Domestic Violence and Abuse Lecture Powerpoint Flashcards
Physical abuse
Hurting another using physical methods resulting in bruising, broken bones, permanent scars, or even death
Verbal/emotional abuse
Acts such as brainwashing, sleep deprivation, verbal battering, diminished self worth, threats of harm and death, destruction of property and pets, and isolating the victim from other family or friends
Sexual abuse
Any forced sexual act including unwanted touching, rape, marital rape, often during or after a battering incident where other types of physical violence are used
Economic abuse
Mantaining absolute control over a victims use of personal, marital, or otherwise shared financial resources that can limit their access to medical care, transportation, or relationships with others
Pattern/cycle of abuse 7 steps
- Honeymoon
- jealousy
- minor abusive incident
- isolation
- eggshells
- major battering incident
Domestic violence trends (5)
- Abusive behavior is present in all communities, populations, no matter religion/ethnicity/occupation
- Can occur in hetero or same sex couples
- Verbal and emotional abuse often becomes physical
- Power and control is the underlying psychological dynamic
- Women more likely to experience intimate partner violence but not limited to women
__% of women murdered by their intimate partner had visited an ED 2 years prior to the homicide, __% had at least 1 injury related to the visit to an ED which represents an opportunity to intervene
44%, 93%
SAFE screening questions often used in ED or OB office
Safety - feel safe in relationship?
Afraid - ever been in relationship where hurt, abused, or afraid?
Friends/family - are your friends/family aware you have been hurt?
Emergency - Do you have a safe place to go in an emergency?
Risk factors for victimization for interpersonal violence (4)
- Prior history
- at risk alcohol or drug use
- Couples with income, educational, or job status disparities
- weak community sanctions
Risk factors for perpetration of intimate partner violence (4)
- exposure to childhood violence
- unresolved PTSD
- substance abuse
- job loss or instability
Risk factors associated with increased danger to patient in an IPV relationship (4)
- Perpetrator violent outside the home
- Perpetrator obsessive controlling relationship
- Victim attempting to leave relationship
- Victim afraid for life
“Battering”
Severe and escalating violence with terrorization and increasingly controlling behavior
“Common couple violence”
More moderate form of battering where violence occurs occasionally, and is triggered by frustration and or anger
Clinical presentation of intimate partner violence (4)
- Inconsistent explanation of injuries
- Delay seeking treatment
- Frequent ED visits
- Partner answers questions and refuses to leave room
General principles of asking about intimate partner violence
- Avoid labeling “domestic violence”
- Assure confidentiality unless someone is in grave danger
- Understand why they might deny it (feel ashamded, think it will not happen again, believe no alternatives)
Age related effects on childhood exposure to intimate partner violence (3)
- Toddlers act out behaviors and recreate acts
- school aged see decreased school performance
- adolescents see substance abuse and aggression
Adverse childhood experiences (ACE score) correlation with disease states
Direct correlation to likelihood of developing chronic lifetime illness, often due to (but not completely) behavioral changes which are in turn due to brain developmental issues such as nucleus accumbans delay, prefrontal cortex shrinkage, etc. seen as the greatest health threat facing the country according to the American Academy of Pediatrics
Most common type of child abuse
Neglect
Common perpetrators of child abuse (6)
- Fathers
- mothers’ boyfriends
- female babysitters
- mothers
- those abused themselves
- psychiatric illness
Children risk factors at highest risk for being abused (4)
- learning disabilities
- hyperactive children
- adopted children
- stepchildren
4 main types of abuse in children
- Physical
- Sexual
- Emotional
- Child neglect (hygiene, failure to love, failure to enroll in school, delay in seeking medical care)
Important clues of child abuse (4)
- History is inconsistent with injuries of child
- changing the story
- Injuries are old
- child tries to comfort parents
Classic indicators of child abuse (3)
- Bruises on uncommonly injured surfaces
- human hand marks or bite marks
- unexplained retinal hemorrhages
Sexual peds abuse shows no…
….signs 60% of the time
Labs for abuse (4)
- CBC
- LFT
- Toxicology
- X ray/CT/MRI
Retinal hemorrhages and intracranial bleeding (specific subdural hemorrhage) is ___ until proven otherwise
Child abuse
Abnormal bruising areas (6)
- Buttocks
- back
- trunk
- cheeks
- neck
- earlobes
Can you date bruises?
No, but should document details anyways
Mandated reporter
Refers to how providers are required to make a report to CPA if any suspected child abuse, do not have to make diagnosis but have to report otherwise can be blatant malpractice (if reported in false situations protected by good faith laws) even if not at work
Provider role in intimate partner violence
Provide resources to victim if possible, screen and identify at risk persons
Different conditions that appear like child abuse (4)
- Mongolian spots
- osteogenesis imperfecta
- impetigo
- cupping
