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.

• Several third sector organizations active in preventing domestic violence and helping its victims exist. Find out about local possibilities.