Interpersonal Violence

Question 1

Cycles of violence

Answer 1

1. Quiet period (“walking on eggshells”)
2. Escalating nature
   - accusations of cheating; jealous outbursts
   - cut off victim from family/friends
   - demeaning, shaming, often in front of children
   - taking away money, anything that would give the victim opportunity for freedom/escape
3. Physical abusive episode
   - can be life-threatening
4. Apologies/promises/gifts
   - victim wants to believe things are better
   Starts again.

Question 2

Identifying physical abuse as a provider

Answer 2

• victim will typically present to family doc with complaints of back pain, headache; otherwise complaints are vague and nebulous (ill-defined)
• stories about falling/tripping to explain bruises, black eyes
• victim will present multiple times before questions about DV are asked by provider
• rarely will they say CC is “my partner is abusing me”
• other suspicious scenarios: pregnant women comes in many times saying she hasn’t felt the baby move; young girls with multiple presentations for pelvic pain; 16yo with miscarriage and no parents

Question 3

Why don’t victims just leave?

Answer 3

• they truly believe their partner is the only one who could love them
• the money is held by abuser, victim has no resources
• threats are made against children/pets*, victim is worried about getting killed
• 1/5 victims are killed w/in 2d of obtaining order of protection
• 1/3 victims are killed w/in 1mo of leaving
• many shelters don’t accept pets, and that’s a reason victims stay

Question 4

What do you say to screen for abusive relationships?

Answer 4

• Do you feel safe at home?
• Are you in a relationship that you’d like to disclose?
• It’s normal for couples to argue, but not okay for hitting/threatening. Do you experience this from your partner?

Question 5

When the patient reveals that they are in an abusive relationship, what do you do?

Answer 5

• if between 2 adults, must get pt’s permission to report
• if children are being harmed you must report
• if pets are being harmed you can report (this can help get the abuser out of the house so that the family can make a plan/get away)
• tell the patient “you do not deserve this”, “this will not get better and you’ll eventually get killed”, “this is harming the children to watch this”, “think through plan of escape - hoard money, keep records, prepare clothes”