Domestic Violence

Intimate partner violence

actual or threatened psychological, physical, or sexual harm by a current or former partner or spouse

psychological/emotional violence

threat of actions or coercive tactics using words, gestures, or weapons to communicate an intent to cause physical harm

physical violence

the intentional use of physical force with the potential to cause harm, injury, disability, or death

sexual violence

The use of physical force to compel a person to engage in a sexual act against their will

An attempted or completed sex act involving a person who is unable to understand the nature of the act, or unable to communicate unwillingness because of illness, disability, the influence of alcohol or other drugs, or intimidation or pressure

Abusive sexual contact

Battering

severe, escalating violence with terrorization and increasingly controlling behavior

common couple violence

moderate form of IPV in which violence occurs occasionally, triggered by frustration and/or anger → more common between both partners

staling, psychological, Latino, pregnancy, unintended, homicide

Epidemiology

• 32% of females and 28% of males in the US have experience rape, physical violence, and/or ________ by an intimate partner

• 46% of all people have experienced __________ violence

• Violence is less common among White and _______ individuals than those who identified as African American, Native American, or Native Alaskan

• IPV often begins or increases during _________ and the postpartum period

  • A US national survey found that abuse was reported at least once during 4-8% of pregnancies

    • Higher risk in ________ pregnancies than planned pregnancies

  • The risk of __________ for pregnant/postpartum individuals is 1.84 times that of non-pregnant/non-postpartum females

IPV, 24, alcohol, sexual, child, depression, educated

Risk Factors for Victimization

• Individual Factors

  • Prior history of ___

  • Female

  • Young age (<__)

  • At-risk _______ use or drug use

  • High-risk ________ behavior

  • Witnessing or experiencing violence as a ______

  • Hx of __________ or chronic mental illness

  • Being less _________

  • Unemployment or being below the poverty line

  • Being Native American, Alaskan Native, or African American

disparities, dominance, jealousy, poverty, institutions, community, gender, honor, chastity, isolation

Risk Factors for Victimization

• Relationship factors

  • Partners with income, educational, or job status ________

  • _________ and control of the relationship by a male partner

  • Excessive ___________ or possessive behavior

• Community and Societal Factors

  • _________ and associated factors (ex overcrowding)

  • Lack of _________ or community norms that shape social interactions

  • Weak _________ sanctions against IPV (ex police unwilling to intervene)

  • Traditional _______ norms

  • In some cultural traditions, notions of male/family ______ and female _________

  • Social ___________, restricted movement outside the home, and lack of usual access to in-person health care and support services

premenstrual, STIs, abortions, pain, general, injuries, psychological

Assessing for Domestic Violence → Presenting Symptoms

• Gynecological complaints

  • _________ syndrome

  • _____

  • Unintended pregnancies or repeated ________

  • Chronic pelvic _____

• _________ complaints (chronic pain, IBS, reflux, HA)

• ___________ (bilateral bruising, lacerations, oral and facial bruises)

• ___________ symptoms (anxiety, depression, substance use, eating disorders)

money, somatic, inconsistent, partner, moves, spouse

Assessing for Domestic Violence → Signs

• Isolated

• Can’t make decisions

• Lack of ______

• Cover up

• ________, non-specific symptoms

• ____________ explanation of injuries

• Increased dependence on ________

• Accident prone

• Absenteeism

• Noncompliant

• _______ frequently

• Always accompanied by ______

• Reluctance to undress or have genital and rectal exam

substance, STIs, miscarriage, movement, ultrasound, ER, contractions, bleeding

Warning signs in Pregnancy

• _________ abuse

• Depression and anxiety

• ____

• ___________ and stillbirth

• Decreased fetal __________

• Pain during ________

• Inappropriate use of the __

• Unusual interactions during counseling

• Preterm _________

• Preterm delivery

• Vaginal __________

stress, afraid, friend, emergency

SAFE Screening

• _______/Safety → Do you feel safe in your relationship?

• _______/Abused → Have you ever been in a relationship where you were threatened, hurt, or afraid?

• _______/Family → Are your friends aware you have been hurt?

• __________ Plan → Do you have a safe place to go and the resources you need in an emergency?

hurt, insult, threaten, scream

HITS Screening

• How often does your partner:

  • _____ you physically?

  • _______ you or talk down to you?

  • ________ you with harm?

  • ________ or curse at you?

harm, empowerment, accountability, social, safety

What Should You Do

• Survivor Safety

  • The primary concern is to maximize safety and not increase risk for further ____

• Survivor ___________

  • Facilitate the patient’s ability to make their own choices

• Perpetrator ___________

  • Frame the violence as occurring because of the perpetrator’s behavior not the survivor’s

• Advocacy for ______ change

  • Collaborate and advocate beyond the healthcare setting

• Empathy

• Validation

• Assistance

• Assessing for ______

outside, children, self, escalating, drugs, pregnancy, controlling, serious, weapons

Perpetrator Factors

• Violent _______ the home

• Violent to _________

• Threatening to kill victim, children, ____

• __________ threats

• Using _______ (PCP, crack cocaine, amphetamines, alcohol)

• Abusive during ___________

• Obsessive, ___________ relationship

• Has provoked ________ prior injury

• Owns ______, especially handguns

• Has threatened others, including friends and/or family

leave, intervention, afraid, suicidal, homicidal

Victim Factors

• Attempting to _______ the relationship

• Has sought outside ___________

• Acknowledgement that they are _______ for their life

• _________ (with a plan, or with prior suicide attempts, or has means)

• ___________

outside, documents, essential, place, children, rooms

The Safety Plan

• A safety plan should include the following elements:

  • Emergency kit stored ________ the home in case they need to escape urgently

    • Important ________, keys, money, other __________ items

  • A _______ to go (friends, family, shelter)

  • A signal to alert _________ or neighbors to call 911

  • During times of escalating conflict, avoiding _____ with potential weapons or risk for increased injury