05 - PJ20 Physical maltreatment, spouse or partner

PJ20 Physical maltreatment, spouse or partner, or QE51.10 history of spouse or partner ...

Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders Physical maltreatment, spouse or partner, or history of spouse or partner violence, physical Essential (required) features • At least one non-accidental act of physical force (e.g. pushing or shoving, scratching, slapping, throwing something that could cause injury, punching, biting) is required for diagnosis. • The act causes (or exacerbates) at least one of the following: • any physical injury; • significant fear; • reasonable potential for significant physical injury. • The act was not for physical protection of the individual (e.g. to ward off a partner’s punches) or partner (e.g. to prevent a partner from attempting suicide). Note: these categories are assigned to the victim, not the perpetrator. In cases of mutual violence in which the couple is being evaluated, they may be assigned to both parties if applicable. If PJ20 Physical maltreatment is diagnosed, the perpetrator should be specified as a spouse or partner using the extension code XE454 (PJ20&XE454). On the ICD-11 platform, the option to specify the perpetrator–victim relationship appears in the context of the assault field. Additional clinical features • Intimate partner physical abuse is, by definition, associated with an increased risk of physical injury and need for medical attention. • Intimate partner physical abuse is associated with an increased risk of poor physical health and the development of a chronic disease. • Intimate partner physical abuse is associated with higher rates of depressive disorders, post-traumatic stress disorder and disorders due to substance use, as well as suicidality. • A pattern of recurrent acts, or the intent to assert control or power, are not required features for assigning a diagnosis of intimate partner physical abuse. The diagnosis only requires at least one act of violence that causes or exacerbates at least one negative impact. • Most children (i.e. approximately 75%) living in households with clinically significant intimate partner physical abuse witness it. Exposure to parental or caregiver intimate partner violence places children at significantly greater risk of a range of mental disorders, negative affect/distress and negative cognitions, as well as social and academic difficulties. PJ20 / QE51.10 Relationship problems and maltreatment | Relationship distress and current or past maltreatment by spouse or partner

715 Relationship problems and maltreatment Boundary with normality (threshold) • Acts of physical aggression (e.g. grabbing a partner’s arm) that do not cause injury or significant fear are relatively common in intimate relationships. In contrast, the acts of physical violence and associated impacts characteristic of intimate partner physical abuse are not part of healthy functioning relationships. Course features • Intimate partner physical abuse may lessen and remit over time. However, for many affected relationships, intimate partner physical abuse reoccurs and sometimes increases in frequency or severity. • The risk of intimate partner physical abuse increases in the context of external stressors (e.g. job loss) or when the victim is disabled. Developmental presentations • In general, adolescents and young adults are at greater risk of being victims of intimate partner physical abuse because the rate of physically violent acts against intimate partners among perpetrators tends to decrease across the lifespan. Boundaries with other disorders and conditions (differential diagnosis) Boundary with relationship distress with spouse or partner Intimate partner physical abuse may be, but is not always, associated with relationship distress with spouse or partner. If all diagnostic requirements are met for both relationship distress with spouse or partner and maltreatment or history of spouse or partner violence, both may be assigned. Relationship problems and maltreatment | Relationship distress and current or past maltreatment by spouse or partner