Prevalence of Intimate Partner Violence and Beliefs About Partner Violence Screening Among Young Men

Tova B. Walsh; Rita C. Seabrook; Richard M. Tolman; Shawna J. Lee; Vijay Singh

doi:10.1370/afm.2536

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RE: Prevalence of Intimate Partner Violence and Beliefs About Partner Violence Screening Among Young Men
Lawrence M Gibbs

Published on: 11 August 2020
RE: Prevalence of Intimate Partner Violence and Beliefs About Partner Violence Screening Among Young Men
Shelby M Reimer

Published on: 07 August 2020

Published on: (11 August 2020)
Page navigation anchor for RE: Prevalence of Intimate Partner Violence and Beliefs About Partner Violence Screening Among Young Men
RE: Prevalence of Intimate Partner Violence and Beliefs About Partner Violence Screening Among Young Men
Lawrence M Gibbs, Faculty Family Physician, Methodist Health System Family Medicine Residency - Dallas TX
I very much appreciated the article by Walsh et al. and thought it brought up two very good points.

First, it furthers the data supporting the need for primary care physicians to be aware that their male patients may be victims of IPV (1 in 4 men surveyed).(1) From Straus and Gelles’ work in the 1970s and '80s using the National Family Violence Survey, which targeted married and cohabiting couples' use of violence in relationships,(2,3) to Archer’s extensive meta-analysis of the IPV research in the '80s and '90s,(4) to Whitaker et al.’s longitudinal study of young adults (National Longitudinal Study of Adolescent Health),(5) it is clear that men do experience violence from romantic partners.

In the last of these, Whitaker et al. found that IPV was present in approximately 24% of intimate relationships.(5) Among these violent relationships, nearly 50% were comprised of bi-directional or reciprocal violence, while in the non-reciprocal half women were more frequently sole perpetrators of IPV according to both male (74.9%) and female (67.7%) reports.(5) Here the authors made note that reciprocal violence seemed to be more dangerous for both male and female victims, citing that men were injured in over one quarter of reciprocally violent cases.(5)

Second, as was described in the study by Walsh et al.(1) and also by Whitaker et al. above,(5) the rates of mutual or bi-directional violence are even higher than that of unidirectional viole...
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I very much appreciated the article by Walsh et al. and thought it brought up two very good points.

First, it furthers the data supporting the need for primary care physicians to be aware that their male patients may be victims of IPV (1 in 4 men surveyed).(1) From Straus and Gelles’ work in the 1970s and '80s using the National Family Violence Survey, which targeted married and cohabiting couples' use of violence in relationships,(2,3) to Archer’s extensive meta-analysis of the IPV research in the '80s and '90s,(4) to Whitaker et al.’s longitudinal study of young adults (National Longitudinal Study of Adolescent Health),(5) it is clear that men do experience violence from romantic partners.

In the last of these, Whitaker et al. found that IPV was present in approximately 24% of intimate relationships.(5) Among these violent relationships, nearly 50% were comprised of bi-directional or reciprocal violence, while in the non-reciprocal half women were more frequently sole perpetrators of IPV according to both male (74.9%) and female (67.7%) reports.(5) Here the authors made note that reciprocal violence seemed to be more dangerous for both male and female victims, citing that men were injured in over one quarter of reciprocally violent cases.(5)

Second, as was described in the study by Walsh et al.(1) and also by Whitaker et al. above,(5) the rates of mutual or bi-directional violence are even higher than that of unidirectional violence. Langhinrichsen-Rohling et al. also found this to be true, showing that for 49.2%-69.7% of partner-violent couples across diverse samples, IPV is perpetrated by both partners.(6) Furthermore, this mutual violence is not just due to one partner acting in self-defense, which was found in fewer than one-quarter of males and one-third of females.(7)

This second point becomes even more important as the screening tools we readily have at our disposal do not discern whether someone is in a mutually violent or uni-directionally violent relationship. Patients are merely asked about potential acts committed against them and never asked if they ever exhibit any behaviors of aggression toward their partners. Approaching IPV in this way obscures an accurate estimate of the rate of partner violence and the consequences it has for all couples.(8) The study by Walsh et al. gives us reason to think that at least half the population (men) may be open to such a line of screening.

It is time for physicians to take off their blinders and begin to see the wider scope of IPV and its complete presentation, including male victims and male and female patients who are involved in mutually violent relationships. Though it must be done with care and empathy toward potential victims of IPV, asking ALL patients about their potential perpetration and victimization is the only way to ensure we are correctly identifying the actual behaviors and dynamics of IPV affecting our patients.

