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Course Objectives:

1. Define "domestic violence".
2. Describe the cycle of violence.
3. Discuss situations that can lead to death in domestic violence.
4. Explore proper caregiver responses to suspected domestic violence.
5. Recognize legal implications as it relates to domestic violence.

Overview

Domestic violence is a major problem around the world. If abuse is to be prevented, healthcare professionals must be educated to help patients by looking for signs of abuse during each visit and for those at high risk, offer quick interventions and referral information. Only through such measures can we promote the health and well being of our society.

Victims can be of any age, sex, race, culture, religion, education, employment or marital status. Although both men and women can be abused, most victims are women. Children in homes where there is domestic violence are more likely to be abused and/or neglected. Most children in these homes know about the violence. Even if a child is not physically harmed, they may have emotional and behavior problems.

The problem with domestic violence is that it is often overlooked, excused, or even denied by the victim. Domestic violence can be psychological or physical. Noticing and acknowledging the warning signs and symptoms of domestic violence is the first step to ending it.

What is Domestic Violence?

Domestic violence and emotional abuse are behaviors used by one person in a relationship to gain and maintain control of the other. An abuser can use fear, guilt, shame, and intimidation to keep the victim in their control. Domestic violence may include actual or threatened physical, sexual, psychological or economical abuse of an intimate partner and/or children.

Violence can be criminal and include physical assault (hitting, pushing, shoving, etc.), sexual abuse (unwanted or forced sexual activity), and stalking. Although emotional, psychological, and financial abuse are not always considered criminal behaviors, they often lead to criminal violence.

Examples of abuse include:

• Name-calling or putdowns
• Keeping a partner from contacting their family or friends
• Withholding money
• Stopping a partner from getting or keeping a job
• Actual or threatened physical harm
• Sexual assault
• Stalking
• Intimidation

Signs of Domestic Violence

ALL HEALTHCARE PROFESSIONALS ARE REQUIRED BY LAW TO RECOGNIZE THE SIGNS OF DOMESTIC VIOLENCE AND ABUSE AND TO REPORT IT. The healthcare professional is responsible for recognizing signs of abuse, whether it's physical, emotional or verbal.

The most common injuries from domestic violence include: burns (especially cigarette burns), bruises, internal bleeding, head injuries (especially hematomas), injuries to the abdominal area and broken or fractured bones. Often, the victims are fearful and either will not tell you what happened to them or will tell you a story that matches the injury. Both are warning signs that an injured person could be a victim of domestic violence.

Cycle of Violence

There are many reasons why domestic violence takes place. Drugs and alcohol often play a big role in domestic violence. Stress is another factor in domestic violence. The abuser could be stressed out over family or work matters. The stress causes the abuser to take out his or her frustration a family member(s).

Often, the abuser was once a victim. This is what is known to professionals as the “cycle of violence.” When children are abused, the parents are indirectly teaching the child how to be violent. When a parent vents aggressive feelings through verbal or physical abuse, the child picks up on this and they accept this learned behavior as the norm. As time goes on, the child believes this is the only way to cope with problems.

Understanding the Abuser

Contrary to what many believe, abuse is not an accident. It does not happen because someone was stressed-out, drinking, or using drugs. Abuse is an intentional act that one person uses in a relationship to control the other whether the abuser is conscious of it or not.

Abusers are often emotionally dependent individuals with low self-esteem. They often suffer from depression and/or drug or alcohol addiction, which can increase violent tendencies. Abusers are scared to be alone. They believe that one day their family will leave them. An abuser will do everything in their power to avoid being alone. They may isolate the victim, keeping him or her from talking to others about what is happening. Abusers who mean something to their victims will often either threaten to commit suicide if the victim leaves. Other abusers will often tell their victims that they are going to kill them or people that they love. The abusers’ goal is to keep the victim weak and down in order to have control over the victim. Without control, they feel weak in front of the victim.

Contrarily, some abusers will also behave in a very loving and caring manner in between incidents of abuse. This can be very confusing for the victim and may be another reason the victim hesitates to report the abuse. The abusers may love their families very much and actually feel terrible after they hurt them. But feeling bad about violent behavior does not excuse the behavior. There is no excuse for domestic violence.

Help for the Abuser

Since domestic violence is a learned behavior, it has to be unlearned. There are treatment programs available that focus on helping the abuser deal with his or her problems by using positive coping skills in place of violence.

How Bad is the Problem of Domestic Violence in America?

Abuse is the most under-reported crime in America. Many times this is because the victim feels ashamed and too scared to report it.

According to the National Coalition Against Domestic Violence, more than half of all women are victims of abuse at sometime in their life.
Studies show there are more injuries in domestic violence than rape, auto accidents, muggings, and shootings combined.
40% of women murdered, are murdered by their husband, ex-husband or boyfriend.
FBI statistics show that 1 in 4 girls and 1 in 6 boys will be sexually assaulted before they are 16 years old. At least 75% of them know the abuser.
One in 3 women and 1 in 5 men will be sexually assaulted sometime in their lifetime.
According to the Center for the Prevention of Sexual Assault, 65% of rapes and as many as 80% of attempted rape are not reported to police.

Fighting is an escalating process. It often starts out with name-calling followed by saying they will put you in danger. It often leads to: hitting, pushing, slapping, biting, kicking, and worse. When the victim tries to fight back, it can become dangerous or life threatening. The abuser can choke, break bones, and push the victim down stairs, cause head injuries or use of a weapon to retaliate against a victim fighting back. And thus the violence escalates.

Understanding Terms used in Domestic Violence

Dominance – Abusive individuals need to feel in charge of the relationship. They will make decisions for the victim and the family, tell the victim what to do, and expect him/her to obey without question. An abuser may treat the victim like a servant, child, or even as his or her possession.

