- Domestic violence is a serious problem. Like elder abuse, it is often ignored and under-reported. It has been estimated that the police in the United States spend approximately 33% of their working hours responding to calls involving domestic violence, and approximately 25% of the population has been affected by domestic violence.
- Millions of women and a surprisingly large number of men are subjected to physical violence, sexual assaults, and psychological and emotional abuse from their partners. But only a small fraction of all cases of domestic violence are reported or prosecuted. The abuse just keeps on, and it has serious consequences. Victims of domestic violence often suffer from depression, substance use and addiction, chronic mental illness, and poor overall health. These victims can also suffer serious injuries or even death from abuse.
- Physical violence as a form of domestic violence is very common. No one knows exactly how many people are struck or injured by a partner each year but recent surveys suggest that in any given year over 5 million women and 3 million men are physically abused by their intimate partner.
- Domestic violence has traditionally been thought of as men abusing women; however, there is strong evidence that a large number of men are abused by their female partners. No one knows for sure how common this is, but there are many experts who feel that the incidence of females abusing their male partners may be almost equal to that of men abusing women.
- Many people believe that domestic violence is a problem that affects certain socio-economic groups to a greater degree than others. A full understanding of any trend here is limited by under-reporting and reporting biases so this may or may not be true. For these reasons, it is difficult to know who is more likely to be a victim of domestic violence. Regardless of any trends that may be seen with domestic violence, it is clear that domestic violence can happen to anyone, anywhere, regardless of age, ethnic background, gender, income, or location. It should not be assumed that someone cannot be a victim of domestic violence because of his/her background.
- Domestic violence has traditionally been thought of as a physical assault, such as someone being struck, injured, or killed. Physical force is certainly one type of domestic violence but there are many other ways that someone in an intimate relationship may be abused. Domestic violence is defined here as: Domestic violence is physical, sexual, and/or psychological abuse committed by someone who is intimately related to the victim.
- The physical abuse that characterizes domestic violence can involve seemingly minor types of harm such as pushing, pinching, rough touching, etc., or it may involve dangerous and injurious behavior such as slapping, choking, punching, kicking, or physical contact that causes injury or death. Physical abuse can also include forcing a victim to engage in dangerous behavior such as excessive use of alcohol or the use of dangerous and illegal drugs.
- Domestic violence that involves sexual abuse can take many forms. It may involve the threat of unwanted or forced sexual contact or intercourse; it may involve sexual contact or intercourse that is humiliating, painful, or dangerous, such as unprotected intercourse with someone who has a sexually transmitted disease. In its most severe form, it involves physical harm that occurs during sexual contact or rape.
Emotional or Psychological Abuse
- Emotional and psychological abuse always accompanies the other forms of domestic violence; it is impossible to suffer physical or sexual abuse without being injured both emotionally and psychologically. But there are millions of cases of domestic violence in which the victim does not suffer physical or sexual harm. An abusive partner may constantly subject the victim to bullying, harassment, or criticism.
- The victim may be subjected to daily threats or intimidation. The abuser may be overly controlling and prevent the victim from enjoying normal freedom of movement and normal social relationships and will do so by the use of threats, screaming, or abusive language. The abuser may stalk the victim or make uninvited visits to someone’s home or workplace. The person who is being terrorized may, in the end, find that he/she has become totally dependent on the abuser, which of course is often the abuser’s intent.
- The emotional and psychological abuse that each victim experiences are unique to his/her situation. But regardless of how someone is being abused, whether it is physically, sexually, or psychologically, fear is one common feeling that is evident in all abusive situations. Fear is the environment in which the victim lives on a daily basis because domestic violence occurs over and over; it is a continuing phenomenon. If someone is being abused, it is rarely an isolated incident.
- The victim of domestic violence lives in a constant state of fear. What is that fear like? One way to know is to look at what women who are being victimized say about their relationships. The Women’s Experience with Battering Scale is an assessment tool that is used to determine if a woman is involved in an abusive relationship. The victim is given a sheet with these statements and asked whether she characterizes her relationship in the following manners:
- He makes me feel unsafe even in my own home.
- I feel ashamed of the things he does to me.
- I try not to rock the boat because I am afraid of what he might do.
- I feel like I am programmed to react in a certain way to him.
- I feel like he keeps me prisoner.
- He makes me feel like I have no control over my life, no power, no protection.
- I hide the truth from others because I am afraid not to.
- I feel owned and controlled by him.
- He can scare me without laying a hand on me.
- He has a look that goes straight through me and terrifies me.
- It is easy to see that if someone is intimately involved with a partner who through words, actions, or both makes him/her feel this way, life would be very frightening. Also, it is well known that people in abusive relationships are more likely to suffer from poor health, chronic health problems, chronic psychiatric problems (depression, low self-esteem, etc.) and are more likely to commit suicide. The level of violence in an abusive relationship often escalates dramatically if a victim reports the abuse, and the risk of being murdered is the highest when a victim attempts to break off the relationship.
Investigating Domestic Violence
- In some healthcare facilities, it is required to ask someone if there is a problem of domestic violence. Many times this is not done directly. The questions may be very general in nature, such as “Do you feel safe at home?” or “Are there any relationship issues you would like to talk about?” Some emergency rooms simply give each patient a pamphlet or information sheet that briefly discusses domestic violence and has contact numbers. It may also be useful to ask if there are any problems with alcohol or substance use in the home, as excessive use of alcohol and/or drugs is associated with an increased risk for domestic violence. Certainly, the subject should be brought up if there are very strong indications that domestic violence is occurring.
