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Expert discusses the ‘subtle’ signs of domestic abuse in primary care
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Every minute, an average of 20 people in the United States are physically abused by an intimate partner, totaling more than 10 million victims a year, according to the National Coalition Against Domestic Violence.
In addition, one in three women and one in four men will be physically abused by an intimate partner during their lifetime, according to the coalition. Victims of domestic violence have an increased risk for physical injuries and adverse mental effects, such as depression and suicidal behaviors; however, only 34% receive medical care for their injuries, according to the coalition.
To mark Domestic Violence Awareness Month, Healio Internal Medicine spoke with Caren Behar, MD, clinical associate professor of internal medicine at New York University Langone Health, about identifying potential warning signs of domestic abuse and the primary care provider’s role in caring for victims. – by Alaina Tedesco
Question: What are some warning signs that patients may demonstrate if they are being domestically abused?
Answer: There are a few different warning signs that might demonstrate that a patient is being domestically abused. Some of these signs can be very subtle, which make them hard to identify. Some signs include a string of unexplained and inconsistent injuries, a distracted or fearful affect that makes the patient jumpy and nervous, or reluctance to undress and expose the injuries.
Some signs can also come from the patient’s partner if he or she is present — the partner might be overly involved answering for the patient or reluctant or unwilling to leave the patient alone with his or her physician. These signs don’t always indicate domestic abuse, but it’s important to take note of it as a possibility and talk to the patient.
Q: What should primary care providers look for behavior-wise during exams that may be attributable to domestic violence?
A: There are also some other psychological behaviors associated with domestic violence that include depression, anxiety, eating disorders, or even substance abuse, all of which should be taken very seriously. The patient might not always express these directly, so it’s important to keep careful watch and discuss with your patient. They also don’t directly correlate with domestic abuse and could be related to other problems.
Q: What can primary care providers do for patients who are being subjected to domestic violence?
A: With patients being subjected to domestic abuse, primary care providers should offer a nonjudgmental, confidential and compassionate attitude. A primary care physician can have a discussion with the patient about the issues that isn’t rushed since there can be many complexities associated with this violence.
The physician can offer supportive listening and be sure not to pressure the patient to disclose the information elsewhere. It’s also important to not disclose this information to the partner, not inquire about the abuse in the presence of others, or question his or her decisions.
Q: What are some resources that primary care providers can refer patients to if they are being domestically abused?
A: Physicians can direct patients to organizations that intervene, support and help others with this like Futures Without Violence, the National Domestic Violence Hotline, the National Sexual Assault Hotline, or the National Teen Dating Abuse Hotline. It’s important to discuss the patients’ needs and options with him or her.
Q: Is there anything else you would like to mention about identifying/treating domestic violence patients that is important for primary care physicians to be aware of?
A: Some recommendations state that screening for domestic violence should be regular for women of childbearing age. When a physician suspects that a patient might be experiencing domestic violence, it should be asked about again at subsequent visits. Patients might be more likely to share their information if they’re asked repeatedly in a health care setting to make it seem more normalized and routine. As a physician, it’s important to have these discussions and offer the best care for your patient that you can.
Disclosure: Behar reports no relevant financial disclosures.