/ncipc/dvp/ipv_factsheet.pdf. Accessed July 20, 2008.
Max W, Rice DP, Finkelstein E, Bardwell RA, Leadbetter S. The economic toll of intimate partner violence against women in the United States. Violence and Victims. 2004;19(3):259–72.
Walker L. The Battered Woman Syndrome. New York: Springer Publishing Company; 1984.
Rosenberg M, Fenley MA, eds. Violence in America: A Public Health Approach. New York: Oxford University Press, Inc.; 1991.
Rosenberg M, O’Carroll P, Powell K. Let’s be clear: Violence is a public health problem. JAMA. 1992;267(22):3071–2.
Stark E, Flitcraft A. Women At Risk: Domestic Violence and Women’s Health Thousand. Oaks: SAGE; 1996.
Parks LF, Cohen L, Kravitz-Wirtz N. (Prevention Institute). Poised for Prevention: Advancing Promising Approaches to Primary Prevention of Intimate Partner Violence. 2007. http://www.preventioninstitute.org/documents/VP_RWJ_IntimatePartnerViolence_RWJFformatting.pdf. Accessed July 20, 2008.
Krug E, Dahlberg L, Mercy J, Zwi A, Lozano R. (World Health Organization). World Report on Violence and Health; 2002.
Warshaw C, Alpert E. Integrating routine inquiry about domestic violence into daily practice. Annals of Internal Medicine. 1999;131(8):619–20.
Lachs MS. Screening for family violence: What’s an evidence-based doctor to do? 2004;140:399–400.
Chamberlain L. The USPSTF Recommendation on Intimate Partner Violence: What We Can Learn From It and What We Can Do About It. Family Violence Prevention and Health Practice: An E-Journal of the Family Violence Prevention Fund. 2005;1(1):1–24. http://endabuse.org/health/ejournal/archive/1-1/EditorsIntroduction.pdf. Accessed July 20, 2008.
The Family Violence Prevention Fund. http://endabuse.org.
Warshaw C, Ganley A. Improving the Health Care Response to Domestic Violence: A Resource Manual for Health Care Providers. San Francisco: Family Violence Prevention Fund; 1998.
American Medical Association. Diagnostic and Treatment Guidelines on Domestic Violence. 1992.
Campbell J, ed. Empowering Survivors of Abuse: Health Care for Battered Women and Their Children. Thousand Oaks: SAGE Publications; 1998.
Liebschutz J, Frayne S, Saxe G, eds. Violence Against Women: A Physicians Guide to Identification and Management. Philadelphia: American College of Physicians-American Society of Internal Medicine; 2003.
Kimberg LS. Intimate partner violence. In: King T, Wheeler B, eds. Medical Management of Vulnerable and Underserved Patients: Principles, Practice, and Populations. New York: McGraw Hill: Lange Series; 2007:307–17.
Salber P, Taliaferro E. The Physician’s Guide to Intimate Partner Violence and Abuse: A Reference for All Health Care Professionals. Volcano: Volcano Press; 2006.
Mechem CC, Shofer FS, Reinhard SS, Hornig S, Datner E. History of domestic violence among male patients presenting to an urban emergency department. Academic Emergency Medicine. 1999;6(8):786–91.
Rhodes KV, Lauderdale DS, He T, Howes DS, Levinson W. Between me and the computer: Increased detection of intimate partner violence using a computer questionnaire. Annals of Emergency Medicine. 2002;40(5):476–84.
Ernst AA, Nick TG, Weiss SJ, Houry D, Mills T. Domestic violence in an inner-city ED. Annals of Emergency Medicine. 1997;30(2):190–7.
Oriel KA, Fleming MF. Screening men for partner violence in a primary care setting: A new strategy for detecting domestic violence. The J Family Practice. 1998;46(6):493–8.
Houry D, Kaslow N, Kemball R, et al. Does screening in the emergency department hurt or help victims of intimate partner violence? Ann Emergency Med. 2008;51:433–42.
Mills T, Avegno J, Haydel M. Male victims of partner violence: prevalence and accuracy of screening tools. The J Emergency Med. 2006;31(4):447–52.
Muelleman RL, Burgess P. Male victims of domestic violence and their history of perpetrating violence. Acad Emergency Med. 1998;5(9):866–70.
