domestic abuse, abuse or violence commonly describing spouse or partner abuse, including physical and/or sexual violence (use of physical force) or threats of such violence or psychological and/or emotional abuse and/or coercive tactics. Also called intimate partner violence. ▪ OBSERVATIONS: The individual may have no obvious signs of physical injury, but may present with vague complaints, such as sleep and appetite disturbances, fatigue, dizziness, weight change, and symptoms associated with depression, anxiety, or posttraumatic stress. Illnesses, such as gastrointestinal and autoimmune disorders, have also been associated with abuse. Women also seek help for problems that are seemingly unrelated to abuse (e.g., a blood pressure check, a routine physical, treatment of allergies, or an upper respiratory infection). Physical abuse signs include bruising (face, neck, arms, legs, abdomen, or back), cuts, broken bones, black eyes, burns, marks of strangulation, wounds or bruises at different stages of healing, and swelling or puffiness in the face or around the eyes. Other signs include a history that does not match the presenting injuries and reports of being hit or injured. Signs of sexual abuse include bruising around the breasts or genitalia; genitalia, vaginal, or rectal swelling or lacerations; torn, stained, or bloody underclothing; and reports of being assaulted or raped. Manifestations of emotional abuse include reports of intimidation (such as looks, gestures, yelling, and throwing objects), threats to harm children, isolation from family and friends, and economic domination. The Abuse Assessment Screen is used for initial screening and is used for all high-risk individuals. Further definitive diagnosis is typically made by social service, health care, and legal experts after a more detailed history, investigation, and physical examination. Severe injury, disfigurement, and death are all complications of chronic and/or severe physical abuse. ▪ INTERVENTIONS: Obvious signs of abuse should be reported immediately to appropriate local authorities for prompt investigation and victim protection. If the individual is perceived to be in immediate danger, protection should be sought through local Adult Protective Services or county Department of Social Services. Vague or inconsistent manifestations should be documented and referred for further evaluation and investigation. ▪ PATIENT CARE CONSIDERATIONS: Health care providers serve as a frontline resource for the detection, intervention, and prevention of domestic abuse. This includes the identification of high-risk dependent domestic relationships, such as previous history of abuse or violence, feelings of worthlessness, inability to trust, high index of suspicion, substance abuse, depression, social isolation, financial dependence, poverty, homelessness, unemployment, intense family responsibilities, and inappropriate or fearful interaction patterns with spouse. Referrals for counseling to prevent or halt abuse and placement for safe haven are needed. Social agency referrals should be made for financial assistance, food, clothing, and shelter needs. Prevention activities center on raising individual and community awareness through education about the incidence and causes of domestic violence, provision of empowerment and assertiveness training, and screening of all women ages 14 and older as required of all health care settings by The Family Violence Prevention Fund and The Joint Commission on Healthcare.
