Domestic violence is best understood as a pattern of abusive behaviors–including physical, sexual, and psychological attacks as well as economic coercion–used by one intimate partner against another (adult or adolescent) to gain, maintain, or regain power and control in the relationship. Batterers use of a range of tactics to frighten, terrorize, manipulate, hurt, humiliate, blame, often injure, and sometimes kill a current or former intimate partner.
Domestic violence, also known as intimate partner violence, is a serious and widespread problem. In the United States, 1 in 4 women and 1 in 9 men experience contact sexual violence,* physical violence, and/or stalking by an intimate partner in their lifetime and report negative impacts such as injury, fear, concern for safety, and needing services (CDC, 2017).
* Contact sexual violence includes rape, being made to penetrate, sexual coercion, and/or unwanted sexual contact.
A wonderful serenity has taken possession of my entire soul
Evaluation
Establishing that injuries are related to domestic abuse is a challenging task. Life and limb-threatening injuries are the priority. After stabilization and physical evaluation, laboratory tests, x-rays, CT, or MRI may be indicated. It is important that healthcare professionals first attend to the underlying issue that brought the victim to the emergency department.
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The evaluation should start with a detailed history and physical examination. Clinicians should screen all females for domestic violence and refer females who screen positive. This includes females who do not have signs or symptoms of abuse. All healthcare facilities should have a plan in place that provides for assessing, screening, and referring patients for intimate partner violence. Protocols should include referral, documentation, and follow-up.
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Health professionals and administrators should be aware of challenges such as barriers to screening for domestic violence: lack of training, time constraints, the sensitive nature of issues, and a lack of privacy to address the issues.
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Although professional and public awareness has increased, many patients and providers are still hesitant to discuss abuse.
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Patients with signs and symptoms of domestic violence should be evaluated. The obvious cues are physical: bruises, bites, cuts, broken bones, concussions, burns, knife or gunshot wounds.
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Typical domestic injury patterns include contusions to the head, face, neck, breast, chest, abdomen, and musculoskeletal injuries. Accidental injuries more commonly involve the extremities of the body. Abuse victims tend to have multiple injuries in various stages of healing, from acute to chronic.
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Domestic violence victims may have emotional and psychological issues such as anxiety and depression. Complaints may include backaches, stomachaches, headaches, fatigue, restlessness, decreased appetite, and insomnia. Women are more likely to experience asthma, irritable bowel syndrome, and diabetes.