Ganley A. Health care responses to perpetrators of domestic violence. In: Ganley A, Warshaw C, eds. Improving the Health Care Response to Violence: A Resource Manual for Health Care Providers. San Francisco: Family Violence Prevention Fund; 1998.
Hamberger LK, Lohr JM, Gottlieb M. Predictors of treatment dropout from a spouse abuse abatement program. Behavior Modification. 2000;24(4):528–52.
Jackson S, Feder L, Forde DR, Davis RC, Maxwell CD, Taylor BG. (National Institute of Justice). Batterer Intervention Programs: Where do we go from here? 2003, Report No.: NCJ 195079.
Adams D. Guidelines for doctors on identifying and helping their patients who batter. JAMWA. 1996;51(3):123–6. May/June.
Salber PR, Taliaferro E. Men and domestic violence. Acad Emergency Med. 1998;5(9):849–50.
Hamberger L, Saunders D, Hovey M. Prevalence of domestic violence in community practice and rate of physician inquiry. Family Med. 1992;24:283–7.
Chelmowski M, Hamberger LK. Screening Men for Domestic Violence in Your Medical Practice. Wisconsin Medical J. 1994:640–3.
Jaeger J. RADAR. see: http://www.instituteforsafefamilies.org/pdf/healthcare/MenRADAR.doc; 2003. Accessed July 20, 2008.
Romans SE, Poore MR, Martin JL. The perpetrators of domestic violence. MJA. 2000;173:484–8.
Mintz HA, Cornett FW. When your patient is a batterer. Postgraduate Medicine. 1997;101(4):219–21, 225–8.
Saltzman L, Fanslow J, McMahon P, Shelley G. Intimate Partner Violence Surveillance: Uniform Definitions and Recommended Data Elements. In: National Center for Injury Prevention and Control, ed: Centers for Disease Control and Prevention, found at: http://www.cdc.gov/ncipc/pub-res/ipv_surveillance/Intimate%20Partner%20Violence.pdf; 1999, revised 2002. Accessed July 20, 2008.
Hamby S, Gray-Little B. Responses to partner violence: Moving away from deficit models. J Family Psychol. 1997;11:339–350.
Hamby SL, Gray-Little B. Labeling partner violence: When do victims differentiate among acts? Violence and Victims. 2000;15(2):173–86.
Lindhorst T, Tajima E. Reconceptualizing and operationalizing context in survey research on intimate partner violence. J Interpersonal Violence. 2008;23(3):362–88.
Warrier S. The Culture Handbook. The Family Violence Prevention Fund; 2005. http://endabuse.org/programs/immigrant/files/Culture_Handbook.pdf. Accessed July 20, 2008.
Fernandez M. Cultural beliefs and domestic violence. Ann NY Acad Sci. 2006;1087:250–260.
Straus M, Gelles R. Physical Violence in American Families: Risk Factors and Adaptations to Violence in 8,145 Families. New Brunswick, NJ: Transaction Publishers; 1990.
Stets J, Straus M. Gender differences in reporting marital violence and its medical and psychological consequences. In: Straus MaG, Richard, eds. Physical Violence in American Families: Risk Factors and Adaptation to Violence in 8,145 Families. New Brunswick: Transaction Publishers; 1999:151–166.
Phelan M, Hamberger L, Guse C, Edwards S, Walczak S, Zosel A. Domestic violence among male and female patients seeking emergency medical services. Violence and Victims. 2005;20(2):187–206.
Straus MA, Gelles RJ. How Violent Are American Families? Estimates from the National Family Violence Resurvey and Other Studies. Physical Violence in American Families. New Brunswick, NJ: Transaction Publishers; 1999:95–112.
Cascardi M, Langhinrichsen J, Vivian D. Marital aggression: impact, injury, and health correlates for husbands and wives. Arch Intern Med. 1992;152:1178–1184.
Whitaker DJ, Haileyesus T, Swahn M, Saltzman LS. Differences in frequency of violence and reported injury between relationships with reciprocal and nonreciprocal intimate partner violence. Am J Public Health. 2007;97(5):941–7.
Johnson MP. Conflict and control: gender symmetry and asymmetry in domestic violence. Violence Against Women. 2006;12(11):1003–18.
