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Dynamics of Intimate Partner Violence

Intimate Partner Violence -

A Training Resource

By: James J Messina, Ph.D., CCMHC, NCC, DCMHS-T

Tips for Victims of IPV to Recognize Steps to Take

The National Domestic Violence Hotline presents the following tips to help victims to better understand if they are indeed victims of Intimate Personal Violence (IPV)

Common signs of abusive behavior in a partner include:

Even one or two of these behaviors in a relationship is a red flag that abuse may be present.

Telling you that you never do anything right.

Showing extreme jealousy of your friends or time spent away from them.

Preventing or discouraging you from spending time with friends, family members, or peers.

Insulting, demeaning, or shaming you, especially in front of other people.

Preventing you from making your own decisions, including about working or attending school.

Controlling finances in the household without discussion, including taking your money or refusing to provide money for necessary expenses.

Pressuring you to have sex or perform sexual acts you’re not comfortable with.

Pressuring you to use drugs or alcohol.

Intimidating you through threatening looks or actions.

Insulting your parenting or threatening to harm or take away your children or pets.

Intimidating you with weapons like guns, knives, bats, or mace.

Destroying your belongings or your home.


Documenting the warning signs of dating abuse (in every form that it occurs) will help provide proof of your partner’s behavior if you ever need it, for legal reasons or otherwise.

For some survivors, it can simply be useful to validate your experience and process complex emotions.

Keeping a journal of what you experience, including descriptions of how the incident made you feel.

Writing down statements you, your partner, or any witnesses make before, during, or after the abuse.

Recording dates, times, and descriptions of incidents. If furniture is overturned or items were thrown, describe the scene and take photos of the damage.

Documenting any injuries, no matter how small (with photos if possible).

Seeking medical care, even if there are no visible injuries, especially if you have been strangled or choked.

Filing a report with the police, if you determine that it’s safe for you to do so.


Risk factors to consider when using drugs or alcohol include:

Emotions that may be stronger than usual or change quickly.

Bad or unsafe situations developing further, including an abusive partner’s escalation of force.

Individual or family histories of addiction among you or your partner(s).

Potential challenges leaving a bad or unsafe situation, including not being able to drive or find a trusted ride home, unfamiliarity with your surroundings, difficulty remembering important information, or fear of other people finding out about your situation.


Risk Factors for Intimate Partner Violence


Low self-esteem

Low income

Low academic achievement

Young age

Aggressive or delinquent behavior as a youth

Heavy alcohol and drug use


Anger and hostility

Antisocial personality traits

Borderline personality traits

Prior history of being physically abusive

Having few friends and being isolated from other people


Emotional dependence and insecurity

Belief in strict gender roles (e.g., male dominance and aggression in relationships)

Desire for power and control in relationships

Perpetrating psychological aggression

Being a victim of physical or psychological abuse (consistently one of the strongest predictors of perpetration)

History of experiencing poor parenting as a child

History of experiencing physical discipline as a child


Marital conflict – fights, tension, and other struggles

Marital instability – divorces or separations

Dominance and control of the relationship by one partner over the other

Economic stress

Unhealthy family relationships and interactions


Poverty and associated factors (e.g., overcrowding)

Low social capital – lack of institutions, relationships, and norms that shape a community’s social interactions

Weak community sanctions against IPV (e.g., unwillingness of neighbors to intervene in situations where they witness violence)


Traditional gender norms (e.g., women should stay at home, not enter the workforce, and be submissive; men support the family and make the decisions)

Source: Centers for Disease Control and Prevention. (2017). Injury prevention & control: Intimate partner violence: Risk and protective factors. Retrieved at:from

Common Consequences of Intimate Partner Violence


Acute injury



Bladder and kidney infections

Circulatory conditions

Cardiovascular disease


Irritable bowel syndrome

Chronic pain syndromes

Central nervous system disorders

Gastrointestinal disorders

Joint disease

Migraines and headaches



Gynecological disorders

Pelvic inflammatory disease

Sexual dysfunction

Sexually transmitted infections, including HIV/AIDS

Delayed prenatal care

Preterm delivery

Pregnancy difficulties such as low-birth-weight babies, perinatal deaths, and miscarriage

