As COVID-19 cases surge across the country, we appear to have another long winter ahead of us in 2021. In March of 2020, stay-at-home orders were put in place, schools closed, and many people were spending more time at home than ever before. While being home has offered benefits to some, others have been trapped in terrifying circumstances with no escape.

In March of 2020, domestic-violence hotlines prepared for increased call volume. What happened defied the predictions of most experts. There was a substantial drop in domestic-violence hotline calls, in some cases, up to a 53 percent reduction in call volume was observed. Did we suddenly see a huge decrease in intimate partner violence? This is unlikely. A more logical explanation is victims were unable to safely contact these services because of the close proximity of their abuser.

Let that sink in.

Intimate partner violence (IPV) can take many forms, including physical, verbal, emotional, and sexual abuse. On average, nearly 20 people per minute are physically abused by an intimate partner in the United States. 1 in 4 women and 1 in 9 men experience severe physical violence, sexual violence, and/or intimate partner stalking. As a psychiatrist, IPV is alarmingly common among our patient population. When I began as a psychiatrist in training, I forced myself to soften the expressions of shock or horror that would emerge on my face while hearing my patients’ stories. Perhaps more concerning was when I stopped being shocked. Despite everything I’ve heard and experienced in my clinical practice, I was completely unprepared for the events that occurred the weekend before Thanksgiving.

I was working the second of two consecutive call shifts at the hospital. I recall looking forward to a few days off and fantasizing about cooking my first “meat-free” Thanksgiving dinner. We were rounding on the patients and about to enter the COVID-19 unit. As we put on our personal protective equipment, my phone began ringing. As I was about to ignore the call, my sister’s name came across the caller ID.  Our relationship does not typically include casual phone chats, so with curiosity and some sense of alarm, I excused myself and cautiously answered the phone.  I had an inclination that the call wasn’t going to be good, but I was completely unprepared for what awaited me on the other end of the line.

Before any words even registered, I felt obvious panic on the other line. I was greeted by my sister’s screams and my niece’s cries. In her distress, my sister couldn’t speak clearly to explain what was happening. Trying to stay calm, I tried to help her focus and communicate. All of my training regarding psychiatric interviewing and crisis intervention felt useless at this moment.

Finally, she said, “I need your help. There is blood everywhere.”

As I steadied my breath, I was uncertain regarding the specifics of the situation, but quite sure it was really bad.  I asked if she had called my wife or parents since they were closer to her location and not currently working. My sister replied and said no one was answering and she needed help now. She then stopped crying long enough to explain that her husband had assaulted her, and she needed to go to the hospital. Feeling useless at that moment, I told her to hang up and call 911.

I felt helpless and conflicted. My instinct was to rush to my sister’s house; but a rational part of me thought that inserting myself into an unknown domestic violence situation could be dangerous or make the situation worse. I also had a responsibility to my patients. After reaching out to my parents and wife, I completed my call shift. Sometimes the most difficult experience as a doctor is that you can’t always be there for your family. I’m still not sure I made the right decision in staying at the hospital, but ultimately, I hope my clinical efforts were more effective than the feelings of futility attempting to help a loved one address intimate partner violence.

How could we miss the signs that my only sister, part of a tight-knit family, was experiencing intimate partner violence? How could I miss it? I’m a physician pursuing specialty training in psychiatry and, more importantly, a generally observant and thoughtful person. What are we not seeing among friends, family members, and patients? If my sister could be a victim, there must be countless others suffering in silence.

There are many barriers to reporting IPV, from legal ramifications to retaliation on the part of the abuser. As a result, most people do not seek help [source?]. Medical offices can be a safe place to discuss IPV, but we can easily miss the signs or fail to screen patients in this setting. Normalizing the screening questions for IPV can reduce stigma and open up a dialogue. Being mindful of signs of physical abuse while interviewing the person or conducting an exam may provide indications of IPV. Hospital or emergency settings offer opportunities to connect victims with social workers, shelters, and community services.

Be aware. COVID-19 restrictions may increase the risk of intimate partner violence. Abusers rely on power and control, and when they can’t attain those due to loss of job, reduction in finances, and perceived loss of freedom, they may escalate abusive behaviors. Isolation is another technique the abuser can more easily access in light of COVID-19. Don’t overlook the signs.

Garrett Rossi and Kristen Mazoki are psychiatry residents who blog at Shrinks in Sneakers.

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