Stark E. Commentary on Johnson’s “Conflict and control: Gender symmetry and asymmetry in domestic violence”. Violence Against Women. 2006;21(11):1019–25.
Hamby S, Koss M. Violence against women: risk factors, consequences, and prevalence. In: Liebschutz J, Frayne S, Saxe G, eds. Violence Against Women: A Physician’s Guide To Identification and Management. Philadelphia: American College of Physicians; 2003:3–38.
Archer J. Sex differences in aggression between heterosexual partners: a meta-analytic review. Psychological Bull. 2000;126(5):651–80.
Tjaden P, Thoennes N, Allison CJ. Comparing violence over the life span in samples of same-sex and opposite-sex cohabitants. Violence and Victims. 1999;14(4):413–25.
Rhodes KV, Lauderdale DS, Stocking CB, Howes DS, Roizen MF, Levinson W. Better health while you wait: a controlled trial of a computer-based intervention for screening and health promotion in the emergency department. Ann Emergency Med. 2001;37(3):284–91.
Raj A, Santana MC, La Marche A, Amaro H, Cranston K, Silverman JG. Perpetration of Intimate Partner Violence Associated With Sexual Risk Behaviors Among Young Adult Men. 2006;96:1873–1878.
Coben JH, Friedman DI. Health care use by perpetrators of domestic violence. The J Emergency Med. 2002;22(3):313–7.
Sanford C, Marshall S, Martin S, et al. Deaths from violence in North Carolina, 2004: how deaths differ in females and males. Injury Prevention. 2006;12(Supplement II):ii10–6.
Garcia L, Soria C, Hurwitz EL. Homicides and intimate partner violence: A literature review. Trauma Violence Abuse. 2007;8:370–383.
Sheridan D, Nash K. Acute injury patterns of intimate partner violence victims. Trauma Violence Abuse. 2007;8:281–289.
Coker AL, Davis KE, Arias I, et al. Physical and mental health effects of intimate partner violence for men and women. Am J Preventive Med. 2002;23(4):260–8.
Merrill G, Wolfe V. Battered gay men: An exploration of abuse, help-seeking, and why they stay. J Homosexuality. 2000;39(2):1–30.
Relf MV. Battering and HIV in men who have sex with men: A critique and synthesis of the literature. J Assoc Nurses in Aids Care. 2001;12(3):41–8.
Houston E, McKirnan D. Intimate partner abuse among gay and bisexual men: Risk correlates and health outcomes. J Urban Health: Bull NY Acad Med. 2007;84(5):681–90.
Gerlock A. Health impact of domestic violence. Issues in Mental Health Nursing. 1999;20:373–385.
el-Bassel N, Fontdevila J, Gilbert L, Voisin D, Richman BL, Pitchell P. HIV risks of men in methadone maintenance treatment programs who abuse their intimate partners: a forgotten issue. J Subst Abuse. 2001;13(1–2):29–43.
Ehrensaft M, Cohen P, Brown J, Smailes E, Chen H, Johnson JG. Intergenerational transmission of partner violence: A 20 year prospective study. J Consulting and Clin Psychol. 2003;71(4):741–53.
Kwong MJ, Bartholomew K, Henderson AJ, Trinke SJ. The intergenerational transmission of relationship violence. J Family Psychol. 2003;17(3):288–301.
Widom C. Does violence beget violence? A critical examination of the literature. Psychological Bulletin. 1989;106(1):3–28.
Hadley S, Short L, Lezin N, Zook E. Womankind: An innovative model of health care response to domestic violence. Women’s Health Issues. 1995;5(4):189–98.
Dearwater S, Cohen J, Campbell J, et al. Prevalence of intimate partner abuse in women treated at community hospital emergency departments. JAMA. 1998;280(5):433–8. August 5.
McLeer S, Anwar R. A study of battered women presenting in an emergency department. Am J Public Health. 1989;79:65–66.
The Family Violence Prevention Fund. National Consensus Guidelines on Indentifying and Responding to Domestic Violence Victimization in Health Care Settings. 2002. http://endabuse.org/programs/healthcare/files/Consensus.pdf. Accessed July 20, 2008.
American Medical Association. American medical association diagnostic and treatment guidelines on domestic violence. Archives of Family Medicine. 1992;1:39–47.
