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Identifying Domestic Abuse

An Analysis of the Identification of Both Physical and Psychological Effects of Domestic Abuse

By WhoPublished 5 years ago 14 min read
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In the world we live in, there are many things that we must do to protect ourselves. Walking to my car, I look over my shoulder at every instance. Before falling asleep at night, I make sure all doors and windows are locked in the house. When leaving work late at night, I always ask someone to walk me to my car or stay equipped with a hot cup of coffee, ready to be thrown in the face of anyone who may approach me in the wrong way. Many women and men may feel this way and take these precautions, but there is a particular group of people who stay on our toes at all times: domestic abuse survivors.

At a very young age, I was succumbed into a relationship that everyone around me thought was picture perfect, but behind closed doors, was horrific. Nobody would have ever known the atrocities going on in my life until I told them. The signs of domestic abuse are hard to recognize unless you have been exposed to it. It is important that we discuss both the physical and mental abuse occurring in violent relationships in an attempt to help others and end the stigma behind getting help. This is an implication we face that must be elaborated on in order to recognize the abuse and enhance treatment for survivors.

The Problem

I want to point out that throughout I will not refer to these people as victims, we should attempt to move away from this term in regards to domestic abuse. When we put a solid label on them, they may feel as if they were wholly passive throughout the relationship, in which they were not (Motz 2014). It is important that they recognize their role in the relationship because in turn, they may be able to pick up on abusive signs much earlier. They may also live by this label with no attempt to seek help, as it is much easier to fall into the title than to work away from it. In one study focused on the implications of seeking help in abusive relationships, Richard Carpiano at Baylor University found four persisting reasons as to why survivors do not seek help. The first being threats presented by their significant other. The second being the lack of questionnaire by physicians and medical professionals in emergency rooms, clinics, or private offices. The third being their perceptions on health; that their injuries were not serious enough. Finally, survivors feared being identified as a victim to both the medical facility and people from their community (Carpiano 1998). In addition, to call them a victim would be to victimize them all over again, instead we must move away from this term and refer to them as “survivors.”

When it comes to seeking help, survivors do not always take the first step for an array of reasons. Their victimization may result in a toxic pattern in which he or she may feel as if they cannot help themselves. There is a pattern in both the victim and abuser in which they both project their unwanted feelings or aspects about themselves that are unbearable, on to the other (Motz 2014). I theorize this as a domino effect that ends with the demolition of the relationship. Although it is circular in its pattern, going back and forth at one another, there does come an end to it, whether it be death or ending the relationship. This domino effect causes the victim to become completely ignorant and normalizes the abuse (Cook & Bewley 2008). This is just one of many.

As mentioned in Carpiano’s research, many survivors are reluctant about taking steps toward help. Many times, nurses, physicians, and emergency room clinicians are not trained to notice signs of domestic abuse and on top of that, are often times insensitive to the situation (Carpiano 1998). In one study conducted by Sugg and Inui (1992), they interviewed physicians on their exploration into domestic violence and found that 18 percent of those referred to their intervention as “opening Pandora's box.” In an interview with a trauma nurse clinician, she expressed that “Even if not asked, they [Survivors] have to feel like the person they are about to say that to cares. And if they don’t feel that, they are not going to tell it to anyone” (Carpiano 1998). Despite the American Medical Associations attempts to publish guidelines to help medical professionals in identifying domestic abuse, research has shown that domestic abuse is dynamic and directly related to each's lived experience (Carpiano 1998).

Helping to Identify Physical Abuse

Physical domestic abuse is easier to identify than psychological abuse in a medical setting that is not trained in such psychological skills. I must point out that physical abuse does not end when a child is involved or still inside their mother’s womb. In one study by Hilton and Wyatt on 50 women, they find that those who are pregnant reported more threats, actual abuse and scored higher on an assessment of danger from intimate partner violence (Campbell 2007). In another study by Keeling and Birch (2004), they find that 30 percent of abuse commences in pregnancy and in Carpiano’s (1998) research, he finds that 45 percent of battered women are abused during pregnancy. These are alarming statics and are important to remember when evaluating women.

When it comes to intervention, it does not always need to include law enforcement or a means of serious action, especially if the survivor is pregnant. If we can help these men and women to feel safer not only in their skin but in what their future holds, it could push them to leave the relationship or even help the abuser in their actions. In a project done in London, routine screening of pregnant women was coupled with a referral to a help service in terms of domestic abuse. Researchers find that at the six month follow up, women showed a reduction in violence, controlling behavior, injuries, anxiety, and depression. They also find that the survivors have a serious improvement in self-esteem and sources of support (Cook & Bewley 2008). This won’t be the case for everyone, but it is a small step medical professionals could take.

