Domestic+Violence

=**Domestic Violence**=


 * 1. Define domestic violence.**

Domestic violence is physical, emotional or sexual abuse of a domestic partner. Domestic violence has a long history and has only recently been seen as a problem and made illegal. Rule of thumb etc.


 * 2. Describe epidemiology of domestic violence.**

Six million women are beaten in their homes each year. Four million incidents are reported. One out of every three women treated in emergency departments is a victim of violence. One in five has been injured by male partner. Abuse by a husband or partner is the leading cause of injury to women between the ages of 15 and 44. Each year 1,500 women are killed by a current or former husband or boyfriend. Pregnant women are especially at risk. AMA estimates that more than one-third of pregnant women are abused.


 * 3. List the primary risk factors for domestic violence.**


 * Alcohol and drug abuse
 * Stress
 * Pregnancy
 * Children
 * Holidays
 * Television


 * 4. Recognize common presentations of battered women and patterns of battering.**

Battered women present fewer common characteristics than abusive men: Low self-esteem, Low self-image, Childhood abuse, Traditional role model.


 * 5. Discuss clinical approaches to identifying victims of domestic violence and eliciting a history.**

__Screening Questions:__
 * Have you ever been in a relationship in which you have been physically hurt or threatened?
 * Have you ever been forced to have sex when you said,”no”?
 * Do you ever feel afraid of your partner?
 * What happens when you and your partner disagree?
 * Does your partner keep you from seeing friends, working, or handling the money?
 * Have you ever been physically, mentally or sexually abused?

__Physicial signs:__ Apparent shyness, fear, evasiveness, Lacerations, hematomas, fractures, abrasions, burns, or Injuries in various stages of healing __Common somatic complaints:__ headaches, chest pain, pelvic pain, insomnia, heart palpitations, choking sensation, gi symptoms, fatigue, nervousness, numbness and tingling, depression, and hearing loss.


 * 6. Describe documentation and reporting requirements for domestic violence victim.**

In Ohio there is no mandatory reporting. The physician is expected to conduct a one on one interview of victim and family members accompanying victim, document in the medical records of suspected abuse, and take photographs of injury, whenever possible and when victim gives consent.


 * 7. Discuss common psychiatric illness associated with domestic violence.**

The stress of domestic violence may aggravate co-morbid psychiatric disorders, or generate new pathology. Common comorbid disorders or symptoms include: Feelings of isolation and inability to cope, Suicide attempts or gestures, Depression, Panic attacks and other anxiety symptoms, Alcohol or drug abuse, Post‑traumatic stress reactions and/or disorders.


 * 8. State the treatment approaches to victims of domestic violence.**

The Survivor Therapy Approach was developed by Lenore Walker and is based in its similarities to post-traumatic stress disorder. Treatment consists of five stages:

__Stage 1: Assessment and labeling of the abuse__ Building trust and establishing a therapeutic relationship with therapist to help overcome denial and minimization of abuse.

__Stage 2: Safety plan__ Recognize danger signs and develop an escape route, pack important papers etc. to prepare for leaving the relationship.

__Stage 3: Dealing with the trauma effects__ Many techniques can be used to help overcome the trauma of abuse: Guided imagery, Cognitive restructuring, Thought stopping, Relaxation training, and Systematic desensitization. Psychotherapy of PTSD involves emotional engagement with the trauma memory, organization of the trauma narrative and correction of dysfunctional cognitions. These dysfunctional cognitions are beliefs that the world is extremely dangerous and conception of oneself as extremely incompetent.

__Stage 4: Dealing with Other Psychological Issues__ There may be many other psychological issues that can result from the abuse such as a Need for control, Anger and rage, Sexuality and body image issues, Trust and betrayal issues, Emotional intimacy and boundaries, and trouble balancing Compliance and confrontation.

__Stage 5: Preparation for Therapy Termination__ The determination for the endpoint of therapy is best directed by patient. There my be issues of rejection, or relapse if therapy is ended too soon. It is best to leave the door open for the patient to return if they relapse.


 * 9. Discuss support services for victims of domestic violence.**

There are safe shelters where women can go to escape violence. There are support groups of fellow survivors who can help them recover from abuse. There are legal resources such as restraining orders, or criminal charges that can protect women.


 * 10. Describe psychological profiles of men who are abusers.**

There are three types of typical abusers: the Traditional batterer who engages in a cycle of violence (Tension Building, Acute Battering Incident, and Loving Contrition), the Episodic batterer who has rare eruptions, and the Rapid cycler who is violent in many situations. For the typical batterer the goal is power and control. They may deny and minimize the abuse and blame the woman. They are often highly dependent on females for emotional support, with a fear of abandonment. They are often insecure, vulnerable, feeling both guilt and shame. Lack trust in their partners and no secure attachment as children. Depression common and chemical dependency is found in half of all abusers.