American College of Obstetricians and Gynecologists. (American College of Obstetricians and Gynecologists). Domestic Violence. ACOG Technical Bulletin #209. 1985 August 1985. Report No.: internet address: http://www.acog.com.
American Nurses Association. Position Statement on Physical Violence Against Women. 1994.
Committee on Child Abuse and Neglect, American Academy of Pediatrics. The role of the pediatrician in recognizing and intervening on behalf of abused women. Pediatrics. 1998;101(6):1091–2.
American College of Emergency Physicians. Policy on Domestic Violence. Vol. Policy #400286; October 1999.
American Psychological Association. Report of the American Psychological Association Presidential Task Force on Violence and the Family. 1996.
Joint Commission on Accreditation of Healthcare Organizations. How to Recognize Abuse and Neglect Joint Commission Resources; 2002.
U.S. Preventive Services Task Force. Screening for family and intimate partner violence: Recommendation statement. Ann Internal Med. 2004;140(5):382–6.
Phelan MB. Screening for intimate partner violence in medical settings. Trauma, Violence, and Abuse. 2007;8(2):199–213.
Abbott J, Johnson R, Koziol-McLain J, Lowenstein S. Domestic violence against women: Incidence and prevalence in an emergency department population. JAMA. 1995;273(22):1763–7. June 14.
Parker B, McFarlane J, Soeken K, Torres S, Campbell D. Physical and emotional abuse in pregnancy: A comparison of adult and teenage women. Nursing Research. 1993;42(3):173–8.
Parker B, McFarlane J, Soeken K. Abuse during pregnancy: Effects on maternal complications and birth weight in adult and teenage women. Obstetrics and Gynecology. 1994;84:323–328.
McFarlane J, Christoffel K, Bateman L, Miller V, Bullock L. Assessing for abuse: self-report versus nurse interview. Public Health Nursing. 1991;8(4):245–50.
McCauley J, Kern D, Kolodner K, et al. The “Battering Syndrome”: Prevalence and clinical characteristics of domestic violence in primary care internal medicine practices. Ann Internal Med. 1995;123(10):737–46. November.
McGrath M, Hogan J, Peipert J. A prevalence survey of abuse and screening for abuse in urgent care patients. Obstetrics and Gynecology. 1998;91:511–514.
Elliot B, Johnson M. Domestic violence in primary care setting: Patterns and prevalence. Archives of Family Medicine. 1995;4:113–119. February.
Bonds D, Ellis S, Weeks E, Palla S, Lichstein P. A practice-centered intervention to increase screening for domestic violence in primary care practices. BMC Family Practice. 2006;7(63):1–8.
MacMillan H, Wathen C, Jamieson N, et al. Approaches to screening for intimate partner violence in health care settings: A randomized trial. JAMA. 2006;296(5):530–6.
Glass N, Dearwater S, Campbell J. Intimate partner violence screening and intervention: Data from eleven Pennsylvania and California community hospital emergency departments. J Emergency Nursing. 2001;27(2):141–9.
Hamby S, Sugarman D, Boney-McCoy S. Does questionnaire format impact reported partner violence rates?: An experimental study. Violence and Victims. 2006;21(4):507–18.
Edleson J. Children’s witnessing of adult domestic violence. J Interpersonal Violence. 1999;14(8):845.
Felitti V, Anda R, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) study. Am J Preventive Med. 1998;14(4):245–58.
Arean JC. Effects of parenting interventions on fathers who have perpetrated IPV. The Family Violence Prevention Fund, personal communication; 2006.
Scott K, Wolfe D. Readiness to change as a predictor of outcome in batterer treatment. J Consulting and Clinical Psychology. 2003;71(5):879–89.
Scott K, King C. Resistance, reluctance, and readiness in perpetrators of abuse against women and children. Trauma, Violence, and Abuse. 2007;8(4):401–17.
Stringham P. A Violence Prevention Web Page for Parents: http://people.bu.edu/pstring/1.html. 2003. Accessed July 20, 2008.
Kivel P.http://www.paulkivel.com/. 2006. Accessed July 20, 2008.
Gordon M. Roots of empathy: Responsive parenting, caring societies. The Keio J Med. 2003;52(4):236–43.
