Domestic violence is a pattern of controlling behaviors aimed at gaining power in order to control an intimate partner. Domestic violence is about power and control. It is not just about hitting or punching. It is a pattern of assaultive and coercive behavior, including psychological, sexual and physical abuse. The syndrome of dominance and control by the perpetrator leading to increasing entrapment of the victim is also known as the "battering syndrome." The majority of the time, it is a female that is abused. There are instances of a male being abused but it is less common.
Scope of the Problem
It is conservatively estimated that between two and four million women are battered each year in the United States. Nearly a quarter of women in the United States will be abused at some time in their lives. There are two thousand deaths each year. About 20-25 percent of pregnant women are victims of domestic violence. Nineteen to 30 percent of women coming to emergency departments with physical injuries are battered. Battered women account for 25 percent of women who attempt suicide and 25 percent of women using a psychiatric emergency service. There is no typical victim of domestic violence.
Until recently, wife-beating was an accepted part of marriage in many cultures. British common law allowed a man to "chastise" his wife with "any reasonable instrument." It was eventually modified to state that the weapon used to beat her must be no thicker than his thumb. This led to the commonly used saying "the rule of thumb." In 1895, the Married Women's Property Act gave women the right to use conviction for assault as sufficient grounds for divorce. The battered women's movement, which spearheaded the development and proliferation of shelters for battered woman, had its roots in the women's movement of the late 1960s and early 1970s. Today there are over twelve hundred shelters in this country.
Types of Abuse
Abuse does not just mean physical abuse. It takes several different
forms that I will briefly describe.
Risk Factors for Domestic Violence
1. Single, separated or divorced
Why Don't Victims Just Leave?
One very important reason why women don't just leave an abusive relationship is the very real fear that they will be harmed if they try to leave. The perpetrator will threaten the woman as well as other family members including children. She may not have the financial means to support herself and their children. The victim may feel that the children need an intact family. She may have religious or cultural beliefs that the family must remain intact at all costs. She may believe that the violence is her fault. She may still love the perpetrator and succumb to his promises never to let it happen again. It is a vicious cycle. Victimized women may not admit that the injuries they have received are the result of abuse even if they are asked. They may fear retribution if they tell. She may be unable to talk freely because the perpetrator is present.
Presentation of Victims of Domestic Violence
Victims may present with almost any physical complaint irrespective of traumatic injuries. Recurring physical complaints with negative evaluations can suggest domestic violence. Headaches, chest pains, heart palpitations, numbness and tingling, and choking sensations. Chronic pelvic pain with a negative work up is suggestive of domestic violence. Attempted suicide is a frequent presentation of a battered woman. Chemical dependency is felt to be a frequent result of domestic violence. Victims of abuse may present to the doctor with injuries that are not consistent with their stories of how the injury occurred. Anxiety can be the main presenting complaint.
Increasing the Recognition of Domestic Violence
Physicians must keep a high index of suspicion to diagnose domestic violence early. Many medical schools have recently included domestic violence in their core curriculum. The American Medical Association is actively trying to educate physicians about domestic violence. The past president of the AMA, Dr. Robert McAfee has spread the message by lecturing all over the country to physicians as well as the general public. Physician education is a key component to early diagnosis and treatment since they are frequently directly involved in treating the injuries and may have a good rapport with the patient. A warning signal to physicians would be a time delay between the time of the injury and the time the patient seeks attention. Physicians should learn to question the victims in private where they are more likely to talk freely. Routine screening of patients during physical exams would be a good habit for physicians to develop although the evidence that intervention improves outcome is lacking. A physical exam can frequently give clues that could open up questioning concerning domestic violence.
Where to Go for Help
Victims need to know their options. It may not always be better for them to leave the relationship abruptly. Frequently many factors are involved and they need to be the ones that make the decision. The Refuge House in Tallahassee offers a shelter as well as outpatient counseling and help groups that are funded by the United Way. The number is 681-2111. The American Medical Association has educational materials on domestic violence and can be reached at 1-312-464-5066. Information is also available through The Family Violence Prevention Fund at 1-800-313-1310. It is important that the victim is informed that she does not deserve to be abused. There is never a reason to justify abuse of a spouse. She needs to know that battering is a common problem that affects millions of women. She needs to know that help is available.
1. Salber PR and Taliaferro E. The Physician's Guide to Domestic Violence.
Volcano Press, Inc. P. O. Box 270, Volcano, Ca 95689. 1-800-879-9636
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