Staff Perspective: Intimate Partner Violence - Understanding its Impact, Improving Screening Methods, and Strengthening Support Systems
October is Domestic Violence Awareness Month, a time dedicated to recognizing the serious effects of domestic violence, including intimate partner violence (IPV). During this month, various programs focus on this critical issue to support those affected by domestic violence and to educate professionals who assist them. On a recent Star Behavioral Health Providers Coffee and Community Building Call, Star Providers1 had an opportunity to learn more about the role of Sexual Assault Response Coordinators in the Air National Guard and how they support service members who have experienced IPV.
Individuals who experience IPV can face significant short- and long-term impacts on their overall health and well-being. While it is widely acknowledged that IPV disproportionately affects women and sexual, gender, ethnic, and racial minority groups (Stockman et al., 2015), we are continually learning about the systemic effects of these traumatic experiences. Further research is essential to fully understand the impact of IPV across all gender identities, races, ethnicities, sexual orientations, religions, cultures, abilities, and types of violence experienced.
News media portrayals of individuals who have experienced IPV have long been stigmatizing (Taccini & Mannarini, 2024). However, the rise of social media and user-generated video content has created new opportunities for sharing personal experiences. This shift enables the general public to learn about IPV directly from those who have lived through it. Additionally, there is greater accessibility to mental health providers and advocates who work with this community, as many professionals have turned to these platforms to educate the public about the signs and symptoms of IPV. Terms like gaslighting, love bombing, toxic relationships, and red flags have become widely used, contributing to a generation that is more aware of these issues. Despite this progress, much work remains to support individuals who have experienced IPV. This includes improving understanding of the long-term impacts of various forms of abuse, including physical, psychological, sexual, financial, and other coercive and stalking behaviors that can be experienced within an intimate partner relationship (Leemis, et al., 2022).
Among the military and veteran community, IPV remains a prevalent issue. In a study of women veterans, almost one-third had experienced IPV compared to estimated prevalence rates of one in four among women within the broader U.S. population (Taft & Campbell, 2024). IPV can also be considered military sexual trauma (MST) when sexual harassment or assault by an intimate partner occurs during military service (Wilson, 2018). Of note, MST can also encompass non-partner sexual assault. In a longitudinal study of National Guard and Reserve Component service members and their partners, military sexual trauma (MST) was reported by one-third of respondents, with females reporting MST at over twice the rate of male service members (Fillo et al., 2023). MST can have especially damaging consequences on service members’ physical and mental health, morale, unit cohesion, and the military's ability to accomplish its mission (Department of Defense, 2021).
In a recent review of the literature on the impact of military identity on mental health, it was found that hidden identities that do not align with military culture can be harmful to service members’ mental well-being (Heward et al., 2024). Service members often face significant internal and external pressure to exhibit high levels of excellence, resilience, and commitment to their military duties. Those who have experienced MST may struggle to connect with these ideals, even if only temporarily. This disconnection can lead to challenges related to military service and affect overall functioning following a traumatic experience.
Additionally, the stoic culture prevalent in the military can make it difficult for service members to disclose incidents of MST, as they may fear being perceived as weak or flawed. Although the military has implemented measures to improve reporting options for service members, these concerns persist and can perpetuate the presence of a hidden identity. Consequently, this hidden identity may leave service members feeling alone and isolated after a traumatic event, which can further contribute to mental health issues and potentially lead to moral injury (Heward et al., 2024).
Extensive research has explored the relationship between substance use and intimate partner violence (IPV). Substance use not only increases the likelihood of IPV but can also serve as a maladaptive coping mechanism for those who have experienced it. In the same aforementioned study involving National Guard and Reserve Component members, male service members who previously experienced MST demonstrated a 70% higher rate of alcohol consumption and a 45% increase in self-reported potential alcohol problems compared to their peers without a history of MST (Fillo et al., 2023). This increase in substance use can lead to additional physical, mental health, legal, and sociocultural implications for those affected by IPV. It underscores the importance of primary care physicians and mental health providers being aware of this connection and conducting thorough screening and assessment when substance use is present.
As noted, the growing body of literature on IPV continues to demonstrate the long-term impact among military-connected populations. In one study, it was noted that the effects of IPV have noteworthy consequences on the provision and cost of Veterans Health Administration (VHA) care among female veterans who have experienced IPV (Dichter et al., 2018). Researchers found that women had higher rates of inpatient hospital stays and emergency department utilization than their female veteran counterparts without a history of intimate partner violence (Dichter et al., 2018).
