Recognizing domestic violence can be difficult. If the violence is psychological/emotional or sexual in nature, there will not be any visual signs of violence. Even the effects of physical violence can be difficult to spot 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 health care workers are inadequately trained to understand the problem or have not been taught how to look for the signs and symptoms of domestic violence.

However, 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.

• Physical injuries: 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 or 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 you should suspect domestic violence.

• Sexual injuries: Obviously this can hard to detect. Many of the signs and symptoms of sexual abuse cannot be seen unless you have very intimate contact with the victim. But you should suspect sexual abuse if someone has injuries to the genital area, rectum, or breasts.

• Emotional/psychological abuse: People who are abused by an intimate partner are often fearful, withdrawn, or hesitant when the abuser is present. They may seem overanxious to please this person. They may not speak unless they have “permission” from the partner. They 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 health care professional screen for domestic violence. The first test is the HITS test; the second is the Women Abuse Screening Tool (WAST).

The HITS screen is a series of four questions that asks how often does your 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.