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Domestic Violence
Continuing Education Activity
Family and domestic violence is a common problem in the United States, affecting an estimated 10 million people every year; as many as one in four women and one in nine men are victims of domestic violence. Virtually all healthcare professionals will at some point evaluate or treat a patient who is a victim of domestic or family violence. Domestic and family violence includes economic, physical, sexual, emotional, and psychological abuse of children, adults, or elders. Domestic violence causes worsened psychological and physical health, decreased quality of life, decreased productivity, and in some cases, mortality. Domestic and family violence can be difficult to identify. Many cases are not reported to health professionals or legal authorities. This activity describes the evaluation, reporting, and management strategies for victims of domestic abuse and stresses the role of team-based interprofessional care for these victims.
Objectives:
Identify the epidemiology of domestic violence.
Describe the types of domestic violence.
Explain challenges associated with reporting domestic violence.
Review some interprofessional team strategies for improving care coordination and communication to identify domestic violence and improve outcomes for its victims.
Introduction
Family and domestic violence including child abuse, intimate partner abuse, and elder abuse is a common problem in the United States. Family and domestic health violence are estimated to affect 10 million people in the United States every year. It is a national public health problem, and virtually all healthcare professionals will at some point evaluate or treat a patient who is a victim of some form of domestic or family violence.[1][2][3][4][5]
Unfortunately, each form of family violence begets interrelated forms of violence. The "cycle of abuse" is often continued from exposed children into their adult relationships and finally to the care of the elderly.
Domestic and family violence includes a range of abuse, including economic, physical, sexual, emotional, and psychological, toward children, adults, and elders.
Intimate partner violence includes stalking, sexual and physical violence, and psychological aggression by a current or former partner. In the United States, as many as one in four women and one in nine men are victims of domestic violence. Domestic violence is thought to be underreported. Domestic violence affects the victim, families, co-workers, and community. It causes diminished psychological and physical health, decreases the quality of life, and results in decreased productivity.
The national economic cost of domestic and family violence is estimated to be over 12 billion dollars per year. The number of individuals affected is expected to rise over the next 20 years, increasing the elderly population.
Domestic and family violence is difficult to identify, and many cases go unreported to health professionals or legal authorities. Due to the prevalence in our society, all healthcare professionals, including psychologists, nurses, pharmacists, dentists, physician assistants, nurse practitioners, and physicians, will evaluate and possibly treat a victim or perpetrator of domestic or family violence.[6][7]
Definitions
Family and domestic violence are abusive behaviors in which one individual gains power over another individual.
Intimate partner violence typically includes sexual or physical violence, psychological aggression, and stalking. This may include former or current intimate partners.
Child abuse involves the emotional, sexual, physical, or neglect of a child under 18 by a parent, custodian, or caregiver that results in potential harm, harm, or a threat of harm.
Elder abuse is a failure to act or an intentional act by a caregiver that causes or creates a risk of harm to an elder.
Center for Disease Control and Prevention (CDC)
Domestic violence, spousal abuse, battering, or intimate partner violence, is typically the victimization of an individual with whom the abuser has an intimate or romantic relationship. The CDC defines domestic violence as "physical violence, sexual violence, stalking, and psychological aggression (including coercive acts) by a current or former intimate partner."
Domestic and family violence has no boundaries. This violence occurs in intimate relationships regardless of culture, race, religion, or socioeconomic status. All healthcare professionals must understand that domestic violence, whether in the form of emotional, psychological, sexual, or physical violence, is common in our society and should develop the ability to recognize it and make the appropriate referral.
Violence Abuse Types
The types of violence include stalking, economic, emotional or psychological, sexual, neglect, Munchausen by proxy, and physical. Domestic and family violence occurs in all races, ages, and sexes. It knows no cultural, socioeconomic, education, religious, or geographic limitation. It may occur in individuals with different sexual orientations.
Etiology
Reason Abusers Need to Control[8][9][10]
Anger management issues
Jealousy
Low self-esteem
Feeling inferior
Cultural beliefs they have the right to control their partner
Personality disorder or psychological disorder
Learned behavior from growing up in a family where domestic violence was accepted
Alcohol and drugs, as an impaired individual may be less likely to control violent impulses
Risk Factors
Risk factors for domestic and family violence include individual, relationship, community, and societal issues. There is an inverse relationship between education and domestic violence. Lower education levels correlate with more likely domestic violence. Childhood abuse is commonly associated with becoming a perpetrator of domestic violence as an adult. Perpetrators of domestic violence commonly repeat acts of violence with new partners. Drug and alcohol abuse greatly increases the incidence of domestic violence.
Children who are victims or witness domestic and family violence may believe that violence is a reasonable way to resolve a conflict. Males who learn that females are not equally respected are more likely to abuse females in adulthood. Females who witness domestic violence as children are more likely to be victimized by their spouses. While females are often the victim of domestic violence, gender roles can be reversed.
Domination may include emotional, physical, or sexual abuse that may be caused by an interaction of situational and individual factors. This means the abuser learns violent behavior from their family, community, or culture. They see violence and are victims of violence.
Epidemiology
Domestic violence is a serious and challenging public health problem. Approximately 1 in 3 women and 1 in 10 men 18 years of age or older experience domestic violence. Annually, domestic violence is responsible for over 1500 deaths in the United States.[11][12][13]
Domestic violence victims typically experience severe physical injuries requiring care at a hospital or clinic. The cost to individuals and society is significant. The national annual cost of medical and mental health care services related to acute domestic violence is estimated at over $8 billion. If the injury results in a long-term or chronic condition, the cost is considerably higher.
Financial hardship and unemployment are contributors to domestic violence. An economic downturn is associated with increased calls to the National Domestic Violence Hotline.
Fortunately, the national rate of nonfatal domestic violence is declining. This is thought to be due to a decline in the marriage rate, decreased domesticity, better access to domestic violence shelters, improvements in female economic status, and an increase in the average age of the population.
National
Most perpetrators and victims do not seek help.
Healthcare professionals are usually the first individuals with an opportunity to identify domestic violence.
Nurses are usually the first healthcare providers victims encounter.
Domestic violence may be perpetrated on women, men, parents, and children.
Fifty percent of women seen in emergency departments report a history of abuse, and approximately 40% of those killed by their abuser sought help in the 2 years before death.
Only one-third of police-identified victims of domestic violence are identified in the emergency department.
Healthcare professionals who work in acute care need to maintain a high index of suspicion for domestic violence as supportive family members may, in fact, be abusers.
Child Abuse
Age, family income, and ethnicity are all risk factors for both sexual abuse and physical abuse. Gender is a risk factor for sexual abuse but not for physical abuse.
Each year there are over 3 million referrals to child protective authorities. Despite often being the first to examine the victims, only about 10% of the referrals were from medical personnel. The fatality rate is approximately two deaths per 100,000 children. Women account for a little over half of the perpetrators.
Intimate Partner Violence
According to the CDC, 1 in 4 women and 1 in 7 men will experience physical violence by their intimate partner at some point during their lifetimes. About 1 in 3 women and nearly 1 in 6 men experience some form of sexual violence during their lifetimes. Intimate partner violence, sexual violence, and stalking are high, with intimate partner violence occurring in over 10 million people each year.
One in 6 women and 1 in 19 men have experienced stalking during their lifetimes. The majority are stalked by someone they know. An intimate partner stalks about 6 in 10 female victims and 4 in 10 male victims.
At least 5 million acts of domestic violence occur annually to women aged 18 years and older, with over 3 million involving men. While most events are minor, for example grabbing, shoving, pushing, slapping, and hitting, serious and sometimes fatal injuries do occur. Approximately 1.5 million intimate partner female rapes and physical assaults are perpetrated annually, and approximately 800,000 male assaults occur. About 1 in 5 women have experienced completed or attempted rape at some point in their lives. About 1% to 2% of men have experienced completed or attempted rape.
The incidence of intimate partner violence has declined by over 60%, from about ten victimizations per 1000 persons age 12 or older to approximately 4 per 1000.
Elderly
Due to underreporting and difficulty sampling, obtaining accurate incidence information on elder abuse and neglect is difficult. Elderly abuse is thought to occur in 3% to 10% of the population of elders.
Elderly patients may not report due to fear, guilt, ignorance, or shame. Clinicians underreport elder abuse due to poor recognition of the problem, lack of understanding of reporting methods and requirements, and concerns about physician-patient confidentiality.