Humiliation – An abuser will do everything he or she can to make the victim feel defective in some way. The rationale is that if victims believe that they are worthless and that no one would want them, they are less likely to leave. Insults, name-calling, shaming, and public put-downs are all weapons of abuse designed to chip away at the victim’s self-esteem and make him or her feel powerless.

Isolation – In order to increase a victim’s dependence on him or her, an abusive partner will cut the victim off from the outside world. He or she may keep the victim from seeing family or friends, or even prevent the person from going to work or school. A victim may have to ask permission to do anything, go anywhere, or see anyone.

Threats – Abusers commonly use threats to keep their partners from leaving or to scare them into dropping charges lodged against the abusers. An abuser may threaten to hurt or kill the victim, their children, other family members, or even pets. He or she may also threaten to commit suicide, file false charges against the victim, or report the victim to child services.

Intimidation – An abuser may use a variety of intimidation tactics designed to scare a victim into submission. Examples of intimidation include: making threatening looks or gestures, smashing things in front of the victim, destroying property, hurting their pets, or putting weapons on display. The intended message is that if the victim does not obey the abuser that there will be violent consequences.

Denial and Blame – Abusers are very good at making excuses for the inexcusable behavior. They will blame their abusive and violent behavior on a bad childhood, a bad day, and even on the victims. An abusive partner may minimize the abuse or even deny that it occurred. They often shift the responsibility onto their victim saying it was the victim’s fault for getting them upset.

Why Do Victims Stay with the Abuser?

Victims of domestic violence typically have no place to go because the abuser has isolated them from friends and family. The abuser usually makes sure that victims do not have access to money of so their own in order for them to be able to be on their own. The abuser often demands the victim’s paycheck. Many victims have younger children and worry about how they will provide for their children's needs if they were to leave. Sometimes they have no car to get away because the abuser has made sure they cannot have one. Abusers also threaten to kill the victim if they try to leave. Sadly, many victims have been killed by their abuser in the process of trying to escape.

Sometimes due to religious beliefs, an abused woman will choose to stay in an abusive marriage. Believing that divorce is wrong, she will try and keep her marriage at all costs. Some victims don't believe domestic violence is really a crime and/or that police can protect them.

Victim Safety/Escape Plan

1. Call a shelter or domestic violence hotline.
2. Get all the following items and hide them at a friend’s or neighbor’s house:
Medications and prescriptions
Insurance information
Clothes for yourself and your kids
Birth certificates
Marriage certificate
Social Security cards
Bank information
ATM cards or credit cards
School and medical records
Legal documents
Account numbers for bank accounts
A set of duplicate keys
Save as much money as you can
Remove bullets from any weapons in the home (unload guns, get rid of ammo, hide them)
Make a plan to escape
The first opportunity you have- leave

Precautions Once Away from Abuser

1. If staying in the home, change locks in the house.
2. If staying in the home, install a security system if possible.
3. Teach your children what to do if their safety is at risk.
4. Speak to someone that can help you. There are always qualified people available at a shelter or a hospital.
5. Get a restraining order.

Legal Implications

Statistics show that between 4 and 6 million women are abused and that up to 10 million children witness domestic abuse annually. Many states have laws that mandate the reporting of suspected or known abuse. In Florida, domestic Violence is defined as, “any assault, aggravated assault, battery, aggravated battery, sexual assault, stalking, aggravated stalking, kidnapping, false imprisonment, or any criminal offense resulting in physical injury or death of one family member by another who is in or was residing in the same single dwelling unit.”

The Florida Statute, Section 456.031, updated in 2012, states that healthcare professionals licensed in Florida needs to complete “2-hour continuing education course, approved by the board, on domestic violence, as defined in s. 741.28 (“Domestic violence” means any assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnapping, false imprisonment, or any criminal offense resulting in physical injury or death of one family or household member by another family or household member.), as part of every third biennial relicensure or recertification.”

In 2001, Governor Jeb Bush signed into law a “Family Protection Act” that states that there is a mandatory 5 day jail term for any crime of domestic violence in which the perpetrator deliberately hurts a victim. The law makes a second offense a felony. The offenders are treated and sentenced as criminals.

How to Screen for Domestic Violence

As a healthcare professional you should be aware of how to screen a victim for violence. Some questions to ask are as follows:

• How were you hurt?
• Has this happened before?
• Do you know who hurt you?
• Was there a weapon involved?
• Do you have children?
• Are they hurt?
• Have they been hurt by the abuser?
• Did you report it to the police?
• Does the abuser have a restraining order?
• Did he threaten to kill you?
• Do you have a safe place to go?
• Do you have financial ability to leave the abuser?
• Can I give you the number to the abuse shelter in our area?

It is important to advise those who come to you to report abuse to document what has happened to them in notes. Be certain when documenting their report that you use only objective charting and quote what the victim tells you as fact. Do not add any of your assumptions or judgments in your notes.

National Domestic Violence Hotline Number: 1-800-799-7233
National Abuse Registry 1-800-96ABUSE
National Child Abuse Hotline Number 1-800-962-2873 (1-800-96ABUSE)

References:

Domestic Abuse Intervention Project
www.theduluthmodel.org

Center for Prevention of Sexual and Domestic Violence
www.cpsdv.org

National Coalition against Domestic Violence
www.ncadv.org

Domestic Violence Statistics
http://domesticviolencestatistics.org/domestic-violence-statistics/

2012 Florida Statutes

http://www.flsenate.gov/Laws/Statutes/2012/456.031

http://www.flsenate.gov/Laws/Statutes/2012/741.28

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