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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.