Intimate partner violence (IPV) encompasses physical, sexual, psychological, and economic abuse within intimate relationships. In cPNI and evolutionary medicine contexts, IPV includes reproductive coercion (sabotaging contraception, forced pregnancy/termination, stealthing) which represents attempts to control reproductive outcomes and paternal certainty.
IPV operates through multiple pathways: (1) Direct physical trauma causing injury and chronic pain; (2) Chronic psychological stress activating HPA axis and sympathetic systems causing allostatic load; (3) Reproductive coercion affecting fertility, pregnancy outcomes, and maternal-fetal health through stress hormones; (4) Social isolation reducing access to resources and support; (5) Economic control creating dependency and limiting healthcare access. Reproductive coercion specifically includes: birth control sabotage, condom removal (stealthing), forced pregnancy, forced abortion, controlling pregnancy decisions. From evolutionary perspective, some IPV patterns reflect male attempts to ensure paternal certainty and prevent cuckoldry.
IPV must be assessed in cPNI practice as it profoundly affects physical and mental health through chronic stress, trauma, and reproductive disruption. IPV victims show: elevated chronic inflammation, HPA axis dysregulation, PTSD, depression, chronic pain syndromes, autoimmune disease, adverse pregnancy outcomes, and increased infection susceptibility. Reproductive coercion specifically affects birth outcomes, maternal stress during pregnancy (programming offspring), and ability to plan family. Practitioners must screen sensitively for IPV, recognize physical signs (injuries, chronic stress patterns), provide resources, and understand that stress-reduction interventions cannot succeed while violence continues. Documentation in medical records is critical for victim protection and legal purposes.
- Includes physical, sexual, psychological, and economic abuse within relationships
- Reproductive coercion: birth control sabotage, forced pregnancy/abortion, stealthing
- Causes chronic HPA axis activation and allostatic load
- Associated with PTSD, depression, chronic pain, autoimmune disease
- Adverse pregnancy outcomes common in IPV contexts
- Maternal stress from IPV programs offspring through prenatal environment
- Social isolation and economic control maintain victim dependency
- Medical documentation critical for victim protection
- Stress-reduction interventions ineffective while violence continues
- Evolutionary perspective: some patterns reflect paternal certainty concerns
- chronic stress — IPV causes chronic stress with sustained HPA axis and sympathetic activation
- allostatic load — chronic IPV creates high allostatic load from sustained stress response systems
- PTSD — IPV is major cause of PTSD with lasting neurobiological effects
- depression — IPV victims have elevated rates of depression through chronic stress and trauma
- reproductive coercion — reproductive coercion is form of IPV controlling pregnancy and contraceptive decisions
- pregnancy — IPV during pregnancy increases maternal stress, preterm birth, and low birth weight
- maternal stress — IPV-induced maternal stress programs offspring through prenatal environment
- birth weight — IPV during pregnancy associated with reduced birth weight through chronic stress
- HPA axis — chronic IPV dysregulates HPA axis causing cortisol dysregulation
- inflammation — chronic stress from IPV elevates inflammatory markers increasing disease risk
- chronic pain — IPV victims have elevated rates of chronic pain syndromes
- autoimmune diseases — chronic stress and trauma from IPV increase autoimmune disease risk
- social support — IPV involves social isolation reducing protective effects of social support
- stealthing — stealthing (condom removal without consent) is reproductive coercion within IPV
- paternal investment — some IPV patterns reflect evolutionary conflicts over paternal investment and certainty
- sexual coercion — sexual coercion is component of IPV affecting reproductive autonomy
- trauma — IPV causes complex trauma with neurobiological and psychological sequelae
- cortisol — chronic IPV disrupts cortisol rhythms through sustained HPA axis activation
- social determinants of health — IPV is major social determinant affecting multiple health outcomes
- clinical-practice — screening for IPV essential in cPNI practice to address root causes of stress-related disease