section name header

Information

Editors

KatjaKero

Domestic Violence

Essentials

  • Domestic violence is violence towards family members or other close people. It may be physical, psychological, sexual or financial.
  • It has prolonged effects on its victims, increasing the use of health services.
  • In addition to having physical consequences, violence may cause mental, psychological or psychosomatic symptoms.
  • Pregnancy may increase the threat of domestic violence.
  • You should ask directly about violence, ensuring that the perpetrator is not present and that it is safe for the victim to return home. Encountering a victim of violence also involves increasing awareness of the many forms of violence, of help that is available and of routes of recovery from the trauma.

Background

  • Domestic violence is a common public health problem that is easily missed.
  • Domestic violence is a wider concept than family violence or intimate partner violence. It also includes stalking after divorce and so-called honour related violence.
  • The perpetrator may be the victim's current or former partner, a family member or other close person.
  • There is a behaviour pattern violating human rights and characterized by the use of control and power.
  • Such violence is most commonly experienced by a woman.
  • The fear, shame and confusion experienced by the victim raise the threshold for seeking help.
  • Risk factors include maltreatment in childhood, earlier experience of family violence, substance abuse and a lower level of education.
  • Multi-agency risk assessment conferences (MARAC) are available in some countries/areas (see e.g. http://safelives.org.uk/sites/default/files/resources/MARAC%20FAQs%20General%20FINAL.pdf). Find out about local policies and practices concerning cooperation between relevant actors.

Diagnosis

  • It is essential to be able to suspect domestic violence.
  • Ask directly about violence.
  • Violence experienced within a family often also involves children.
  • Exposure to domestic violence, abuse and neglect in childhood is associated with numerous medical and health problems in adulthood. Toxic stress experienced by a child will cause permanent changes to brain structure, to the function of the hormonal system and to the immune system.
  • In addition, early experiences predispose the person to new traumatic experiences and to becoming a victim in adulthood.

Treatment

  • It is essential to recognize violence, to bring it up and to support the victim in seeking help; see Table T1.
  • In the acute situation, document the injuries Examination of Maltreatment Victims, treat them, and assess the risks involved in various situations in the near future. If there is severe, life-threatening violence in an emergency setting, call 112 and cooperate with the police.
  • Emergency social services will assess the need for essential urgent social services outside office hours and take any action required.
  • Find out about the family situation. Health care professionals are obliged to submit a child welfare notification if suspicion arises that investigations into the need for child welfare measures may be necessary. See also Children and Domestic Violence Suspected Child Abuse: Identification and Actions.
  • Cooperation with social services, the police and the third sector is also recommended to arrange further treatment. Find out about local cooperation policies and practices.

Encountering a victim of domestic violence

Ask directly about violence.
Listen openly and with empathy.
Make sure that the perpetrator is not present.
Explain how many forms violence can take.
State clearly that violence is a crime. Say that you are obliged to report certain types of crime.
Find out about the client's own ideas and experience of violence.
Tell the client about available services and help them to receive help.
Assess the immediate safety needs of the victim and the family.
Make a personal safety plan together with the patient for use if need arises.
  • Several third sector organizations active in preventing domestic violence and helping its victims exist. Find out about local possibilities.

References

  • World Health Organization (WHO). Clinical and policy guidelines on responding to intimate partner violence and sexual violence against women. WHO 2013 http://www.ncbi.nlm.nih.gov/books/NBK174250/pdf/Bookshelf_NBK174250.pdf
  • Cronholm PF, Fogarty CT, Ambuel B et al. Intimate partner violence. Am Fam Physician 2011;83(10):1165-72. [PubMed]
  • Sugg N. Intimate partner violence: prevalence, health consequences, and intervention. Med Clin North Am 2015;99(3):629-49. [PubMed]

Related Keywords

ATC Code:

Primary/Secondary Keywords