Navigating Intimate Partner Violence in Psychiatric Practice

According to the CDC’s National Intimate Partner and Sexual Violence Survey (NISVS), 37.3% of women and 30.9% of men experience intimate partner violence (IPV) in their lifetime. But when patients do not identify violence as their primary reason for seeking care, how can psychiatric clinicians recognize IPV and provide appropriate support?

At the 39th annual Psych Congress, Michelle Lanspa, DO, MBA, MS, and Valerie Rosen, MD, tackled this question in their session, “Safety, Stabilization, and Empowerment: Psychiatric Care for Women Experiencing Sexual and Domestic Violence.”

In this Q&A, Lanspa discusses practical considerations for clinicians working with patients who may be experiencing or have disclosed IPV. She explores the association between IPV and psychiatric illness, offers trauma-informed screening approaches that foster trust and collaboration, and outlines what an immediate safety plan should look like following disclosure.

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Key Takeaways for Clinical Practice:

• IPV is associated with depression, anxiety, posttraumatic stress disorder (PTSD), substance use disorders (SUDs), psychosis, eating disorders, and suicidality, and patients may present with psychiatric symptoms without identifying violence as their primary concern.
• IPV screening should occur privately using a trauma-informed approach that emphasizes safety, trust, collaboration, empowerment, patient choice, and preparedness to respond with appropriate referral resources.
• IPV safety assessment should address immediate safety, weapons, children at risk, trusted supports, safe destinations, and emergency resources, with collaborative safety planning that respects patient autonomy and readiness for change. 

Editors' note: This interview has been lightly edited for clarity.

Psych Congress Network: Why should IPV be considered a core concern in psychiatric practice, even when patients do not identify violence as their primary reason for seeking care?

Michelle Lanspa, DO, MBA, MS: IPV is highly prevalent and is associated with psychiatric morbidity across the diagnostic spectrum, including depression, anxiety, PTSD, substance use disorders, psychosis, eating disorders, and suicidality. 

Its consequences can also be profound: IPV contributes to mortality, homicide, homelessness, and intergenerational trauma, while pre-existing mental illness may itself increase vulnerability to victimization. 

Because many survivors do not identify their experiences as abuse or present with IPV as their chief concern, psychiatrists need to recognize that the symptoms bringing a patient into treatment may be manifestations of ongoing or past violence.

PCN: Which psychiatric symptoms, behavioral patterns, or changes in functioning should prompt clinicians to consider possible current or past IPV?

Lanspa: Clinicians should maintain a high index of suspicion when psychiatric symptoms are difficult to explain, fluctuate with relationship stress, or are accompanied by behavioral signs of coercive control, such as appearing fearful of a partner, frequently checking in, receiving harassing calls, or having a partner who speaks for the patient or refuses to leave the room. 

Particularly concerning changes that may signal escalating danger or trauma-related destabilization include increasing self-harm or suicidality, escalating substance use, worsening dissociation, and loss of therapeutic engagement or alliance.

PCN: How can psychiatric clinicians ask about IPV in a way that supports disclosure, protects patient autonomy, and minimizes the risk of retraumatization?

Lanspa: Before routinely screening for IPV, clinicians should be prepared to respond to a disclosure, including knowing local referral resources and having a clear pathway to appropriate services. 

Screening should be conducted privately through a trauma-informed lens that prioritizes safety, trust, collaboration, empowerment, and patient choice. To minimize retraumatization, clinicians should explain what they are doing and why, ask permission, offer choices whenever possible, avoid judgment or pressure to disclose, and remain attentive to signs of trauma activation such as agitation, dissociation, hyperarousal, or withdrawal. 

Above all, the goal is to restore rather than replicate control, recognizing that coercion, loss of autonomy, and power imbalances within healthcare can themselves recreate elements of the patient’s traumatic experience.

PCN: When IPV is disclosed or suspected, how should clinicians assess immediate danger and develop a safety plan without increasing the patient’s risk?

Lanspa: When IPV is suspected or disclosed, clinicians should begin by assessing whether the patient feels safe returning home, whether weapons are present, whether children are at risk, and whether the patient has access to trusted supports, a safe destination, and resources in an emergency. 

Safety planning should be collaborative rather than prescriptive. Help patients identify options and develop an emergency plan while respecting their autonomy and readiness for change rather than assuming that immediately leaving the relationship is always the safest or most feasible course.

PCN: How can trauma alter a survivor’s perception of themselves and others, and how should that understanding inform diagnosis and treatment planning in psychiatric care?

Lanspa: Trauma can fundamentally alter beliefs about the self and the world, transforming “I am a good person,” into “This was my fault,” or “The world can be safe,” into “No one can be trusted.”

Trauma, therefore, may contribute to self-blame, shame, mistrust, hypervigilance, and a diminished sense of safety or control. These beliefs can be reinforced by the cycle of violence, in which periods of abuse alternate with apologies, affection, and relative calm, making the relationship—and the survivor’s decisions about it—far more complex than simply choosing whether to leave. 

Clinicians should understand where a patient is in the Transtheoretical Model of Change and meet them there with empowerment rather than blame, recognizing trauma-related behaviors as adaptations and supporting movement toward safety and recovery at the patient’s own pace.

PCN: What is one key takeaway from your session that you’d like to share with our audience of practicing clinicians?

Lanspa: Ask about IPV and be prepared for the answer. Screening alone is not enough: psychiatrists need to recognize IPV, respond in a trauma-informed manner, assess safety, and have appropriate referral resources available. 

Survivors should also know that trauma does not have to define the rest of their lives, because effective treatments for PTSD are available. 

Michelle Lanspa, DO, MBA, MS, received her medical degree, as well as a Master's of Science in Nutrition, from Nova Southeastern University College of Osteopathic Medicine and is currently completing her psychiatry residency with Memorial Healthcare System in Hollywood, FL. She is specializing in reproductive psychiatry, and also has interests in integrative psychiatry and LTBQIA+ care.

She completed her undergraduate studies at Georgetown University's School of Foreign Service, majoring in Science and Technology in International Affairs with a concentration in International Public Health. She spent the next seven years living in Europe, working as a project manager and grant writer for the Italian anti-human trafficking nonprofit organization the Tampep Association, in partnership with the European Commission and the United Nations. Dr. Lanspa has also completed an MBA through IE Business School in Madrid, Spain, with concentrations in Corporate Social Responsibility and Social Entrepreneurship. Dr. Lanspa served for 5 years on the Board of the Broward Human Trafficking Coalition and continues to be an active volunteer with the organization, educating the community on sexual exploitation and advocating for survivors.

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