- The best approach is to follow the guidelines that have been developed in the workplace and, if required to ask about abuse, the healthcare worker should do so in a way that is non-confrontational, non- judgmental, and supportive. Each situation should be assessed individually for the best way to open a very sensitive subject.
- Concerned healthcare workers are essentially a stranger asking someone to share intimate information about being a victim of abuse, and, the victim will likely view their relationship with members of the health team as temporary, at best. Victims should be encouraged to talk but not coerced in a forceful or intrusive way. Again, if abuse is occurring or suspected to occur, even if there are no obvious signs of abuse, concerns can be brought forward to a supervisor or a social worker.
Recognizing Domestic Violence
- Recognizing domestic violence can be difficult. If the violence is psychological, emotional, or sexual in nature, there may not be visual signs of violence. Even the effects of physical violence can be difficult to identify because injuries can be hidden or explained away. And the problem of recognizing domestic violence is made worse by the fact that only a small percentage of those who are being abused by their partner will report the abuse. Many victims of domestic violence are ashamed or embarrassed about their situation.
- The victims are often manipulated by the abuser and are made to feel as if the abuse is “their fault.” Many are frightened that if they report the abuse, the law will not protect them and the abuse will get worse. Some medical and mental health professionals can detect domestic violence, but many physicians and healthcare workers are inadequately trained to understand the problem or have not been taught how to look for the signs and symptoms of domestic violence.
Although recognizing domestic violence is often not easy, there are definitely some signs that indicate that physical, sexual, or psychological abuse is going on in an intimate relationship.
Signs of Domestic Violence
- Some of the signs of domestic violence are obvious; lacerations or bruises around the throat or on the face, scratches that suggest fingernail marks, bruises that suggest slapping, punching, or bite marks. What is even more suggestive are injuries that occur time and again.
- If a woman or a man is being injured in the same way in the same area of the body and this has happened several times, this strongly indicates the presence of domestic violence. Also, if someone has one of these injuries, but the person’s explanation just does not make sense or they don’t want to talk about how the injury occurred then domestic violence should be suspected.
- Sexual injuries can be hard to detect. Many of the signs and symptoms of sexual abuse cannot be seen initially. Healthcare workers should suspect sexual abuse if someone has injuries to the genital area, rectum, or breasts.
Emotional or Psychological Abuse
- People who are abused by an intimate partner are often fearful, withdrawn, or hesitant when the abuser is present. They may seem overly anxious to please this person. They may not speak unless they have “permission” from the partner, and may report that the partner frequently yells, threatens, or humiliates them. Their movements are severely restricted and they cannot go anywhere without first checking with the partner.
There are several screening tests that can be used to detect domestic violence. Using these tests requires training and experience but they are provided here to illustrate how other healthcare professionals screen for domestic violence. The first test is the HITS screen; the second is the Women Abuse Screening Tool (WAST).
- The HITS screen is a series of four questions that ask how often does a partner:
- Physically Hurt you
- Insult or talk down to you
- Threaten you with harm
- Scream or curse at you
- The WAST screening tool is a bit more complex and a bit longer.
- In general, how would you describe your relationship?
- Do you and your partner work out arguments with great difficulty, some difficulty, or no difficulty?
- Do arguments ever result in you feeling put down or bad about yourself?
- Do arguments ever result in hitting, kicking, or pushing?
- Do you ever feel frightened by what your partner says or does?
- Has your partner ever abused you physically?
- Has your partner ever abused you emotionally?
- Has your partner ever abused you sexually?
These screening tools assume that domestic violence is being done by a man to a woman, but they can easily be used to screen for women to men domestic violence.
The Abused Victim in Domestic Violence
- Intervening in a situation of domestic violence can be very complicated and potentially very frightening. There are medical, legal, and safety issues, and the healthcare worker’s job is not to try and solve these. Rather, healthcare workers should try and recognize domestic violence, and report it so that people with the experience can start a coordinated plan to stop the violence and make sure the victim is safe. Healthcare workers have a legal obligation to report physical, sexual, and/or emotional or psychological abuse.
- Some healthcare workers feel hesitant to report domestic violence, however, there are many resources available to them to support proper reporting. Even if there were no legal obligation to do so, reporting abuse should be done because there is no excuse for domestic violence; nobody deserves to be abused, and the abuse is not the fault of the victim.
- If someone is in immediate danger or a crime has just been committed, call 911 or the local police.
- If there is no immediate danger, call or notify a supervisor immediately.
- As previously mentioned, there are a lot of resources available to help the victims of domestic violence. The National Violence Domestic Hotline is 1-800-799-7233. This is a 24 hour, seven days a week service that can provide advice and assistance for people who are suffering from domestic violence.
- As with elder abuse, it is very important that if a healthcare worker has a reasonable suspicion that domestic violence is actually happening they should report the concern. Reporting that someone is being abused should not occur on the basis of feelings or intuition. Suspicions that domestic violence is occurring should be based on objective information that can be observed, documented, and verified.
- Elder abuse and domestic violence are serious problems. With elder abuse, physical abuse is one aspect of the problem but elder abuse can take many forms. It may involve financial abuse, abandonment, or neglect. It may also include physical, sexual, or emotional abuse. This is also true for domestic violence; it may include physical, sexual, or emotional abuse.
- Signs of elder abuse or domestic violence may be observed. The most sensible approach would be to follow the guidelines that have been developed by an employer or in the workplace. If required to ask a client about abuse, it should be done in a way that is non-confrontational, non-judgmental, and supportive.
- Healthcare workers should not decide that someone is being abused on the basis of feelings or intuition. Suspicions should be based on objective information that can be observed, documented, and verified. When there is a reasonable suspicion that elder abuse or domestic violence is happening, healthcare workers are obliged to report the abuse to the proper authority.