Understanding Domestic Abuse

Domestic abuse, often referred to as intimate partner violence, can affect anyone, regardless of gender or identity. It’s not just physical violence. Abuse can take many forms, including emotional manipulation, controlling behavior, threats, and financial exploitation.

In the United States, about 1 in 4 women and 1 in 10 men report having experienced some form of intimate partner violence during their lifetime. The World Health Organization estimates nearly 1 in 3 women have faced physical or sexual abuse by a partner. These sobering statistics underscore how critical it is that we talk about this issue openly and without stigma.

People who experience abuse often feel isolated or afraid, and many don’t know where to turn for help. Some fear judgment or worry that they won’t be believed. Others stay silent because they depend on their partner financially or have been manipulated into thinking the abuse is their fault. But abuse is never the victim’s fault, and no one deserves to feel unsafe in their own home.

In healthcare settings, survivors of domestic abuse don’t always disclose their experience. Instead, they may come in with symptoms that don’t raise immediate red flags such as chronic headaches, abdominal or pelvic pain, or other vague complaints that don’t have a clear medical explanation. Reproductive issues, like unintended pregnancies or frequent infections, may also be signs of abuse, particularly when there’s a history of sexual coercion. Mental health concerns such as depression, anxiety, or insomnia are common; and some patients may show signs of substance use as a way to cope. It’s also not unusual for survivors to either avoid medical care or show up frequently with multiple, unresolved concerns.

Board Certified PAs and all frontline clinicians play a crucial role in recognizing and supporting these individuals. One of the most powerful things a provider can do is to create a safe, nonjudgmental space. That starts with ensuring privacy during visits by asking any accompanying partners to step out.  Then, providers can use gentle, universal language such as, “Because violence is so common and can affect health in many ways, we ask all our patients a few quick questions about safety at home.” Screening tools like HITS (Hurt, Insult, Threaten, Scream) and the WAST (Woman Abuse Screening Tool) can help guide these conversations. If a patient does share abuse, the response matters: “You’re not alone,” and “This isn’t your fault,” can be powerful and validating words.

Accurate documentation is essential.  Describe injuries objectively and record the patient’s words carefully. Most importantly, be prepared with local and national resources. Knowing how to connect a patient to shelters, counseling, or legal support such as the National Domestic Violence Hotline at 1-800-799-SAFE or Love Is Respect for younger individuals can make all the difference. If the survivor isn’t ready to leave their situation, that’s okay. Providers can still help by offering support and helping patients think about safety planning when they are ready.

Resources like UpToDate offer detailed, evidence-based guidance for clinicians managing intimate partner violence, including screening checklists and intervention strategies. According to UpToDate, routine screening in primary care, OB/GYN, and emergency settings improves the likelihood of disclosure, especially when patients feel supported and believed.

Ultimately, whether it’s a subtle comment or a clear call for help, clinicians—especially PAs—are in a powerful position to interrupt the cycle of abuse. Sometimes, all it takes is one compassionate conversation to set a survivor on the path to safety and healing.

Patient Resources

• futureswithoutviolence.org/
• ncadv.org/resources
• womenshealth.gov/relationships-and-safety/get-help/state-resources
• www.cdc.gov/violence-prevention

Telephone Resources:

• National Domestic Violence Hotline: 1-800-799-SAFE (1-800-799-7233)
• The National Sexual Assault Hotline: 1-800-656-4673
• The National Teen Dating Abuse Hotline: 1-866-331-9474

Additional References & Resources

Sherin, K. M., Sinacore, J. M., Li, X. Q., Zitter, R. E., & Shakil, A. (1998). HITS: A short domestic violence screening tool for use in a family practice setting. Family Medicine, 30(7), 508–512. https://pubmed.ncbi.nlm.nih.gov/9669164/

Brown, J. B., Lent, B., Schmidt, G., & Sas, G. (2000). Application of the Woman Abuse Screening Tool (WAST) and WAST-Short in the family practice setting. The Journal of Family Practice, 49(10), 896–903. https://www.researchgate.net/publication/14412197

Alvarez, C., & Federman, D. D. (2023). Intimate partner violence: Intervention and patient management. UpToDate. Retrieved May 13, 2025, from https://www.uptodate.com/contents/intimate-partner-violence-intervention-and-patient-management

Greenfield P, Calcia M, McCree C, Sahota M, Thomas H, Kirkpatrick K, Vagi R, Howard LM, Markham S, Bhavsar V. Identifying, assessing and responding to perpetration of domestic abuse: practice guide for mental health professionals. BJPsych Adv. 2025 Jan;31(1):8-19. doi: 10.1192/bja.2024.39. PMID: 39959570; PMCID: PMC11826930.

CDC National Intimate Partner and Sexual Violence Survey (NISVS): https://www.cdc.gov/nisvs/about/index.html

World Health Organization: Violence Against Women: https://www.who.int/news-room/fact-sheets/detail/violence-against-women

National Domestic Violence Hotline: https://www.thehotline.org | 1-800-799-7233

RAINN (Rape, Abuse & Incest National Network): https://www.rainn.org | 1-800-656-4673

Love Is Respect (for teens and young adults):

https://www.loveisrespect.org | 1-866-331-9474 or text “LOVEIS” to 22522