Intimate partner violence targets teenagers, too

Avanti Adhia, ScD

Megan Bair-Merritt, MD, MSCE

Intimate partner violence can occur at any age, with 7% of teenaged homicides perpetuated by intimate partners and mostly against female victims.¹

The study, published in JAMA Pediatrics, reveals just how serious a problem intimate partner violence against teenagers has become. According to the report, a multistate study of more than 2000 homicides involving 11- to 18-year-olds reveals that 150 of those homicides were carried out by an intimate partner of the victim.¹

Most research on intimate partner violence has focused on adults, the researchers say, but intimate partner violence among teenagers is perhaps more widespread than some realize, they note.

Of the 6.9% of total homicides among teenagers that were perpetuated by intimate partners, the study reveals that 90% of the victims were female. Nearly 78% of perpetrators in these cases were aged older than 18 years and 88.9% were male, adds the report. Perpetrators were typically about 4 years older than their victims, and roughly 63% were current intimate partners of the victims.

The study also delved into the motives behind the crimes, noting that the most common motives were broken/desired relationships, jealousy or altercation related, reckless firearm behavior, and pregnancy.

Teen dating violence is escalating

“There is a perception that teen dating violence is less serious or not as harmful as adult intimate partner violence, and I think this study really highlights the potential for this violence to escalate and result in tragic and deadly outcomes,” says Avanti Adhia, SCD, a senior fellow at the Harborview Injury Prevention and Research Center at the University of Washington School of Medicine, Seattle, and lead author of the study. “Teen dating violence is a serious problem that has the potential to lead to death. The adolescents who are at highest risk of this outcome are girls,” she points out.

According to the 2011 National Intimate Partner and Sexual Violence Survey, an estimated 71.1% of females and 58.2% of males experience sexual violence, physical violence, and/or stalking by an intimate partner before they reach age 25 years. Even in the high school years, the 2017 National Youth Risk Behavior Survey reveals that 6.9% of teenagers who dated experienced sexual violence and 8% experienced physical violence by someone whom they were or had been dating.

Who is vulnerable

Teenagers who may be particularly at risk for intimate partner violence are those who have a history of abuse in their families or other family dysfunction because their parents may be less likely to intervene or establish strong support systems, the report notes. Additionally, emotions are heightened in adolescence, and poor emotional regulation and a lack of positive relationship skills make conflict resolution among teenaged intimate partners difficult. Finally, the authors point out that intervention can be difficult even when a good support system is in place, as teenagers who are in abusive relationships will often turn to peers for help rather than adults.

“Physicians, especially pediatricians, can play a big role in identifying adolescents experiencing intimate partner violence, talking to them about healthy relationships and being able to refer them to appropriate services,” Adhia says. “They can ask their adolescent patients about their relationships and look for signs of mental health problems or problems in school or socially that commonly result from intimate partner violence. Physicians should be prepared to respond appropriately and know about community-based resources that they can refer to if an adolescent discloses intimate partner violence to them.”

Adhia says she hopes that the study will increase awareness about intimate partner violence and its prevalence, as well as the long-lasting mental and physical health consequences. Physicians, in particular, should keep this on their radar when talking to adolescent patients, and know the right resources and services for referrals should these teenagers need help getting out of an abusive relationship, she says.

“Routine office-based intimate partner violence screening for all women of childbearing age is recommended by the US Preventive Services Task Force, so making screening a regular part of doctors’ visits is critical,” Adhis says. “Building trust with patients so that they feel comfortable disclosing and presenting themselves as compassionate and trustworthy is important. They may want to have information readily available and visible in the office so patients know it is a safe place to talk about this issue. It’s also important to respect a patient’s confidentiality and not force a patient to disclose intimate partner violence if they are not ready or do not want to do so.”

Assess for dating violence

Megan Bair-Merritt, MD, MSCE, a pediatrician and researcher at Boston Medical Center and associate professor, Pediatrics, at Boston University School of Medicine, Massachusetts, wrote a companion editorial to Adhia’s study, outlining the need for specific strategies and interventions in cases of intimate partner violence among teenagers.² She says she hopes the study and editorial will help pediatricians understand the importance of their role in preventing and intervening in intimate partner violence.

“I hope that pediatricians recognize their important role in discussing healthy and unhealthy romantic relationships at each adolescent well-child visit. Pediatricians are a valued and important source of support and information for adolescents and their families,” Bair-Merritt says. “Pediatricians also have a role in advocating for local, state, and federal policies to better support and protect adolescents in violent relationships.”

Finding the time to counsel teenagers can be a challenge, Bair-Merritt notes. “While time is always an issue, I do think it is critical to assess for dating violence at adolescent well visits, given its prevalence and adverse health impact,” she says. “Depending on the practice, social workers and other members of the healthcare team may be able to work together to assess and respond to dating violence.”

There are numerous resources to help clinicians provide counseling to teenagers, including Futures Without Violence, the Centers for Disease Control and Prevention, Love is Respect, and the One Love Foundation.

“Pediatricians often have longitudinal relationships with adolescents, and adolescents view pediatricians as a trusted source of information about romantic relationships. I hope that pediatricians provide early guidance about healthy and unhealthy romantic relationships, ideally starting when children are aged between 9 and 11 years, and have this conversation at each well-child visit,” Bair-Merritt says. “Pediatricians also should routinely ask their adolescents about dating violence-defined widely to include not just physical and sexual violence but also emotional and cyber abuse-and support them, and ensure connection with resources, if there are concerns.”

References:

1. Adhia A, Kernic MA, Hernenway D, Vaviliala MS, Rivara FP. Intimate partner homicide of adolescents. JAMA Pediatrics. 2019;173(6):571-577.

2. Kistin CJ, Rothman EF, Bair-Merritt MH. Deadly adolescent intimate partner violence and the need for youth-specific strategies for effective intervention. JAMA Pediatrics. 2019;173(6):524-525.