Editorials

Adolescent Dating Violence

Am Fam Physician. 2010 Feb 15;81(4):428-432.

  Related Article

Adolescent dating violence is associated with increased rates of eating disorders, substance abuse, depression, sexually transmitted infections, and pregnancy, and continued perpetration and victimization, yet many physicians are unfamiliar with this term.13 Adolescent dating violence is defined as physical, sexual, or psychological violence within an adolescent dating relationship,4 which manifests as, but is not limited to, threatening partners with physical harm; humiliation; controlling behaviors; or threatening to reveal sexual activity, sexual orientation, or gender identity of the victim to others.46

Adolescent dating violence is increasingly identified as a major public health problem, but there is limited evidence to support routine screening by physicians. The U.S. Preventive Services Task Force does not recommend for or against screening for family and intimate partner violence, but it is important to note that this recommendation does not specifically recognize adolescent dating relationships or adolescent dating violence.7 The American Academy of Family Physicians policy statement on adolescent care states, “In meeting our ethical obligations to our adolescent patients…we rely on our professional judgment, informed by clinical assessment, training, and experience, to address a patient's health conditions or a sensitive situation.”8 Thus, even in the absence of outcomes evidence, family physicians should be prepared to support adolescents in their development of healthy relationships, be able to identify those who are experiencing dating violence, and educate adolescents and parents about this issue.

As with adult relationship violence, adolescent dating violence occurs in all social classes, locations, and ethnic and racial groups.4 Studies demonstrate that up to 30 percent of adolescents have been threatened or physically or sexually abused by a dating partner, with young women disproportionately affected by these types of violence. Approximately 50 percent of adolescents reported victimization from controlling behaviors by a dating partner.5,9 Few studies have specifically examined adolescent dating violence in those who are lesbian, gay, bisexual, or transgender; however, data suggest that these adolescents experience the same rates of dating violence as their heterosexual peers.6

Unfortunately, many adolescents in abusive relationships do not seek help. In one study, only 44 percent of female and 32 percent of male adolescent victims, and 17 percent of female and 33 percent of male adolescent perpetrators sought help.9 When adolescents did seek help, whether perpetrators or victims, they most often disclosed the abuse to peers, with only one third confiding in parents.5,9 Data show that parents and physicians are not inquiring about this issue as they do about other behaviors, such as sexual activity and drug use. A lack of knowledge and outcomes evidence contributes to the fact that health care professionals are missing the chance to identify and intervene in one of the more common and serious health problems faced by adolescents.5,912

It is important that family physicians be aware of the possibility of dating violence among adolescents and be able to provide a supportive environment in which adolescents may feel comfortable disclosing issues of relationship violence. A variety of questions can be used to initiate a discussion about dating violence, including asking if adolescents are in a dating relationship; if they ever feel threatened in the relationship; and if they know of peers who experience dating violence.4 This allows physicians to work further with those who are in abusive relationships, and to provide anticipatory guidance to parents and adolescents. Clinical signs that adolescents may be experiencing dating violence include physical signs of injury, problems at school, poor self-esteem, and changes in mood or personality.3,4

The Family Violence Prevention Fund has developed resources that physicians can use to assess the risk of experiencing violence and to educate and empower adolescents.4 Family physicians should be familiar with the youth violence reporting requirements in their state. Suspected abuse of adolescents by their guardians and all forms of sexual assault are reportable in every state, but the definition of consensual adolescent sexual activity varies by state. Sexual violence can affect adolescents in dating relationships; however, dating violence also includes bullying, harassment, and other controlling behaviors that are not often required to be reported to authorities. Although there are similarities between adult and adolescent relationship violence, there are some notable differences, including fewer legal protections afforded to adolescents.4 Local domestic violence agencies are good resources for state-specific legal information and information about local community-and school-focused adolescent dating violence prevention programs.

Family physicians are in an ideal position to break the cycle of violence through awareness and identification of abuse in dating relationships, and by educating adolescents and their parents about the possibility of abuse. Table 1 lists resources that health care professionals can use to educate themselves, as well as adolescents and parents, about adolescent dating violence.

Table 1.

Resources on Adolescent Dating Violence

Organization or project Contact information Primary audience Additional information

Centers for Disease Control and Prevention's National Center for Injury Prevention and Control

Web site: http://www.chooserespect.org

Adolescents (11 to 14 years of age) and parents

Programs to prevent dating abuse before it starts and to help adolescents form healthy relationships

Break the Cycle

Web site: http://www.breakthecycle.org

Health care professionals, adolescents, parents

Many resources available; The Safe Space is for adolescents to learn about and identify dating violence

The Safe Space

Web site: http://www.thesafespace.org

National Teen Dating Abuse Helpline

Web site: http://www.loveisrespect.org

Health care professionals, adolescents, parents

Peer counselors available for Internet- and telephone-based helpline Technical assistance for health care professionals

Telephone: (866) 331-9474 or (866) 331-8453 TTY (for deaf and hard-of-hearing callers)

Hotline is available 24 hours/seven days a week

American Bar Association National Teen Dating Violence Prevention Initiative

Web site: http://www.abanet.org/publiced/teendating.shtml

Health care professionals and parents

Educational resources about prevention and identification of dating violence

Family Violence Prevention Fund

Web site: http://endabuse.org/

Health care professionals, adolescents, parents

Many resources available; state-by-state evaluation of laws affecting adolescents in dating violence relationships Technical assistance for health care professionals

National Health Resource Center on Domestic Violence telephone: (888) Rx-ABUSE ([888] 792-2873)

The National Center for Victims of Crime

Web site: http://www.ncvc.org; click on Dating Violence Resource Center

Health care professionals, adolescents, parents

Free online training, brochures, posters Hotline for persons who have been abused

Telephone: (800) FYI-CALL ([800] 394-2255) or (800) 211-7996 TTY (for deaf and hard-of-hearing callers)

Hotline availability: Monday through Friday, 8:30 a.m. to 8:30 p.m. Eastern standard time; more than 150 languages available

Table 1.   Resources on Adolescent Dating Violence

View Table

Table 1.

