Domestic violence includes physical, sexual, and psychological abuse between people who live together, including sex partners, parents or guardians and children, children and grandparents, and siblings. Domestic violence includes intimate partner violence (IPV), which refers to physical, sexual, or psychological abuse by a current or former sex partner or spouse.
(See also Child Maltreatment and Elder Abuse.)
Domestic violence is a common problem. In the United States from 2003 to 2012, domestic violence comprised 21% of all violent crime, with 15% of violent crime being intimate partner violence (1). Globally, on average, a woman or girl is killed by someone in her own family every 11 minutes; 47,000 women and girls were killed by an intimate partner or a family member in 2020 (2).
During the COVID-19 pandemic, domestic violence became more prevalent 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 (7).
The Center for Disease Control and Prevention (CDC) National Intimate Partner and Sexual Violence Survey found that, in their lifetime, 47% of women and 44% of men experienced stalking, physical violence, and/or sexual violence by an intimate partner; women are more likely to experience severe physical violence or contact sexual violence (3). Intimate partner violence occurs among people of all ages, races, and ethnicities. Domestic violence is as prevalent among lesbian and bisexual women, gay and bisexual men, and transgender people as among the general population (4). Women are more likely to be killed by an intimate partner than are men; in 2021, 34% of female murder and manslaughter victims were killed by an intimate partner versus 6% of male victims (5). The risk is especially high if the perpetrator has access to a gun (6).
Physical abuse is the most obvious form of domestic violence. It may include hitting, slapping, kicking, punching, breaking bones, pulling hair, pushing, and twisting arms. The victim may be deprived of food or sleep. Weapons, such as a gun or knife, may be used to threaten or cause injury.
Sexual assault is also common; many women who are physically assaulted by their partner are also sexually assaulted by their partner. Sexual assault is any type of sexual activity or contact that a person does not consent to. Sexual assault involves the use of threats or force to coerce sexual contact and includes unwanted touching, grabbing, or kissing, as well as sexual assault.
Psychological abuse may be even more common than physical abuse and may precede it or occur at the same time. 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
Frequently, perpetrators use language to demean, degrade, humiliate, intimidate, or threaten victims in private or in public. Perpetrators may emotionally abuse victims so that victims start to question their own feelings, instincts, and sanity (gas lighting) and may make victims feel guilty or responsible for the abusive relationship.
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 direct, written, telephone, or e-mail contact with others. The perpetrator may manipulate the victim into thinking that others cannot or will not help, or use jealousy to justify these actions. The perpetrator may also prevent the victim from accessing medical care.
Often, the perpetrator withholds money to control the victim. The victim may depend on the perpetrator for most or all of their money. The perpetrator may maintain control by preventing the victim from getting a job, by withholding information about their finances, and by taking money.
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.
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. Stalking can include
Unwanted phone calls, emails, messages through social media, mail, or presents (eg, flowers)
Watching, spying, or following the victim from a distance
Intruding into the victim's home, workplace, or school
Perpetrators may use technology (eg, social media web sites, phones) to post videos or stalk the victim and to monitor, isolate, punish, threaten, and/or humiliate victims (8, 9). Also, perpetrators may monitor the victim's devices, often without the victim knowing it.
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 patients about terms they prefer (see RAINN [Rape, Abuse & Incest National Network]: Key Terms and Phrases and Women Against Abuse: The Language We Use).
General references
1. Truman JL, Morgan RE, BJS statisticians: Nonfatal domestic violence, 2003-2012. U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics. Accessed January 2024.
2. United Nation Office on Drugs and Crime (UNDOC): Killings of women and girls by their intimate partner or other family members. Global estimated 2020. Data 3 matters [Internet] 2021. Accessed January 2024.
3. Leemis R.W., Friar N., Khatiwada S., Chen M.S., et al: The National Intimate Partner and Sexual Violence Survey: 2016/2017 Report on Intimate Partner Violence. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; Atlanta, GA, USA: 2022.
4. Brown TNT,, Herman JL: Intimate partner violence and sexual abuse among LGBT people: A review of existing research. Williams Institute, 2015. Accessed 6/16/22.
5. FBI Bureau of Justice Statistics: Female Murder Victims and Victim-Offender Relationship, 2021 (Dec. 2022). Accessed January 2024.