Foshee V, Bauman K, Ennett S, Linder G, Benefield T, Suchindran C. Assessing the long-term effects of the safe dates program and a booster in preventing and reducing adolescent dating violence victimization and perpetration. Am J Public Health. 2004;94:619–624.
American Psychological Association. (The ad hoc Committee on Legal and Ethical Issues in the Treatment of Interpersonal Violence). Potential Problems for Psychologists Working with the Area of Interpersonal Violence. http://www.apa.org/pi/potential.html. Accessed July 20, 2008.
Shakil A, Donald S, Sinacore J, Krepcho M. Validation of the HITS domestic violence screening tool with males. Family Medicine. 2005;37(3):193–8.
Bancroft L. Why Does He Do That?: Inside the Minds of Angry and Controlling Men New York: The Berkley Publishing Group; 2002.
Bala N. A differentiated legal approach to the effects of spousal abuse on children: A canadian context. In: Geffner R, Jaffe P, Sudermann M, eds. Children Exposed To Domestic Violence: Current Issues in Research, Intervention, Prevention, and Policy Development. New York: The Haworth Trauma and Maltreatment Press; 2000:301–328.
Bancroft L, Silverman J. Is it real? Assessing and fostering change in batterer’s as parents. The batterer as parent: Addressing the impact of domestic violence on family dynamics. Thousand Oaks: Sage Publishing; 2002.
Ferris L, Norton P, Dunn E, Gort E, Degani N. Guidelines for managing domestic abuse when male and female partners are patients of the same physician. JAMA. 1997;278(10):851–7. Sept 10.
Ganley A. Understanding Domestic Violence. Manual: Improving the Health Care System’s Response to Domestic Violence. Family Violence Prevention Fund, 1998.
McCloskey L, Williams C, Lichter E, Gerber M, Ganz M, Sege R. Abused women disclose partner interference with health care: An unrecognized form of battering. J General Internal Med. 2007;22.
Nicolaidas C. Partner interference with health care: Do we want one more piece of a complex puzzle? J General Internal Med. 2007;22:1216–1217.
Bograd M, Mederos F. Battering and couples therapy: Universal screening and selection of treatment modality. J Marital and Family Therapy. 1999;25(3):291–312.
Campbell JC, Webster D, Koziol-McLain J, et al. Risk factors for femicide in abusive relationships: results from a multisite case control study. Am J Public Health. 2003;93(7):1089–97.
McFarlane J, Campbell J, Watson K. Intimate partner femicide and stalking: Urgent implications for women’s safety. Behavioral Sciences and the Law. 2002;20(1–2):50–61.
Campbell JC, Glass N, Sharps PW, Laughon K, Bloom T. Intimate Partner Homicide: Review and Implications of Research and Policy. 2007;8:246–269.
Ferris LE, Barkun H, Carlisle J, Hoffman B, Katz C, Silverman M. Defining the physician’s duty to warn: consensus statement of Ontario’s medical expert panel on duty to inform. CMAJ. 1998;158:1473–9.
Felthous AJ. The clinician’s duty to protect third parties. Forensic Psychiatry. 1999;22(1):49–60.
Acknowledgments
The author wishes to gratefully acknowledge the Family Violence Prevention Fund for providing leadership, technical expertise, and funding to produce the pilot guidelines introduced in this article. The author would like to thank the national advisory committee members for contributing to the development of the guidelines. The author is indebted to Anne Ganley, PhD, L. Kevin Hamberger, PhD, Jeff Jaeger, MD, and Peter Stringham, MD, for invaluable advice and critiques and to Dr. Margaret Wheeler for invaluable editorial assistance. (http://endabuse.org/health).
Conflict of Interest
None disclosed.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
ESM 1
Identifying and Responding to Male Intimate Partner Violence (IPV) in the Health Care Setting—Pilot Guidelines (PDF 87.4 kb)
ESM 2
Pilot Guidelines on Identifying and Responding to Male Intimate Partner Victimization and Perpetration in the Health Care Setting (PDF 272 kb)
Rights and permissions
About this article
Cite this article
Kimberg, L.S. Addressing Intimate Partner Violence with Male Patients: A Review and Introduction of Pilot Guidelines. J GEN INTERN MED 23, 2071–2078 (2008). https://doi.org/10.1007/s11606-008-0755-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11606-008-0755-1