Revised Statement on Intimate Partner Violence

The American College of Surgeons (ACS) Intimate Partner Violence Task Force and Women in Surgery Committee have updated the Statement on Intimate Partner Violence developed by the Committee on Trauma (COT) in 2014. This revised statement also replaces the COT’s 2000 Statement on Domestic Violence. The Board of Regents approved the statement at its June 2018 meeting in Chicago, IL.

Intimate partner violence (IPV), also called domestic violence, is a major public health problem. IPV is defined as behavior designed to exert undue control over another person using physical, sexual, verbal, or emotional abuse within the context of an intimate relationship with a current or former partner or spouse.

IPV affects both women and men, regardless of sexual orientation, gender identity, age, socioeconomic status, education, culture, religion, race, or ethnicity. As such, surgical colleagues and trainees are at risk for IPV. IPV victims may feel afraid, embarrassed, or ashamed and, therefore, may not be forthcoming about their circumstances.

Nearly one in four adult women and one in seven men report being a victim of IPV in their lifetime.¹ IPV is the leading cause of serious injury and death to women ages 18–24 in the U.S.² IPV victims are at increased risk of developing major depression and post-traumatic stress disorder, attempting suicide, and abusing drugs and alcohol.³ Women exposed to IPV have a fivefold increased risk of suicide, and 40 percent of women homicide victims are killed by an intimate partner.¹

Physical manifestations of IPV range from minor injuries, such as bruises and abrasions, to lethal blunt and penetrating wounds and strangulation injuries. Households with firearms portend an increased risk of death and serious injury. IPV is highly likely to recur, and the failure to recognize it can have lethal consequences for patients, colleagues, and innocent bystanders.

Screening with explicit questioning can help identify victims of IPV. Although various models of questioning are available, one simple approach is the SAFE screening technique:^4,5

• Stress/Safety: Do you feel safe in your relationship?
• Afraid/Abused: Have you been physically hurt or threatened by your partner?
• Friends/Family: Are your friends and family aware of what is going on?
• Emergency: Do you have a safe place to go in an emergency?

It is the responsibility of surgeons not only to care for our patient’s immediate injuries, but also to refer patients to appropriate resources and follow up for IPV. Surgical training should include education about IPV.

Surgeons should identify and intervene when colleagues and trainees are victims of IPV or can be identified as an at-risk situation. Surgeons and surgical departments should develop programs within their practices and departments to help identify and support colleagues who are victims of IPV using national and international guidelines.^1,6

Moreover, surgeons should take a leadership role in their communities, hospitals, and medical schools in advocating for the appropriate identification, prevention, and treatment of IPV among colleagues.

The ACS supports legislation and policies that enhance judicial and law enforcement tools to combat IPV, prevent violence, and improve services for victims of IPV.

References

1. Niolan PH, Kearns M, Dills J, Rambo K, Armstead TL, Gilbert L. Preventing Intimate Partner Violence Across the Lifespan: A Technical Package of Programs, Policies, and Practices. Atlanta, GA: Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 2017.
2. Truman JL, Morgan RE. Special Report: Nonfatal Domestic Violence, 2003−2012. Washington, DC: U.S. Department of Justice, Office of Justice Program, Bureau of Justice Statistics; 2014.
3. American College of Obstetricians and Gynecologists. Committee opinion: Intimate partner violence. Available at: www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Intimate-Partner-Violence. Accessed August 13, 2018.
4. Snider C, Webster D, O’Sullivan CS, Campbell J. Intimate partner violence: Development of a brief risk assessment for the emergency department. Acad Emerg Med. 2009;16(11):1208-1216.
5. Ashur ML. Asking about domestic violence: SAFE questions. JAMA. 1993;269(18):2367.
6. Butchart A, Garcia-Moreno C, Mikton C. Preventing Intimate Partner and Sexual Violence Against Women: Taking Action and Generating Evidence. Geneva, Switzerland: World Health Organization; 2010.