Unintended pregnancy





Symptoms of posttraumatic stress disorder

Antisocial behavior

Suicidal behavior in females

Low self-esteem

Inability to trust others, especially in intimate relationships

 Fear of intimacy

 Emotional detachment

 Sleep disturbances


 Replaying assault in the mind


 Restricted access to services

 Strained relationships with health providers and employers

 Isolation from social networks


Health behaviors

Engaging in high-risk sexual behavior

     Unprotected sex

     Decreased condom use

     Early sexual initiation

     Choosing unhealthy sexual partners

     Multiple sex partners

     Trading sex for food, money, or other items

Using harmful substances

     Smoking cigarettes

     Drinking alcohol

     Drinking alcohol and driving

     Using illicit drugs

Unhealthy diet-related behaviors



    Abusing diet pills


Overuse of health services

Source: Centers for Disease Control and Prevention. (2017). Injury prevention & control: Intimate partner violence: Risk and protective factors. Retrieved at:from

Recognizing Possible Signs of Intimate Partner Violence in Various Settings


Emergency Department - Assorted acute injuries; pain from previous injuries; multiple visits with vague complaints; psychosocial issues

Counseling Offices - Victims and perpetrators may present for couple’s counseling or as individuals seeking therapy for reasons other than IPV. Additionally, pastoral counseling may be sought by victims and perpetrators. Refusal to meet individually may be a sign of controlling behavior.

Prenatal & Obstetric Clinics & Practices - Increased incidence of abuse during pregnancy; missed appointments; late entry into the prenatal care system

Mental Health Setting - Symptoms of anxiety, depression; substance abuse; suicide attempts

Schools - Child-centered systems will often be the first place of IPV disclosure, driven sometimes by a child’s behavioral clues (e.g., regressed or internalized or

externalized behavior).

Pediatrician’s offices - Behavioral clues or other stress-related conditions reflective of witnessing violence; mother presenting with black eyes and bruises in different stages of healing

Child protective services - Families with IPV may come to the attention of child protective services for reasons other than IPV; however, IPV screening should be universal

Primary care - Missed appointments; multiple visits with vague complaints; poor compliance with recommendations; symptoms of insomnia, inability to concentrate; chronic pain; problems with weight loss or weight gain

Home care - Patient-perpetrator interaction in an informal setting; signs of recent

environmental destruction, such as broken furniture and holes in the wall

Possible Indicators of Abuse


Potential indicators of abuse for adults:

The presence of a controlling, dominating partner

Discomfort when asked about one’s relationship

Failure to keep appointments or comply with treatment (although this could simply reflect other client problems)

Unexplained injuries or vague complaints

Presence of IPV-related health problems or somatic complaints

Injury to head, neck, chest, breasts, abdomen, or genitals

Multiple physical injuries in varied stages of healing

Delay between injury occurrence and treatment seeking

Chronic pain of unknown origin

High number of sexually transmitted infections, pregnancies, miscarriages, abortions, vaginal infections, or urinary tract infections

Physical injury during pregnancy


Perpetrator dynamics often involve:

If partner is present, controlling behavior in the healthcare or other setting, reluctance to allow the client to be interviewed or assessed alone

Control over money, property, and other assets

Jealousy of others in the partner’s social network

Use of social or professional status to maintain power over partner

Minimization or rationalization of the IPV behavior

Scorn of the partner’s perspective

Documented prior use of violence

Physical injuries sustained during perpetration of an assault from the victim’s attempts to avoid the assault (e.g., bite marks, scratches)


Victim dynamics often include:

Fear of the partner

Reduced autonomy

Restricted access to social supports

Feelings of guilt, blame, and shame

Physical, mental, and behavioral health consequences noted above


Source: Family Violence Prevention Fund. (2004). National consensus guidelines on identifying and responding to domestic violence victimization in health care settings. San Francisco, CA. Retrieved from:

Assessment to Use to Identify IPV

The United States Preventive Services Task Force (USPSTF) identified the first four of these assessments because they showed the most sensitivity and are directed at patients and can be self-administered or used in a clinician interview format. 

HITS (Hurt, Insult, Threaten, Scream) 

OVAT (Ongoing Violence Assessment Tool) 

HARK (Humiliation, Afraid, Rape, Kick)

WAST (Woman Abuse Screen Tool) 

Abuse Assessment for Women who are pregnant

Once a Safety Plan has been established this additional assessment can be used by case managers, home visitors or therapist:

Relationship Assessment Tool

For a complete list of addition IPV Assessments available from the CDC go to:

Safety Plans

Interactive guide to safety planning available through National Domestic Violence Hotline at:


Download the form in a traditional format: Domestic Violence Personalized Safety Plan

The National Domestic Violence Hotline presents the following tips to help victims to better understand if they are indeed victims of Intimate Personal Violence (IPV)