In 2020, VHA implemented the relationship health and safety screening as a clinical reminder for completion in primary and specialty care settings. (Department of Veterans Affairs, 2024). The VHA’s relationship health and safety screening is now in full use across the VHA system and must be completed annually or when risk factors are present (Department of Veterans Affairs, 2024). When a veteran screens positive, they are immediately offered a referral to the Intimate Partner Violence Assistance Program (IPVAP). Similar universal screening and referral protocols can be implemented in other systems as a critical first step to identifying and supporting individuals who have experienced IPV.
Another important consideration in working with this population is the availability and access to evidence-based psychotherapies. Based on the clinical presentation, a provider may want to refer a person who has experienced IPV to protocols such as Cognitive Processing Therapy, Prolonged Exposure Therapy, EMDR, or symptom-specific CBT (e.g., insomnia, depression, substance use disorders, chronic pain, or suicide prevention). It is also important to be aware of programs within your agency, community, or geographic area that can directly address the effects of experiencing IPV, like the IPVAP through VHA. Programs like this offer evidence-based, trauma-informed interventions, such as Recovering from IPV through Strengths and Empowerment (RISE) (Department of Veterans Affairs, 2024). This is an up-to-eight-session, patient-centered, brief counseling protocol designed to educate and support individuals coping with the effects of IPV (Department of Veterans Affairs, 2024).
Additionally, If you are a Star Provider, you can register today for Intimate Partner Violence: An Overview of Assessment and Response with Military-Connected Clients on November 12th to learn more about this important topic. Alternatively, if you want to join the Star Provider community, consider taking a Tier One training and joining the Star Providers Directory to help increase access to high-quality care for service members, veterans, and their families.
1 Star Providers are mental health professionals on the Star Behavioral Health Providers Directory who have been trained on topics for working with military-connected individuals and families. To learn more, visit: starproviders.org.
Resources
National Domestic Violence Hotline (thehotline.org)
Call: 1-800-799-7233 Text: 88788
For Active Duty service members, contact your local Family Advocacy Program for support:
DOD Domestic Abuse Victim Advocate Locator | Military OneSource
For National Guard and Reserve component members, contact the Soldier and Airmen Readiness Center in your state.
DoD Safe Helpline
1-877-995-5247
Text your zip code or installation name to 55-247 to find a local Sexual Assault Response Coordinator.
Healthy relationships for young adults
1-866-331-9474
Text: loveis to 22522
National Sexual Assault Hotline | RAINN
Call: 1-800-656-4673
Learn more about the signs and symptoms of intimate partner violence and develop a safety plan by downloading this free app.
If you or someone you know is in imminent danger, call 911 or your local military or civilian law enforcement.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Jennifer Nevers, MSW, LCWS, is a Military Behavioral Health Social Worker for the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.
References
Department of Defense. (2021). Hard truths and the duty to change: Recommendations from the
Independent Review Commission on Sexual Assault in the Military.
https://media.defense.gov/2021/Jul/02/2002755437/-1/-1/0/IRC-FULL-REPORT-FINAL-1923-7-1- 21.PDF/IRC-FULL-REPORT-FINAL-1923-7-1-21.PDF
Department of Veterans Affairs. (2024, June 11). Intimate partner violence assistance program.[VHA
Directive- 1198(1)]. https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=11826
Dichter, M. E., Sorrentino, A. E., Haywood, T. N., Bellamy, S. L., Medvedeva, E., Roberts, C. B., & Iverson,
K. M. (2018). Women’s healthcare utilization following routine screening for past-year intimate
partner violence in the veterans health administration. Journal of General Internal Medicine,
33(6), 936-941. https://doi.org/10.1007/s11606-018-4321-1
Fillo, J., Anderson Goodell, E. M., Homish, D. L., & Homish, G. G. (2023). Sex differences in the relation
between military sexual trauma and risk for alcohol misuse among U.S. Army Reserve and
National Guard soldiers. Alcohol, Clinical & Experimental Research, 47(4), 736-747.
https://doi.org/10.1111/acer.15045
Heward, C., Li, W., Chun Tie, Y., & Waterworth, P. (2024). A scoping review of military culture, military
identity, and mental health outcomes in military personnel. Military Medicine. usae276.
https://doi.org/10.1093/milmed/usae276
Stockman, J. K., Hayashi, H., & Campbell, J. C. (2015). Intimate partner violence and its health impact on
ethnic minority women [corrected]. Journal of Women's Health, 24(1), 62-79.
https://doi.org/10.1089/jwh.2014.4879
Taccini, F., & Mannarini, S. (2024). News media representation of intimate partner violence: A systematic
review. Sexuality Research & Social Policy. https://doi.org/10.1007/s13178-023-00922-z
Wilson, L. C. (2018). The prevalence of military sexual trauma: A meta-analysis. Trauma, Violence, &
Abuse, 19(5), 584-597. https://doi.org/10.1177/1524838016683459
October is Domestic Violence Awareness Month, a time dedicated to recognizing the serious effects of domestic violence, including intimate partner violence (IPV). During this month, various programs focus on this critical issue to support those affected by domestic violence and to educate professionals who assist them. On a recent Star Behavioral Health Providers Coffee and Community Building Call, Star Providers1 had an opportunity to learn more about the role of Sexual Assault Response Coordinators in the Air National Guard and how they support service members who have experienced IPV.
