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Provider Tips:
Identifying Victims of Domestic Violence

Domestic Violence Symbol

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
    • Abdomen
    • Genitalia
  • 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.

Resources

How to Help Known Victims of Domestic Violence

Useful Web Sites for Clinical Practice

http://www.sfms.org/domviol.htm
"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

http://www.cdc.gov/ncipc/factsheets/natamer.htm
CDC's American Indian/Alaska Natives and Intimate Partner Violence factsheet.

Compiled by
Aileen MacLaren, CNM, PhD
Assistant Professor
Director, Nurse Midwifery Program
Family and Child Nursing
School of Nursing
University of Washington

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