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The Common—and Long-term—Consequences of Teen Dating Violence

May 2, 2023

Editor’s Note: Eli Cahan is a resident physician in pediatrics at University of California, San Francisco and an investigative journalist whose work focuses on the intersection of health equity and social justice. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics

High school romance, in Hollywood’s depiction, is something idyllic, nostalgic, and safe. The reality in some cases, however, is something else entirely.

Increasing bodies of evidence show that adolescent relationships, just like adult relationships, can be fraught. Research indicates that 1 in 5 teen relationships entail physical violence; 1 in 10 involve sexual violence. Emotional violence is even more common; in some settings, almost all teens experience emotional violence at some point.

Furthermore, teen dating violence—or TDV—has long-term consequences. For example, studies have found that TDV increases the likelihood of participation in high-risk behaviors (i.e., substance use), as well as the probability of emotional dysregulation (i.e., anger management) that can precede future relational conflict. These outcomes—substance use, emotional dysregulation, relationship fragility—when occurring early in life, have all likewise been correlated with long-term psychosocial sequelae.

Despite the emerging evidence, the long-term outcomes of TDV are inadequately characterized (especially when compared to those of intimate partner violence, or IPV, in adults). An article that is being early released this week in Pediatrics entitled “Long-Term Adverse Outcomes Associated with Teen Dating Violence: A Systematic Review,” seeks to fill that evidentiary gap (10.1542/peds.2022-059654).

In their systematic review, Piolanti and colleagues evaluated 38 studies across 23 unique populations addressing the prevalence and outcomes of TDV. They found that TDV is associated with numerous adverse future outcomes.

One of the unifying emotional consequences of TDV is what the authors refer to as “internalizing symptoms”. While such symptoms can manifest as anxiety and depression, the sequelae of such symptoms are not limited only to diagnoses of generalized anxiety disorder or major depressive disorder.

Piolanti and colleagues also found that TDV is associated with future high-risk behavior, namely, substance use. They highlight marijuana, tobacco, and alcohol as 3 substances correlated with preceding TDV. However, it should be noted that substances (including illicit substances) other than these 3 are less easily traceable in large datasets (due, in part, to underreporting on account of illegality and/or stigma). The authors also highlight the connection between TDV and future high-risk sexual behaviors, including sex under the influence of alcohol and unprotected sex.

Lastly, the authors note that, based on the available data, these outcomes are not evenly distributed across genders. Females, they say, more frequently reported such consequences of TDV. That said, since many of the included studies relied on self-reporting, it is possible that males underreported such behaviors, or failed to recall them when they were asked the questions in the study surveys.

In summary, the authors write that the repercussions of TDV are far-reaching; they call behaviors like substance use “both an outcome and a coping mechanism” following abusive relationships. Authors note that even 1 episode of TDV can potentially lead to future episodes, thus creating a vicious cycle.  TDV “may further reduce self-confidence in addressing future abusive situations during sexual intercourse,” they write.

Taken together, these findings indicate that TDV is more common than we may think. Accordingly, practitioners seeking to better understand and mitigate upstream factors of health—including those less frequently discussed—can learn from the article about an important topic that is likely impacting their patients.

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