If your practice sees adolescent patients and you’re not identifying intimate partner violence or coercion on a regular basis, it’s time to ask, "Why not?"
It’s there, it’s more common than you may suspect, and it often produces lifelong health consequences. Not enough teenagers are reporting it – and not enough physicians are asking about it – for a slew of reasons.
Increased attention to these problems in recent years has generated some handy resources for physicians to improve prevention, detection, and responses to intimate partner violence and sexual or reproductive coercion.
More than half (53%) of 1,278 women aged 16-29 years who were seen at family planning clinics reported physical or sexual violence by intimate partners, 19% reported pregnancy coercion, and 15% reported birth control sabotage in one study (Contraception 2010;81:316-22).
Some 40% of 448 females aged 14-20 years who were seen at five urban adolescent clinics said they had experienced intimate partner violence in a separate study (Matern. Child Health J. 2010;14:910-7). A survey of 10th and 11th graders found that more than half of the girls and 13% of boys reported sexual coercion, defined as sexual behaviors involving verbal coercion, threats of force, or use of drugs or alcohol (Violence Vict. 1995;10:299-313).
In a survey of 1,430 seventh graders in three states that was conducted by the Robert Wood Johnson Foundation, 37% said they had witnessed physical dating violence against a peer, 37% reported experiencing psychological dating abuse, and – during the prior 6 month – 15% experienced physical dating abuse and 31% experienced electronic dating aggression.
In a survey of 305 school counselors, the majority (71%) had not received formal training on adolescent dating violence (ADV). Eighty-one percent said their school did not have a protocol to respond to incidents of ADV, and 83% said the school did not conduct periodic student surveys that included questions that mentioned ADV (Pediatrics 2012;130:202-10).
Adolescents overwhelmingly want health care providers to ask about intimate partner violence and coercion, other studies have shown. So, why aren’t they telling you about it, even if you ask?
You may not be asking in the right way, nor asking often enough, Dr. Harise Stein said at Stanford (Calif.) University’s annual pediatric update and preconference.
Teens aged 15-19 years have the highest rates of intimate partner violence and stalking of any age group, yet they report only an estimated 1 in 11 episodes of dating-related violence, said Dr. Stein, an ob.gyn at the university. She is a member of the Santa Clara County (Calif.) Domestic Violence Council.
One in six U.S. women experience rape – "which I think is a national disgrace," she said – and 32% of first rapes occur in female victims aged 12-17-years. In that age group, 36% of rapists are intimate partners, and 33% are acquaintances, according to a 2006 U.S. Department of Justice report.
Abuse during adolescence interferes with emotional development and has been associated with mental and physical illness both during the teen years and carried forward into adulthood, she said. It can exacerbate asthma, headaches, or other chronic illnesses. Consider abuse in the diagnostic differential when you see an adolescent who has developed school problems, increased isolation, personality changes, mental health issues, an eating disorder, substance abuse, cutting and other forms of self-harm, or suicidal ideology, Dr. Stein said.