In order to help identify physical abuse, physicians should evaluate the area in which the injury has occurred. In Cook and Bewley’s study, they found that 40 percent of survivors experienced trauma to the head and neck and 28 percent reported musculoskeletal injuries, broken bones of some sort. In another study by Keeling and Birch (2004), they find that out of 83 women who reported severe emotional or physical abuse, 25 reported injury to the head, 14 to their arms, 11 to their legs, and nine in the stomach. This shows a correlation between both findings, facial and neck injury being the most common while broken bones to either the arm or leg coming in second. Interestingly, the abuser refrains from hitting the stomach area, I theorize this as a possible attempt to control the others reproductive system. For both a male and female, a blow to the stomach could be detrimental to their ability to reproduce. The abuser may use this as a threat to manipulate and coerce the survivor into staying.

In addition, we need to consider the demographics of abuse. According to Hilton and Wyatt alcohol use in both the abuser and survivor are common (Campbell 2007). When treating them for injuries, it is important to note the alcohol level of the survivor. Also in Carpiano’s (1998) study in emergency rooms, he finds that domestic abuse survivors request pain medication more often than any other type of medical service. Just like in any domestic abuse case, the dynamics of it are dependent upon the specific relationship. These trends may help physicians to notice persisting patterns in those who come in for treatment for domestic abuse.

Additionally, physicians should consider the age of survivors when evaluating them for physical domestic abuse. In Keeling and Birch’s (2004) study on 83 abused women, 54.5 percent of those physically abused were between the ages 40 to 44, with the age group 25 to 29 coming in second at 23.5 percent. I find this interesting, as those in the age ranges between the two experienced fairly low rates of abuse. Possibly, the young age group of 25 to 29 are first entering a serious relationship and are unaware of the risk factors of domestic abuse. At such a young age, they learn tendencies to stay away from abusive relationships. The dramatic increase occurs at an age in which we are typically married, and have been for a period of time as well as having children. The survivor may feel comfortable with their partner and as previously mentioned, the prevalence of children may increase the risk factor. Although these risk factors are different for everyone, they should be considered when trying to identify physical domestic abuse.

Helping to Identify Psychological Abuse

When it comes to identifying psychological abuse in a medical setting, there is very little research. According to Carpiano (1998) in his study, most medical intervention focuses only on physical trauma and that there is an absence of studies focused on psychological trauma. It is important to recognize both, as emotional trauma typically accompanies physical trauma, but physical trauma may not always accompany emotional trauma. Additionally, it is detrimental to these survivors that we do focus on their psychological states, as physical trauma may be healed in a few weeks, but psychological trauma will persist for months, and possibly even years.

There are an abundance of tests designed to expose psychological domestic abuse in both the research level as well as the judicial level. Psychiatrists and/or researchers will typically administer a test referred to as the Exposure to Domestic Violence/Abuse composed of two parts. The first focuses on the frequency and intensity of nine aspects of abuse including but not limited to: verbal abuse, physical abuse, sexual abuse, child abuse, and legal action taken. The second part focuses on decision making process (Chemtob & Carlson, 2004). They may also administer tests such as the Post-Traumatic Diagnostic Scale and the Dissociative Experience Scale. All of these scales help to identify abuse at a research level. When it comes to the judicial level, investigators may initiate a Danger Assessment Test, consisting of 15 items that help assess a survivor's risk for lethal assault by their significant other (Campbell 2007). As demonstrated, there many tests designed to assess a survivor's psychological trauma at the judicial and research level, but none in regard to the medical level outside of a specified unit. We have the tools to evaluate the levels of psychological abuse in survivors, if we can work together to combine them into a case sensitive test, medical professionals will have a basis of testing to work from.

Medical professionals should also be considerate of their tone when discussing these issues with patients. Instead of being so direct in their questionnaire, they should take a more intimate approach while displaying compassion and genuine concern. In addition, the questions that they do ask should be addressed in a way that is not confrontational or victimizing. Instead of asking questions like, “Is someone at home hurting you at home?” we should be approaching it as, “Has anyone at home ever made you feel frightened?” or, “Is there anyone at home that puts you down?” Cook and Bewley (2008) focus on this in their research by stating that over half of abused women do not describe their relationship as abusive and may not disclose it under the general definitions of abuse. By approaching these issues with a more understanding syntax, survivors may begin to become conscious of the degree of abuse occurring in their relationship.

