Domestic Violence: The abuse must stop.

Written By Dr. Jason Goldman

One of the most heinous crimes is the physical and sexual assault on another human being. It is unconscionable in this day and age that domestic violence and sexual assault continues to be an epidemic. The numbers are staggering and the problem needs to be stopped. It is imperative as individuals, and as a society, that we recognize the warning signs and put an end to this tragedy. The victim is never at fault and no action ever justifies domestic violence or sexual assault. No means no and victims need to be supported in every way possible. As a physician, I have seen too many people victimized by this crime and am frustrated by a system that does not fully support the victim. In cases of child and elder abuse, I am mandated to report any suspicion of such abuse. Unfortunately, the law prevents me from reporting any suspicion of domestic violence unless I have the consent of the patient. All I can do is provide as much information as possible to help the victim get safety and help. In this article, I will touch on the incidence of the crime, the warning signs and options for the victim to seek help and safety. The problem is so large that it cannot be fully dealt with in the scope of this article but many resources exist for more detailed and in depth analysis.

The data that we have comes from surveys of men and women throughout the United States. As with all surveys, the data is only as good as the information collected. It is possible that the incidence is much higher but under reported. The CDC has excellent information on Intimate Partner Violence. The following are some staggering statistics of how serious and widespread this problem is:

• 1 in 5 women (29 million) have been involved with severe physical violence with an intimate partner
• 1 in 7 men (16 million) have been involved with severe physical violence with an intimate partner
• 1 in 5 women have been raped at some point in their lives
• This accounts for 15% of all violent crime but only 34% seek medical care.

These are just a few statistics but clearly show a significant incidence and impact. More statistics can be found at the National Coalition against Domestic Violence www.ncadv.org with fact sheets and information handouts. The cost to both the individual and society is enormous and many victims are suffering from physical and mental health issues that are often times overlooked. While abuse occurs against both men and women, the statistics show that women are more likely to be the victim of domestic violence and sexual assault.

As physicians, it is imperative to recognize signs and symptoms of abuse and counsel the patient on how to seek help. The psychology of the abuser and victim relationship is very complex and the dynamic that is created makes it very difficult for the victim to leave. After years of abuse, the victim can feel depressed, isolated, dependent, helpless and even guilty. The victim tends to feel that it is his or her fault for the cycle of abuse and becomes so immersed in the situation that escape seems impossible. The victim will frequently not come right out and state that abuse is occurring. The signs and symptoms can range from the obvious to the subtle. While multiple injuries, trauma and clear signs of physical abuse are obvious warning signs of domestic violence, the more vague and nebulous complaints are the ones that should make the physician aware of a possible abusive relationship. If a patient seems depressed, has exacerbations of chronic conditions, multiple vague complaints that do not seem to have a cause, unusual or unexplained injuries, anxiety, alcohol and drug abuse, or even a partner that will not leave the room or answers for the patient; the physician should explore the possibility of an abusive relationship. Sexual assault and abuse must be thought of in these situations as well. I was shocked and appalled to find out that many states have laws which either do not consider marital rape to be a crime or has the punishment as a lesser offense. Simply put, rape is rape in any form and not to be tolerated or allowed. As physicians, we need to be aware and look for signs of abuse and as a society, we need to advocate for rights of victims and punish those who would violate another. Regardless of the relationship or situation, nonconsensual sex is rape. Even if consent was given initially, but the sex act becomes uncomfortable or harmful to the person and consent is withdrawn, it becomes rape.

As mentioned before, physicians are bound by certain privacy laws and cannot report suspected abuse except in cases of child or elder abuse. The patient does have a right to privacy but that does not stop the physician from providing information and guidance to help the victim. It is important to speak with the patient alone, without the partner being present. A partner that refuses to leave the exam room, answers questions for the patient and seems overly controlling are suspect behaviors that need to be evaluated. Several resources exist for victims of domestic violence and everyone should know how to access this information.

The National Domestic Violence Hotline is a very important number to have on hand. It is 1-800-799-SAFE (7233). This is a 24/7 number that can give information on the issue. The first and most important step is to have a plan in place. If in immediate danger then calling 911 is imperative. It is always important to activate the first responder system when in imminent danger. Many shelters exist that will protect victims of domestic abuse. The victim has to want to leave and then know how to leave. A list of important contacts including law enforcement, medical care, friends and family should be made, a bag should be packed and ready to go and a safe location needs to be identified in advance. Most states will have shelters and resources that can be found online and are located in multiple areas. Knowing the closest shelter is important to advise patients on where they can go. A more thorough list of planning steps can be found at the National Coalition against Domestic Violence. This was a brief overview of some of the issues regarding domestic violence and sexual assault. It is a very real and horrible epidemic that affects millions of people. It can be stopped if both individuals and society do what is necessary to both raise awareness, educate and advocate about this issue. As a physician, I try to do my part to identify and help those who are being victimized but it is up to each of us to do so as well in order to end the cycle of abuse.