Identify

Identify

All health professionals must know how to identify domestic abuse, as health professionals have a duty of care.

Many of the signs of domestic violence may also be indicators of other underlying causes so the following list should be treated as indicative rather than definitive.

Having said that, if several of the factors apply, you should attempt to elicit more information through sensitive direct questioning:

  • Unexplained bruises - especially those at different stages of healing, petechea, ‘pepper-pot' bruising, areas of erythema consistent with slap injuries, lacerations, burns, multiple sites of injury or multiple injuries in various stages of healing.
  • Injuries to areas hidden by clothing.Injuries to face, chest, breast and abdomen.
  • Evidence of sexual abuse, e.g. injuries to genitals.
  • Chronic pain problems, including pelvic pain, back pain, neck pain, psychogenic pain or pain due to diffuse trauma without physical evidence.
  • The explanation given by the service user, as to how her injuries have occurred, is inconsistent with those injuries.
  • Delay exists between time of injury and presentation for treatment.
  • The service user describes the alleged ‘accident' in a hesitant, ashamed, embarrassed, frightened or evasive manner.
  • Service user, partner and/or family deny or minimise injuries/violence.
  • Review of the medical records reveals that the service user has presented with repeated ‘accidental' injuries.
  • Repeated visits to the surgery.
  • Service user presents repeatedly with vague complaints or symptoms for which no explanation can be found, e.g. abdominal pain, reduced foetal movements, ‘query UTI', etc.
  • Non-compliance with treatment regimes. Not being allowed to obtain or take medication. Missed appointments. Lack of access to finances. Lack of ability to communicate by telephone.
  • The service user is accompanied by an ‘overprotective' partner. The perpetrator of the violence will actively try to prevent health care professionals from obtaining an accurate picture of what is happening.
  • Intense irrational jealousy or possessiveness expressed by partner or reported by service user.
  • Service user reluctant to speak or disagree in front of her partner.
  • Service user has a history of miscarriage, stillbirth, pre-term labour, intrauterine growth retardation, low birth weight babies and/or unplanned or unwanted pregnancies.
  • Postpartum, removal of perineal sutures.
  • Service user has persistent gynaecological complaints, e.g. pelvic pain, pain during intercourse, frequent urinary and/or vaginal infections.
  • Failure to use condoms and other contraceptive methods.
  • History of psychiatric illness, alcohol or drug dependence in service user or partner.
  • History of attempted suicide and/or self-harm.
  • History of depression, anxiety, panic attacks, inability to cope, social withdrawal, feelings of isolation and/or a sense of helplessness. One survey found that depression was the strongest indicator of domestic violence. The depression caused by domestic violence, when present after childbirth, can be misdiagnosed as postnatal depression.
  • Physical symptoms related to stress, anxiety and depression
  • Frequent use of prescribed tranquillisers or pain medications.
  • Children: history of behaviour problems or unexplained injuries.