REVIEW OF PSYCHOLOGICAL ISSUES IN VICTIMS OF DOMESTIC VIOLENCE SEEN IN EMERGENCY SETTINGS
Section snippets
GENDER AND VICTIMIZATION
In community surveys, men experience domestic assault at roughly half the rate that that women do.56, 102 Rates of male-directed violence in clinical populations and during courtship are even higher.22, 79 Although adult male victims are more likely to be attacked with knives, guns, or thrown objects56, 105 and suffer serious injury123 or death,16, 63, 73 they differ from female victims in important respects. At least in committed relationships, men are nearly always assaulted by women whom
RECOGNIZING VICTIMS OF DOMESTIC VIOLENCE
Medical recognition of the problem of domestic violence dates to the 1970s.119 Early researchers tried with limited success to develop a profile of victims that would make them easily recognizable.13 ED staff are most concerned with risk factors that are obvious in that setting. Demographic risk factors include age younger than 39 years34; being separated, divorced, or single,8, 9, 82 especially if cohabitating122; partner substance abuse; partner unemployed54; being a repeat visitor for any
UNDERSTANDING VICTIMS OF DOMESTIC VIOLENCE
Awareness of the mushrooming literature about victims of violence3, 55, 67, 119 allows a clinician to place a woman's answers to questions about violence in appropriate context. General understanding of intimate violence and its consequences derives mainly from in-depth studies of women using victim services. Victims identified by universal screening imperfectly mirror the service-seeking population.33 Screening can identify women who have experienced minimal violence, violence without feeling
VICTIMS' MENTAL HEALTH
Even educated and well-disposed emergency medicine clinicians can react negatively to victims, who often do not display the disarming postures of desirable patients. Depression18 and anxiety, ranging from scattered symptoms to diagnosable disorder,58 are the most common sequelae of abuse. Time pressures may limit caregivers' tolerance for the negativism, hopelessness, and helplessness of depressed or anxious patients. Abused women also can seem evasive, manipulative, or withdrawn.59 Even more
IMPLICATIONS FOR EMERGENCY INTERVENTION
Women who “screen positive” for domestic abuse, then, can have medical problems that are life threatening or trivial. They may be calm or agitated, overtly distressed or unusually withdrawn, alert or confused. They can be articulate or unable to communicate; rich or poor; white, black, Hispanic, or Asian; cooperative, or hostile and defensive. The victimization may have occurred prior to admission or months before. The history of abuse may be disclosed at any point between triage and discharge,
CONCLUSION
By conservative estimate, one in six women seeking emergency care for any reason describe abuse by someone they know within the past year. A substantial number of these women are battered wives or cohabitants. Medical caregivers in every setting have a moral obligation to address such victimization when they uncover it, to prevent further injury to the patient. Women remain in abusive relationships out of continuing attachment to their partners, economic dependency and other social forces, and
ACKNOWLEDGMENTS
Dr. Frank gratefully acknowledges the extensive bibliographic assistance provided by Irene Fuerst and Amy Schiffman (MSII).
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Address reprint requests to Julia B. Frank, MD, Department of Psychiatry AN8411, 2150 Pennsylvania Avenue NW, Washington, DC 20037
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This article uses female pronouns to characterize victims of domestic violence, although male subjects who have been assaulted also seek emergency treatment.