The Critical Role of Physicians in Addressing Domestic Violence

The Critical Role of Physicians in Addressing Domestic Violence

Domestic violence is a pervasive public health issue that touches every community. It cuts across age, race, income and geography, leaving lasting harm to survivors and families. Nearly all healthcare professionals will eventually treat a patient impacted by domestic or family violence. For physicians, recognizing the signs and understanding the dynamics is essential.

The Scope and Prevalence of Domestic Violence

Each year, domestic violence affects an estimated 10 million people in the U.S. One in four women and one in nine men are victims of domestic violence.i Despite these numbers, intimate partner violence remains highly underreported, which means the true prevalence is even greater. Domestic violence extends beyond physical harm. It includes emotional, psychological, financial and sexual abuse. These behaviors are used to exert control within intimate or family relationships. The patterns often escalate in severity over time.

Why Healthcare Providers Are Central to the Response

For many victims, the healthcare system is their only consistent contact outside the home. Physicians and nurses encounter them in emergency rooms, clinics and primary care offices. Sometimes they present with suspicious injuries, but just as often they come for unrelated concerns. This uniquely positions providers to identify abuse, initiate conversations and connect patients with resources. That same access also makes clinicians key to recognizing victims of human trafficking, who frequently seek care but may not engage law enforcement. Even brief interventions can make a difference. Women who disclose abuse to their healthcare provider are four times more likely to seek help and more than twice as likely to leave an abusive relationship. Creating a private, judgment-free space reduces fear and stigma and increases the likelihood of disclosure of abuse.

Recognizing Warning Signs

Abuse is not always obvious. Some patients present with repeated or unexplained injuries. Others show subtle behavioral or situational cues.

Possible patient signs:

• Hesitancy answering questions in front of a partner 
• Frequent missed appointments 
• Minimizing or denying injuries 
• Emotional cues such as tearfulness, anxiety or hypervigilance

Possible abuser signs:

• Refusal to leave the exam room 
• Speaking for the patient or controlling the conversation 
• Restricting the patient’s access to care

Spotting these red flags requires clinical attentiveness and a readiness to consider abuse as a diagnosis.

At-Risk Populations

Anyone can be a victim, but certain groups face greater risk or barriers to support:

• Children: Exposure to violence causes emotional and developmental harm. It raises risks of depression, anxiety, behavioral issues and repeating the cycle in adulthood.  
• Teens: Among U.S. high school students who dated in the past year, one in twelve report physical dating violence and one in ten report sexual dating violence. Underreporting makes physician vigilance crucial.  
• Pregnant Women: Intimate partner violence during pregnancy increases risks of depression, obstetric complications, low birth weight, preterm delivery and even perinatal death. The American College of Obstetricians and Gynecologists recommends screening every trimester and at postpartum checkups.
• LGBTQIA+ Individuals: Rates of intimate partner violence are comparable to or higher than those among heterosexual women. Stigma and fear of “outing” prevent many from seeking help. Transgender individuals face particularly high risks of physical violence and discrimination. Inclusive, culturally competent care is essential.
• Elderly Adults: Older victims often face physical, emotional or financial abuse. This can be difficult to detect when victims are isolated or dependent on caregivers. Watch for unexplained injuries, sudden financial changes or shifts in behavior.

The Health Consequences of Domestic Violence

The effects reach far beyond immediate harm. Survivors often face long-term physical or psychological consequences.

Physical consequences:

• Chronic pain, headaches and gastrointestinal problems
• Gynecological problems, such as pelvic pain, sexually transmitted infections and painful intercourse
• Injuries inconsistent with typical accidents, such as burns, strangulation marks or patterned bruising

Mental health consequences:

• Depression and anxiety
• Post-traumatic stress disorder (PTSD)
• Substance user disorders

These consequences drive higher healthcare utilization and significant economic costs. A 2018 study estimated the lifetime cost of intimate partner violence at over $100,000 per female survivor and over $23,000 per male survivor.

Challenges to Screening and Intervention

Despite strong evidence, screening is not performed consistently. Common barriers include: 

• Limited appointment time 
• Lack of training or confidence 
• Fear of offending patients 
• Unfamiliarity with available resources

Emergency departments are especially underutilized even though nearly half of women treated there report a history of abuse.

Best Practices for Physicians

A structured approach can improve detection and support:

1. Screen universally. Make it a routine part of care. 
2. Ensure privacy. Speak with patients alone. 
3. Use validated tools such as HITS, PVS or the Danger Assessment. 
4. Document thoroughly with details and diagrams. 
5. Offer resources and referrals tailored to patient needs. 
6. Prioritize safety through planning and knowledge of reporting laws.

A Call to Action 

Domestic violence is a leading cause of injury, death and long-term health consequences. Physicians are uniquely positioned to intervene by screening, recognizing risks and creating safe spaces for disclosure. Every patient encounter is an opportunity to uncover hidden violence and guide patients toward safety and healing.