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Domestic violence is physical, sexual, and psychologic abuse between people who live together or are in a relationship, usually done by a man against his sex partner (called intimate partner violence).
The victim is usually a woman but may be a man.
Physical injuries, psychologic problems, social isolation, loss of a job, financial difficulties, and even death can result.
Doctors may suspect domestic violence based on injuries, inconsistent or puzzling symptoms, or the behavior of the victim and/or the victim's partner.
Keeping safe—for example, having a plan of escape—is the most important consideration.
Domestic violence can occur between parents and children, children and grandparents, and siblings, as well as intimate partners. It occurs among people of all cultures, races, occupations, income, educational levels, and ages.
Women are more commonly victims of domestic violence than are men. About 95% of people who seek medical attention as a result of domestic violence are women, and perhaps 400,000 to 500,000 of women’s visits to the emergency department each year are for injuries related to domestic violence. In the United States, domestic violence was reported at some point in their life by the following groups:
More than 1 in 3 women and more than 1 in 4 men in the United States have experienced rape, physical violence, and/or stalking by an intimate partner during their lifetime. Women are more likely to be severely assaulted or killed by a male partner than by anyone else. Each year in the United States, experts estimate that about 3 to 4 million women are severely beaten by their partner.
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Sexual assault is also common: 40 to 45% of women who are physically assaulted by their partner are also sexually assaulted by their partner. Sexual assault involves the use of threats or force to coerce sexual contact and includes unwanted touching, grabbing, kissing, and rape (see page Rape).
Psychologic abuse is very common and often accompanies physical or sexual abuse. Psychologic abuse involves any nonphysical behavior that undermines or belittles the victim or that enables the perpetrator to control the victim. Psychologic abuse can include
Usually, the perpetrator uses language to demean, degrade, humiliate, intimidate, or threaten the victim in private or in public. The perpetrator may make the victim think that her perceptions of reality are wrong and that she is crazy (called gaslighting) or make her feel guilty or responsible, blaming her for the abusive relationship. The perpetrator may also humiliate the victim in terms of her sexual performance, physical appearance, or both.
The perpetrator may try to partly or completely isolate the victim by controlling the victim’s access to friends, relatives, and other people. Control may include forbidding direct, written, telephone, or e-mail contact with others. The perpetrator may use jealousy to justify his actions. The perpetrator may further isolate the victim by convincing her that family members and friends will not help her.
Often, the perpetrator withholds money to control the victim. The victim may depend on the perpetrator for money (most or all). The perpetrator may maintain control by preventing the victim from getting a job, by keeping information about their finances secret, and by taking money from the victim.
After an incident of abuse, the perpetrator may beg for forgiveness and promise to change and stop the abusive behavior. However, typically, the abuse continues and often escalates.
The perpetrator's outbursts of violence tend to be episodic and unpredictable. Thus, victims may live in near-constant fear of the next outburst.
Often, victims do not leave the abusive relationship. Reasons include
Feeling dependent on the perpetrator for money
Feeling alone, with no one to help
Being afraid that planning or trying to leave will trigger more intense violence
Being afraid of what the perpetrator will do after they leave (for example, stalk them or hurt their children, another family member, or a pet)
Believing that the abuser will change (for example, because of promises to do so) and still loving the abuser
Believing that abuse may be normal (for example, because of upbringing or culture)
Victims of domestic violence may be physically injured. Physical injuries can include bruises, black eyes, cuts, scratches, broken bones, lost teeth, and burns. Injuries may prevent victims from going to work regularly, causing them to lose their job. Injuries, as well as the abusive situation, may cause embarrassment, causing victims to isolate themselves from family and friends.
Victims may develop symptoms that have no obvious physical cause. These symptoms can include headaches, abdominal or pelvic pain, and fatigue.
Many victims also get sexually transmitted diseases and have problems during pregnancy.
Victims may also have to move often—a financial burden—to escape the perpetrator.
Sometimes the perpetrator kills the victim.
As a result of domestic violence, many victims have psychologic problems. For example, among battered women,
About 54 to 84% have posttraumatic stress disorder (PTSD—see page Posttraumatic Stress Disorder (PTSD)).
About 63 to 77% have depression.
About 38 to 75% have anxiety.
Many women have both depression and PTSD. Battered women and men can also develop eating disorders and substance abuse.
Women who are more severely battered are more likely to develop psychologic problems. Even when physical abuse decreases, psychologic abuse often continues, reminding the woman that she can be physically abused at any time. Psychologic abuse can be just as damaging as physical abuse.
Doctors may suspect domestic violence based on injuries, inconsistent or puzzling symptoms, and/or the behavior of the victim and/or partner. Or a victim may report the abuse.
If doctors suspect domestic violence, they may gently ask the person questions about the relationship with the partner. Many experts recommend that health care practitioners ask all people questions about domestic violence.
If domestic violence is suspected, doctors try to determine whether the victim can safely return home before leaving the office. Safety is in doubt in the following circumstances:
If domestic violence is confirmed, doctors are required to document the evidence of abuse, often by photographing the injuries. This documentation can be used to support a legal case against the perpetrator.
Victims must remember that abuse is never justified and that support is available whether they decide to stay in or leave the abusive relationship.
In cases of domestic violence, the most important consideration is safety. During a violent incident, victims should try to move away from areas in which they can be trapped or in which the perpetrator can obtain weapons, such as the kitchen. If possible, victims should promptly call 911 or the police and leave the residence. Victims should have any injuries treated and documented with photographs. Victims should teach their children not to get in the middle of a fight and when and how to call for help.
Developing a safety plan is extremely important. It should include
Where to go for help (victims should have several possible places to go and people who can be called)
How to get away (often including appearing to do a routine task that involves leaving the house, such as going on an errand or walking the dog)
How to access money (including hiding money away and obtaining a separate bank account and, if possible, credit card)
Victims should also make and hide copies of official documents (such as children’s birth certificates, social security cards, insurance cards, and bank account numbers). They should keep an overnight bag packed and hidden in case they need to leave quickly.
Sometimes the only solution is to leave the abusive relationship permanently because domestic violence tends to continue, especially among very aggressive men. Also, even when physical abuse decreases, psychologic abuse may persist.
The decision to leave is not simple or easy. After the perpetrator knows the victim has decided to leave, the victim’s risk of serious harm and death may be greatest. At this time, victims should take additional steps (such as obtaining a restraining or protection order) to protect themselves and their children. Help is available through shelters for battered women, support groups, the courts, and a national hotline (1-800-799-SAFE or, for TTY, 1-800-787-3224). Victims should seek such help even if abuse is not severe. Seeking such help does not necessarily cause trouble for the partner.
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