In regards to psychological abuse during pregnancy, unfortunately the unborn child typically experiences the effects the most. According to Cook and Bewley’s (2008) research, “features of fetal morbidity, such as low birth weight, small gestational age, and preterm delivery” may be a result from the psychological trauma imposed by the abuser. Although these health issues may arise in situations outside of abuse, medical professionals should evaluate these conditions and other risk factors to help identify psychological abuse.

Survivors of abuse may also exhibit strange behavior that a typical person may not exhibit, these should be noted by medical professionals. The most obvious unusual behavior shown by survivors is their attachment to their abuser. As previously mentioned, abusers may pose a threat to the survivors availability of help. They will keep them as close to them as possible while become weary when having to leave their side. This should be a red flag for medical professionals. Also, the survivor may act confused and look down often. This may be a result of their lack of self-esteem and allowing the abuser to make their decisions for them (Carpiano 1998). They may also exhibit fearfulness, which can commonly be recognized by wide eyes, lips pressed horizontally, and wrinkles on the forehead (Parvez). Survivors who experience psychological abuse may also show symptoms of chronic fatigue or tension, excessive tiredness and/or long term headaches. They may also develop sleeping disorders as well as eating disorders (Carpiano 1998). These behaviors and symptoms should be accounted for by medical professionals.

Another serious behavior survivors may exhibit are exaggerated, startled reactions. This is a result of a conditioning from the abuse. Often times, survivors will adapt a defensive response to fast motions and or motions that may feel threatening to them (Carpiano 1989). Although this conditioning typically occurs after physical abuse, it is a sign that psychologically, they have been conditioned to respond quicker to an unnatural stimulus.

The Importance

When it comes to identifying psychological abuse, more research on how to identify signs in professional medical setting needs to be done. Here, I have highlighted some stepping stone that researchers may start with to help develop their research. The main implication we face is that we do not want to be too intrusive into one’s life. We live in an era where privacy is respected and must be held to specific standards. Despite this, it is important that we attempt to figure out what is going on in these people’s life before the abuse becomes debilitating or lethal. In a study conducted by Forensic Psychologist Anna Motz (2014), she finds that of the cases she has examined, 61 percent of abused females were killed by their significant other, and 12 percent of abused men were killed by their significant other. These are alarming statistics and if more research is conducted, it may help to lower these rates and save lives.

Although each case of domestic abuse is different, similar effects and symptoms occur across many. Medical professionals can use these similarities to help pinpoint when domestic abuse is occurring, and decide on non-confrontational tactics to help the survivor and abuser. Further research may also help to create training programs that will help educate nurses, clinicians, and physicians on signs of domestic abuse and how to approach it in the most effective way.

As for the future, I can only hope that survivors become more comfortable with talking about these issues as a means to help others obtain help and ultimately survive. To be silent about the issue would imply that it is not a problem. The more we talk about the issue, the more people will be aware of it and reach out to help others or help themselves.

References

Campbell, J. (2007). Assessing dangerousness: Violence by batterers and child abusers. New York: Springer Pub.

Carpiano, R. (1998). Three steps forward, two steps back: Personal health perspectives and needs of female domestic abuse victims and their access and utilization of health services. Department of Sociology, Anthropology, and Social Work Baylor University,1-36.

Chemtob, C. M., & Carlson, J. G. (2004). Psychological Effects of Domestic Violence on Children and Their Mothers. International Journal of Stress Management,11(3), 211-224. doi:10.1037/1072-5245.11.3.209

Cook, J., & Bewley, S. (2008). Acknowledging a persistent truth: Domestic violence in pregnancy. Journal of the Royal Society of Medicine,101(7), 358-363. doi:10.1258/jrsm.2008.080002

Keeling, J., & Birch, L. (2004). Asking pregnant women about domestic abuse. British Journal of Midwifery,12(12), 746-749. doi:10.12968/bjom.2004.12.12.17172

Parvez, H. (n.d.). Facial expressions: Fear. Retrieved from https://www.psychmechanics.com/2015/06/facial-expressions-fear.html

Motz, A. (2014). Toxic couples: The psychology of domestic violence(pp. 271-280). London: Routledge.

Sugg, N. K. (1992). Primary Care Physicians Response to Domestic Violence. Journal of the American Medical Association,267(23), 3157. doi:10.1001/jama.1992.03480230049026

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