Pathophysiology
There may be some pathologic findings in both the victims and perpetrators of domestic violence. Certain medical conditions and lifestyles make family and domestic violence more likely.[13][14][15]
Perpetrators
While the research is not definitive, a number of characteristics are thought to be present in perpetrators of domestic violence. Abusers tend to:
Have a higher consumption of alcohol and illicit drugs and assessment should include questions that explore drinking habits and violence
Be possessive, jealous, suspicious, and paranoid.
Be controlling of everyday family activity, including control of finances and social activities.
Suffer low self-esteem
Have emotional dependence, which tends to occur in both partners, but more so in the abuser
Children
Domestic violence at home results in emotional damage, which exerts continued effects as the victim matures.
Approximately 45 million children will be exposed to violence during childhood.
Approximately 10% of children are exposed to domestic violence annually, and 25% are exposed to at least 1 event during their childhood.
Ninety percent are direct eyewitnesses of violence.
Males who batter their wives batter the children 30% to 60% of the time.
Children who witness domestic violence are at increased risk of dating violence and have a more difficult time with partnerships and parenting.
Children who witness domestic violence are at an increased risk for post-traumatic stress disorder, aggressive behavior, anxiety, impaired development, difficulty interacting with peers, academic problems, and they have a higher incidence of substance abuse.
Children exposed to domestic violence often become victims of violence.
Children who witness and experience domestic violence are at a greater risk for adverse psychosocial outcomes.
Eighty to 90% of domestic violence victims abuse or neglect their children.
Abused teens may not report abuse. Individuals 12 to 19 years of age report only about one-third of crimes against them, compared with one-half in older age groups
Pregnant and Females
The American College of Obstetricians and Gynecologists (ACOG) recommends all women be assessed for signs and symptoms of domestic violence during regular and prenatal visits. Providers should offer support and referral information.
Domestic violence affects approximately 325,000 pregnant women each year.
The average reported prevalence during pregnancy is approximately 30% emotional abuse, 15% physical abuse, and 8% sexual abuse.
Domestic violence is more common among pregnant women than preeclampsia and gestational diabetes.
Reproductive abuse may occur and includes impregnating against a partner's wishes by stopping a partner from using birth control.
Since most pregnant women receive prenatal care, this is an excellent time to assess for domestic violence.
The danger of domestic violence is particularly acute as both mother and fetus are at risk. Healthcare professionals should be aware of the psychological consequences of domestic abuse during pregnancy. There is more stress, depression, and addiction to alcohol in abused pregnant women. These conditions may harm the fetus.
Gay, Lesbian, Bisexual, and Transgender
Domestic violence occurs in gay, lesbian, bisexual, and transgender couples, and the rates are thought to be similar to a heterosexual woman, approximately 25%.
There are more cases of domestic violence among males living with male partners than among males who live with female partners.
Females living with female partners experience less domestic violence than females living with males.
Transgender individuals have a higher risk of domestic violence. Transgender victims are approximately two times more likely to experience physical violence.
Gay, lesbian, bisexual, and transgender victims may be reticent to report domestic violence. Part of the challenge may be that support services such as shelters, support groups, and hotlines are not regularly available. This results in isolated and unsupported victims. Healthcare professionals should strive to be helpful when working with gay, lesbian, bisexual, and transgender patients.
Men
Usually, domestic violence is perpetrated by men against women; however, females may exhibit violent behavior against their male partners.
Approximately 5% of males are killed by their intimate partners.
Each year, approximately 500,000 women are physically assaulted or raped by an intimate partner compared to 100,000 men.
Three out of 10 women at some point are stalked, physically assaulted, or raped by an intimate partner, compared to 1 out of every 10 men.
Rape is primarily perpetrated by other men, while women engage in other forms of violence against men.
Although women are the most common victims of domestic violence, healthcare professionals should remember that men may also be victims and should be evaluated if there are indications present.
Elderly
The elderly are often mistreated by their spouses, children, or relatives.
Annually, approximately 2% of the elderly experience physical abuse, 1% sexual abuse, 5% neglect, 5% financial abuse, and 5% suffer emotional abuse.
The annual incidence of elder abuse is estimated to be 2% to 10%, with only about 1 in 15 cases reported to the authorities.
Approximately one-third of nursing homes disclosed at least 1 incident of physical abuse per year.
Ten percent of nursing home staff self-report physical abuse against an elderly resident.
Elder domestic violence may be financial or physical. The elderly may be controlled financially. Elders are often hesitant to report this abuse if it is their only available caregiver. Victims are often dependent, infirm, isolated, or mentally impaired. Healthcare professionals should be aware of the high incidence of abuse in this population.
History and Physical
The history and physical exam should be tailored to the age of the victim.
Child Abuse
The most common injuries are fractures, contusions, bruises, and internal bleeding. Unexpected injuries to pre-walking infants should be investigated. The caregiver should explain unusual injuries to the ears, neck, or torso; otherwise, these injuries should be investigated.
Children who are abused may be unkempt and/or malnourished. They may display inappropriate behavior such as aggression, or maybe shy, withdrawn, and have poor communication skills. Others may be disruptive or hyperactive. School attendance is usually poor.
Intimate Partner Abuse
Approximately one-third of women and one-fifth of men will be victims of abuse. The most common sites of injuries are the head, neck, and face. Clothes may cover injuries to the body, breasts, genitals, rectum, and buttocks. One should be suspicious if the history is not consistent with the injury. Defensive injuries may be present on the forearms and hands. The patient may have psychological signs and symptoms such as anxiety, depression, and fatigue.
Medical complaints may be specific or vague such as headaches, palpitations, chest pain, painful intercourse, or chronic pain.
Intimate Partner Abuse: Pregnancy and Female
Abuse during pregnancy may cause as much as 10% of pregnant hospital admissions. There are a number of historical and physical findings that may help the provider identify individuals at risk.
If the examiner encounters signs or symptoms, she should make every effort to examine the patient in private, explaining confidentiality to the patient. Be sure to ask caring, empathetic questions and listen politely without interruption to answers.
Intimate Partner Abuse: Same-Sex
Same-sex partner abuse is common and may be difficult to identify. Over 35% of heterosexual women, 40% of lesbians, 60% of bisexual women experience domestic violence. For men, the incidence is slightly lower. In addition to common findings of abuse, perpetrators may try to control their partners by threatening to make their sexual preferences public.
The provider should be aware there are fewer resources available to help victims; further, the perpetrator and victim may have the same friends or support groups.
Intimate Partner Abuse: Men
Men represent as much as 15% of all cases of domestic partner violence. Male victims are also less likely to seek medical care, so that the incidence may be underreported. These victims may have a history of child abuse.
Elderly Abuse
Health professionals should ask geriatric patients about abuse, even if signs are absent.
Risk Factors
Dementia
Pathologic characteristics of perpetrators including dementia, mental illness, and drug and alcohol abuse
A shared living situation with the abuser
Social isolation
Evaluation
Establishing that injuries are related to domestic abuse is a challenging task. Life and limb-threatening injuries are the priority. After stabilization and physical evaluation, laboratory tests, x-rays, CT, or MRI may be indicated. It is important that healthcare professionals first attend to the underlying issue that brought the victim to the emergency department.[1][16][17][18]
The evaluation should start with a detailed history and physical examination. Clinicians should screen all females for domestic violence and refer females who screen positive. This includes females who do not have signs or symptoms of abuse. All healthcare facilities should have a plan in place that provides for assessing, screening, and referring patients for intimate partner violence. Protocols should include referral, documentation, and follow-up.
Health professionals and administrators should be aware of challenges such as barriers to screening for domestic violence: lack of training, time constraints, the sensitive nature of issues, and a lack of privacy to address the issues.
Although professional and public awareness has increased, many patients and providers are still hesitant to discuss abuse.
Patients with signs and symptoms of domestic violence should be evaluated. The obvious cues are physical: bruises, bites, cuts, broken bones, concussions, burns, knife or gunshot wounds.
Typical domestic injury patterns include contusions to the head, face, neck, breast, chest, abdomen, and musculoskeletal injuries. Accidental injuries more commonly involve the extremities of the body. Abuse victims tend to have multiple injuries in various stages of healing, from acute to chronic.
Domestic violence victims may have emotional and psychological issues such as anxiety and depression. Complaints may include backaches, stomachaches, headaches, fatigue, restlessness, decreased appetite, and insomnia. Women are more likely to experience asthma, irritable bowel syndrome, and diabetes.
