Victims of domestic violence (DV) can be
members of any social class or racial group. They can be women or men,
in heterosexual or same-sex relationships. Whatever the group, it is unlikely
that the victim will volunteer the information about abuse. You must remain
alert for signs of DV and know how to ask.
1. Recognize "red flags" that suggest domestic violence
On the History:
- Multiple visits for vague somatic complaints
- Frequent walk-in or ER visits
- Multiple missed appointments
- Previous abusive relationships or child abuse
- Depression/anxiety/panic disorder
- Personality disorder
- Past suicide attempts
- Over-solicitous partner who will not leave the patient
On the Physical exam:
- Central pattern of injury, multiple injuries
- Facial bruises/fractures, tympanic membrane rupture
- Breast injuries/broken ribs
- Multiple injuries in various stages of healing
- Burns in unusual places or human bites
- Type of injury does not match history
2. Remember to ASK About Domestic Violence
Develop lead-in questions that can be incorporated into every visit to
normalize the topic and create an atmosphere of acceptance.
Interview the patient alone and assure confidentiality.
Sample lead-in statements:
- "Because violence is so common in women's lives, I now ask every woman
in my practice about domestic violence."
- "I don't know if this is a problem for you, but many of the women
I see as patients are dealing with abusive or controlling relationships.
Some are too afraid or too uncomfortable to bring it up themselves so
I've started asking about it routinely."
3. Acknowledge and support the victim
When a woman affirms abuse, acknowledge that you've heard what she's said
and you believe her. Send an underlying message that conveys concern and
empathy, i.e., "No one deserves to be abused."
If time allows:
- Let her tell her story.
- Describe the cycle of violence to her.
- Reinforce the criminal nature of DV.
How to Help Known Victims of Domestic Violence
Useful Web Sites for Clinical Practice
- "Domestic Violence: A Practical Approach for Clinicians" provided
by the San Francisco Medical Society developed with Family Violence
Prevention Fund, 1996, and American Medical Association, 1992.
A brief but comprehensive protocol that covers risks and
forms of domestic abuse, screening, diagnosis and clinical findings,
interventions, continuity of care, documentation.
Useful Web Sites for Working with Multicultural Populations
- CDC's American Indian/Alaska Natives and Intimate Partner Violence
Aileen MacLaren, CNM, PhD
Director, Nurse Midwifery Program
Family and Child Nursing
School of Nursing
University of Washington