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Domestic abuse

Terms in this set (18)

Describe the general epidemiology of domestic violence
- Very common. 1/3 women in the US have experienced rape, physical violence or stalking by an intimate partner
- 81% of victims report PTSD
- More than half of women murdered were killed by a former or current romantic partner
Define domestic violence
- Pattern of abusive and coercive behaviors used to gain power/control over a domestic partner
- The violence can be physical, sexual, financial or psychological
Characteristics of a domestic abuser
- Is almost always male
- Often uses alcohol or drugs
- Is impulsive and angry
- Has a low tolerance for frustration
- Has threatened to harm the abused if he or she reports or leaves him
- Shows apologetic and loving behavior after the abuse
- Has low self-esteem
Characteristic of a victim of domestic abuse
- Can be male or female
- Has been raised in a home in which there was domestic abuse
- Is financially or emotionally dependent on the abuser
- Blames him- or herself for the abuse
- May neither report to the police nor leave the abuser
- Has low self-esteem
Health impacts of domestic violence
- Stress related illnesses are worsened with domestic violence (migraines, depression, anxiety, chronic pain, insomnia)
- Pts with hx of domestic violence report increased rates of IBS, asthma, and diabetes
Why might victims of domestic abuse not seek health care?
- Victim reluctance to seek care due to fear of law enforcement
- Lack of transportation
- Lack of childcare
- Lack of insurance
- Lack of money to pay for care/prescriptions
What patient mannerisms are red flags for domestic abuse?
- Exaggerated sense of personal responsibility for the relationship and the violence
- Non-compliance with treatment/medication
- Denial/minimization of violence
What physical symptoms are red flags for domestic abuse?
- Defensive injuries
- Injuries to head, neck, breasts, trunk, abdomen or pelvis
- Bite marks
- Injuries during pregnancy
- Delay between injury and treatment
- inconsistent history
- Multiple different acute injuries
- Multiple in different stages of healing
What mannerisms of the abuser are red flags for domestic abuse?
- Jealousy or possessiveness
- They insist on being present during exam
- They answer questions on behalf of the patient
What are the barriers to victim safety?
- Lack of or loss of financial resources
- Lack of available and affordable housing
- Lack of support from friends and family
- Fear of losing custody of children
- Traumatic affects of long-term victimization
- Hope and belief in change
- Threats to severely injure or kill her or the children.
- Fear for safety of pets
- Fear of systems response
- Lack of community demand for perpetrator accountability
Why might the victim not leave their domestic abuser?
Has nowhere to go

Abuser has threatened harm if victim reports/leaves (in fact, a woman victim has much higher risk of murder if she leaves abuser)
What is your role as a provider when you suspect domestic abuse?
- Document
- Ensure current safety of victim
- Develop an emergency escape plan for victim
- Provide emotional support
- Refer victim to appropriate shelter/program
- Encourage the patient to report the case to law enforcement
What should you not do as a provider as a provider when you suspect domestic abuse?
Do not directly report because the victim is usually a competent adult
Define lethality factors
factors that put the victim is at increased risk of death
List the lethality factors
- Homicidal/Suicidal threats
- Victims leaves relationships or is planning to leave
- Offender has access to weapons
- History of domestic violence
- Offender has hurt or threatened the children
- Abusing pets
- Drug and/or alcohol dependency
- Increase in severity and frequency of violence
- Strangulation
- Stalking
How do you discuss lethality factors with a domestic violence victim?
**************
What is the WATS questoinnaire?
domestic abuse screening with 8 questions. Can have a short version too with only 2 questions.

Examples of questions:
1. How would you describe your relationship (lots/some/no tension)
2. Do you and your partner work out arguments with... (great/some/no difficulty)
What is the HITS questionnaire?
Screening of domestic violence with a Leikert scale

Examples: How often does your partner... physically hurt you, insult you, threaten you with harm (never → frequently)
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