Assessment
Assuming the patient is stable and not in pain, a detailed assessment of victims should occur after disclosure of abuse. Assessing safety is the priority. A list of standard prepared questions can help alleviate the uncertainty in the patient's evaluation. If there are signs of immediate danger, refer to advocate support, shelter, a hotline for victims, or legal authorities.
If there is no immediate danger, the assessment should focus on mental and physical health and establish the history of current or past abuse. These responses determine the appropriate intervention.
During the initial assessment, a practitioner must be sensitive to the patient’s cultural beliefs. Incorporating a cultural sensitivity assessment with a history of being victims of domestic violence may allow more effective treatment.
Patients that have suffered domestic violence may or may not want a referral. Many are fearful of their lives and financial well-being. They hence may be weighing the tradeoff in leaving the abuser leading to loss of support and perhaps the responsibility of caring for children alone. The healthcare provider needs to assure the patient that the decision is voluntary and that the provider will help regardless of the decision. The goal is to make resources accessible, safe, and enhance support.
If the patient elects to leave their current situation, information for referral to a local domestic violence shelter to assist the victim should be given.
If there is a risk to life or limb, or evidence of injury, the patient should be referred to local law enforcement officials.
Counselors often include social workers, psychiatrists, and psychologists that specialize in the care of battered partners and children.
Testing
Children
A detailed history and careful physical exam should be performed. If head trauma is suspected, consider an ophthalmology consultation to obtain indirect ophthalmoscopy.
Laboratory
Laboratory studies are often important for forensic evaluation and criminal prosecution. On occasion, certain diseases may mimic findings similar to child abuse. As a consequence, they must be ruled out.
Urine
A urine test may be used as a screen for sexually transmitted disease, bladder or kidney trauma, and toxicology screening.
Hematology
If bruises or contusions are present, there is no need to evaluate for a bleeding disorder if the injuries are consistent with an abuse history. Some tests can be falsely elevated, so a child abuse-specialist pediatrician or hematologist should review or follow-up these tests.
Gastrointestinal and Chest Trauma
Consider liver and pancreas screening tests such as AST, ALT, and lipase. If the AST or ALT is greater than 80 IU/L, or lipase greater than 100 IU/L, consider an abdomen and pelvis CT with intravenous contrast.
The highest-risk are those with abusive head trauma, fractures, nausea, vomiting, or an abnormal Glasgow Coma Scale score of less than 15.
Imaging
The evaluation of the pediatric skeleton can prove challenging for a non-specialist as there are subtle differences from adults, such as cranial sutures and incomplete bone growth. A fracture can be misinterpreted. If there is a concern for abuse, consider consulting a radiologist.
Imaging: Skeletal Survey
A skeletal survey is indicated in children younger than 2 years with suspected physical abuse. The incidence of occult fractures is as high as 1 in 4 in physically abused children younger than 2 years. The clinician should consider screening all siblings younger than 2 years.
The skeletal survey should include 2 views of each extremity; anteroposterior and lateral skull; and lateral chest, spine, abdomen, pelvis, hands, and feet. A radiologist should review the films for classic metaphyseal lesions and healing fractures, most often involving the posterior ribs. A “babygram” that includes only 1 film of the entire body is not an adequate skeletal survey.
Skeletal fractures will remodel at different rates, which are dependent on the age, location, and nutritional status of the patient.
Imaging: CT
If abuse or head trauma is suspected, a CT scan of the head should be performed on all children aged six months or younger or children younger than 24 months if intracranial trauma is suspected. Clinicians should have a low threshold to obtain a CT scan of the head when abuse is suspected, especially in an infant younger than 12 months.
CT of the abdomen and pelvis with intravenous contrast is indicated in unconscious children, have traumatic abdominal findings such as abrasions, bruises, tenderness, absent or decreased bowel sounds, abdominal pain, nausea, or vomiting, or have elevation of the AST, an ALT greater than 80 IU/L, or lipase greater than 100 IU/L.
Special Documentation
Photographs should be taken before treatment of injuries.
Intimate Partner and Elder
Laboratory
Evaluate for evidence of dehydration, electrolyte abnormalities, infection, substance abuse, improper medication administration, and malnutrition.
Imaging
X-rays of bruised of tender body parts to detect fractures
Head CT scan to evaluate for intracranial bleeding as a result of abuse or the causes of altered mental status
Other
Pelvic examination with evidence collection if sexual assault
Evidence Collection
Domestic and family violence commonly results in the legal prosecution of the perpetrator. Preferably, a team specializing in domestic violence is called in to assist with evidence collection.
Each health facility should have a written procedure for how to package and label specimens and maintain a chain of custody. Law enforcement personnel will often assist with evidence collection and provide specific kits.
It is important to avoid destroying evidence. Evidence includes tissue specimens, blood, urine, saliva, and vaginal and rectal specimens. Saliva from bites can be collected; the bite mark is swabbed with a water-moistened cotton-tipped swab.
Clothing stained with blood, saliva, semen, and vomit should be retained for forensic analysis.
Treatment / Management
The priority is the ABCs and appropriate treatment of the presenting complaints. However, once the patient is stabilized, emergency medical services personnel may identify problems associated with violence.[19][20][21]
Emergency Department and Office Care
Interventions to consider include:
Make sure a safe environment is provided.
Diagnose physical injuries and other medical or surgical problems.
Treat acute physical or life-threatening injuries.
Identify possible sources of domestic violence.
Establish domestic violence as a diagnosis.
Reassure the patient that he is not at fault.
Evaluate the emotional status and treat.
Document the history, physical, and interventions.
Determine the risks to the victim and assess safety options.
Counsel the patient that violence may escalate.
Determine if legal intervention is needed and report abuse when appropriate or mandated.
Develop a follow-up plan.
Offer shelter options, legal services, counseling, and facilitate such referral.
Medical Record
The medical record is often evidence used to convict an abuser. A poorly document chart may result in an abuser going free and assaulting again.
Charting should include detailed documentation of evaluation, treatment, and referrals.
Describe the abusive event and current complaints using the patient's own words.
Include the behavior of the patient in the record.
Include health problems related to the abuse.
Include the alleged perpetrator's name, relationship, and address.
The physical exam should include a description of the patient's injuries including location, color, size, amount, and degree of age bruises and contusions.
Document injuries with anatomical diagrams and photographs.
Include the name of the patient, medical record number, date, and time of the photograph, and witnesses on the back of each photograph.
Torn and damaged clothing should also be photographed.
Document injuries not shown clearly by photographs with line drawings.
With sexual assault, follow protocols for physical examination and evidence collection.
Disposition
If the patient does not want to go to a shelter, provide telephone numbers for domestic violence or crisis hotlines and support services for potential later use. Provide the patient with instructions but be mindful that written materials may pose a danger once the patient returns home.
A referral should be made to primary care or another appropriate resource.
Advise the patient to have a safety plan and provide examples.
Remember
Forty percent of domestic violence victims never contact the police.
Of female victims of domestic homicide, 44% had visited a hospital emergency department within 2 years of their murder.
Health professionals provide an opportunity for victims of domestic violence to obtain help.
Differential Diagnosis
The differential diagnosis varies with the injury type of injury and age.
Child
Head Trauma
Accidental injury
Arteriovenous malformations
Bacterial meningitis
Birth trauma
Cerebral sinovenous thrombosis
Hemophilia
Solid brain tumors
Bruises and Contusions
Accidental bruises
Birth trauma
Bleeding disorder
Coining
Cupping
Congenital dermal melanocytosis (Mongolian spots)
Erythema multiforme
Hemangioma
Hemophilia
Burns
Accidental burns
Atopic dermatitis
Contact dermatitis
Impetigo
Inflammatory skin conditions
Sunburn
Fractures
Accidental
Birth trauma
Congenital syphilis
Malignancy
Osteogenesis imperfecta
Osteomyelitis
Rickets
Scurvy
Toddler’s fracture
Prognosis
Without proper social service and mental health intervention, all forms of abuse can be recurrent and escalating problems, and the prognosis for recovery is poor. Without treatment, domestic and family violence usually recurs and escalates in both frequency and severity.[3][22][23]
Of those injured by domestic violence, over 75% continue to experience abuse.
Over half of battered women who attempt suicide will try again; often they are successful with the second attempt.
In children, the potential for poor outcomes is particularly high as abuse inflicts lifelong effects. In addition to dealing with the sequelae of physical injury, the mental consequences may be catastrophic. Studies indicate a significant association between child sexual abuse and increased risk of psychiatric disorders in later life. The potential for the cycle of violence to continued from childhood is very high.
