Intimate partner and sexual violence (mental-health care) !
Physical, sexual or psychological harm by a current or former partner. Health teams can detect it, give first-line support and treat its mental-health effects.
Updated 2026-11-01
Structures involved
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Why it happens
What it is
Behaviour by a current or former partner that causes physical, sexual or psychological harm, including physical aggression, sexual coercion, stalking, threats and controlling behaviour. It is a major cause of injury, depression, PTSD, substance use and suicide, and health services are often the first place a survivor discloses it.
Who gets it
The WHO estimates that about one in three women worldwide has experienced physical or sexual violence by a partner or sexual violence by someone else during her life; men and sexual-minority people are also affected. In Colombia, violence against women and family violence are notifiable public-health events, and sexual violence is managed as a medical emergency under Resolución 459 de 2012.
Causes
- Gender inequality and social norms that accept violence
- Controlling and coercive relationships
- Alcohol and drug use by the perpetrator
- Exposure to violence in childhood (in both survivors and perpetrators)
- Armed conflict, displacement and economic dependence
Risk factors
- Female sex and young age
- Pregnancy and the postpartum period
- Recent separation from the partner
- Economic dependence, low education and social isolation
- Disability, migration and lack of support networks
Pathophysiology
Repeated threat activates the stress response through the amygdala and hypothalamic-pituitary-adrenal axis. Chronic stress and trauma impair hippocampal memory processing and frontal regulation of fear, which underlies PTSD, depression and anxiety. Head and neck injuries, including strangulation, can add traumatic brain injury.
Classification
- Physical violence
- Sexual violence, including within the couple
- Psychological violence and coercive control
- Economic violence and stalking
Symptoms and signs
- Injuries inconsistent with the explanation, of different ages, or on the face, neck, breasts or abdomen
- Delay in seeking care, repeated emergency visits and missed appointments
- Chronic pain, headaches, gastrointestinal and gynaecological complaints
- Sexually transmitted infections and unintended pregnancy
- Depression, anxiety, insomnia, PTSD symptoms and substance use
- A partner who answers for the patient or will not leave the patient alone
Diagnosis
- Clinical
- Asking about violence privately, without the partner or family present and with a professional interpreter if needed, using direct, non-judgemental questions. Positive disclosure leads to assessment of immediate danger, injuries, sexual violence, mental health (depression, PTSD, suicide risk, substance use) and children at home. Clinical records are written objectively, with body maps of injuries.
- Tests
- Pregnancy test, HIV, syphilis, hepatitis B and other STI tests after sexual violence; forensic samples according to the national protocol.
- Imaging
- As guided by injuries: radiographs for fractures, CT for head injury or after strangulation when indicated.
Differential diagnosis
- Accidental injuries
- Self-harm
- Bleeding disorders or medication-related bruising
- Primary depressive or anxiety disorder without violence
Goal of treatment
Ensure immediate safety, treat injuries, provide first-line psychological support, prevent infection and pregnancy after sexual violence, treat mental-health consequences and connect the survivor with protection and justice services.
Treatment
- Acute
- Urgent care of injuries and, after sexual violence, priority care as a medical emergency: HIV post-exposure prophylaxis, STI prophylaxis, hepatitis B vaccination, emergency contraception and forensic evidence collection within the recommended time windows.
- Conservative
- First-line support (WHO LIVES model): listen, inquire about needs, validate, enhance safety and support with referral, respecting the survivor's decisions.
- Conservative
- Trauma-focused psychotherapy (cognitive behavioural therapy, EMDR) for PTSD and support for depression; couples therapy is avoided while violence continues.
- Medical
- Medicines for associated conditions, such as SSRIs for depression or PTSD, with attention to overdose risk in suicidal patients.
- Follow-up
- Safety planning, documentation, follow-up and, in Colombia, notification to public-health surveillance (SIVIGILA) and activation of the protection and justice route; the national Línea 155 offers orientation to women.
Complications
- Severe injury and femicide or homicide
- PTSD, depression, anxiety and substance use
- Suicide
- HIV and other sexually transmitted infections
- Unintended pregnancy, miscarriage, preterm birth and low birth weight
- Harm to children who witness violence
Prognosis
With support, safety measures and trauma-focused treatment, many survivors recover from PTSD and depression. The risk of serious injury and death is highest around separation and when strangulation or weapon threats have occurred.
Prevention
- Programmes that challenge norms accepting violence and promote healthy relationships
- Routine inquiry in prenatal, mental-health and emergency services
- Economic empowerment and support networks for women
Test yourself
Think of the answer, then tap the question to see it.
How should a health worker ask about intimate partner violence?
Privately, without the partner or family present, with direct, non-judgemental questions and a professional interpreter if needed.
What does the WHO first-line support model LIVES stand for?
Listen, Inquire about needs, Validate, Enhance safety and Support.
Which history in intimate partner violence strongly predicts homicide risk?
Non-fatal strangulation, along with threats with a weapon and recent separation.
Which Colombian regulation sets the protocol for health care of victims of sexual violence?
Resolución 459 de 2012 of the Ministerio de Salud y Protección Social.
Which mental disorder is most characteristically linked to intimate partner violence?
Post-traumatic stress disorder, often with depression.
Related conditions
- Sexual violence (care of the survivor)
- Post-traumatic stress disorder (PTSD) and acute stress disorder
- Major depressive disorder
- Suicidal behaviour and suicide risk
- Alcohol use disorder
- Perinatal depression and postpartum psychosis
- Child maltreatment (physical abuse, abusive head trauma, neglect)
- HIV infection and AIDS
- Traumatic brain injury
Educational information, not medical advice. For any symptom, see a health professional.
Sources: Violence against women (World Health Organization (WHO), 2024); About Intimate Partner Violence (Centers for Disease Control and Prevention (CDC), 2024).
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