Chapter 2
Spousal Abuse

Spousal Abuse

Intimate partner violence—or IPV—is actual or threatened physical or sexual violence or psychological and emotional abuse directed toward a spouse, ex-spouse, current or former boyfriend or girlfriend, or current or former dating partner. Intimate partners may be heterosexual or of the same sex. Some of the common terms used to describe intimate partner violence are domestic abuse, spouse abuse, domestic violence, courtship violence, battering, marital rape, and date rape (http://www.cdc.gov/ncipc/factsheets/ipvfacts.htm ).

The increase in spousal abuse, especially towards women, is a widespread and ever more alarming problem. Yet assaults against wives were only considered to be misdemeanors until the mid-1970s, even though an identical assault to a stranger would have been considered a felony under the law.  There are certain types of women who may be more at risk to situations of domestic violence. These include:

 Facts about Spousal Abuse:

·         Approximately 1.5 million women and 834,700 men are raped and/or physically assaulted by an intimate partner each year (Tjaden and Thoennes 2000a).  
   

·        Among women who are physically assaulted or raped by an intimate partner, one in three is injured. Each year, more than 500,000 women injured as a result of IPV require medical treatment (Tjaden and Thoennes 2000a).
   

·         Nearly two-thirds of women who reported being raped, physically assaulted, or stalked since age 18 were victimized by a current or former husband, cohabiting partner, boyfriend, or date (Tjaden and Thoennes 2000a).
 

Acts of Spousal Abuse:

Domestic violence is a degrading experience that includes physical, psychological, and/or sexual abuse in the home, associated with increased isolation from the outside world and limited personal freedom and accessibility to resources.

Anger is just one way that an abuser tries to gain authority. The batterer may also turn to physical violence — kicking, punching, grabbing, slapping or strangulation, for example. The abuser may also use sexual violence — forcing the partner to have sexual intercourse or to engage in other sexual activities against their will. The abuser may also use:

·         Children as pawns. Accusing the partner of bad parenting, threatening to take the children  

·         Coercion and threats. Threatening to hurt other family members, pets, children or self.

·         Denial and blame. Denying that the abuse occurs and shifting responsibility for the abusive behavior onto the partner.

·         Economic abuse. Controlling finances, refusing to share money.

·         Emotional abuse. Using put-downs, insults, criticism or name-calling to make the partner feel bad about themselves.

·         Intimidation. Using certain looks, actions or gestures to instill fear. The abuser may break things, destroy property, abuse pets or display weapons.

·         Isolation. Limiting the partners' contact with family and friends.

·         Privilege. Making all major decisions, defining the roles in relationships, is in charge of the home and social life, and treats the partner like a servant or possession.

(http://www.mayoclinic.com; Domestic Help is Available).

Common Spousal Abuse Signals

Physicians should consider the possibility of domestic violence when the explanation of the injury does not seem plausible or when there has been a delay seeking medical care for an injury. Common types of injury include: Contusions, abrasions, and minor lacerations, as well as fractures or sprains, injuries to the head, neck, chest, breast, and abdomen; injury during pregnancy; multiple sites of injury; repeated or chronic injuries

Physical Symptoms - Physicians should be aware of physical symptoms related to stress, chronic post-traumatic stress disorder, other anxiety disorders, and/or depression. Examples can include: Sleep and appetite disturbances, fatigue, decreased concentration, chronic headaches, abdominal and gastrointestinal complaints, and palpitations, Atypical chest pain, dizziness, & dyspnea.

Psychological Symptoms - Situations of domestic violence should also be assessed by routine psychological evaluations. Stress from these situations can aggravate psychiatric disorders. These symptoms can include: Feelings of isolation, an inability to cope, suicide attempts or gestures, panic attacks and other anxiety symptoms, alcohol or drug abuse to list a few.

Partner Behavior - A physician might also be able to observe the partner's behavior signs indicating an abusive relationship. These can include: Partner accompanies patient, insists on staying close, and answers all questions directed to patient, reluctance of a patient to speak or disagree in front of partner, denial or minimization of violence by partner or by patient to list a few.

Interviewing Victims of Spousal Abuse

The victim may not want to bring up the subject of abuse on their own.  Yet simple, direct questions asked in a nonjudgmental way may bring a victim to discuss a situation of domestic violence. Questions should be asked in a confidential setting, without the partner present. The physician should make an opening supportive statement, such as, "Because abuse and violence are so common in women’s lives, I’ve begun to ask about it routinely." Even if the patient does not respond at the time, the fact that a health care provider is concerned and believes that violence is a possibility will make an impression. By asking routine questions about violence, physicians are able to not only identify women in present situations of domestic violence, but also serve to assess the safety of any who have been victims in the past and to heighten the awareness of those who have not been in violent situations of abuse.

Questions should be in a physician’s own words and in a nonjudgmental way.   Here are some examples of questions:

A medical encounter could provide the only opportunity to stop the cycle of violence before more serious injuries occur, and intervention begins by gathering information.

Patient/Family Interventions

Care of the Abused Woman

Begin by believing any woman who admits being abused. She has shown trust and courage to disclose the facts. Skillful, non-judgmental interviewing can help build trust and help establish a therapeutic relationship. Holtz and Furniss (1993) developed guidelines for care of the abused woman called the ABCDES framework:

A - Assure the woman she is not alone. Isolation enforced by her abusive partner prevents her understanding that others are in a similar situation and that health care providers can help.

B - Express the belief that violence against the woman is unacceptable in any situation and that it is not her fault.

C - Ensure confidentiality. She may fear (justifiably) that the abuser will retaliate.

D - Document the case thoroughly.

E - Educate the woman about the cycle of violence likelihood of repeated violence and about her options for ending the abuse.

S - Safety-help the woman formulate a plan of action for either leaving or remaining in the relationship, which some women do for a variety of reasons. Provide information about available resources such as hotline and shelter numbers. Suggest a quick getaway bag packed with personal items be hidden or left with a neighbor. If possible, the woman should have an extra set of car keys, house keys, money and any legal documents needed for identification.

 

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