Children raised in families of sexual abuse may develop:
Attention deficit hyperactivity disorder (ADHD)
Conduct disorder
Depression
Bipolar disorder
Panic disorder
Sleep disorders
Suicide attempts
Post-traumatic stress disorder (PTSD)
Health Outcomes
There are multiple known and suspected negative health outcomes of family and domestic violence. There are long-term consequences to broken bones, traumatic brain injuries, and internal injuries.
Patients may also develop multiple comorbidities such as:
Asthma
Insomnia
Fibromyalgia
Headaches
High blood pressure
Chronic pain
Gastrointestinal disorders
Gynecologic disorders
Depression
Panic attacks
PTSD
Pearls and Other Issues
Screening: Tools
The American Academy of Pediatricians has free guides for the history, physical, diagnostic testing, documentation, treatment, and legal issues in cases of suspected child abuse.
The Center for Disease Control and Prevention (CDC) provides several scales assessing family relationships, including child abuse risks.
The physical examination is still the most significant diagnostic tool to detect abuse. A child or adult with suspected abuse should be undressed, and a comprehensive physical exam should be performed. The skin should be examined for bruises, bites, burns, and injuries in different stages of healing. Examine for retinal hemorrhages, subdural hemorrhages, tympanic membrane rupture, soft tissue swelling, oral bruising, fractured teeth, and organ injury.
Screening: Recommendations
Evaluate for organic conditions and medications that mimic abuse.
Evaluate patients and caregivers separately
Clinicians should regularly screen for family and domestic violence and elder abuse
The Elder Abuse Suspicion Index can be used to assess for elder abuse
Screen for cognitive impairment before screening for abuse in the elderly
Pattern injury is more suspicious
Risks
Failure to report child abuse is illegal in most states.
Failure to report intimate partner and elder abuse is illegal in many states.
Legal
It is important to be aware of federal and state statutes governing domestic and family abuse. Remember that reporting domestic and family violence to law enforcement does not obviate detailed documentation in the medical record.
Battering is a crime, and the patient should be made aware that help is available. If the patient wants legal help, the local police should be called.
In some jurisdictions, domestic violence reporting is mandated. The legal obligation to report abuse should be explained to the patient.
The patient should be informed how local authorities typically respond to such reports and provide follow-up procedures. Address the risk of reprisal, need for shelter, and possibly an emergency protective order (available in every state and the District of Columbia).
If there is a possibility the patient’s safety will be jeopardized, the clinician should work with the patient and authorities to best protect the patient while meeting legal reporting obligations.
The clinical role in managing an abused patient goes beyond obeying the laws that mandate reporting; there is a primary obligation to protect the life of the patient.
The clinician must help mitigate the potential harm that results from reporting, provide appropriate ongoing care, and preserve the safety of the patient.
If the patient desires, and it is acceptable to the police, a health professional should remain during the interview.
The medical record should reflect the incident as described by the patient and any physical exam findings. Include the date and time the report was taken and the officer's name and badge number.
National Statutes
Federal Child Abuse Prevention and Treatment Act (CAPTA)
Each state has specific child abuse statutes. Federal legislation provides guidelines for defining acts that constitute child abuse. The guidelines suggest that child abuse includes an act or failure recent act that presents an imminent risk of serious harm. This includes any recent act or failure to act on the part of a parent or caretaker that results in death, physical or emotional harm, sexual abuse, or exploitation.
Elder Justice Act
The Elder Justice Act provides strategies to decrease the likelihood of elder abuse, neglect, and exploitation. The Act utilizes three significant approaches:
Patient Safety and Abuse Act
The Violence Against Woman Act makes it a federal crime to cross state lines to stalk, harass, or physically injure a partner; or enter or leave the country violating a protective order. It is a violation to possess a firearm or ammunition while subject to a protective order or if convicted of a qualifying crime of domestic violence.
Enhancing Healthcare Team Outcomes
Domestic violence may be difficult to uncover when the victim is frightened, especially when he or she presents to an emergency department or healthcare practitioner's office. The key is to establish an assessment protocol and maintain an awareness of the possibility that domestic and family violence may be the cause of the patient’s signs and symptoms.
Over 80% of victims of domestic and family violence seek care in a hospital; others may seek care in health professional offices, including dentists, therapists, and other medical offices. Routine screening should be conducted by all healthcare practitioners including nurses, physicians, physician assistants, dentists, nurse practitioners, and pharmacists. Interprofessional coordination of screening is a critical component of protecting victims and minimizing negative health outcomes. Health professional team interventions reduce the incidence of morbidity and mortality associated with domestic violence. Documentation is vital and a legal obligation.
Healthcare professionals including the nurse should document all findings and recommendations in the medical record, including statements made denying abuse
If domestic violence is admitted, documentation should include the history, physical examination findings, laboratory and radiographic finds, any interventions, and the referrals made.
If there are significant findings that can be recorded, pictures should be included.
The medical record may become a court document; be objective and accurate.
Healthcare professionals should provide a follow-up appointment.
Reassurance that additional assistance is available at any time is critical to protect the patient from harm and break the cycle of abuse.
Involve the social worker early
Do not discharge the patient until a safe haven has been established.
Resources
National
The following agencies provide national assistance for victims of domestic and family violence:
Centers for Disease Control and Prevention (800-CDC-INFO (232-4636)/TTY: 888-232-6348
Childhelp: National Child Abuse Hotline: (800-4-A-CHILD (2-24453))
The coalition of Labor Union Women (cluw.org): 202-466-4615
Corporate Alliance to End Partner Violence: 309-664-0667
Employers Against Domestic Violence: 508-894-6322
Futures without Violence: 415-678-5500/TTY 800-595-4889
Love Is Respect: National Teen Dating Abuse Helpline: 866-331-9474 /TTY: 866-331-8453
National Center on Domestic and Sexual Violence
National Center on Elder Abuse
National Coalition Against Domestic Violence (www.ncadv.org)
National Network to End Domestic Violence: 202-543-5566
National Organization for Victim Assistance
National Resource Center on Domestic Violence: 800-537-2238
National Sexual Violence Resource Center: 717-909-0710
References
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Klein LB, Chesworth BR, Howland-Myers JR, Rizo CF, Macy RJ. Housing Interventions for Intimate Partner Violence Survivors: A Systematic Review. Trauma Violence Abuse. 2021 Apr;22(2):249-264. [PubMed: 30913998]
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Marie-Mitchell A, Kostolansky R. A Systematic Review of Trials to Improve Child Outcomes Associated With Adverse Childhood Experiences. Am J Prev Med. 2019 May;56(5):756-764. [PubMed: 30905481]
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Lewis NV, Dowrick A, Sohal A, Feder G, Griffiths C. Implementation of the Identification and Referral to Improve Safety programme for patients with experience of domestic violence and abuse: A theory-based mixed-method process evaluation. Health Soc Care Community. 2019 Jul;27(4):e298-e312. [PMC free article: PMC6617800] [PubMed: 30868711]
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Sarkar R, Ozanne-Smith J, Bassed R. Systematic Review of the Patterns of Orofacial Injuries in Physically Abused Children and Adolescents. Trauma Violence Abuse. 2021 Jan;22(1):136-146. [PubMed: 30852989]
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Gao S, Assink M, Liu T, Chan KL, Ip P. Associations Between Rejection Sensitivity, Aggression, and Victimization: A Meta-Analytic Review. Trauma Violence Abuse. 2021 Jan;22(1):125-135. [PubMed: 30813848]
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Zeppegno P, Gramaglia C, di Marco S, Guerriero C, Consol C, Loreti L, Martelli M, Marangon D, Carli V, Sarchiapone M. Intimate Partner Homicide Suicide: a Mini-Review of the Literature (2012-2018). Curr Psychiatry Rep. 2019 Feb 21;21(3):13. [PubMed: 30788614]
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Hackenberg EAM, Sallinen V, Handolin L, Koljonen V. Victims of Severe Intimate Partner Violence Are Left Without Advocacy Intervention in Primary Care Emergency Rooms: A Prospective Observational Study. J Interpers Violence. 2021 Aug;36(15-16):7832-7854. [PubMed: 30913955]
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Gottlieb A, Mahabir M. The Effect of Multiple Types of Intimate Partner Violence on Maternal Criminal Justice Involvement. J Interpers Violence. 2021 Jul;36(13-14):6797-6820. [PubMed: 30600751]
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Harland KK, Peek-Asa C, Saftlas AF. Intimate Partner Violence and Controlling Behaviors Experienced by Emergency Department Patients: Differences by Sexual Orientation and Gender Identification. J Interpers Violence. 2021 Jun;36(11-12):NP6125-NP6143. [PMC free article: PMC7034778] [PubMed: 30465625]
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Jiang Y, DeBare D, Colomer I, Wesley J, Seaberry J, Viner-Brown S. Characteristics of Victims and Suspects in Domestic Violence-Related Homicide - Rhode Island Violent Death Reporting System, 2004-2015. R I Med J (2013). 2018 Dec 03;101(10):58-61. [PubMed: 30509011]
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Man charged with domestic violence at campus apartments
An Indianapolis man was arrested by Vanderburgh County Sheriff’s deputies Monday night for dating violence that occurred in the O’Daniel South Apartments.
