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domestic violence (includes intimate partner violence)

Also see elder abuse. Classification: Types of abuse: 1) physical abuse 2) emotional abuse 3) sexual abuse 4) neglect - especially prevalent in the elderly 5) financial abuse: use of financial dependence for manipulation or exploitation Etiology: Risk factors: 1) all socioeconomic classes 2) all racial backgrounds 3) alcohol or drug use involved in 50% of cases 4) child-abuse may increase likelihood of perpetration of domestic violence as adult [5] Epidemiology: 1) 33% of women 2) 4% of elderly individuals 3) 10-25% of adolescents: 20% of girls, 10% of boys [13] Populations at risk: 1) partner abuse - women at highest risk a) ages 17-28 b) recently separated or divorced c) pregnant d) history of childhood abuse e) homeless f) depression 2) children 3) elderly Clinical manifestations: 1) exacerbations or poor control of chronic medical conditions 2) seeming non-compliance with medications 3) sleep or appetite disturbances 4) fatigue 5) impaired concentration 6) chronic pain, especially abdominal pain 7) depression 8) anxiety 9) stress a) acute stress b) post-traumatic stress 10) somatization 11) eating disorder 12) suicide attempts 13) substance abuse 14) frequent appointment changes 15) sexually transmitted diseases, HIV, unplanned pregnancies 16) visible bruises or injuries * also see child abuse Management: Provider's primary responsibilities 1) assist with health 2) assess for safety 3) maintain supportive relationship [2] Assess for risk of homicide, suicide, or serious injury 1) escalating threats or abuse 2) escalating level of fear 3) stalking 4) weapons, especially firearms in the home 5) sexual assault and abuse during pregnancy 6) recent separation or abuser's awareness of impending separation Safety planning 1) determine if the patient wants to leave home, return home, or have the abuser removed from the home 2) refer to domestic violence advocate Screening: - USPSTF recommends all women of reproductive age (14-46 years) be screened for intimate partner violence [8] - evidence is insufficient to screen for intimate partner violence in healthcare settings (BMJ study) [12] - USPSTF finds not enough evidence to determine whether screening all elderly adults & adults with physical or mental disabilities would reduce abuse, physical or mental harm, or mortality [8] Reporting: [5] -> NOT reportable UNLESS provider is treating an injury he/she suspects is the result of domestic violence. Then the provider is mandated to report it to the police. Notes: Adolescent abuse: 1) screen all patients a) ask about caretakers separately b) use direct & indirect questions c) be non-judgmental d) ask follow-up questions 2) behavioral problems a) substance abuse b) promiscuity c) deteriorating school work d) truancy (running away from home) e) suicide attempts 3) presentation a) urinary tract infections b) urogenital trauma [16] c) sexually transmitted diseases d) unexplained rectal or genital pain e) unexplained fractures or bruises f) frequent presentation with injuries due to 'clumsiness' 4) intervention a) required by law to report all cases of suspected child abuse b) referral services 1] counseling 2] education (drugs, sex) 3] legal services 4] employment & financial aid for emancipated minors 5] shelter Partner abuse: 1) women are 6X more likely to experience domestic violence 2) women in the US are more likely to be injured, raped, or murdered by male partner than by any other individual 3) 25-33% of female homicide victims are killed by their male partner 4) ask about partner abuse a) introduce the topic 1] 'These days many people are exposed to violence in some form.' 2] 'It is our routine procedure to ask adult patients about their exposure to violence.' b) ask screening questions 1] 'Has anyone threatened you or actually used a knife or gun to scare or hurt you?' 2] 'Has anyone choked, kicked, bit or punched you?' 3] 'Has anyone forced or coerced you into having sex?' 4] 'Have you been afraid that a current or former intimate partner would hurt you physically?' c) ask about reproductive & sexual coercion [9] 1] sabotage of contraceptive methods 2] pregnancy coercion 3] pregnancy pressure d) screening for partner abuse helps depression, but does not improve quality of life [10] 5) increased smoking & problem drinking may be a clue [4] 6) presentation a) acute injuries b) chronic somatic complaints c) negative behavior patterns d) negative pregnancy outcomes e) escalating pattern f) depression & anxiety 7) physical findings a) injuries to face, chest, breasts, abdomen b) multiple injuries of different ages c) ano-genital trauma d) unusual bruises or unexplained injuries e) face is most common site of injury 8) intervention a) assess readiness for change b) assess safety c) referral services 1] shelters 2] counseling 3] legal services d) report - firearms & illegal acts e) follow-up Phases of abuse: 1) tension-building 2) violence 3) honeymoon period - remorseful perpetrator Domestic violence & pregnancy: 1) domestic violence sometimes escalates during pregnancy 2) unplanned pregnancies are associated with 4X more domestic violence Domestic violence in the family 1) concurrent child abuse & partner abuse occurs (30%) 2) children who observe abuse are more likely to have behavioral & academic problems & to react with violence to situations

Related

HITS Tool for Intimate Partner Violence Screening Ongoing Abuse Screen (OAS) & Ongoing Violence Assessment Tool (OVAT) SAFE questions for domestic violence

Specific

child abuse corporal punishment; spanking elder abuse sexual abuse violence against women

