Intimate Partner Violence (AKA Domestic Violence)

Intimate partner violence (IPV, DV)

Harm inflicted by one intimate partner on the other, with the intention of causing pain or controlling other’s behavior

physical violence, sexual violence, psychological abuse, aggression, stalking, deprivation, intimidation, reproduction coercion

IPV can include

20% of females and 1.7% of men have been raped, 25% of women and 14% of men have been the victim of severe physical violence, 15.2% of women and 5.75% of men have been stalked, Just as common in same sex relationships

Stats about IPV - majority of victimization starts EARLY in life

multiple forms of IPV

Female victims frequently experience…

physical violence

Male victims frequently experience…

under 24, divorced/separated, presence of EtOH or substance abuse, pregnancy, LES, recent restraining order, childhood abuse

Risk factors for IPV

May be any race, age, or SES; feelings of inadequacy, minimize their abusive behavior, different private and public personalities, witness to or a victim of abuse in childhood, socialize and interact with other abusive/aggressive men

Common characteristics of an Abuser

Tensions Building → incident → reconciliation → calm

What is the cycle of abuse?

Cycles increase in frequency and intensity, worsening violence, shorter honeymoon phase, low self worth and esteem with each cycle, increased isolation and dependence on an abuser, violence associated with EtOH usage

Characteristics of an abuse relationship

Inconsistent explanation of injuries or delay in treatment, chronic somatic complaints (HA, GI, fatigue, Eating disorders, depression), frequent ER visits, noncompliance, flat affect, avoids eye contact, anxious, partner refuses to leave the room or answers the questions

Hx findings that are sus of IPV

Injuries are on the central body (breast, abdomen, genitals), defensive wounds to the forearms, Bruising, attempted strangulation, bruises in various stages of healing

Physical Exam findings that are sus of IPV

S - Do you feel safe?

A - Have you felt abuse?

F - Support system (family or friends)

E - Plan in case of emergencies/

What can we use as a way to remember what questions to ask in a IPV Hx?

Routinely ask, Ask directly, Document findings, Assess safety, Review options and refer

What does RADAR stand for?

Universal screening (ask everybody) in a safe and confidential environment, provider must have the ability to listen, screening must occur alon

What do I mean by “routinely ask” as a part of RADAR?

lack of training, Prejudice (socioeconomic or cultural), time, frustration, fear, personal history

What are some reasons that IPV screening may not occur?

Do you feel threatened by your partner, Do you feel safe with them, Has your partner ever physically hurt you, Has anyone ever forced you to perform sexual activities

What do I mean by “Ask Directly” as a part of RADAR?

Describe details in the patients words, be specific (time, date, number of attacks, weapons)

What do I mean by “Document Findings” as a part of RADAR?

Children at home, guns or other weapons, is the patient afraid to go home

What do I mean by “Assess Safety” as a part of RADAR?

Provide resources, hotline numbers, shelter numbers, referral to social work and counseling, positive reinforcement, review the exit plan

What do I mean by “Review options and Refer” as a part of RADAR?

Money (savings account or credit cards), money, keys, documents, clothes on hand, someone to stay with, resource phone numbers, cell phone or calling card

An exit plan should include?

NO mandatory reporting

Do we have to report IPV?

Violence may begin or worsen, follow closely for complications, linked to LWB, preterm labor, trauma, abruption, and increased risk of attempted homicide

How are pregnancy and IPV related - screen at the initial visit, each trimester, and post-partum

Trauma, somatization, limited resources and income, depression, anxiety, PTSD, substance abuse, multiple personalities, death

Long term consequences for the victim

Psychological effects, poor social skills, poor academic performance, repeat pattern of abuse (children mirror their same sex parent)

Long term consequences for children

Fear, isolation, financial, lack of social support, inability of law enforcement to protect, fear of legal proceedings

Why doesn’t the victim leave in the case of IPV?

the use of violence and aggression, a sexual act that is performed on a person without consent, encompasses coercion to contact abuse to rape

Sexual Assault can be defined as

ER physician (medical clearance), OB/GYN, SANE nurse (evidence collection)

Who can perform a sexual assault examination?

Improved quality of forensic evidence, protection of chain of evidence, expedit evaluation and referral to community services, improved sensitivity to psychological trauma

Benefits of SANE

Circumstance dates, times, locations, weapons; any memory loss or LOC, specific of penetration and type of contact, bleeding from victim/assailant, recent consensual activity and site of contact, has the victim brushed teeth, changed clothes, or showered?

What do we need to find out in the Hx of a SANE?

Emotional state, evidence of trauma with special attention to extragenital trauma, the labia minor and posterior vagina are common areas of anogenital trauma, colposcopy can aid in evaluation, UV light to check for semen

Physical exam tips for SA patients

clothing, swabs of buccal mucosa, vagina, rectum, areas highlighted by UV light, combed specimen from scalp and pubic hair, control samples of hair, blood and saliva samples

What needs to be collected in a forensic eval (may be collected up to 96 hours after the assault in Tx)

Gonorrhea, chlamydia, trichomoniasis, syphilis, hep B, HIV, pregnancy, Drug screen PRN

Lab testing that can be offered to SANE patients

Treat any physical injuries, STD prophylaxis, emergency contraception, psychosocial care

ER management for SANE cases

1-2 weeks with PCP, repeat HIV 72 hours, 6 weeks, 3 months, 6 months

Follow up for SANE

PTSD, depression, somatization, sexual dysfunction, cervical cancer, unwanted pregnancy, Rape trauma syndrome

Long term consequences of SA

Shock, confusion, cognitive dysfunction, anxiety, fear, sleep disturbances, humiliation

How is the acute phase (disorganization phase) of Rape Trauma Syndrome characterized?

rationalization of the event, reality of victimization, changes in lifestyle, daily habits, social life, somatization, insomnia, shame, guilt

How is the delayed phase (reorganization phase) of Rape Trauma Syndrome characterized?