6. 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 93(7):1089-1097, 2003. doi:10.2105/ajph.93.7.1089
7. Noman AHM, Griffiths MD, Pervin S, et al: The detrimental effects of the COVID-19 pandemic on domestic violence against women. J Psychiatr Res 134:111–112, 2021. doi: 10.1016/j.jpsychires.2020.12.057
8. Woodlock D: The abuse of technology in domestic violence and stalking. Violence Against Women 23 (5):584–602, 2017. doi: 10.1177/1077801216646277
9. Henry N, Powell A: Technology-facilitated sexual violence: A literature review of empirical research. Trauma, Violence, & Abuse 19 (2), 195–208, 2018. doi: 10.1177/1524838016650189
Effects of Domestic Violence
A person who experiences domestic violence may be physically injured. Physical injuries can include bruises, black eyes, cuts, scratches, broken bones, lost teeth, and burns. Injuries may negatively affect the victim's ability to work, possibly leading to loss of income. Injuries, as well as the abusive situation, may embarrass victims, causing them to isolate from family and friends. The victim may also have to move often—a financial burden—to escape the perpetrator. Sometimes the perpetrator kills the victim.
As a result of domestic violence, many survivors develop mental health conditions. Such problems include post-traumatic stress disorder (PTSD), substance use disorders, anxiety, and depression. Physical abuse is often related to more severe psychological issues (1). Even when physical abuse decreases, psychological abuse often continues, reminding victims that they can be physically abused at any time. Victims may feel that psychological abuse is more damaging than physical abuse.
Effects reference
1. Coker AL, Davis KE, Arias I, et al: Physical and mental health effects of intimate partner violence for men and women. Am J Prev Med 23(4):260-268, 2002. doi:10.1016/s0749-3797(02)00514-7
Evaluation of Domestic Violence
History and physical examination
Clinicians may suspect domestic violence based on injuries, inconsistent or puzzling symptoms, and/or behavior of the victim and/or partner (eg, a partner is reluctant to leave the victim alone with the clinician). Or, a victim may report the abuse.
If clinicians suspect domestic violence, they may gently ask patients about their relationship with their partner or with other people living in their home. Many experts recommend that clinicians screen all patients for domestic violence by asking specific questions.
Clinicians should also 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 (most common precipitant for femicide) (1, 2).
Violence has been increasing in risk of injury or death (eg, 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 suspected, clinicians should provide information about resources to help. If domestic violence is confirmed, clinicians 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).
Evaluation references
1. Auchter, B: Men who murder their families: what the research tells us. NIJ Journal, No. 266 (June 2010), pp. 10–12
2. Nicolaidis C, Curry MA, Ulrich Y, et al: Could we have known? A qualitative analysis of data from women who survived an attempted homicide by an intimate partner. J Gen Intern Med 18(10):788-794, 2003. doi:10.1046/j.1525-1497.2003.21202.x
Management of Domestic Violence
In cases of domestic violence, the most important consideration is safety. 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 the kitchen, although doing so may not be possible. If they can, victims should promptly call emergency services or the police and leave the residence. Victims should have any injuries treated and documented with photographs. They 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 important. It should include where to go for help, how to get away, and how to access money. Victims should also make and hide copies of official documents (such as children’s birth certificates, social security cards, insurance cards, and bank account numbers). They should keep an overnight bag packed in case they need to leave quickly.
Sometimes the only solution is to leave the abusive relationship permanently because domestic violence continues, especially among very aggressive perpetrators. Also, even when physical abuse decreases, psychological abuse may persist. The decision to leave is not simple or easy. Victims often feel unable to leave an abusive relationship for multiple reasons, including fear of retaliation and economic dependence on the abuser.
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, by obtaining a restraining or protection order (although such an order does not guarantee safety).
In the United States, help is available through shelters for domestic violence survivors (including those in LGBTQ+ communities), 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 make a voice call.
Key Points
Domestic violence includes physical, sexual, and psychological abuse between people who live together, including sex partners, parents or guardians and children, and siblings.
Physical injuries, psychological issues, social isolation, loss of a job, financial difficulties, and even death can result.
Keeping safe—for example, having a plan of escape—is the most important consideration.
Because domestic violence tends to continue, sometimes the only solution is to leave the abusive relationship permanently, which requires preparation and extra precautions to ensure safety.
More Information
The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.
The National Intimate Partner and Sexual Violence Survey: This web site provides the most current and comprehensive national and state data from the Centers for Disease Control and Prevention on the national prevalence of intimate partner violence, sexual violence, and stalking among women and men in the United States and tracks trends over time; special reports provide more information or in-depth analyses on a specific topic.
National Domestic Violence Helpline: Information about the domestic violence hotline and live, online chat service available for victims, survivors, and friends and family members who are concerned about a loved one's safety
