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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.