References:
1. Walsh TB, Seabrook TC, Tolman RM, Lee SJ, Singh V. Prevalence of intimate partner violence and beliefs about partner violence screening among young men. Annals of Family Medicine. 2020 July; 18(4): 303-308.
2. Straus MA and Gelles RJ. Societal change and change in family violence from 1975 to 1985 as revealed by two national surveys. Journal of Marriage and the Family. 1986; 48: 465-479.
3. Straus MA and Gelles RJ. Physical violence in American families: Risk factors and adaptations to violence in 8,145 families. 1990. New Brunswick, NJ: Transaction Press.
4. Archer J. Sex Differences in Physically Aggressive Acts Between Heterosexual Partners: A Meta-Analytic Review. Aggression and Violent Behavior. 2002; 7: 313-351.
5. Whitaker DJ, Haileyesus T, Swahn M, and Saltzman LS. Differences in Frequency of Violence and Reported Injury Between Relationships With Reciprocal and Nonreciprocal Intimate Partner Violence. American Journal of Public Health. 2007; 97(5): 941-947.
6. Langhinrichsen-Rohling J, Selwyn C, Rohling ML. Rates of bidirectional versus unidirectional intimate partner violence across samples, sexual orientations, and race/ethnicities: a comprehensive review. Partner Abuse. 2012; 3: 199-230.
7. Langhinrichsen-Rohling J, McCullars A, Misra TA. Motivations for men and women’s intimate partner violence perpetration: a comprehensive review. Partner Abuse. 2012; 3: 429-468.
8. Sprunger JG, Schumacher JA, Coffey SF, and Norris DR. It’s time to start asking all patients about intimate partner violence. Journal of Family Practice. 2019 April; 68(3): 152-154,156-161A.
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Competing Interests: None declared.
Published on: (7 August 2020)
Page navigation anchor for RE: Prevalence of Intimate Partner Violence and Beliefs About Partner Violence Screening Among Young Men
RE: Prevalence of Intimate Partner Violence and Beliefs About Partner Violence Screening Among Young Men
Shelby M Reimer, Chief Resident, OhioHealth Riverside Methodist Hospital Family Medicine Residency Program
To the editor:

Walsh et al determined that exposure to intimate partner violence (IPV), either as a perpetrator or as a survivor, is pervasive amongst young, predominantly heterosexual men and that a majority of this group believes that it is appropriate for their physician to screen them for IPV.(1) The authors oversimplify the complexity of IPV, however, by focusing on the Conflict Tactics Scale (CTS) which emphasizes physical violence and does not adequately screen for other forms of IPV. As a result, the article perpetuates traditional notions of masculinity and may result in under recognition of this population.

The medical and anthropological communities, propelled by “second-wave feminism” in the 1960s,(2) began to examine IPV with increasing fervor in the 1970s. The CTS was developed in 1979 (3) and has become a reference standard against which other screening tools are often compared.(4) In the years since the creation of the CTS, however, our understanding of IPV has broadened. IPV as it’s currently defined includes emotional and sexual abuse, coercion, stalking, and intimidation between two people who are not necessary romantically involved.(5) An updated tool for IPV screening in the ambulatory setting is HITS (hurt, insult, threaten, scream), which acknowledges that patients encounter violence in many forms,(6,7) thus increasing the likelihood that they are identified and referred to the appropriate community resources.

It is commend...
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To the editor:

Walsh et al determined that exposure to intimate partner violence (IPV), either as a perpetrator or as a survivor, is pervasive amongst young, predominantly heterosexual men and that a majority of this group believes that it is appropriate for their physician to screen them for IPV.(1) The authors oversimplify the complexity of IPV, however, by focusing on the Conflict Tactics Scale (CTS) which emphasizes physical violence and does not adequately screen for other forms of IPV. As a result, the article perpetuates traditional notions of masculinity and may result in under recognition of this population.

The medical and anthropological communities, propelled by “second-wave feminism” in the 1960s,(2) began to examine IPV with increasing fervor in the 1970s. The CTS was developed in 1979 (3) and has become a reference standard against which other screening tools are often compared.(4) In the years since the creation of the CTS, however, our understanding of IPV has broadened. IPV as it’s currently defined includes emotional and sexual abuse, coercion, stalking, and intimidation between two people who are not necessary romantically involved.(5) An updated tool for IPV screening in the ambulatory setting is HITS (hurt, insult, threaten, scream), which acknowledges that patients encounter violence in many forms,(6,7) thus increasing the likelihood that they are identified and referred to the appropriate community resources.

It is commendable to expand our understanding of IPV as it relates to male survivors, but family physicians should beware of falling into an antiquated view of focusing primarily on the physical harm. Use of the Conflict Tactics Scale as an ambulatory screening tool narrows the potential of providers to develop trust within this community of survivors and accurately identify them as being at risk.

Citations
1. Walsh TB, Seabrook TC, Tolman RM, Lee SJ, Singh V. Prevalence of intimate partner violence and beliefs about partner violence screening among young men. The Annals of Family Medicine. 2020 July, 18(4): 303-308.

2. Sprey, J. The family as a system in conflict. Journal of Marriage and Family. 1969 Nov, 31(4): 699-706.

3. Straus, MA. Measuring intrafamily conflict and violence: the conflict tactics (CT) scales. Journal of Marriage and Family. 1979 Feb, 41(1): 75-88.

4. Langhinrichsen-Rohling, J. Top 10 greatest “hits”: important findings and future directions for intimate partner violence research. Journal of Interpersonal Violence. 2005 Jan, 20(1): 108-118.

5. Breiding MJ, Basile KC, Smith SG, Black MC, Mahendra RR. Intimate partner violence surveillance: uniform definitions and recommended data elements, version 2.0. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. 2015.

6. Coker AL, Davis KE, Arias I, et al. Physical and mental health effects of intimate partner violence for men and women. Am J Prev Med. 2002 Nov; 23(4): 260-268.

7. Rabin RF, Jennings JM, Campbell JC, Bair-Merritt MH. Intimate partner violence screening tools: a systematic review. Am J Prev Med. 2009 May; 36(5): 439-445.
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Competing Interests: None declared.