Domestic violence is physical, sexual, or psychological abuse between people who live together. It includes intimate partner violence, which refers to physical, sexual, or psychological abuse by a current or former sex partner or spouse.
Physical injuries (sometimes severe or fatal), mental health issues, social isolation, loss of a job, and financial difficulties can result.
Doctors may suspect domestic violence based on injuries, inconsistent or puzzling symptoms, or the behavior of the victim and/or the victim's partner.
Keeping safe—for example, having a plan of escape—is the most important consideration.
Domestic violence can affect children (see also Child Abuse and Neglect), adults, or older adults (see also Elder Abuse). It may be caused by parents or guardians, grandparents, siblings, or other adults or minors in a household, as well as between intimate partners. It occurs among people of all ages, cultures, races, ethnicities, religious backgrounds, sexual orientations, genders, occupations, income levels, and educational levels.
Women are more commonly victims of domestic violence than are men. In 2021, 34% of female murder and manslaughter victims were killed by an intimate partner versus 6% of male victims. About 47% of women and 44% of men experience stalking, physical violence, and/or sexual violence by an intimate partner.
In the United States, domestic violence occurs at the same rates among people of all sexual orientations and gender identities.
During the COVID-19 pandemic, domestic violence became more common in many countries. Reasons probably include stress due to loss of income and loss of contact with other people. Also, people who were abused often could not escape to a shelter or another safe place.
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Terminology regarding people who have experienced domestic abuse varies. The term “victim” is a term used by the criminal justice system and is also often used for someone who is currently or has recently experienced abuse. The term "survivor" is often used to refer to someone who has gone through a recovery. Clinicians should ask people about terms they prefer (see RAINN [Rape, Abuse & Incest National Network]: Key Terms and Phrases and Women Against Abuse: The Language We Use).
Types of Domestic Violence
Physical abuse
Physical abuse is the most obvious form of domestic violence. It may include hitting, slapping, kicking, punching, breaking bones, pulling hair, pushing, twisting arms, slamming against something, choking, suffocating, beating, and burning. Weapons, such as a gun or knife, may be used to threaten or cause injury. The victim may be deprived of food or sleep.
Sexual assault
Many people who are physically assaulted by their partner are also sexually assaulted by their partner (see Sexual Assault and Rape). Sexual assault is any type of sexual activity or contact that a person does not consent to, including unwanted touching, grabbing, kissing, and rape. If sexual activity occurs without consent, it is considered sexual assault, even it occurs between people who have had consensual sex at other times before or after the assault. Sexual assault may involve the use of threats or force to coerce sexual contact, or the perpetrator may give the victim alcohol or drugs. It may cause physical injury, illness, or psychological trauma.
Psychological abuse
Psychological abuse is very common. It may start before or at the same time as physical or sexual abuse. Psychological abuse involves any nonphysical behavior that undermines or belittles the victim or that enables the perpetrator to control the victim. Psychological abuse can include
Abusive language
Social isolation
Financial control
Usually, the perpetrator uses language to demean, degrade, humiliate, intimidate, or threaten the victim in private or in public. The emotional abuse may cause the victim to start to question their own feelings, instincts, and sanity (called gaslighting) and may make the victim feel guilty or responsible for the abusive relationship. The perpetrator may also humiliate the victim in terms of sexual performance, physical appearance, or both.
The perpetrator may try to partly or completely isolate the victim by controlling the victim’s access to friends, relatives, and other people. Control may include forbidding contact with others—directly or through writing, telephone, e-mail, texting, or social media. The perpetrator may use jealousy to justify these actions. The perpetrator may convince the victim that family members and friends cannot or will not help and thus further isolate the victim.
The perpetrator may use the victim's children as a tactic for psychological abuse. Examples include using the children as a way to stay in the victim's life or intimidate/harass the victim. Perpetrators might also try to turn the children against the victim or use the children to convince the victim to continue the relationship.
Often, the perpetrator withholds money to control the victim. The victim may depend on the perpetrator for money (most or all). The perpetrator may maintain control by preventing the victim from getting a job, by keeping information about their finances secret, and by taking money from the victim.
The perpetrator may also prevent the victim from getting medical care.
Stalking
Stalking is a pattern of repeated, unwanted attention and contact by a partner that causes fear or concern for one’s own safety or the safety of someone close to the victim. Perpetrators may stalk their victims by
Contacting the victim with unwanted phone calls, emails, messages through social media, mail, or presents (for example, flowers)
Watching, spying, or following the victim from a distance
Intruding into the victim's home, workplace, or school
Abuse using technology
Perpetrators may use technology (such as social media) to post videos of, stalk, monitor, isolate, punish, threaten, and/or humiliate the victim. Also, perpetrators may monitor the victim's devices, often without the victim's knowing it.
Ongoing Abuse
The perpetrator's behavior after an incident of abuse
After an incident of abuse, the perpetrator may beg for forgiveness and promise to change and stop the abusive behavior. However, typically, the abuse continues and often escalates.
The perpetrator's outbursts of violence tend to be episodic and unpredictable. Thus, victims may live in near-constant fear of the next outburst.
