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Council on Ethical and Judicial Affairs, American MedicalAssociation

Definition of Domestic Violence


The use of physical, sexual, economic, and/or emotional abuse by one person in an intimate relationship in order to establish and maintain power and control over the other person

DOMESTIC VIOLENCE Barriers to Detection


1) Lack of knowledge

2) Lack of Confidence in Intervention 3) Lack of time

Who are the

VICTIMS ?

THE VICTIMS
Domestic violence happens between

people who are dating, married, separated, and divorced. It occurs in heterosexual as well as in gay and lesbian relationships and in adolescent dating relationships.

Who are the VICTIMS? Victims cross all socio-economic, religious, racial, ethnic, age groups

THE VICTIMS
When people meet me, and find out that Ive been in an abusive relationship they just cant believe it. Looking at me, with all the things Ive done in my life.. They think, how could I have been in a relationship like that?

Stacy First American woman to summit Mount Everest

THE VICTIMS
Women represent 95% of adult victims
Between 1 and 4 million women abused per year Lifetime risk for women is about 20%

THE VICTIMS
Domestic violence is the leading cause of injury to women ages 15-44 in the United States

THE VICTIMS
Research suggests DV results in more injuries to women requiring medical treatment than rape, auto accidents and muggings. (US Senate Judiciary Committee, 1992; Stark & Flitcraft, 1988)

THE VICTIMS
Abused women comprise approximately 11-30% of

women presenting with injury to hospital emergency services. Medical expenses from domestic violence total at least $3 to $5 billion annually.

DYNAMICS OF DOMESTIC VIOLENCE

POWER
AND

CONTROL

THE DYNAMICS OF DOMESTIC VIOLENCE


A pattern of assaultive and coercive behavior
Physical
Sexual Psychological

threats intimidation emotional abuse isolation

Economic

DYNAMICS OF DOMESTIC VIOLENCE


Either dinner wasnt exactly what he wanted, the house wasnt immaculate, I didnt look presentable enough any excuse at all, really and it was always my fault.
It was very debilitating, I ended up walking on eggshells. I began questioning my own competence to do anything.

THE DYNAMICS OF DOMESTIC VIOLENCE


It started out slowly. At first he just wanted to know where I was going all the time. Then he wanted to tell me where I was going all the time. By the end, I wasnt allowed to go anywhere.
If I went out with my girlfriends, I knew I would come back to find the house trashed he would always break something he knew I really cared about.

Who are the BATTERERS? Batterers cross all socio-economic, religious, racial, ethnic, age groups

Characteristics of Batterers
Sense of Entitlement Controlling Manipulative Frequently Charming Uninvolved parent Show contempt for others

Lundy Bancroft - Emerge

THE BATTERERS
DV Is Learned Behavior by Batterers
DV Is NOT Caused By:
Illness Genetics or gender Alcohol or other drugs Anger Stress Victims behavior Relationship problems

What Makes Batterers So Powerful?


Isolation of victim Societal Denial Use of Religious Issues Use of Cultural Issues Threats of Retaliation

THE CHILDREN
Perpetrators of domestic violence traumatize children (1) Physical injuries
- intentional - unintentional

(2) Psychological injuries


- witnessing violence

THE CHILDREN
Effect on Children:
In 85% of police calls for domestic violence, children had

witnessed the violence


Witnessing parental violence is a risk factor for:

Males- to physically abuse Females- to become victims of abuse

DOMESTIC VIOLENCE
Entry into the health care system represents an opportunity for detection of domestic violence and referral to appropriate community resources

DOMESTIC VIOLENCE and the Emergency Department


30% of all female trauma patients
22-35% of all females presenting to the Emergency

Department most are repeat ED patients


20% 11 or more abuse related visits 23% 6-10 abuse related visits

DOMESTIC VIOLENCE SEQUELAE


In the 12 month period following violence:
Victims use health care services twice as

often as

non-victims Healthcare costs were 2.5 times higher for victims

Victimization was the single best predictor of total yearly physician visits and of outpatient health care costs

FAILURE TO DIAGNOSE DOMESTIC VIOLENCE


Inappropriate treatment Increase victims sense of helplessness and entrapment Lost opportunity to refer to appropriate community resources Increase danger to the patient

Opening Pandoras Box: Why physicians do not ask patients about domestic violence
#1 #2 #3 #4 #5 Not enough time -71% Fear of offending the patient-55% Powerlessness to intervene -50% No control over patient behavior 42% Too close for comfort -39%

ACKNOWLEDGE - You Have Heard What the Patient Said


Use supportive statements: You dont deserve this. and, Our

concern is for your safety and your kids safety. Affirm her autonomy and right to control decision-making.

What to do if she says, Yes!


The single most important thing you can do is to communicate the message

NO ONE DESERVES TO BE HURT LIKE THAT

REFER - Intervention With a Victim


Be aware, materials and referrals you provide a victim may

place her in danger Make a follow-up appointment

Why dont they just leave?


FEAR LOW SELF ESTEEM

ISOLATION
LACK OF RESOURCES PROMISES TO CHANGE

FEAR SEPARATION VIOLENCE


73% of battered women seek emergency medical services after

separation (Stark, 1981) Up to 75% of domestic assaults reported to police are made after separation (US Dept. of Justice, 1995) Women are most likely to be killed when attempting to report abuse or leave the abuser (Sonkin, 1985) Approximately one-half of males who kill their wives, do so after separation (Hart, 1992)

FEAR
Everyone seems to think that what you need to do is to just leave the relationship and then everything will be fine. Thats the myth. The reality is that the violence escalates if you try to get away. I knew that not only did I have to leave, I had to DISAPPEAR.

LOW SELF ESTEEM


I thought that I was worthless, that I couldnt do anything right. I thought I was ugly, just a horrible individual no one would ever love me and I myself was incapable of love. Stacy First American Woman to summit Mount Everest

LEAVING IS A PROCESS
I think I left 12 times before I finally stayed gone. When I look back on it now, I realize I was practicing. It was a process it took time, I had to learn how to leave and I had to learn how to stay gone.

Promises to Change
I dont really know why I kept going back... He begged me to, swore hed never do it again. And, I wanted to hear it. I was overweight, I felt unloved

LACK OF RESOURCES
After years of violence, I was completely bewildered. I didnt know how to get away! There has to be a place to go to, its not just a matter of leaving from someone. And, for many victims of domestic violence that place either doesnt exist or they dont know that it exists.

Leaving is a Process
Safety Issues
Threats of Retaliation Fear of Talking about Abuse to Others

Breaking Isolation
Access to Resources Survival Strategies

Batterer Accountability

Leaving Is a Process
SURVIVORS OF DOMESTIC VIOLENCE DO LEAVE! They leave when they are ready They leave when it is safe to do so We can support their process by providing an institutional response affirming battered women and their decision making ability

THE VICTIMS
Domestic violence is the leading cause of injury to women ages 15-44 in the United States