Domestic Violence

The Department of Justice defines domestic violence as “a pattern of abusive behavior in any relationship that is used by one partner to gain or maintain power and control over another intimate partner. “(DOJ, 2016).  It is sometimes referred to intimate partner violence, but it is not limited to sexual partners.  Domestic violence can involve children, adult parents, or disabled and the key concept is the exertion of some kind of power over another person.  It can be physical, sexual, emotional, psychological, or financial. Behaviors that intimidate or humiliate are considered abusive.  Also, any behaviors that isolate, manipulate, frighten, terrorize, threaten, blame, hurt, injure or wound someone.   These are all variations of domestic violence.

In a family setting, domestic violence can look many different ways.  It may include emotional abuse, sexual abuse and the use of male privilege.  These acts are sometimes categorized into psychological battering, sexual abuse, or physical abuse.  (CDC, 2010).   Intimate partner violence is defined by the WHO as “any behavior within an intimate relationship that causes physical, psychological, or sexual harm to those in the relationship. (Rhodes, 2012).

Prevalence and Trends – Knowing and Understanding Patterns and Trends Can Save Your Patient’s Life!

According to the National Coalition Against Domestic Violence (NCADV) fact sheet, an average of 20 people are physically abused by intimate partners EVERY MINUTE.  That’s 10 million people of all genders, races, ages, and abilities that are abused every year just in the United States. 

THAT’S A LOT OF PEOPLE!  Most people might say that they don’t know anyone who is a victim but they would be wrong!  The stigma of domestic violence keeps it hidden.  The signs and symptoms are at times difficult to see and are easily discounted.  It doesn’t always present as a black eye or a broken wrist.  It can.  It does.  But it also presents in subtle ways.  Healthcare workers need to be aware of the prevalence of domestic violence, its overt and covert presentations, and how they can help.

A FEW STATISTICS TO PUT THE SCOPE OF THE ISSUE INTO PERSPECTIVE:

The following statistics are from the NCADV site:

According to the NCADV website and fact sheets, domestic violence is a significant problem nationwide.  The statistics are staggering.  Current statistics are reporting that every nine seconds a woman is assaulted by her partner.  Physical abuse and beatings are not limited to women.  The domestic violence hotlines field over 20,000 calls daily.

Women and children are the most likely victims, but according to the NCADV, one out of four men have experienced physical abuse!

The problem is pervasive and crosses all gender, racial, sexual preference and socio-economic lines, but stressors such as substance abuse and poor financial states can increase its likelihood.

Women are stalked.  Men are stalked.  Workplace violence is rising in exponential numbers. Domestic violence and abuse surround each and every one of us, but the healthcare professional is in a unique position to do something about it and help the victim.  Not all victims present with injuries.  In fact, the NCADV reports that only 34% of people who are injured by intimate partners receive medical care for their injuries.

According to the NCADV, every 9 seconds in the US a woman is assaulted or beaten and 1 in 7 women have been stalked.  1 in 4 men have been physically abused, and 1 in 18 men have been stalked! 

THINKING ABOUT THE MAGNITUDE OF THESE STATISTICS MAKES IT PRETTY UNLIKELY THAT EACH OF US DOES NOT KNOW A DOMESTIC VIOLENCE VICTIM.  Look around, wherever you are right now.   If there are more the 10 people in the room, one or more of them is probably a victim of some type of abuse.

SO WHO ARE THEY?  WHO ARE THE VICTIMS?  WHO ARE THE ABUSERS?

“I don’t think there is anything particularly wrong about hitting a woman – although I don’t recommend doing it in the same way that you’d hit a man. An openhanded slap is justified – if all other alternatives fail and there has been plenty of warning. If a woman is a bitch, or hysterical, or bloody-minded continually, then I’d do it. I think a man has to be slightly advanced, ahead of the woman. I really do – by virtue of the way a man is built, if nothing else. But I wouldn’t call myself sadistic.”  Sean Connery

Shocking?  Not really.  There are tons of celebrities with domestic violence arrest records.  Now Sean Connery said this in a Playboy interview in 1965, and hopefully the world has moved towards a more kind and gentler philosophy. But the domestic violence trends indicate a persistent and troubling pattern. 

Who are the victims and the abusers?  How can we recognize them?

 The healthcare professional must first start by understanding that anyone can be a victim and anyone an abuser.  But there are certain patterns, behaviors, antecedents that make an individual more prone to violence. The health care professional needs to know them.

Anybody can be a victim, and anybody can be an abuser.  The key words are power and control.  Women and children are more likely to be abused, but men can be victims too.  People of limited power are more likely to be abused or stay in an abusive relationship.

 According to the Bureau of Justice Statistics, domestic violence/intimate partner violence accounts for approximately 17% of all violent crime in the United States (Catalano, 2012). Most victims of domestic violence/intimate partner violence are spouses/significant others, but children and other family members are often victimized as well. The incidence of child physical abuse and child neglect associated with intimate partner violence has been estimated to be between 30%-60% (Lamers-Winkleman, et al., 2012).