Domestic violence is a pattern of coercion or assault used by an adult or adolescent to force a partner to comply with his wishes. This control includes physical, psychological, and sexual abuse. Conservative estimates put the number of women assaulted by their partner at 2 to 4 million per year. Despite an increased focus, there still seems to be deficiencies in doctor’s identification and treatment of victims of domestic violence.
Doctors may lack knowledge about the subject, harbor attitudes that hinder detection, or lack the necessary skills to address victims of domestic violence. Neither demographic factors nor psychological problems have been found to be predictors of victimization or violence. Domestic violence cuts across all racial, socioeconomic, religious, and ethnic lines. The only consistent risk factor of this type of violence is being female, and actions perpetrated by men against female partners that tend to be more aggressive, more numerous, and more severe than actions by women against men. Although alcohol and drug use can worsen violence, no causal relationship has been established between the two and domestic abuse.
Some doctors may feel uncomfortable addressing an area culturally defined as private. Discussing violence with a victim while the batterer is present can put the victim at increased risk. Many victims don’t leave their partners after given advice. Because of this, some doctors may think that questioning and intervention aren’t worthwhile. Many battered women don’t spontaneously disclose information about violence. By opening the discussion, health care providers communicate the message that the problem is important. Failure to diagnose abuse can increase a woman’s feelings of isolation and discourage her efforts to leave the relationship. Experts now think that screening for violence should be incorporated into routine medical screenings. If the victim doesn’t want to leave their partner, she should be offered counseling or a referral to a battered women’s shelter. The victim should be counseled to have a plan to extricate herself from a violent situation that may arise in the future. She should have an emergency bag packed.
The National Domestic Violence Hotline is: 1-800-799-7233. They have a computer data base of emergency shelters.
Factors that increase the risk of homicide in cases of domestic violence are:
- presence of firearms in the home
- threats of homicide or suicide
- sexual abuse
- increase severity of injuries
- use of drugs and alcohol by abuser
- increase frequency of battering
A health care provider should schedule a follow-up appointment for ongoing assessment of victims that elect not to leave their abuser or deny there is abuse when the provider suspects that it is occurring.