How to Change a Woman’s Life in 30 Seconds

Intimate partner violence (IPV) is more common than breast cancer, diabetes, or depression, with one in four women affected. Though research on IPV among women with ADHD is limited, the prevalence in this community is thought to be particularly high. According to the Berkeley Girls with ADHD Longitudinal Study (BGALS), women aged 17 to 24 with ADHD were five times more likely than their neurotypical peers to experience physical IPV. Greater ADHD symptom severity in childhood, the researchers found, was associated with increased risk for IPV.¹

The ramifications of abuse are dire and, in some cases, life-threatening: half of female homicide victims are killed by current or former partners.² The consequences of psychological abuse — the most frequent kind of IPV and often a precursor to physical violence — are no less critical. Research shows that psychological abuse is an even stronger predictor of post-traumatic stress disorder and depression than is physical abuse.³

Though intimate partner violence is startlingly common and harmful, many avenues can lead victims to help and health care providers are instrumental in connecting patients to these paths. Though traditional IPV screening is an effective intervention, it’s not the only one. For some providers, distributing safety cards may be a better fit.

The size of business cards, these safety cards contain information about the red flags and health consequences of IPV. They share contact information for hotlines as well as guidance for safely seeking help, and they let people know they’re not alone.

“It takes 30 to 45 seconds to share the card, and it can change someone’s life,” says Tami Sullivan, Ph.D., director of Family Violence Research and Programs and professor at Yale University’s School of Medicine. “We hear from women with lived experience of violence: ‘Why didn’t anyone ever give me something like this? It could have made all the difference to me.’”

[Read: Why Do Toxic Relationships Swallow People with ADHD?]

Obstacles to IPV Screening

With traditional IPV screening, a provider uses a survey like the HITS (Hurt, Insult, Threaten, Scream) to detect if a patient is experiencing violence. This can be transformative.

“If you trust your provider, it can be a very empowering experience to connect with someone who can listen, make you feel less alone, talk to you about making decisions,” Sullivan says.

But several significant obstacles stand in the way of effective screening for IPV. Survivors may be hesitant to disclose their experiences of violence, fearful of retaliation by their partners, or of being reported to police and potentially losing custody of their children. They may worry they’ll be judged, blamed, or shamed. These concerns may be particularly salient for women with ADHD who receive near-constant criticism, correction, and judgement.

[Watch: “How to Avoid Toxic Relationships and Find Your Ideal Match”]

These obstacles contribute to relatively low rates of disclosure in IPV screenings; less than a quarter of women who have experienced IPV report disclosing this to a health care provider.⁴

The efficacy of screenings also relies on a meaningful response from the provider. Many providers don’t feel comfortable addressing such a sensitive and personal revelation because they’ve not received training in IPV.

“We shouldn’t expect people to develop expertise in responding,” Sullivan explains. “But we want the provider to feel comfortable enough so that they’re not being judgmental, so they can let the person know they’re heard, and connect them to someone who does have expertise.”

If a survivor reveals abuse on a survey and her disclosure is never addressed, or if it’s met with judgement, Sullivan explains, it can discourage her from revealing the abuse to others in the future.

Safety Cards: A Universal Approach

The part of IPV screening that helps survivors most, research has found, is the engagement with support services that happens after disclosure.⁵ This is where safety cards come in.

IPV safety cards, which are distinct from screening methods, bypass surveys altogether and take a direct path to offering help.

The method is simple: Providers order safety cards like these for free and hand them out to every female patient they see (without their partner present). The cards come in 10 languages and contain information about the red flags and health consequences of IPV. They also connect patients to support and resource hotlines

For providers looking for guidance on how to distribute the cards, Sullivan suggests the following language:

“We’ve started talking with all of our patients about relationship health and abuse in relationships, in case it’s ever an issue for them or for their friends and family. This card talks about healthy and safe relationships, ones that aren’t — and how relationships affect your health.”

Safety cards offer myriad benefits, including:

• Getting help to the people who need it, no questions asked. Offering resources to everyone, a universal education model, ensures that the women who need help will get access to it – regardless of whether they disclose abuse.
• Empowering women to help others. Many of the patients who receive cards may not be experiencing IPV, but they may know people who are. Safety cards enable these individuals to recognize abuse in the lives of loved ones, and empower them to offer helpful resources. Research found that people who received universal education were twice as likely as those who did not to share the number for an IPV hotline to someone in need.⁶
• De-stigmatizing conversations about IPV. Broaching the topic of intimate partner violence to all patients helps to break the taboo which often keeps women silent about their experience.
• Planting a seed for future action. It’s important for providers to distribute safety cards at every visit because it may take more than one interaction for patients to recognize abuse in their own lives, or to prepare themselves to consider next steps.  “Often, the cards plant a seed for future action. You give it to patients every time they come in so that it’s routine and becomes comfortable,” Sullivan says. “They come to understand that their relationships affect their health.”

While disclosures aren’t necessary in this IPV intervention, they may happen. When responding, providers should use non-judgmental, validating language, and avoid directing patients to take specific action. “It should never be a provider, trained or not, telling people what they should do,” Sullivan explains. “Though it’s likely well-intentioned, this prescriptive approach mimics the dynamics of abuse and disempowerment.”

Instead, follow the patient’s lead. “Let people know the supports available to them and listen to them,” suggests Sullivan. “You might ask: ‘Have you thought about what you want to do? Do you want help thinking about what makes sense? Would you like to call a helpline from this office?’”

What survivors of abuse need from providers, Sullivan explains, is autonomy, empathy, and information about their options for getting help.

To Order Free Safety Cards

• Visit Futures Without Violence.

Get Help

If you, or someone you love, is experiencing intimate partner violence, these resources may help

• National Domestic Violence Hotline, Call 800-799-7233 or text START to 8878
• Love Is Respect, for people aged 13-26, Call 866-331-9474 or text LOVEIS to 2252
• National Sexual Assault Helpline, Call 1-800-656-HOPE

Abusive Relationships and IPV Screening: Next Steps

• Read: “What Are the Signs of a Controlling Relationship?”
• Quiz: “Is My Relationship Toxic?” A Quiz for Adults with ADHD
• Read: How to Respond to Gaslighting — In Your Relationship and In Yourself

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