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 behavior, 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:
- 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.