A 25-year-old G1P0 presents to your office for a routine return OB visit at 30 weeks. When you listen to the fetal heart tones, you notice that the patient has a number of bruises on her abdomen. You ask her what happened, and she tells you the bruises resulted from a fall she suffered several days earlier, when she slipped on the stairs. The patient returns to your office 3 weeks later for another routine visit, and you note that she has a broken arm in a cast. She says that she fell again. You question her about physical abuse, and the patient begins crying, and reveals a long-standing history of abuse by her husband.
Which of the following is the normal course of an abusive relationship during pregnancy?
IPV affects millions of women, regardless of age, ethnicity, economic status, religion, or sexual orientation. More than one in three women in the United States have experienced rape, physical violence, or stalking in their lifetime. There are 4.8 million incidents reported annually in the United States, but the true incidence is unknown, because victims are afraid to disclose their personal experience of violence. Physical abuse is common in pregnancy, occurring in up to 10% of pregnancies. In women who have been previously abused, about 20% will experience an increase in abuse during pregnancy. Abused women sometimes receive inadequate prenatal care and have more somatic complaints than those who have not been abused. Screening for IPV should be a core part of women’s health visits. It should be done at the first prenatal visit, once per trimester, and at the postpartum visit. Battering is frequently directed toward the breasts and abdomen. Other common sites of injury are the head, neck, chest, and upper extremities. An upper extremity may be fractured as the woman attempts to defend herself.
A 73-year-old woman is brought to your clinic for a gynecological examination by a neighbor for vaginal bleeding. She appears unkempt and frail. Her friend is concerned about abuse by the patient’s family. You interview and examine the patient and make the appropriate referrals for social services.
What is the common type of abuse of the elderly?
As many as 1 in 10 older adults have been victims of elder abuse, and more than 65% of these are women. The U.S. Census data shows significant growth in the population of people older than 65 years, and as the population ages, the incidence of elder abuse is expected to increase. It is estimated that for every case of elder abuse that is reported, 23 cases go undetected. Elder abuse is defined as: “a single or repeated act, or lack of appropriate actions, which causes harm, risk of harm, or distress to a person age 60 or older, and occurs: (1) where there is a relationship with the expectation of trust, or (2) when the act is targeted toward an older person by virtue of age or disability.” Elder abuse may be physical, emotional, sexual, financial exploitation, neglect, self-neglect, and miscellaneous. By far, neglect is the most common form of abuse. It most often occurs at the hands of family members and in the home of the elder. Risk factors include caregiver stress, cognitive impairment of the patient, need for assistance with activities of daily living, conflicts within the family, and poor social support.
You are evaluating a 36-year-old woman in the emergency department for a broken arm. She states that she slipped in the tub. This is the third time you have seen her for a trauma-related injury in the past 6 months. You suspect domestic violence. After treating her broken arm and evaluating her emotional status, which of the following is the next appropriate step in the management of this patient?
Approximately 25% of women treated for injuries in emergency departments are victims of IPV. Victims of IPV sometimes make repeated visits to clinics and emergency rooms with a variety of somatic complaints. Physicians treating these patients correctly make the diagnosis in only 3% of the cases. Most women report that they would be willing to divulge their domestic abuse to a physician if the physician were to ask. Partner abuse may be seen in conjunction with other forms of abuse such as elder abuse and child abuse. Physical injury in cases of IPV usually involves the head and neck, trunk, skin, and extremities. As a physician, you should treat the injuries and assess the emotional needs of the patient from a psychiatric standpoint, such as possible depression or anxiety. If such a condition exists, you should refer the patient to a mental health worker. You should investigate the patient’s own awareness of her situation and her willingness to take appropriate action. The physician’s job is to recognize IPV, and to ensure counseling for the patient so that she understands her rights and options and can protect herself and her children. A victim of abuse may not leave her situation for economic reasons or fear of retribution.
You are evaluating a 36-year-old woman in the emergency department for a broken arm. She states that she slipped in the tub. This is the third time you have seen her for a trauma-related injury in the past 6 months. You suspect domestic violence.
Which of the following is a common characteristic of intimate partner violence (IPV)?
You are seeing a 37-year-old woman in your office for follow-up of an injury related to domestic violence. She states that her husband is over with his abusive behavior and is treating her like royalty. He has bought her a new necklace to show how sorry he is about the incident. She has changed her plans to seek counseling and to move out.
Which of the following is the most likely outcome in this situation?
IPV attacks often run in cycles of three phases. The first phase consists of a buildup of tension with an escalation of friction between family members. It includes name-calling, intimidation, and mild physical abuse. The second phase is the acute battering, which is an uncontrolled discharge of built-up tension. Verbal or physical abuse may occur. Alcohol is involved in two-thirds of cases. The third phase occurs after the abuse has taken place. At this time the batterer apologizes, begs forgiveness, and shows remorse. Abusers will offer gifts and make promises to the victim. They are often very charming in this phase. The cycles repeat themselves, with the first phase becoming longer and increasing in intensity; the battering is usually more severe, and the third phase usually decreases in both length and intensity.
Click to expand