Some clinical pearls in treating domestic violence

I was lucky to be present at a talk for medical students that was part of the Katie Brown Educational Program. The KBEP is focused on teaching children, boys and girls, how to have safe, healthy relationships. Here are a few important learning points from the talk:

What is the underlying basis of domestic violence?
Control and power. Initially, a perpetrator can be the sweetest person in the world. Violence starts subtly, and can even be exciting at first. But it turns into an obsession, and a need to control. People who experience violence in this systematic, repeated way can begin to believe that it is normal, that they deserve and even need it. It is important to realize that as doctors, we are in a position of power and control, which victims may respond to.

What are some forms of domestic violence?
Physical violence is the one that comes first to mind. But emotional, verbal, and financial abuse are just as real.

Some victims will refer to violence as “crazy making:” their perpetrator made them think that THEY were the ones who were crazy for questioning the violence. “You know it makes me mad when you do ____…so why do you continue to do it?” or “No one will ever love you like I do,” or threaten children or pets.

Is there a pattern to domestic violence?
Yes. Usually, it goes like this:

  • build up: perpetrator starts acting more edgy, being more accusatory or obsessive
  • explosive anger: lashing out, the abuse
  • buyback: buying necklaces, cars, etc to “make up for it”…”this is how much I love you”…”I’m sorry, it’ll never happen again.”

Choking is a sign of escalation, most women who are murdered are choked before.

How can you tell if a patient might be abused?
There are no 100% give-away signs. Sometimes they look down or depressed. Sometimes there are sketchy bruises or too many “accidents.” Sometimes they seem indecisive or constantly change their mind, which can be really frustrating to office staff when they are scheduling appointments, doing tests, etc.

Why don’t victims of domestic violence just leave? No one is making them stay.
It can take a woman seven times (or more) to successfully leave an abusive relationship.

Is there anything you can offer to patients who are victims of violence?
As a doc you should use reality testing. Tell them, “This is not your fault. You don’t deserve to have this happen to you.”

You can always offer them a hotline to call. My clinic puts hotline cards in the bathroom so they can taken discreetly.


About the friendly intern

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One Response to Some clinical pearls in treating domestic violence

  1. Ms McKahsum says:

    Hi! I’d like to add a couple things to this great post. I am researching the first part of the patterns of abuse, The Tests and The Lure. No abusive relationship starts at the build-up, the victims have be tested to be sure they can be isolated and make it to the build-up stage, and then abusers go through the initial Lure. That’s the initial Sweetest person in the world. They use kindness, amazing romantic gestures, and often money to lure victims in. The Lure is what makes leaving so difficult. Victims don’t know how to stand up for themselves, but most importantly they don’t know they should be. When the court appointed Domestic Violence Advocate said, “She’s a human being and deserves to be treated with respect.”, in my hearing, it was the first time I had ever thought about that. These conversations are so important! Keep it going.

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