Understanding the effects of intimate partner violence

Intimate partner violence (IPV) occurs when a person abuses or is aggressive toward their romantic partner. You may also hear it called:

• Domestic violence
• Battered woman syndrome
• Battered spouse syndrome
• Battered person syndrome

Anyone can experience IPV, regardless of sex or gender identity. Having a sexual relationship isn’t necessary.

IPV is common in the United States. About 40 percent of women and 26 percent of men face sexual violence, physical violence, or stalking by an intimate partner within their lifetime, according to the Centers for Disease Control and Prevention (CDC). The CDC also estimates that more than 61 million women and 53 million men are the target of psychological abuse by a partner at some point in their lives.

The true incidence of IPV is unknown, however, since many victims don’t report their experiences. This may hold especially true for men who are abused, since they often face cultural stigmas related to masculinity and victimization.

IPV is extremely serious and can have lasting health implications for the abused person and any family members who may witness the abuse.

Signs of an abusive relationship

IPV usually involves a partner who seeks power and control. Abuse is expressed in many different forms, but abusive partners evoke fear through violence, threats, and emotional manipulation. They prevent partners from making their own decisions, forcing them to do what the abuser wants—and often threatening them in the process.

Forms of abuse vary, but can involve:

• Physical abuse such as hitting, choking, or using weapons
• Sexual violence and coercion
• Reproductive coercion, which involves controlling a person’s contraception use and pregnancy choices
• Stalking, meaning repeated, unwanted contact from a partner that causes a person to feel their life or a loved one’s safety is threatened
• Financial abuse and monitoring
• Digital abuse, such as controlling social media accounts
• Verbal abuse, such as name-calling, threats, and humiliation
• Psychological and emotional abuse such as bullying, intimidation, or gaslighting

Abusive relationships can be hard to predict in the beginning. In fact, abusive partners can initially seem charming and caring. “Abusers often have a seductive personality,” says Franklin Drummond, MD, a psychiatrist with Trident Medical Center in Charleston, South Carolina.

In most cases, however, this charming behavior is an act, a preliminary role they play to draw someone close to them and gain their trust. Before long, the relationship becomes tense, and may eventually escalate into violence and other forms of abuse. Apologies may follow, after which the pattern begins again. This is called the cycle of abuse.

Risk factors for IPV

Anyone can experience abuse. However, research has suggested that some people have a higher risk of experiencing IPV than others. Risk factors include:

• Experiencing financial or housing instability
• Being of a younger age
• Having lower levels of education
• Being unemployed
• Lacking access to healthcare
• Being pregnant

People who have had adverse childhood experiences (ACEs) are also at higher risk of IPV. ACEs include abuse, neglect, or family dysfunction experienced as a child.

Transgender individuals are at significantly higher risk, as well. In a 2020 systematic review and meta-analysis published in the American Journal of Public Health, researchers found that transgender people were 1.7 times more likely to experience any type of IPV in their lifetime compared to people who weren’t transgender. They were also 2.2 times more likely to experience physical abuse and 2.5 times more likely to be sexually abused by an intimate partner.

Mental health symptoms after experiencing IPV

About 20 percent of survivors of IPV report having psychiatric disorders, according to the American Psychiatric Association. The physical and mental symptoms may mirror those of post-traumatic stress disorder (PTSD), which is commonly seen in military personnel or people who are exposed to trauma or abuse, notes Dr. Drummond.

The four main types of PTSD symptoms include:

• Recurring flashbacks, nightmares, or recollections
• Avoidance of people, places, or events that serve as reminders of the abuse
• Negative thoughts and emotions, feeling numb, experiencing memory problems, and feeling alone
• Changes in behavior after the trauma, such as trouble sleeping, difficulty concentrating, feeling anxious and jumpy, or getting easily irritated or angry

PTSD is more common among women than men. This is partly because women are more likely to experience sexual assault, which comes with a high risk of PTSD.

Experiences with IPV can also contribute to major depressive disorder (MDD), generalized anxiety disorder (GAD), and substance use disorders. Compulsive or self-destructive behaviors may also occur.

Self-blame and self-directed resentment and anger are common, too, however unjustified. It may be difficult to form new relationships, regulate emotions, or read facial expressions and social cues.

Difficulties of leaving an abusive relationship

Leaving an abuser is extremely important for the safety of the victim and any family members they are caring for. In addition to long-term mental health issues, staying in an abusive relationship can lead to physical injuries like organ damage, broken bones, and even death. But many people find it difficult to leave their partner for a variety of reasons.

Victims of IPV may worry that losing a relationship with the abuser could have serious repercussions. Drummond notes that a person may feel that, “financially, they’ll lose everything if they end the relationship, leaving them possibly homeless with no resources to provide for themselves or their children." They may also fear being separated from their children, or being deported. They may fear they will be killed or that their children will be harmed if they leave, as well.

The fear of leaving an abuser is justified. About 75 percent of domestic violence-related homicides happen during or after the abused person leaves the relationship, according to the Center for Relationship Abuse Awareness and other advocacy groups.

Abusive partners tend to retaliate or lash out when the abused person leaves because it signifies they’ve lost some amount of control over their victims. This doesn’t mean that leaving can’t be done safely, only that it should be done with a support network and safety resources in place.

The emotional and physical trauma that a victim goes through can also cloud their mind. “The helplessness in the face of ongoing trauma changes a person’s psychology and is one reason they make seemingly bad decisions, like staying with their abusive partner,” says Drummond. Learned helplessness is the term for when someone who has been subject to a constant threat of violence, intimidation, or isolation stops trying to escape even in situations where they may have escape opportunities.

How to get help

Although many people fear for their safety and may feel as though they can’t leave an abusive relationship, Drummond notes that there are often resources available for those who need them.

These include a variety of local and national shelters where people who are experiencing IPV can take refuge. They are safe and secure, keep your information confidential, and help prevent you from being followed by your abuser. You can find a shelter near you using DomesticShelters.org.

In many cases, an emergency room or hospital can be a safe space. If you feel comfortable doing so, you may also find protection at a local police station or fire department.

The National Domestic Violence Hotline at 1-800-799-SAFE (7233) offers around-the-clock crisis and counseling services. They can also help you build a safety plan. This is a practical and personalized plan that helps ensure your safety while you’re in an abusive relationship, when you’re getting ready to leave the relationship, or after you’ve left.

When it comes to treatment for PTSD, a therapist can talk you through options. These may include the following.

• Cognitive behavioral therapy (CBT): A person focuses on past trauma and works toward understanding, identifying, and changing the way they view and handle certain situations. This is often the most effective treatment for PTSD.
• Eye movement desensitization and reprocessing (EMDR): This is a type of psychotherapy that asks people to revisit traumatic memories while paying attention to a repeated sound or movement.
• Present-centered therapy: This type of treatment helps patients work through current life situations, rather than focusing on the past.
• Medications: Antidepressants like selective serotonin reuptake inhibitors (SSRIs) or antianxiety medications can be prescribed to relieve symptoms and improve mood.

If you are currently experiencing intimate partner violence, the most important thing you can do is to reach out for help. A trusted friend or family member, local shelter, member of the clergy, or an organization like the National Domestic Violence Hotline will be able to help you gather the support and practical resources you need to keep yourself and your family members safe.

They can also help you strategize and build a plan for leaving, and assist you when you do leave. Once you’re safely out of the abusive environment, you can seek treatment and begin to heal.