Twenty-year-old Demond Lamont Glover was charged with multiple accounts of battery, as well as criminal mischief and intimidation.
A Rave Alert issued by Public Safety said Glover had fled the scene, but was apprehended and eventually taken into custody. He was booked into the Vanderburgh County Jail at 10:08 p.m. and is being held without bond.
Glover was refusing to leave his girlfriend’s apartment according to the probable cause affidavit. Police say the victim had a large knot over her right eye and said that Glover had beaten her up in the apartment.
There were broken items in the living room and bedroom and damage to the ceiling light in the bedroom and the wall near the bathroom, indicating a sign of a struggle and fight.
The victim told police that Glover had forced her against the bedroom wall and started choking her with both his hands. She also said Glover had punched her in her right jaw.
The victim was able to get away from Glover and locked herself in the bathroom. He eventually got into the bathroom to try and talk to the victim, but she left the scene to talk to a friend.
After about 30 minutes, the victim returned to the apartment to find Glover had put holes in the walls and smashed a ceiling light in her bedroom.
The victim then called her relatives to come and get her but was attacked by Glover, who banged her head against the wall and punched her with both fists.
Police say the victim told them Glover was trying to kick her in the head while she was seated in a chair. She also told police that Glover was yelling at her, saying he was going to kill her.
The victim fled the scene and was trying to call 911 before she ran into her Resident Assistant, who then called Public Safety.
A Vanderburgh County K9 tracked Glover down into the wood line near the apartment, where he was taken into custody without incident.
The #MeToo movement may have shifted the balance of credibility on sexual abuse and harassment at work more toward victims and away from alleged perpetrators. But the same cannot be said regarding men’s violence and abuse at home: In fact, women’s reports of domestic violence are still widely rejected, especially in one critical setting: the family court.
When women, children or both report abuse by a father in a case concerning child custody or visitation, courts often refuse to believe them. Judges even sometimes “shoot the messenger” by removing custody from the mother and awarding it to the allegedly abusive father.
For instance, courts reject 81% of mothers’ allegations of child sexual abuse, 79% of their allegations of child physical abuse, and 57% of their allegations of partner abuse. Overall, 28% of mothers alleging a father is abusive lose custody to that father; this percentage rises to 50% when an allegedly abusive father accuses the mother of “parental alienation” (more on this below).
Family courts’ hostility – both in the U.S. and abroad – toward claims of paternal or spousal abuse has been widely reported by scholarsand litigants. But it’s only recently that empirical data has been produced that validates the growing chorus of distress.
‘Dynamic of resistance’
I am a scholar of domestic violence and the law. Working with four other researchers, I conducted a federally funded study that reviewed all electronically published family court cases between parents in the U.S. between 2005 and 2014 related to custody or visitation that involved abuse or alienation claims.
Among the results from this analysis of thousands of cases: Courts rejected women’s claims of partner violence and child abuse by men, on average, roughly two-thirds of the time. They rejected mothers’ claims of child abuse by fathers approximately 80% of the time. And they reversed custody from mothers alleging abuse to the allegedly abusive fathers at rates ranging from 22% – for partner violence claims – to 56% when mothers alleged both sexual and physical child abuse.
The same dynamic of resistance to mothers’ abuse claims against fathers in custody cases has been documented across the globe.
Courts’ skepticism in these cases is due to many factors, but a key driving force is the concept of “parental alienation” or “parental alienation syndrome,” which was invented in the 1980s by a psychiatrist named Richard Gardner.
Gardner claimed that the vast majority of child sexual abuse claims in custody court were false. In addition to attributing false allegations to mothers’ vengeance against their ex-husbands, he theorized that mentally unbalanced mothers also convince themselves (falsely) that their children are being abused by their fathers.
Gardner’s “parental alienation syndrome” (“PAS”) was eventually discredited by courts and scholars. But the notion of parental alienation as the toxic influence of a primary parent that turns children against the other parent continues to profoundly influence family courts’ responses to women’s claims of abuse, especially child sexual abuse.
Thus, our study found, consistent with Gardner and parental alienation theory, that when a father accused of sexual abuse responded by accusing the mother of parental alienation, 50 out of 51 courts sided with the father and refused to believe the sexual abuse claim.
Our study also found that when allegedly abusive fathers respond to any type of abuse allegations by accusing mothers of alienation, mothers are roughly twice as likely to be disbelieved, and their rate of custody losses doubles to roughly 50%.
While Gardner’s syndrome theory has been repudiated as unscientific, parental alienation writ large continues to be treated by many family court professionals and judges as quasi-scientific, even though there is no credible scientific research to support the theory.
More specifically, there is no empirical research supporting the idea that, when one parent bad-mouths the other or takes other steps to undermine the other’s relationship with a child, the child actually turns against the “targeted” parent. In fact, research has found the opposite: that bad-mouthing can actually backfire, by turning the child against the bad-mouthing parent.
Nor is there any objective way to distinguish a child’s legitimate and justified estrangement due to the avoided parent’s own behaviors from an estrangement unjustifiably fueled by the other parent.
In short, there is no scientific or objective means of applying the alienation label. Rather, it is applied whenever an evaluator or court subjectively chooses not to believe a mother and/or a child’s abuse claims and chooses to instead believe the mother is malicious or sick and the child is not in reality.
Who gets protected?
Most people presume that family courts are protective of children and responsive to abuse concerns. This assumption persists in part because society underestimates abusers’ manipulations of the legal system, courts’ inclination to prioritize fathers’ rights and access above most other concerns, and the backlash against women who are seen as not wanting to share the kids.
The belief that it is fathers, not mothers, who can’t get a fair shake in custody cases is further fueled by fathers’ rights groups’ claims that courts are biased against fathers.
This common assertion helps fathers whose parenting may be poor or destructive cast themselves as victims while casting mothers who raise such concerns as perpetrators. And it encourages courts to view their prioritization of fathers’ rights as progressive and egalitarian.
Indeed, the scholarly literature surrounding custody court decision-making routinely emphasizes the importance of fathers and shared parenting. These articles often reiterate that fathering is critically important to children, without much attention to the specifics of individual parents’ past behaviors and impacts on their children. This pro-father sentiment translates into treating mothers as personae non gratae when they seek to restrict paternal access or claim a father is dangerous or harmful.
In fact, while family courts’ special valuation of fathering is difficult to prove empirically, our study did find that protective fathers are not penalized for accusing the mother of abuse, as are mothers who accuse fathers of abuse. The study also found that parental alienation claims benefit fathers more than mothers.
Deadly consequences
The harm to both children and their protective mothers from these family court practices is significant.
One study of what are called “turned-around” cases involved allegations of child abuse that were at first viewed as false and later judged to be valid. This study found that a majority of children in these cases were forced to live with their abusive fathers, that the vast majority reported new incidents of abuse and that children’s mental and physical health significantly deteriorated before a second court finally sent them back to their safe mothers.
Worst of all, family courts’ refusals to take seriously one parent’s claims that the other parent is dangerous have enabled over 100 child homicides.
Perhaps it is time for #MeTooHome.
1 person in custody after domestic violence incident near WTAMU campus
CANYON, Texas (KAMR/KCIT) — One person is in custody after a domestic violence incident near the West Texas A&M University campus.
WTAMU University Police responded to a call at McClaslin Apartments, in the 2400 block of 4th Avenue, around 11:30 p.m., Saturday, July 24. According to UPD, the caller said roommates were fighting. When officers arrived, they found two people at the scene, one with visible injuries.
WT police said one person appeared to be highly intoxicated and was combative toward officers. That person was arrested for Assault Family Violence and Resisting Arrest, and transported to the Randall County Jail.