Reasons victims remain in an abusive relationship
Often, victims do not leave the abusive relationship. Reasons may include
Feeling dependent on the perpetrator for money
Feeling alone, with no one to help
Being afraid that planning or trying to leave will trigger more intense violence
Being afraid of what the perpetrator will do after they leave (for example, stalk them or hurt their children, another family member, or a pet)
Believing that the abuser will change (for example, because of promises to do so)
Still loving the abuser
Believing that abuse may be normal (for example, because of previous experiences)
Effects of Domestic Violence
Victims of domestic violence may be physically injured. Physical injuries can include bruises, black eyes, cuts, scratches, broken bones, lost teeth, and burns. Injuries may interfere with the victim's ability to work. As a result, income may be lost. Injuries, as well as the abusive situation, may cause embarrassment, causing victims to isolate themselves from family and friends.
Victims may develop symptoms that have no obvious physical cause. These symptoms can include headaches, abdominal or pelvic pain, and fatigue.
Many victims also get sexually transmitted infections and may have problems during pregnancy.
Victims may have to move often—a financial burden—to escape the perpetrator.
Tragically, domestic violence can even lead to the death of the victim.
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As a result of domestic violence, many victims have mental health issues, such as depression, posttraumatic stress disorder (PTSD), eating disorders, and/or substance use disorder. More severe physical abuse is usually related to more severe mental health issues. Domestic violence may also worsen symptoms of preexisting mental disorders.
Even when physical abuse decreases, psychological abuse often continues, reminding victims that they can be physically abused at any time. Psychological abuse can cause as much or more of an impact on the victim's life as physical abuse.
Evaluation of Domestic Violence
A doctor's evaluation
Clinicians may suspect domestic violence based on injuries, inconsistent or puzzling symptoms, and/or the behavior of the victim and/or partner. Or a victim may report the abuse.
If clinicians suspect domestic violence, they may ask the person if they feel safe in their relationship and in their home. Many experts recommend that health care professionals ask all people questions about domestic violence.
If domestic violence is suspected, doctors try to determine whether the victim can safely return home before leaving the health care facility. Safety is in doubt in the following circumstances:
The victim has threatened to leave the relationship.
Violence has been increasing; assaults escalate to involve choking.
The partner has access to weapons.
The partner has threatened to kill or injure the victim.
If domestic violence is confirmed, health care professionals may be required to document the evidence of abuse, often by photographing the injuries. This documentation can be used to support a legal case against the perpetrator. Laws about reporting domestic violence vary by state and sometimes by type of clinician (see MandatedReporter.com).
Management of Domestic Violence
Developing a safety plan
Seeking help when needed
Abuse is never justified. Support is available whether victims decide to stay in or leave the abusive relationship.
In cases of domestic violence, the most important consideration is safety. If possible, during a violent incident, victims should try to move away from areas in which they can be trapped or in which the perpetrator can obtain weapons, such as knives in the kitchen. If possible, victims should promptly call emergency services or the police and leave the residence.
Victims should have any injuries treated and documented with photographs. Victims should teach their children not to get in the middle of a fight and when and how to call for help.
Developing a safety plan is extremely important. It should include
Where to go for help (victims should have several possible places to go and people who can be called)
How to get away (often including appearing to do a routine task that involves leaving the house, such as going on an errand or walking the dog)
How to access money (including hiding money away and obtaining a separate bank account and, if possible, credit card)
Victims should also make and hide copies of official documents (such as children’s birth certificates, national identity cards, insurance cards, and bank account numbers). They should keep an overnight bag packed and hidden in case they need to leave quickly.
Sometimes the only solution is to leave the abusive relationship permanently because domestic violence tends to continue, especially among very aggressive perpetrators. Also, even when physical abuse decreases, psychological abuse may persist.
The decision to leave is not simple or easy. Often, victims feel unable to leave an abusive relationship for many reasons, including being afraid of what the perpetrator will do after they leave and being dependent on the perpetrator for money.
After the perpetrator knows the victim has decided to leave, the victim’s risk of serious harm and death may be greatest. At this time, victims should take additional steps to protect themselves and their children. For example, they can obtain a restraining or protection order, although such an order does not guarantee safety.
In the United States, help is available through shelters for battered women, support groups, the courts, and a national hotline (1-800-799-SAFE or, for TTY, 1-800-787-3224). The National Domestic Violence Helpline also has chat options if the victim is unable to speak safely. Victims should seek such help even if abuse is not severe. Seeking such help does not necessarily cause trouble for the partner. Information about using technology safely is available online.
More Information
The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.
Centers for Disease Control and Prevention (CDC): Intimate Partner Violence. This web site provides links to fast facts, prevention strategies, dating, risk and protective factors, and the National Intimate Partner and Sexual Violence Survey, which is an ongoing survey that collects the most current and comprehensive national and state data on intimate partner violence, sexual violence and stalking victimization in the United States.
Centers for Disease Control and Prevention (CDC): Sexual Violence Resources. Resources include links to the CDC's publications about sexual violence, related issues such as mental health after a disaster, rape prevention, and sex trafficking.
