This is common and includes physical, sexual, emotional, and psychological abuse. It is rarely an isolated event, and often escalates in severity and frequency. Do not hesitate to ask directly about this in consultations. Distinguish between generalized aggressors, family only aggressors, and non-family only aggressors. Once violent always violent? This unfair generalization is less likely to be true for family-only aggressors. This an important area because with each subsequent act of violence, guilt is less, at least when women are perpetrators. Violence is not a male-only problem. To respond to violence only as a crime of a single party is a near-guarantee of failure to reduce future violence. Violence can be reduced only by treating each incident of violence as an opportunity for all parties the entire society to explore their own involvement in and responsibilities for violence. Arbitrary punishment of individuals for collective violence is, like most punishment, itself a form of violence. Arbitrary assignment of blame is an evasion of responsibility on the part of the blamer Most existing strategies on violence, which are primarily focussed on blame and criminalisation, are thus inherently counter-productive, resulting in the observed high rates of recidivism.
Epidemiology
35% women experience domestic violence at some time; ~1:10 in the last year. 30% of domestic violence starts in pregnancy. Police record >1 million incidents of domestic violence/yr (1 in 4 of UK assaults). Of women murdered, 40% are killed by a current or ex-partner.
Those who are abused are
5 times more likely to abuse alcohol; 9 times more likely to abuse drugs; 3 times more likely to be diagnosed psychotic or depressed; 5 times more likely to commit suicide; and 15 times more likely to suffer a miscarriage than non-abused women.
Those who work in the health service
should be aware that abuse is common. Those who are abused may attend frequently with trivial or nonexistent complaints; or conversely not attend for treatment because of lack of money. They may minimize signs of violence on the body; be evasive or reluctant to speak in front of partners, and partners may tend to be constantly present so that it may be difficult to talk to the woman alone. This can be particularly difficult if the partner is required for translation purposes: here another translator should be sought who is not from the family.
Social Services
can help women disclose violence (eg after unexplained injury etc). Ask about abuse in antenatal clinics so that issues can be addressed before injury. Involve social services if children are involved.
Refuge
The Women's Aid Federation (0345 023468UK) can provide legal advice, emotional support, and refuge. The police may also help.
Court orders
are obtainable quickly, and may be the only way to prevent someone going near a previous victim. They may also require someone to leave home, or let the victim return home. They are not a long-term solution, but are life savers in emergency. In the UK, Law Centres give access to legal protection: to find the nearest, phone 0207 387 8570. Alternatively, the patient's solicitor may be available. The police may also need calling.
Prevention
Lack of full-time employment is a leading predictor of who is going to get abused but simply saying go out and get a job may be un- helpful if child-care issues cannot be sorted out.
See also Child abuse. Parent-child interaction therapy (PCIT)1 is one validated way of reducing family violence (compared with controls who simply have standard community-based interventions). This offers practical help in recognizing antecedent events which tend to trigger violence.
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