The World Health Organization has declared violence a major public health problem, with intimate partner violence (IPV) being one of the most common types against women. It has reached epidemic proportions in US society and is the single major cause of injury to women in the United States, more common than rapes, muggings, and automobile accidents combined. Approximately 1.5 million women are raped or assaulted annually by an intimate partner. IPV does occur against males; however, women are significantly more likely to be a victim.

Intimate partners are current or former spouses or current or former nonmarital partners (dating or same-sex partners). Violent acts include both physical and sexual violence, as well as threats and psychological/emotional abuse. Physical violence includes acts used with enough force to have the potential to cause death, disability, or injury – actions such as scratching, pushing, shoving, burning, or use of restraint on another’s body. These uniform definitions are important for researchers but also for clinicians charged with detecting IPV.

IPV exacts a heavy toll, not only on the direct victim, but on the children who are exposed to it. Children who live in homes where partner violence occurs are at risk for developing a range of emotional, physical, and behavioral symptoms. Research suggests that they are at serious risk of developing a host of trauma symptoms and delinquency problems. Children who witness domestic violence demonstrate higher levels of depression and lower levels of self-esteem; these effects are especially pronounced in boys. In addition, children from families with domestic violence are at risk for experiencing physical violence themselves.

Screening for domestic violence needs to be systematic and direct. The inclusion of questions that identify IPV in triage and entry-point protocols significantly increases the identification of abused women. Screening for domestic violence also is critically important because the way in which the immediate aftermath of violence is handled is an important determinant of the survivor’s psychologic response.

The American College of Emergency Physicians’ policy statement on this emphasizes the need for evaluating patients presenting to an emergency department for IPV; develops multidisciplinary approaches for identification, treatment, and referral; and recognizes the special services and resources necessary for victims. The Joint Commission has mandated that hospitals have objective criteria for identifying and assessing possible victims of abuse and neglect and that these standards be uniform throughout the organization.

Child maltreatment is a major public health crisis. Neglect is the most common form, followed by physical abuse, and then sexual abuse, emotional maltreatment, and medical neglect.

Child neglect is the presence of certain deficiencies in caretaker obligation that harm the child’s psychological or physical health, or both. Child neglect covers a range of behaviors including educational, supervisory, medical, physical, and emotional neglect and abandonment, often complicated by cultural and contextual factors. Physical abuse includes scalding, beatings with an object, severe physical punishment, and Münchhausen syndrome by proxy. Sexual abuse includes incest, sexual assault by a relative or stranger, fondling of genital areas, exposure to indecent acts, sexual rituals, or involvement in pornography. Emotional maltreatment includes acts such as verbal abuse and belittlement, acts designed to terrorize a child, and lack of nurturance or emotional availability by caregivers. It is difficult to unpack emotional maltreatment from the other forms of abuse insofar as it can be argued that it may be an integral component of all other forms of maltreatment.

Children who are maltreated evidence both physical and behavioral symptoms. Any verbal report or suspicion of child maltreatment must be acted upon. Box 39.1 lists some symptoms to which the clinician should be attuned. Certain symptoms can occur with all types of maltreatment, while others are specific to certain forms of maltreatment.