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Intimate Partner Violence
Aka: Intimate Partner Violence, Partner Abuse, Partner Violence, Domestic Violence, Domestic Abuse
- Epidemiology
- Incidence: 20-39% of women in primary care clinics
- 78% of women approve of Domestic Violence Screening
- Only 5% of women had been asked about Domestic Violence
- Bradley (2002) BMJ 324:271-4
- Risk Factors
- See Intimate Partner Violence Risk Factors
- Screening
- See Intimate Partner Violence Screening
- SAFE Screen for Intimate Partner Violence
- HITS Screen for Intimate Partner Violence
- Women Abuse Screening Tool (WAST, WAST-SF)
- Partner Violence Screen
- Symptoms
- Fatigue
- Headache
- Dyspepsia or Abdominal Pain
- Chest Pain or Palpitations
- Pelvic Pain
- Sexual dysfunction
- Chronic Pain
- Signs
- Multiple injury sites in variable states of healing
- Delayed presentation for injuries
- Contusions, abrasions, burns or Lacerations (especially in areas hidden by clothes)
- Tympanic Membrane Perforation
- Frequently missed appointments
- Partner present for appointment and controls visit
- Associated Conditions
- Generalized Anxiety Disorder or Panic Attacks
- Major Depression
- Post-Traumatic Stress Disorder
- Alcohol Abuse
- Drug Abuse
- Management: (Mnemonic: SOS-DoC Intervention)
- Support and safety offered
- Talk in private offering good eye contact and emphasizing confidentiality (except for Suicidality or homicidality)
- "I'm sorry this has happened. No person deserves to be abused..."
- Identify high risk for serious harm or lethality (recent escalation, available weapons, threats, Chemical Dependency)
- "Are you and your children safe at home in the near future?"
- Options including safety planning and follow-up
- Discuss restraining orders, 911, shelters, resources
- "Do you have an emergency plan in case you need to leave?"
- Plan should include safe place, money, clothes, important papers
- Strength of patient is validated
- Strength to withstand circumstances and courage to make the needed changes for patient and their children's safety
- DOcument observations, assessment and plan
- Careful doumentation of history, exam, potential abuse, level of safety, and overall plan
- Continuity offered
- Discuss clinic and resource follow-up and eliminate barriers for access
- References
- Ambuel (1998) J Aggress Maltreat Trauma 1(2): 55-81
- Cronholm (2011) Am Fam Physician 83(10): 1165-72
- Precautions
- Mandatory reporting varies by state in the U.S.
- In Minnesota, the state requires reporting abuse of minors and vulnerable adults
- Resources
- National Domestic Violence Hotline
- http://www.thehotline.org
- Phone: 1-800-799-7233 (1-800-799-SAFE)
- National Sexual Assault Online Hotline
- http://www.rainn.org/get-help/national-sexual-assault-hotline
- Phone: 1-800-656-4673 (1-800-656-HOPE)
- References
- Ambuel (1998) J Aggress Maltreat Trauma 1(2): 55-81
- Cronholm (2011) Am Fam Physician 83(10): 1165-72
- McCauley J (1995) Ann Intern Med 123:737-46