Individuals who experience IPV can face significant short- and long-term impacts on their overall health and well-being. While it is widely acknowledged that IPV disproportionately affects women and sexual, gender, ethnic, and racial minority groups (Stockman et al., 2015), we are continually learning about the systemic effects of these traumatic experiences. Further research is essential to fully understand the impact of IPV across all gender identities, races, ethnicities, sexual orientations, religions, cultures, abilities, and types of violence experienced.
News media portrayals of individuals who have experienced IPV have long been stigmatizing (Taccini & Mannarini, 2024). However, the rise of social media and user-generated video content has created new opportunities for sharing personal experiences. This shift enables the general public to learn about IPV directly from those who have lived through it. Additionally, there is greater accessibility to mental health providers and advocates who work with this community, as many professionals have turned to these platforms to educate the public about the signs and symptoms of IPV. Terms like gaslighting, love bombing, toxic relationships, and red flags have become widely used, contributing to a generation that is more aware of these issues. Despite this progress, much work remains to support individuals who have experienced IPV. This includes improving understanding of the long-term impacts of various forms of abuse, including physical, psychological, sexual, financial, and other coercive and stalking behaviors that can be experienced within an intimate partner relationship (Leemis, et al., 2022).
Among the military and veteran community, IPV remains a prevalent issue. In a study of women veterans, almost one-third had experienced IPV compared to estimated prevalence rates of one in four among women within the broader U.S. population (Taft & Campbell, 2024). IPV can also be considered military sexual trauma (MST) when sexual harassment or assault by an intimate partner occurs during military service (Wilson, 2018). Of note, MST can also encompass non-partner sexual assault. In a longitudinal study of National Guard and Reserve Component service members and their partners, military sexual trauma (MST) was reported by one-third of respondents, with females reporting MST at over twice the rate of male service members (Fillo et al., 2023). MST can have especially damaging consequences on service members’ physical and mental health, morale, unit cohesion, and the military's ability to accomplish its mission (Department of Defense, 2021).
In a recent review of the literature on the impact of military identity on mental health, it was found that hidden identities that do not align with military culture can be harmful to service members’ mental well-being (Heward et al., 2024). Service members often face significant internal and external pressure to exhibit high levels of excellence, resilience, and commitment to their military duties. Those who have experienced MST may struggle to connect with these ideals, even if only temporarily. This disconnection can lead to challenges related to military service and affect overall functioning following a traumatic experience.
Additionally, the stoic culture prevalent in the military can make it difficult for service members to disclose incidents of MST, as they may fear being perceived as weak or flawed. Although the military has implemented measures to improve reporting options for service members, these concerns persist and can perpetuate the presence of a hidden identity. Consequently, this hidden identity may leave service members feeling alone and isolated after a traumatic event, which can further contribute to mental health issues and potentially lead to moral injury (Heward et al., 2024).
Extensive research has explored the relationship between substance use and intimate partner violence (IPV). Substance use not only increases the likelihood of IPV but can also serve as a maladaptive coping mechanism for those who have experienced it. In the same aforementioned study involving National Guard and Reserve Component members, male service members who previously experienced MST demonstrated a 70% higher rate of alcohol consumption and a 45% increase in self-reported potential alcohol problems compared to their peers without a history of MST (Fillo et al., 2023). This increase in substance use can lead to additional physical, mental health, legal, and sociocultural implications for those affected by IPV. It underscores the importance of primary care physicians and mental health providers being aware of this connection and conducting thorough screening and assessment when substance use is present.
As noted, the growing body of literature on IPV continues to demonstrate the long-term impact among military-connected populations. In one study, it was noted that the effects of IPV have noteworthy consequences on the provision and cost of Veterans Health Administration (VHA) care among female veterans who have experienced IPV (Dichter et al., 2018). Researchers found that women had higher rates of inpatient hospital stays and emergency department utilization than their female veteran counterparts without a history of intimate partner violence (Dichter et al., 2018).
