Chapter 9: Violence and Abuse

Intimate partner violence operates through a cyclical pattern involving tension escalation, acute battering episodes, and deceptive reconciliation phases, during which perpetrators employ physical, emotional, sexual, and financial tactics to dominate their partners. The chapter identifies particularly vulnerable populations including pregnant women and older adults, who experience elevated risk for severe maltreatment and accompanying reproductive and general health complications. Sexual violence manifestations including rape, incest, and childhood sexual abuse are explored for their capacity to generate enduring psychological sequelae, notably post-traumatic stress disorder, characterized by intrusive thoughts, deliberate avoidance behaviors, and heightened physiological arousal. The chapter delineates recovery trajectories following sexual assault, beginning with acute disorganization and progressing through stages toward eventual psychological integration and functional recovery. Clinical assessment and intervention protocols receive substantial attention, including the SAVE screening framework for routine identification of abuse and the Danger Assessment instrument for quantifying homicide risk in dangerous situations. The chapter underscores the essential role of sexual assault nurse examiners in conducting specialized forensic evidence documentation, administering prophylactic sexually transmitted infection treatment, and dispensing emergency contraceptive options to optimize both medical outcomes and legal protections for survivors. Global dimensions of gender-based harm are integrated throughout, addressing female genital cutting as a culturally situated human rights violation and human trafficking as a form of forced exploitation, with emphasis on culturally informed intervention approaches and trauma-informed safety planning to support survivors across diverse contexts.