Intimate Partner Violence: Risk Prediction
A 27-year-old woman attends a primary care clinic with multiple bruises at different stages of healing on her arms and trunk. She says she fell down stairs, but the explanation does not match the pattern of injury. She has been married four years. Which of the following factors most strongly predicts intimate partner violence in a relationship?
- A.Tobacco use
- B.Second marriage
- C.Personal bankruptcy
- D.Marital dissatisfactionCorrect
Explanation
Injuries of differing ages with a history that does not fit the injury pattern should prompt private, direct screening for intimate partner violence. Across population studies the single strongest relationship level predictor of partner violence is marital or relationship dissatisfaction and conflict, which consistently outperforms demographic markers. Related relationship level predictors are male dominance in decision making, jealousy and controlling behaviour, and poor conflict resolution skills. Other established risk factors include male alcohol misuse, witnessing violence in childhood, unemployment and pregnancy, but these operate more weakly than relationship discord itself. Tobacco use is a marker of general risk behaviour and is not an independent predictor of partner violence. Being in a second marriage and financial insolvency correlate loosely with stress but do not predict violence with any consistency. Once violence is suspected the physician should ask directly, document injuries objectively, assess immediate safety including lethality risk, and offer referral to social work and legal support. Mandatory reporting rules vary by jurisdiction, and in Saudi Arabia suspected domestic abuse is reportable to the designated protection committee. Screening should be done alone, never in the presence of the partner.
Why each option
- A.
- Tobacco use is a general health risk behaviour and is not an independent predictor of intimate partner violence.
- B.
- A second marriage carries no consistent association with partner violence in population studies.
- C.
- Financial strain adds stress but bankruptcy alone is a weak and inconsistent predictor.
- D.
- Correct. Relationship discord and marital dissatisfaction are the most consistent relationship level predictors of intimate partner violence.
Reference: ACOG Committee Opinion No. 518: Intimate Partner Violence. Obstet Gynecol. 2012;119(2):412-417 (reaffirmed 2019); WHO. Violence Against Women Prevalence Estimates. Geneva: WHO, 2021.
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