Domestic violence: the general practitioner's
role
Consider the possibility
The possibility of domestic violence should be considered in
any of the following situations:
- Patient admits to past or present abuse.
- Patient presents with unexplained bruises, whiplash injuries
consistent with shaking, areas of erythema consistent with slap
injuries, lacerations, burns or multiple injuries in various stages
of healing.
- Patient presents with injuries to areas hidden by clothing
(Mehta and Dandrea, 1988). Note that it can be very easy not to
examine, for example, first generation Asian women properly because
of their apparent shyness and because of the sometimes unfamiliar
nature of their clothing.
- Patient presents with injuries to face, chest, breast and
abdomen (Stark et al., 1979).
- Patient presents evidence of sexual abuse.
- Extent or type of injury is inconsistent with explanation by
patient.
- Substantial delay exists between time of injury and
presentation for treatment.
- Patient describes the alleged ‘accident’ in hesitant,
embarrassed or evasive manner.
- Review of medical record reveals that patient has presented
with repeated ‘accidental’ injuries.
- Patient presents repeatedly with physical symptoms for which no
explanation can be found (Jaffe et al., 1976). This presentation
may be particularly common among women whose first language is not
English, and who therefore may find it difficult to express their
feelings and suffering (Fenton and Sadiq, 1993).
- Partner accompanies patient, insists on staying close to
patient and answers all questions.
- Patient is pregnant (Mezey and Bewley, 1997). Domestic violence
often begins with the first pregnancy. Injuries are most commonly
to the breasts or abdomen (Lent, 1991).
- Patient has history of miscarriage. Women experiencing domestic
violence are 15 times more likely to have suffered a miscarriage
(Stark and Flitcraft, 1996)
- History of psychiatric illness, alcohol or drug dependence in
patient or partner (Jaffe et al., 1986; Andrews and Brown,
1988).
- History of attempted suicide (Gayford, 1975; Stark et al.,
1979). In the USA, domestic violence accounts for one in four
suicide attempts by women.
- History of depression, anxiety, failure to cope, social
withdrawal, with underlying sense of helplessness.
- History of behaviour problems or unexplained injuries or abuse
affecting children (Mehta and Dandrea, 1988; Abrahams, 1994).