WTAMUPD said neither person associated with the incident are students or employees of WT. The incident was reported in accordance with the Jeanne Clery Disclosure of Campus Security Police and Campus Crime Statistics Act (Clery Act). The Clery Act is a federal law mandating U.S. colleges and universities to disclose information about crime on and around their campuses. A requirement of this law is timely notification to the campus community of certain crimes in a manner that will aid in the prevention of similar crimes.
The Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act (Clery Act) is a federal law that requires colleges and universities across the United States to disclose information about crime on and around their campuses. A requirement of this law is timely notification to the campus community of certain crimes in a manner that will aid in the prevention of similar crimes.
WTAMU Police remind citizens of the following:
- Assaultive abuse may be physical, emotional and/or verbal.
- Assaultive abuse may include damaging your property, including throwing objects, punching walls, kicking doors, etc.
- Assaultive abuse may include damaging your property, including throwing objects, punching walls, kicking doors, etc.
- Believe someone who discloses sexual assault, abusive behavior, or experience with stalking.
- Watch out for friends and fellow students or employees who look like they could be in trouble or need help. Ask if they are ok.
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Content warning: This page contains information about relationship and sexual violence.
Confidential RSVP counselors available 24/7
Email rsvpcenter@wustl.edu or call 314-935-3445 (Monday-Friday 8:30 a.m.-4:30 p.m.)
24/7 emergency via WUPD (314-935-5555) or SARAH during the academic year (314-935-8080)
Dating and relationship violence is a pattern of coercive and abusive tactics employed by one person in a relationship to gain power and control over another person. It can take many forms, including physical violence, coercion, threats, intimidation, isolation, and emotional, sexual or economic abuse.
Abusive relationships may include sexual violence, which is a form of physical violence. Loving someone does not mean that you can never say “no” to sex. No matter what kind of relationship you have, if you are forced to have sex, it is rape. If you are humiliated or forced to be sexual in any way, that is sexual abuse.
Relationship violence is a set of behaviors that are commonly misunderstood in our society. You may have heard people say things like, “Why would she/he/they stay with him/her/them if they are abusing them?” or “Why doesn’t she/he/they leave?” These comments and questions can be hurtful and blaming of the person who is experiencing the violence. They suggest that the survivor is doing something wrong, rather than that the perpetrator of the violence is at fault. In reality, there are a myriad of reasons why it is difficult to leave abusive relationships, and the person being abused is the expert of their own situation.
Definitions
Definitions under the Campus SaVE/Clery Act/VAWA regulations, 34 C.F.R. Section 668.46
Dating Violence
Violence committed by a person who is or has been in a social relationship of a romantic or intimate nature with the victim.
- The existence of such a relationship shall be determined based on the reporting party’s statement and with consideration of the length of the relationship, the type of relationship, and the frequency of interaction between the persons involved in the relationship.
- For the purposes of this definition:
- Dating violence includes, but is not limited to, sexual or physical abuse or the threat of such abuse.
- Dating violence does not include acts covered under the definition of domestic violence.
Domestic Violence
A felony or misdemeanor crime of violence committed:
- By a current or former spouse or intimate partner of the victim;
- By a person with whom the victim shares a child in common;
- By a person who is cohabitating with, or has cohabitated with, the victim as a spouse or intimate partner;
- By a person similarly situated to a spouse of the victim under the domestic or family violence laws of the jurisdiction in which the crime of violence occurred, or
- By any other person against an adult or youth victim who is protected from that person’s acts under the domestic or family violence laws of the jurisdiction in which the crime of violence occurred.
Abusive Behaviors
- Destructive criticism and verbal attack: Name calling, mocking, accusing, swearing, making humiliating remarks or gestures, ridiculing your most valued beliefs.
- Pressure tactics or threats: Rushing you to make decisions using guilt, fear or intimidation; regularly threatening to leave or telling you to leave; making and/or carrying out threats to hurt you or others; threatening you with a weapon, etc.; locking you in or out of the house; taking the children; threatening suicide; reporting you to the Department of Social Services; putting your job or other things that are important to you at risk.
- Emotional abuse: Manipulating you with lies or contradictions (playing “mind games”); making you feel stupid/crazy (usually this is specific to whatever makes you feel the worst); not following through on agreements; manipulating shared children; abandoning you in a dangerous place; refusing to take care of you or get help when you are sick or hurt; destroying your possessions.
- Stalking: Following, harassing or threatening you repeatedly; telephoning and text messaging constantly; waiting on you outside or inside places; watching you from afar, or sending
- Unwanted letters or emails.
- Sexual violence: Degrading treatment; forcing you to have sex; using threats or coercion to obtain sex or perform sexual acts; coercing sex during or after a violent incident.
- Minimizing, denying and blaming: Making light of behavior; insisting it’s not serious; denying the abuse happened; shifting responsibility for abusive behavior (“It’s your fault, you made me do it.”)
- Physical violence: Being violent to you, others or household pets; slapping; punching; grabbing; kicking; choking; pushing; biting; holding you to prevent your leaving.
- Harassment: Making uninvited visits; following you; embarrassing you in public; refusing to leave when asked; accusing you of seeing someone else (being overly jealous); obsessive web communication, such as e-mails, instant messages, Facebook and cell phone calls and text messages.
- Economic control: Interfering with your work or not letting you work; threatening to withhold money; refusing to give you money or taking your money; taking your car keys or otherwise preventing you from using the car; ruining your credit; forcing you to do illegal acts for money.
- Isolation: Preventing or making it difficult for you to see friends or relatives; making family and friends so uncomfortable they do not want to visit; monitoring phone calls; telling you where you can and cannot go; moving to a place where you have no support; not letting you have a phone or access to the car.
- Intimidation: Using looks, actions or gestures to make you scared to do something differently; making angry or threatening gestures; acting “crazy” or out of control; subjecting you to reckless driving; using physical size to intimidate (such as standing in the doorway during arguments); out-shouting you.
LGBTQIA Relationship Violence
While many aspects of relationship violence against Lesbian, Gay Bisexual, Trans or Queer individuals are similar to those experienced by heterosexual victims, it is not in all ways identical. Perpetrators often attempt highly specific forms of abuse based on identity and community dynamics, including:
- Outing or threatening to out a partner’s sexual orientation or gender identity to family, employers, police, religious institutions, communities, in child custody disputes or in other situations where this may pose a threat.
- Reinforcing fears that no one will help the victim because s/he/they is lesbian, gay, bisexual or transgender, or that for this reason, the partner deserves the abuse.
- Alternatively, justifying abuse with the notion that a partner is not really lesbian, gay, bisexual or transgender (i.e. the victim may once have had, or may still have relationships, or express a gender identity, inconsistent with the abuser’s definitions of these terms). This can be used both as a tool in verbal and emotional abuse as well as to further the isolation of a victim from community.
- Using the victim’s fluid orientation against them- this can be in the form of telling bisexual men or women that they are not “really” queer or that their orientation is a betrayal of the same-sex partner. It can also be used against bisexual and queer people in different-sex relationships, through threats of outing, or questioning the abused partner’s commitment to the relationship because of their sexual orientation of gender identity.
According to the CDC, 44% of lesbian women, 61% of bisexual women, 26% of gay men, and 37% of bisexual men report being the victim of rape, physical violence and/or stalking by an intimate partner.
But I’m a college student… I don’t have to worry about relationship abuse, right?
Unfortunately, dating and domestic abuse is a problem for college students and is often a risk factor of abuse in subsequent relationships and marriages. Below is a list of warning signs of abusive behaviors. If these behaviors appear in your or a friend’s relationship, it’s important to remember that they are not the fault of the victim–the perpetrator is solely responsible for his/her/their actions. It is also important to remember that while these behaviors may indicate an abusive relationship, not all of them need to be present for a relationship to be abusive. Everyone in a relationship has the right to set their own boundaries with their partner in a way that feels safe and supportive for them.
Warning Signs of Abusive Behaviors
- Exhibits jealousy when you talk to others. May say that his/her jealousy is a sign of love.
- Consistently accuses a partner of flirting or cheating, or treats other important relationships in a partner’s life with suspicion.
- Tries to control where you go, whom you go with, what you wear, say, do, etc.
- Attempts to isolate you from loved ones. May try to cut you off from resources, friends and family.
- Uses force, coercion or manipulation in sexual activity.
- Degrades or puts you down. Dismisses accomplishments that you achieve.
- Displays frequent mood or behavior swings. May be kind one minute and exploding the next; charming in public and cruel in private.
- Threatens to use physical force. Breaks or strikes objects to intimidate you.
- Physically restrains you from leaving the room, pushes, shoves you, etc.
