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Intimate Partner Violence Flashcards

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1
Q

What is Intimate Partner Violence?

A

Assaultive behavior that functions to dominate, control or punish another in an intimate, supposedly peer, relationship

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2
Q

What are the 4 types of Intimate Partner Violence?

A
  • Physical
    • grabbing & restraining –> using a weapon
  • Sexual
  • Property/pet destruction
  • Psychological battering/terrorism
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3
Q

Incidence of Partner Violence

  • Lifetime physical violence: ___%
  • Lifetime injury: ___%
A
  • Lifetime physical violence: 39%
  • Lifetime injury: 25%
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4
Q

____% of women has been raped by an intimate partner in her lifetime

____% of women have experience an intimate partner sexual violence other than rape

A
  • 9.4% of women has been raped by an intimate partner in her lifetime
  • 16.9% of women have experience an intimate partner sexual violence other than rape
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5
Q

What is the difference between female & male intentional injury?

A
  • Violence against women: primarily IPV
    • 64% of women who reported rape, physical assault, and/or stalking since age 18 were victimized by a current or former partner (husband, cohabiting partner, boyfriend or date)
  • Violence against men: primarily non-IPV
    • 84% of men who reported rape and/or physical assault since age 18 were victimized by non-partner
    • Only 16% of men who reported rape and/or physical assault were victimized by a current/former partner
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6
Q

Compared to men, women in violent intimate relationships experience more…

A
  • Fear
  • Need for medical care
  • Injury
  • Negative psychological impact
    • depression, PTSD
  • Absence from work or school due to IPV
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7
Q

Men are most at risk for violence perpetrated by…

A
  • Male friends
  • Male acquaintances
  • Male strangers
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8
Q

Women in lesbian relationships experience IPV at a rate _______ to women in heterosexual relationships
Men in homosexual relationships experience IPV at rates _______ to men in heterosexual relationships
Bisexual men & women experience ____ rates of IPV

A

comparable

comparable

higher

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9
Q

What are the Relationship Dynamics of Intimate Partner Violence?

A
  • Intimate relationship context
    • IPV vs. stranger violence
    • Very reluctant to call police
    • Constant abuse, attachment, excuses
  • Temporal pattern
  • Injury risk
  • Fear
  • Isolation
  • Dynamics for adolescent girls different than for adult women
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10
Q

What is the importance of a cycle of violence with IPV?

A
  • Transgenerational
    • Biggest risk for boy is seeing violence in his parent’s relationship
  • Cycle of violence w/i the relationship
    • Explosion-tension phases repeating
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11
Q

What are the Societal Dynamics of Intimate Partner Violence?

A
  • Institutional/structural sexism
  • Legislative factors
  • Law enforcement/criminal justice
  • Social services
  • Medicine
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12
Q

_____ & _____ injuries more characteristic of blunt intentional trauma than car crashes or falls

A

Facial & head injuries more characteristic of blunt intentional trauma than car crashes or falls

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13
Q

Battered women experience more hospitalizations for…

A
  • Trauma
  • Surgical disorder, non-trauma
  • Gynecological disorder
  • Induced abortion
  • Medical disorder
  • Observation of undefined condition
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14
Q

With more recent research, compared to controls, victims of IPV have…

A

Significantly more health problems due to any disease

  • More induced abortions
  • More gynecological disease
  • More mental illness
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15
Q

10 Adverse Childhood Events

A
  • Child abuse
    • Physical abuse
    • Sexual abuse
    • Emotional abuse
    • Physical neglect
    • Emotional neglect
  • Family dysfunction
    • Intimate partner violence
    • Mental illness
    • Substance abuse
    • Imprisonment
    • Marital discord
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16
Q

What is the dose-response relationship between adverse childhood events & adult disorders?

*sorry long card*

A
  • Smoking
  • Alcoholism
  • Drug use
  • Injected drug use
  • STIs
  • # sexual partners
  • Severe obesity
  • Depression
  • Anxiety
  • Panic Disorder
  • Suicide
  • IHD
  • COPD
  • Stroke
  • Idiopathic myocarditis
  • Myasthenia gravis
  • Rheumatoid arthritis
  • Autoimmune hemolytic anemia
17
Q

What are the distinguished presentations of IPV?

  • As a Mental Health problem
  • As a Relationship problem
  • As a Child-Related problem
A
  • As a Mental Health problem
    • Depression, Anxiety
    • Alcohol/drug abuse
  • As a Relationship problem
    • Sexual dysfunction
    • Partner as identified patient
  • As a Child-Related problem
    • Suspected child abuse
    • Child behavior problem
18
Q

What are the CLINICAL PATHWAYS between abuse & health?

