Domestic Violence is Serious and Preventable

It’s a Matter of Your Health

One of the biggest problems with domestic abuse is that the abused far too often remain hidden.

Domestic violence is a serious preventable public health problem affecting more than 32 million Americans. It is found in all ages, all socioeconomic groups, ethnicities, gender identities and sexual preferences. Domestic violence is actual or threatened psychological, physical or sexual harm by a current partner or former partner or spouse. It can occur between heterosexual or same sex couples and does not require sexual intimacy.

These relationships often start as verbal and or emotional abuse but may become physical.

The underlying psychological dynamic in most types of violence is power and control of the victim by the abuser.

Too many times the abuse is missed by healthcare providers because the patient may try to conceal that they are in an abusive relationship. They fear what others may think of them. They are extremely vulnerable and anyone dealing with them should approach them in a nonjudgmental and compassionate manner.

Aspects that should heighten your suspicion are as follows:

• Injuries without an adequate explanation for the injury. Such injuries often involve the head, neck, teeth and genital areas.
• Delay in seeking care as the abuser may try to prevent the victim from seeking care.
• Seeing that someone is frequently going to the emergency room or urgent care center and not seeing their primary care provider. Here the abuser does not want the victim to establish a relationship with a primary care provider. They feel that being seen in an ER or urgent care will result in fragmented care and will thus create less suspicion or knowledge of frequent visits.
• Often, victims miss appointments or are not allowed to go to their health care provider.
• Money or transportation maybe withheld by the abuser.
• Pregnancy. If a pregnant woman is late in seeking prenatal care, there is an increased incidence that the pregnant women may be a victim of abuse.
• Repeated abortions. Here sexual assault may result in unplanned pregnancies. Also, the abuser may prevent the victim from obtaining contraception.
• Sometimes victims may be in poor health because they may not have been allowed to take their medications or seek care.
• Inappropriate behavior. They may be jumpy, fearful, or cry easily. Victims sometimes cannot deal with the trauma and they dissociate and appear to not care about anything. Abuse victims may also be evasive about their lives or even hostile when asked about their lives.

When seen in a medical setting, domestic abuse victims may be unwilling to undress for fear of showing bruises. These bruises are primarily on the central body, breast, thighs, and upper arms, areas that can be hidden by clothing. Wounds on the head and neck, especially bruising, may represent attempted strangulation while bruises on the forearms may represent defensive positions.

Psychologically, abuse victims may present as someone with post-traumatic stress syndrome, depression, suicide attempts, anxiety, panic disorders, eating disorders or suffer from substance abuse and poor self esteem. Abuse victims often have a lot of somatic complaints with abdominal pain and pelvic pain.

I am also very leery of a partner who is too attentive and answers questions for the patient. Also, pay attention to whether there is verbal abuse toward that person.

Children who grow up in an abusive environment have a greater chance of being abusers. They need therapy to prevent this and to make sure they are whole and do not accept such treatment in their lives.

Domestic violence is a menacing problem that must be eradicated. Women and men die needlessly. No one should have to live that way.

Veita Bland is a board certified Greensboro physician and hypertension specialist. Email Dr. Bland at ideas@blandclinicpa.com.