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.1–3 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.4–6
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.5,9–12
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.
|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 ( 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 ( 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|