Domestic Violence

Domestic violence, also known as intimate partner violence, involves physical, sexual, emotional, economic, or psychological actions or threats of actions that influence another person within a domestic setting, such as in a marriage or cohabitation.

Causes:

The causes of domestic violence are complex and often stem from a combination of individual, relational, community, and societal factors. These can include:

Power and Control:
- Perpetrators often use violence to exert power and control over their partners.
Learned Behavior:
- Individuals who witnessed domestic violence in their families of origin may be more likely to engage in such behavior.
Societal Factors:
- Societal norms and structures that promote unequal power relations between genders can contribute to domestic violence.
Stress and External Pressures:
- Financial stress, job loss, or other external pressures can contribute, though they are not excuses for violence.
Substance Abuse:
- Can exacerbate violent behaviour, though it’s not a direct cause.
Mental Health Issues:
- Some perpetrators have underlying mental health disorders, although this is not always the case.

Diagnosis:

History Taking:
- Safe and non-judgmental environment where patients feel comfortable discussing sensitive issues.
- Routinely screen patients for domestic violence during medical visits, especially during well-woman exams or prenatal care appointments.
- Open-ended questions and active listening to encourage patients to share their experiences.
- Consider the possibility of domestic violence when presented with vague or recurrent complaints.
- Signs of Abuse: Look for unexplained or frequent injuries, chronic health problems, mental health issues like depression or anxiety, and signs of fear or anxiety around a partner.
- Direct Questioning: Healthcare providers should sensitively ask about domestic violence in a safe and private environment.
Physical Examination:
- Injuries Examination: Look for patterns of repeated or unexplained injuries, bruises, or fractures.
Documentation:
- Document all physical findings with detailed notes, photographs, and diagrams if necessary.
Screening Tools (HITS):
- Use of Validated Tools: Such as the HITS (Hurt, Insult, Threaten, Scream) tool, can help in identifying domestic violence.

Differential Diagnosis:

Accidental Injury:
- Distinguishing between injuries caused by accidents and those due to violence.
Self-Harm:
- Differentiating between self-inflicted injuries and those caused by a partner.
Psychiatric Conditions:
- Some symptoms (like anxiety, depression) may overlap with other conditions.

Management:

Immediate Safety:
- Safety Planning: Assess and ensure the immediate safety of the patient. If there is immediate danger, consider involving law enforcement.
- Confidentiality: Maintain patient confidentiality but recognize the legal obligations to report in cases of child or elder abuse.
Medical Care:
- Treatment of Injuries: Provide or refer for appropriate treatment of any physical injuries.
- Follow-up Care: Arrange for ongoing medical care as needed.
Support and Referrals:
- Social Support: Refer to social services for support with housing, legal advocacy, and financial aid.
- Counseling and Mental Health: Referral to mental health services for support in dealing with trauma and emotional consequences.
Documentation:
- Accurate Record-Keeping: Keep detailed records of physical findings and the patient’s statements, which can be crucial for legal proceedings.
Legal Considerations:
- Mandatory reporting is when the law requires you to report known or suspected cases of abuse and neglect
- It mainly relates to children
- It can also relate to adults if the person involved is living in a residential service, such as psychiatric, aged care, or other government-run facility
- The laws around who is required to report and in what circumstances are different in each state and territory
Education and Prevention:
- Awareness Raising: Educate patients about domestic violence, its risks, and available resources.
- Community Programs: Participate in or refer patients to community-based prevention and support programs.
Ongoing Support:
- Regular Follow-Up: Ensure regular follow-ups to monitor the patient’s situation and well-being.

It’s crucial to approach the subject of domestic violence with sensitivity and understanding, acknowledging that patients may feel ashamed, fearful, or ambivalent about discussing their experiences. Creating a safe and supportive environment for the patient to disclose abuse is a vital part of effective management.

9Rs of Intimate Partner Violence

The “9 R’s” of intimate partner violence (IPV) represent a guideline for healthcare providers to address and manage situations involving intimate partner violence effectively. These steps are designed to help professionals offer the appropriate support and resources to victims of IPV. Here’s a breakdown of the 9 R’s:

Recognize:
- Healthcare providers should be trained to recognize the signs of intimate partner violence, which can be physical, emotional, or sexual.
Respect and Reassure:
- It’s important to respect the victim’s situation and provide reassurance.
- This involves creating a safe and supportive environment where the victim feels comfortable discussing their experiences.
Respond:
- Once IPV is recognized, healthcare providers should respond appropriately.
- This might involve providing medical treatment, emotional support, and information about resources.
Referral:
- Referring victims to appropriate services, such as counseling, legal advice, and domestic violence shelters, is crucial for their safety and recovery.
Records:
- Keeping detailed and accurate records of any signs, symptoms, and disclosures related to IPV is essential for legal and medical reasons.
Rights:
- Informing the victim of their rights, including their legal rights, rights to privacy, and the right to make their own decisions about their care and future.
Review and Reflect:
- Healthcare providers should regularly review their approach to managing IPV and reflect on how effectively they are supporting victims.
Risk Assessment:
- Conducting a risk assessment to determine the immediate safety needs of the victim and any dependents is critical.
- This can guide decisions about emergency interventions or safety planning.
Report:
- In most cases IPV is NOT a mandatory reporting issue.
- In some jurisdictions, there may be a legal requirement to report cases of IPV to authorities, especially if there are concerns about the safety of the victim or others, such as children.

These steps are intended to provide a comprehensive approach for healthcare professionals in identifying and managing cases of intimate partner violence, ensuring that victims receive the necessary support and intervention.