Domestic violence and the general practitioner

Abstract

Domestic violence is a common social problem that raises many difficult questions and management issues for both the patient and the doctor. Domestic violence is an abuse of power within the relationship. Physical assault is common and serious, but psychological abuse is more damaging. Perpetrators of domestic violence do not usually perceive that they have a problem and no change in their behaviour is possible unless they want to change. For general practitioners the first step in dealing with domestic violence is detection, and that means acknowledging that it can exist in any patient. General practitioners have three choices in their management of victims of domestic violence: they can do nothing, they can be sympathetic only or they can be an agent of change. Effective management of domestic violence involves raising the victim's self‐esteem so that she is able to alter her situation herself.

The Detection of Domestic Violence through Routine Screening at Drug and Alcohol Clinics: Volume 1

“…Physical signs of abuse are not always present or if present are not always obvious. As highlighted by Knowlden & Frith. (1993), if physicians are to be effective in treating domestic violence, they need to both suspect it and look for evidence of it.…”

“…However, more ' frequently women will present with signs of psychological distress such as depression, anxiety and sleep problems and a range of somatic complaints including headaches, muscle aches, abdominal pains; there may be no obvious physical injury (Mitchell & Hodson. 1983;Knowlden & Frith. 1993;).…”

“…Not all abused women can be considered to be battered and not all women who are battered have a well defined mental disorder. Often victims of spouse abuse present to their doctor with vague health complaints long before they acknowledge the presence of violence or otherwise seek help (Knowlden & Frith. 1993).…”

“…However, these are of sufficient severity to affect their quality of life and hence warrant intervention. Examples include the milder forms of anxiety and depression, problems with low selfesteem and complaints of headache, abdominal discomfort, palpitations, diarrhoea, insomnia and chronic pain states (Knowlden & Frith. 1993;Mitchell & Hodson.…”