- Has hit other partners in the past but assures you that the violence was provoked.
- May exhibit economic control by not allowing you to go to work, have access or control of your money or paycheck, or access to your car.
Why They Don’t Leave
There is a pervasive myth that a person who is in an abusive relationship doesn’t leave because they enjoy the abuse. This is false. People who are abused by their dating or domestic partner do not stay in the relationship because they enjoy the maltreatment. The victim may stay for practical or emotional reasons including feelings of love and attachment, social isolation or shame, economic factors, or a fear of retaliation for leaving, through physical violence or homicide.
Another pervasive myth is that emotional abuse is not serious or “real abuse.” However, emotional abuse not only impacts the victim’s self-esteem, it can cause long- term psychological trauma. For many victims it is the most damaging aspect of abusive relationships.
Remember, when someone hits or degrades their partner, that behavior is not provoked. While anger can be provoked during an argument, abuse is a choice the perpetrator makes to establish control. It is an intentional act or set of acts designed to force the abused partner to submit to the will of the abuser.
How You Can Take Care of Yourself
- Don’t blame yourself and don’t excuse your partner’s behavior.
- Think about your safety and create a plan. Seek help from friends, family or your healthcare provider.
- Consider what you need to be safe- what are the risks you are facing and how can they be mitigated, even temporarily?
- Consider who may be able to help support you (friends, family, staff members, etc.) and how you might reach out to them.
- If you want to leave the relationship, consider what you may need to be able to successfully do that.
- If you are experiencing sexual violence or reproductive abuse, consider strategies for protecting your sexual health.
- Call a crisis helpline like S.A.R.A.H. 314-935-8080 or Uncle Joe’s 314-935-5099, or a women’s shelter, for advice. These are available during the academic year.
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Domestic Violence
Continuing Education Activity
Family and domestic violence is a common problem in the United States, affecting an estimated 10 million people every year; as many as one in four women and one in nine men are victims of domestic violence. Virtually all healthcare professionals will at some point evaluate or treat a patient who is a victim of domestic or family violence. Domestic and family violence includes economic, physical, sexual, emotional, and psychological abuse of children, adults, or elders. Domestic violence causes worsened psychological and physical health, decreased quality of life, decreased productivity, and in some cases, mortality. Domestic and family violence can dating site online difficult to identify. Many cases are not reported to health professionals or legal authorities. This activity describes the evaluation, reporting, and management strategies for victims of domestic abuse and stresses the role of team-based interprofessional care for these victims.
Objectives:
Identify the epidemiology of domestic violence.
Describe the types of domestic violence.
Explain challenges associated with reporting domestic violence.
Review some interprofessional team strategies for improving care coordination and communication to identify domestic violence and improve outcomes for its victims.
Introduction
Family and domestic violence including child abuse, intimate partner abuse, and elder abuse is a common problem in the United States. Family and domestic health violence are estimated to affect 10 million people in the United States every year. It is a national public health problem, and virtually all healthcare professionals will at some point evaluate or treat a patient who is a victim of some form of domestic or family violence.[1][2][3][4][5]
Unfortunately, each form of family violence begets interrelated forms of violence. The "cycle of abuse" is often continued from exposed children into their adult relationships and finally to the care of the elderly.
Domestic and family violence includes a range of abuse, including economic, physical, sexual, emotional, person in custody over campus dating violence, and psychological, toward children, adults, and elders.
Intimate partner violence includes stalking, sexual and physical violence, and psychological aggression by a current or former partner. In the United States, as many as one in four women and one in nine men are victims of domestic violence. Domestic violence is thought to be underreported. Domestic violence affects the victim, families, co-workers, and community. It causes diminished psychological and physical health, decreases the quality of life, and results in decreased productivity.
The national economic cost of domestic and family violence is estimated to be over 12 billion dollars per year. The number of individuals affected is expected to rise over the next 20 years, increasing the elderly population.
Domestic and family violence is difficult person in custody over campus dating violence identify, and many cases go unreported to health professionals or legal authorities. Due to the prevalence in our society, all healthcare professionals, including psychologists, nurses, pharmacists, dentists, physician assistants, nurse practitioners, and physicians, will evaluate and possibly treat a victim or perpetrator of domestic or family violence.[6][7]
Definitions
Family and domestic violence are abusive behaviors in which one individual gains power over another individual.
Intimate partner violence typically includes sexual or physical violence, psychological aggression, and stalking. This may include former or current intimate partners.
Child abuse involves the emotional, sexual, physical, or neglect of a child under 18 by a parent, custodian, or caregiver that results in potential harm, harm, or a threat of harm.
Elder abuse is a failure to act or an intentional act by a caregiver that causes or creates a risk of harm to an elder.
Center for Disease Control and Prevention (CDC)
Domestic violence, best dating site for seniors abuse, battering, or intimate partner violence, is typically the victimization of an individual with whom the abuser has an intimate or romantic relationship. The CDC defines domestic violence as "physical violence, sexual violence, stalking, and psychological aggression (including coercive acts) by a current or former intimate partner."
Domestic and family violence has no boundaries. This violence occurs in intimate relationships regardless of culture, race, religion, or socioeconomic status, person in custody over campus dating violence. All healthcare professionals must understand that domestic violence, whether in the form of emotional, psychological, sexual, or physical violence, is common in our society and should develop the ability to recognize it and make the appropriate referral.
Violence Abuse Types
The types of violence include stalking, economic, emotional or psychological, sexual, neglect, Munchausen by proxy, and physical. Domestic and family violence occurs in all races, ages, and sexes. It knows no cultural, socioeconomic, education, religious, or geographic limitation. It may occur in individuals with different sexual orientations.
Etiology
Reason Abusers Need to Control[8][9][10]
Anger management issues
Jealousy
Low self-esteem
Feeling inferior
Cultural beliefs they have the right to control their partner
Personality disorder or psychological disorder
Learned behavior from growing up in a family where domestic violence was accepted
Alcohol and drugs, as an impaired individual may be less likely to control violent impulses
Risk Factors
Risk factors for domestic and family violence include individual, relationship, community, and societal issues. There is an inverse relationship between education and domestic violence. Lower education levels correlate with more likely domestic violence. Childhood abuse is commonly associated with becoming a perpetrator of domestic violence as an adult. Perpetrators of domestic violence commonly repeat acts of violence with new partners. Drug and alcohol abuse greatly increases the incidence of domestic violence.
Children who are victims or witness domestic person in custody over campus dating violence family violence may believe that violence is a reasonable way to resolve a conflict, person in custody over campus dating violence. Males who learn that females are not equally respected are more likely to abuse females in adulthood. Females who witness domestic violence as children are more likely to be victimized by their spouses. While females are often the victim of domestic violence, gender roles can be reversed.
Domination may include emotional, physical, or sexual abuse that may be caused by an interaction of situational and individual factors. This means the person in custody over campus dating violence learns violent behavior from their family, person in custody over campus dating violence, community, or culture. They see violence and are victims of violence.
Epidemiology
Domestic violence is a serious and challenging public health problem. Approximately 1 in 3 women and 1 in 10 men 18 years of age or older experience domestic violence. Annually, domestic violence is responsible for over 1500 deaths in the United States.[11][12][13]
Domestic violence victims typically experience severe physical injuries requiring care at a hospital or clinic. The cost to individuals and society is significant, person in custody over campus dating violence. The national annual cost of medical and mental health care services related to acute domestic violence is estimated at over $8 billion. If the injury results in a long-term or chronic condition, the cost is considerably higher.
Financial hardship and unemployment are contributors to domestic violence. An economic downturn is associated with increased calls to the National Domestic Violence Hotline.
Fortunately, the national rate of nonfatal domestic violence is declining. This is thought to be due person in custody over campus dating violence a decline in the marriage rate, decreased domesticity, better access to domestic violence shelters, improvements in female economic status, and an increase in the average age of the population.
National
Most perpetrators and victims do not seek help.
Healthcare professionals are usually the first individuals with an opportunity to identify domestic violence.
Nurses are usually the first healthcare providers victims encounter.
Domestic violence may be perpetrated on women, men, parents, and children.
Fifty percent of women seen in emergency departments report a history of abuse, and approximately 40% of those killed by their abuser sought help in the 2 years before death.
Only one-third of police-identified victims of domestic violence are identified in the emergency department.
Healthcare professionals who work in acute care need to maintain a high person in custody over campus dating violence of suspicion for domestic violence as supportive family members may, in fact, be abusers.