A
  • Psychopathology mediates btwn trauma exposure & poor health outcomes through
    • Elevated symptom reporting
    • Medical adherence & coping
    • Coping strategies for coping (ex: PTSD)
      • Risky behaviors
      • Low self-efficacy to change and/or maintain preventative health regimens
      • Increased risk of re-victimization
19
Q

What are the PHYSIOLOGICAL PATHWAYS between abuse & health?

A
  • Chronic stress disrupts the normal neurochemical mechanisms of coping & stress responding
  • Catecholamine, HPA axis, & immune response
    • Trauma disregulated these physiologic processes
    • Increase in proinflammatory cytokines
      • Creates wear on the system
      • Increases vulnerability to disease
  • Negative effects of sleep disruption
    • Immune function
    • Metabolic changes
    • Chronic HPA axis activation
  • Sleep deprived persons have more:
    • Inflammation
    • Greater functional disability
    • Decreased quality of life
20
Q

What are some patient barriers to diagnosing & treating partner violence?

A
  • Lack of trust
  • Safety jeopardized
  • Financial support jeopardized
  • Shame & humiliation
  • Futile resignation
21
Q

What are some barriers health professionals face in diagnosing & treating partner violence?

A
  • Lack of knowledge
  • Lack of clinical skills & training
  • Fear of offending the patient
  • Too close for comfort
  • Pandora’s Box: powerlessness & loss of control
22
Q

What is the Partner Violence Screen?

A
  • In my practice I’m concerned about prevention & safety, especially in the family
  • Have you been hit, kicked, punched or otherwise hurt by someone w/i the past yr? If so, by whom?
  • Do you feel safe in your current relationship?
  • Is there a partner from a previous relationship who is making you feel unsafe now?
    • Risk of homicide is greatest 2 yrs after violent relationship
23
Q

How would you incorporate questions about IPV into the family/relationship history interview?

A

Begin w/ open-ended questions, then be specific

  • “When did you and your partner meet?”
  • “What was your attraction?”
  • “What happens when you argue or fight?” followed by:
  • “Has your partner ever pushed, kicked or grabbed you?”
24
Q

What are some characteristics of effective interview questions?

A
  • Ask about specific behaviors
  • Avoid general, emotionally charged terms like abuse, violence & victimization
  • Ask about various types of violence & responses to it: fear, injury, sexual assault, control
  • Ask about current problems from previous relationships
25
Q

When should you ask about partner violence?

A
  • Annual or general exams
  • Initial visit w/ 1st time patients
  • As part of the initial assessment at a specialist
  • Well child exams
  • Adolescent & sports physicals
  • OB visits
    • Pregnancy: 4 times
    • Each trimester & post-partum visit
  • **Whenever you suspect it **
26
Q

What is the S-O-S Doc Intervention?

A
  • Support, belief, confidentiality
  • Safety: help assess danger
  • Options: safety planning & follow-up
  • Strengths to build upon
  • Document
  • Continuity
27
Q

S-O-S Doc Intervention

Support, belief, confidentiality

A
  • Talk privately
  • Make eye contact
  • I’m sorry you have been treated this way
  • Nobody deserves to be hit or hurt
  • You have a right to be safe & respected
  • *The abuse is not your fault *
28
Q

S-O-S Doc Intervention

Safety

A
  • Do you feel safe going home?
  • Are your children safe?
  • Indicators of Danger
    • Increasing frequency or severity
    • Weapons used
    • Drug & alcohol abuse
    • Forced or threatened sexual acts
    • Life transitions: pregnancy, separation, divorce
    • History of past violence or suicide attempts
    • Threats to kill
29
Q

S-O-S Doc Intervention

Options

A
  • Local or regional woman’s shelters
  • Legal advocacy
  • Police
  • 911
  • Emergency plan
30
Q

S-O-S Doc Intervention

Strengths

A
  • Identify & validate patient strengths
    • You are facing a very tough situation w/ a great deal of courage
    • I can see that you care deeply about your children
    • *You have shown great strength in very tough circumstances *
31
Q

S-O-S Doc Intervention

History

A
  • History
    • Describe what the patient said using direct quotes
    • Add other historical data
    • Avoid pejorative language
    • Use “Patient said ‘my husband hit me in the head with a pan’”
    • DO NOT use “Patient claimed..” or “Patient alleged..”
  • Observations
    • Behavior
    • Injuries
      • Location & quality
      • Use drawings, body charts or photos
      • In photos use ruler for scale; victim’s face for identity
  • Assessment
    • Your assessment of potential partner violence
    • “Injury inconsistent w/ reported mechanism of injury”
    • “Injury & history consistent w/ intentional injury”
    • Include name of perpetrator if reported by patient
32
Q

S-O-S Doc Intervention

Continuity

A
  • Encourage & schedule follow-up appts
  • Connect to community resources
  • Assess barriers to follow up
    • Will you have transportation for the next appt?
    • Will your partner try to prevent you from returning?

Psych (23 decks)

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