Resources on Adolescent Dating Violence

Organization or project Contact information Primary audience Additional information

Centers for Disease Control and Prevention's National Center for Injury Prevention and Control

Web site: http://www.chooserespect.org

Adolescents (11 to 14 years of age) and parents

Programs to prevent dating abuse before it starts and to help adolescents form healthy relationships

Break the Cycle

Web site: http://www.breakthecycle.org

Health care professionals, adolescents, parents

Many resources available; The Safe Space is for adolescents to learn about and identify dating violence

The Safe Space

Web site: http://www.thesafespace.org

National Teen Dating Abuse Helpline

Web site: http://www.loveisrespect.org

Health care professionals, adolescents, parents

Peer counselors available for Internet- and telephone-based helpline Technical assistance for health care professionals

Telephone: (866) 331-9474 or (866) 331-8453 TTY (for deaf and hard-of-hearing callers)

Hotline is available 24 hours/seven days a week

American Bar Association National Teen Dating Violence Prevention Initiative

Web site: http://www.abanet.org/publiced/teendating.shtml

Health care professionals and parents

Educational resources about prevention and identification of dating violence

Family Violence Prevention Fund

Web site: http://endabuse.org/

Health care professionals, adolescents, parents

Many resources available; state-by-state evaluation of laws affecting adolescents in dating violence relationships Technical assistance for health care professionals

National Health Resource Center on Domestic Violence telephone: (888) Rx-ABUSE ([888] 792-2873)

The National Center for Victims of Crime

Web site: http://www.ncvc.org; click on Dating Violence Resource Center

Health care professionals, adolescents, parents

Free online training, brochures, posters Hotline for persons who have been abused

Telephone: (800) FYI-CALL ([800] 394-2255) or (800) 211-7996 TTY (for deaf and hard-of-hearing callers)

Hotline availability: Monday through Friday, 8:30 a.m. to 8:30 p.m. Eastern standard time; more than 150 languages available

Address correspondence to Jennifer G. Vanderleest, MD, MSPH, at jgvander@email.arizona.edu. Reprints are not available from the authors.

REFERENCES

1. Ackard DM, Eisenberg ME, Neumark-Sztainer D. Long-term impact of adolescent dating violence on the behavioral and psychological health of male and female youth. J Pediatr. 2007;151(5):476–481.

2. Centers for Disease Control and Prevention. Physical dating violence among high school students—United States, 2003. MMWR Morb Mortal Wkly Rep. 2006;55(19):532–535.

3. Silverman JG, Raj A, Mucci LA, Hathaway JE. Dating violence against adolescent girls and associated substance use, unhealthy weight control, sexual risk behavior, pregnancy, and suicidality. JAMA. 2001;286(5):572–579.

4. Family Violence Prevention Fund. Identifying and responding to domestic violence: consensus recommendations for child and adolescent health. http://www.endabuse.org/userfiles/file/HealthCare/pediatric.pdf. Accessed September 22, 2009.

5. Teen dating abuse 2009 [press release]. Family Violence Prevention Fund. June 10, 2009. http://endabuse.org/userfiles/file/Teens/teen_dating_abuse_2009_key_topline_findings.pdf. Accessed September 22, 2009.

6. Halpern CT, Young ML, Waller MW, Martin SL, Kupper LL. Prevalence of partner violence in same-sex romantic and sexual relationships in a national sample of adolescents. J Adolesc Health. 2004;35(2):124–131.

7. US Preventive Services Task Force Screening for family and intimate partner violence Rockville, Md: Agency for Healthcare Research and Quality; March 2004. http://www.ahrq.gov/clinic/uspstf/uspsfamv.htm. Accessed September 22, 2009.

8. American Academy of Family Physicians. Adolescents, protecting: ensuring access to care and reporting sexual activity and abuse (position paper). http://www.aafp.org/about/policies/all/adolescent-protecting.html. Accessed September 22, 2009.

9. Ashley OS, Foshee VA. Adolescent help-seeking for dating violence: prevalence, sociodemographic correlates, and sources of help. J Adolesc Health. 2005;36(1):25–31.

10. Weisz AN, Tolman RM, Callahan MR, Saunders DG, Black BM. Informal helpers' responses when adolescents tell them about dating violence or romantic relationship problems. J Adolesc. 2007;30(5):853–868.

11. Forcier M, Patel R, Kahn JA. Pediatric residents' attitudes and practices regarding adolescent dating violence. Ambul Pediatr. 2003;3(6):317–323.

12. Brown LK, Puster KL, Vazquez EA, Hunter HL, Lescano CM. Screening practices for adolescent dating violence. J Interpers Violence. 2007;22(4):456–464.


Copyright © 2010 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions


Article Tools

  • Print page
  • Share this page
  • AFP CME Quiz

Information From Industry

More in Pubmed

Navigate this Article