In 2020, VHA implemented the relationship health and safety screening as a clinical reminder for completion in primary and specialty care settings. (Department of Veterans Affairs, 2024). The VHA’s relationship health and safety screening is now in full use across the VHA system and must be completed annually or when risk factors are present (Department of Veterans Affairs, 2024). When a veteran screens positive, they are immediately offered a referral to the Intimate Partner Violence Assistance Program (IPVAP). Similar universal screening and referral protocols can be implemented in other systems as a critical first step to identifying and supporting individuals who have experienced IPV.
Another important consideration in working with this population is the availability and access to evidence-based psychotherapies. Based on the clinical presentation, a provider may want to refer a person who has experienced IPV to protocols such as Cognitive Processing Therapy, Prolonged Exposure Therapy, EMDR, or symptom-specific CBT (e.g., insomnia, depression, substance use disorders, chronic pain, or suicide prevention). It is also important to be aware of programs within your agency, community, or geographic area that can directly address the effects of experiencing IPV, like the IPVAP through VHA. Programs like this offer evidence-based, trauma-informed interventions, such as Recovering from IPV through Strengths and Empowerment (RISE) (Department of Veterans Affairs, 2024). This is an up-to-eight-session, patient-centered, brief counseling protocol designed to educate and support individuals coping with the effects of IPV (Department of Veterans Affairs, 2024).
Additionally, If you are a Star Provider, you can register today for Intimate Partner Violence: An Overview of Assessment and Response with Military-Connected Clients on November 12th to learn more about this important topic. Alternatively, if you want to join the Star Provider community, consider taking a Tier One training and joining the Star Providers Directory to help increase access to high-quality care for service members, veterans, and their families.
1 Star Providers are mental health professionals on the Star Behavioral Health Providers Directory who have been trained on topics for working with military-connected individuals and families. To learn more, visit: starproviders.org.
Resources
National Domestic Violence Hotline (thehotline.org)
Call: 1-800-799-7233 Text: 88788
For Active Duty service members, contact your local Family Advocacy Program for support:
DOD Domestic Abuse Victim Advocate Locator | Military OneSource
For National Guard and Reserve component members, contact the Soldier and Airmen Readiness Center in your state.
DoD Safe Helpline
1-877-995-5247
Text your zip code or installation name to 55-247 to find a local Sexual Assault Response Coordinator.
Healthy relationships for young adults
1-866-331-9474
Text: loveis to 22522
National Sexual Assault Hotline | RAINN
Call: 1-800-656-4673
Learn more about the signs and symptoms of intimate partner violence and develop a safety plan by downloading this free app.
If you or someone you know is in imminent danger, call 911 or your local military or civilian law enforcement.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Jennifer Nevers, MSW, LCWS, is a Military Behavioral Health Social Worker for the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.
References
Department of Defense. (2021). Hard truths and the duty to change: Recommendations from the
Independent Review Commission on Sexual Assault in the Military.
https://media.defense.gov/2021/Jul/02/2002755437/-1/-1/0/IRC-FULL-REPORT-FINAL-1923-7-1- 21.PDF/IRC-FULL-REPORT-FINAL-1923-7-1-21.PDF
Department of Veterans Affairs. (2024, June 11). Intimate partner violence assistance program.[VHA
Directive- 1198(1)]. https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=11826
Dichter, M. E., Sorrentino, A. E., Haywood, T. N., Bellamy, S. L., Medvedeva, E., Roberts, C. B., & Iverson,
K. M. (2018). Women’s healthcare utilization following routine screening for past-year intimate
partner violence in the veterans health administration. Journal of General Internal Medicine,
33(6), 936-941. https://doi.org/10.1007/s11606-018-4321-1
Fillo, J., Anderson Goodell, E. M., Homish, D. L., & Homish, G. G. (2023). Sex differences in the relation
between military sexual trauma and risk for alcohol misuse among U.S. Army Reserve and
National Guard soldiers. Alcohol, Clinical & Experimental Research, 47(4), 736-747.
https://doi.org/10.1111/acer.15045
Heward, C., Li, W., Chun Tie, Y., & Waterworth, P. (2024). A scoping review of military culture, military
identity, and mental health outcomes in military personnel. Military Medicine. usae276.
https://doi.org/10.1093/milmed/usae276
Stockman, J. K., Hayashi, H., & Campbell, J. C. (2015). Intimate partner violence and its health impact on
ethnic minority women [corrected]. Journal of Women's Health, 24(1), 62-79.
https://doi.org/10.1089/jwh.2014.4879
Taccini, F., & Mannarini, S. (2024). News media representation of intimate partner violence: A systematic
review. Sexuality Research & Social Policy. https://doi.org/10.1007/s13178-023-00922-z
Wilson, L. C. (2018). The prevalence of military sexual trauma: A meta-analysis. Trauma, Violence, &
Abuse, 19(5), 584-597. https://doi.org/10.1177/1524838016683459