General

assault (violence) abuse

References

  1. Contributions from Linda Kuribayashi MD, Dept of Medicine, UCSF Fresno
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 16 American College of Physicians, Philadelphia 1998, 2006, 2012 - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  3. Journal Watch 24(8):66, 2004 US Preventive Services Task Force, Ann Intern Med, 140:382, 2004 http://www.ahrq.gov/clinic/3rduspstf/famviolence.famviolrs.htm Nelson HD et al, Screening women and elderly adults for family and intimate partner violence: A review of the evidence for the US Preventive Services Task Force, Ann Intern Med, 140:387, 2004 PMID: 14996681 http://www.ahrq.gov/clinic/3rduspstf/famviolence.famviolrev.htm Lachs MS, Ann Intern Med, 140:387, 2004 PMID: 14996683
  4. Journal Watch 25(12):97, 2005 Gerber MR, Ganz ML, Lichter E, Williams CM, McCloskey LA. Adverse health behaviors and the detection of partner violence by clinicians. Arch Intern Med. 2005 May 9;165(9):1016-21. PMID: 15883240
  5. Holmes WC, Sammel MD. Brief communication: physical abuse of boys and possible associations with poor adult outcomes. Ann Intern Med. 2005 Oct 18;143(8):581-6. PMID: 16230724
  6. Zolotor AJ, Denham AC, Weil A. Intimate partner violence. Prim Care. 2009 Mar;36(1):167-79 PMID: 19231608 - Nelson HD et al Screening Women for Intimate Partner Violence: A Systematic Review to Update the 2004 U.S. Preventive Services Task Force Recommendation Ann Intern Med, May 7, 2012 PMID: 22565034 http://www.annals.org/content/early/2012/05/02/0003-4819-156-11-201206050-00447.full
  7. Veterans Administration, Mather CA, social work
  8. Moyer VA et al Screening for Intimate Partner Violence and Abuse of Elderly and Vulnerable Adults: A U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 22 January 2013 PMID: 23338828 http://annals.org/article.aspx?articleid=1558517 - Draft Recommendation Statement U.S. Preventive Services Task Force Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults: Screening. https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/intimate-partner-violence-and-abuse-of-elderly-and-vulnerable-adults-screening1 - Draft Evidence Review U.S. Preventive Services Task Force Draft Evidence Review for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults: Screening https://www.uspreventiveservicestaskforce.org/Page/Document/draft-evidence-review/intimate-partner-violence-and-abuse-of-elderly-and-vulnerable-adults-screening1 - US Preventive Services Task Force Screening for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults. US Preventive Services Task Force Final Recommendation Statement. JAMA. 2018;320(16):1678-1687. PMID: 30357305 https://jamanetwork.com/journals/jama/fullarticle/2708121 - Feltner C, Wallace, Berkman N Screening for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults. Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2018;320(16):1688-1701 PMID: 30357304 https://jamanetwork.com/journals/jama/fullarticle/2708120 - Rhodes KV, Dichter ME, Smith KL. Challenges and Opportunities for Studying Routine Screening for Abuse. JAMA. 2018;320(16):1645-1647 PMID: 30357278 https://jamanetwork.com/journals/jama/fullarticle/2708091 - Miller E, Beach SR, Thurston RC. Addressing Intimate Partner Violence and Abuse of Older or Vulnerable Adults in the Health Care Setting - Beyond Screening. JAMA Intern Med. Published online October 23, 2018 PMID: 30357255 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2707820
  9. American College of Obstetricians and Gynecologists Committee Opinion. Number 554, February 2013 Committee on Health Care for Underserved Women Reproductive and Sexual Coercion. http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Health_Care_for_Underserved_Women/Reproductive_and_Sexual_Coercion
  10. Hegarty K et al Screening and counselling in the primary care setting for women who have experienced intimate partner violence (WEAVE): a cluster randomised controlled trial. The Lancet, Early Online Publication, 16 April 2013 PMID: 23598181 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60052-5/abstract - Jewkes R Intimate partner violence: the end of routine screening. The Lancet, Early Online Publication, 16 April 2013 PMID: 23598182 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60584-X/fulltext
  11. Jewkes R et al Prevalence of and factors associated with non-partner rape perpetration: findings from the UN Multi-country Cross- sectional Study on Men and Violence in Asia and the Pacific. The Lancet Global Health. September 10, 2013 PMID: 25104346 http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(13)70069-X/fulltext - Fulu E et al Prevalence of and factors associated with male perpetration of intimate partner violence: findings from the UN Multi- country Cross-sectional Study on Men and Violence in Asia and the Pacific. The Lancet Global Health. September 10, 2013 PMID: 25104345 http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(13)70074-3/fulltext - Decker MR et al Understanding gender-based violence perpetration to create a safer future for women and girls. The Lancet Global Health. September 10, 2013 PMID: 25104336 http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(13)70085-8/fulltext
  12. O'Doherty LJ et al Screening women for intimate partner violence in healthcare settings: abridged Cochrane systematic review and meta-analysis. BMJ 2014;348:g2913
  13. Vagi KJ et al Teen Dating Violence (Physical and Sexual) Among US High School Students. Findings From the 2013 National Youth Risk Behavior Survey. JAMA Pediatr. Published online March 02, 2015 PMID: 25730143 http://archpedi.jamanetwork.com/article.aspx?articleid=2173573
  14. Miller E, McCaw B Intimate Partner Violence. N Engl J Med 2019; 380:850-857. Feb 28, 2019 PMID: 30811911 https://www.nejm.org/doi/full/10.1056/NEJMra1807166
  15. SAMPLE QUESTIONS FOR EXPLORING SEXUAL AND DOMESTIC VIOLENCE. HARK questions. http://www.stfs.org.uk/sites/stfs/files/Appendix%20C%20-%20Sample%20questions%20and%20HARK%20questions.pdf
  16. Boyd BAJ, Gibson CJ, Van Den Eeden SK et al. Interpersonal trauma as a marker of risk for urinary tract dysfunction in midlife and older women. Obstet Gynecol 2020 Jan; 135:106-112. PMID: 31809425