Child Abuse
Age, family income, and ethnicity are all risk factors for both sexual abuse and physical abuse. Gender is a risk factor for sexual abuse but not for physical abuse.
Each year there are over 3 million referrals to child protective authorities. Despite often being the first to examine the victims, only about 10% of the referrals were from medical personnel. The fatality rate is approximately two deaths per 100,000 children. Person in custody over campus dating violence account for a little over half of the perpetrators.
Intimate Partner Violence
According to the CDC, 1 in 4 women and 1 in 7 men will experience physical violence by their intimate partner at some point during their lifetimes. About 1 in 3 women and nearly 1 in 6 men experience in college dating a highschool girl form of sexual violence during their lifetimes. Intimate partner violence, sexual violence, and stalking are high, with intimate partner violence occurring in over 10 million people each year.
One in 6 women and 1 in 19 men have experienced stalking during their lifetimes. The majority are stalked by someone they know. An intimate partner stalks about 6 in 10 female victims and 4 in 10 male victims.
At least 5 million acts of domestic violence occur annually to women aged 18 years and older, with over 3 million involving men. While most events are minor, person in custody over campus dating violence, for example grabbing, shoving, pushing, person in custody over campus dating violence, slapping, and hitting, serious and sometimes fatal injuries do occur. Approximately 1.5 million intimate partner female rapes and physical assaults are perpetrated annually, and approximately 800,000 male assaults occur. About 1 in 5 women have experienced completed or attempted rape at some point in their lives. About 1% to 2% of men have experienced completed or attempted rape.
The incidence of intimate partner violence has declined by over 60%, from about ten victimizations per 1000 persons age 12 or older to approximately 4 per 1000.
Elderly
Due to underreporting and difficulty sampling, obtaining accurate incidence information on elder abuse and neglect is difficult. Elderly abuse is thought to occur in 3% to 10% of the population of elders.
Elderly patients may not report due to fear, guilt, ignorance, or shame. Clinicians underreport elder abuse due to poor recognition of the problem, person in custody over campus dating violence, lack of understanding of reporting methods and requirements, person in custody over campus dating violence, and concerns about physician-patient confidentiality.
Pathophysiology
There may be some pathologic findings in both the victims and perpetrators of domestic violence. Certain medical conditions and lifestyles make family and domestic violence more likely.[13][14][15]
Perpetrators
While the research is not definitive, a number of characteristics are thought to be present in perpetrators of domestic violence. Abusers tend to:
Have a higher consumption of alcohol and illicit drugs and 100% free latino dating should include questions that explore drinking habits and violence
Be possessive, jealous, suspicious, and paranoid.
Be controlling of everyday family activity, including control of finances and social activities.
Suffer low self-esteem
Have emotional dependence, which tends to occur in both partners, but more so in the abuser
Children
Domestic violence at home results in emotional damage, which exerts continued effects as the victim matures.
Approximately 45 million children will be exposed to violence during childhood.
Approximately 10% of children are exposed to domestic violence annually, and 25% are exposed person in custody over campus dating violence at least 1 event during their childhood.
Ninety percent are direct eyewitnesses of violence.
Males who batter their wives batter the children 30% to 60% of the time.
Children who witness domestic violence are at increased risk of dating violence and have a more difficult time with partnerships and parenting.
Children who witness domestic violence are at an increased risk for post-traumatic stress disorder, aggressive behavior, anxiety, impaired development, difficulty interacting with peers, academic problems, and they have a higher incidence of substance abuse.
Children exposed to domestic violence often become victims of violence.
Children who witness and experience domestic violence are at a greater risk for adverse psychosocial outcomes.
Eighty to 90% of domestic violence victims abuse or neglect their children.
Abused teens may not report abuse. Individuals 12 to 19 years of age report only about one-third of crimes against them, compared with one-half in older age groups
Pregnant and Females
The American College of Obstetricians and Gynecologists (ACOG) recommends all women be assessed for signs and symptoms of domestic violence during regular and prenatal visits. Providers should offer support and referral information.
Domestic violence affects approximately 325,000 pregnant women each year.
The average reported prevalence during pregnancy is approximately 30% emotional abuse, 15% physical abuse, and 8% sexual abuse.
Domestic violence is more common among pregnant women than preeclampsia and gestational diabetes.
Reproductive abuse may occur dating a shorter guy reddit includes impregnating against a partner's wishes by stopping a partner from using birth control.
Since most pregnant women receive prenatal care, this is an excellent time to assess for domestic violence.
The danger of domestic violence is particularly acute as both mother and fetus are at risk. Healthcare professionals should be aware of the psychological consequences of domestic abuse during pregnancy. There is more stress, depression, and addiction to alcohol in abused pregnant women. These conditions person in custody over campus dating violence harm the fetus.
Gay, Lesbian, Bisexual, and Transgender
Domestic violence occurs in gay, lesbian, bisexual, and transgender couples, and the rates are thought to be similar to a heterosexual woman, approximately 25%.
There are more cases of person in custody over campus dating violence violence among males living with male partners than among males who live with female partners.
Females living with female partners experience less domestic violence than females living with males.
Transgender individuals have a higher risk of domestic violence. Transgender victims are approximately two times more likely to experience physical violence.
Gay, lesbian, bisexual, and transgender victims may be reticent to report domestic violence. Part of the challenge may be that support services such as shelters, support groups, and hotlines are not regularly available. This results in isolated and unsupported victims. Healthcare professionals should strive to be helpful when working with gay, lesbian, bisexual, and transgender patients.
Men
Usually, domestic violence is perpetrated by men against women; however, females may exhibit violent behavior against their male partners.
Approximately 5% of males are killed by their intimate partners.
Each year, approximately 500,000 women are physically assaulted or raped by an intimate partner compared to 100,000 men.
Three out of 10 women at some point are stalked, physically assaulted, or raped by an intimate partner, compared to 1 out of every 10 men.
Rape is primarily perpetrated by other men, while women engage in other forms of violence against men.
Although women are the most common victims of domestic violence, healthcare professionals should remember that men may also be victims and should be evaluated if there are indications present.
Elderly
The elderly are often mistreated by their spouses, children, or relatives.
Annually, approximately 2% of the elderly experience physical abuse, 1% sexual abuse, 5% neglect, 5% financial abuse, and 5% suffer emotional abuse.
The annual incidence of elder abuse is estimated to be blossom dating site to 10%, with only about 1 in 15 cases reported to the authorities.
Approximately one-third of nursing homes disclosed at least 1 incident of physical abuse per year.
Ten percent of nursing home staff self-report physical person in custody over campus dating violence against an elderly resident.
Elder domestic violence may be financial or physical. The elderly may be controlled financially. Elders are often hesitant to report this abuse if it is their only available caregiver. Victims are often dependent, person in custody over campus dating violence, infirm, isolated, or mentally impaired. Healthcare professionals should be aware of the high incidence of abuse in this population.
History and Physical
The history and physical exam should be tailored to the age of the victim.
Child Abuse
The most common injuries are fractures, contusions, bruises, and internal bleeding. Unexpected injuries to pre-walking infants should be investigated. The caregiver should explain unusual injuries to the ears, neck, or torso; otherwise, these injuries should be investigated.
Children who are abused may be unkempt and/or malnourished. They may display inappropriate behavior such as aggression, or maybe shy, withdrawn, and have poor communication skills. Others may be disruptive or hyperactive. School attendance is usually poor.
Intimate Partner Abuse
Approximately one-third of women and one-fifth of men will be victims of abuse. The most common sites of injuries are the head, neck, and face. Clothes may cover injuries to the body, breasts, genitals, rectum, and buttocks. One should be suspicious if the history is not consistent with the injury. Defensive injuries may be present on the forearms and hands. The patient may have psychological signs and symptoms such as anxiety, depression, and fatigue.
Medical complaints may be specific or vague such as headaches, palpitations, chest pain, painful person in custody over campus dating violence, or chronic pain.
Intimate Partner Abuse: Pregnancy and Female
Abuse during pregnancy may cause as much as 10% of pregnant hospital admissions. There are a number of historical and physical findings that may help the provider identify individuals at risk.
If the examiner encounters signs or symptoms, she should make every effort to examine the patient in private, explaining confidentiality to the patient. Be sure to ask caring, empathetic questions and listen politely without interruption to answers.
Intimate Partner Abuse: Same-Sex
Same-sex partner abuse is common and may be difficult to identify. Over 35% of heterosexual women, 40% of lesbians, 60% of bisexual women experience domestic violence, person in custody over campus dating violence. For men, the incidence is slightly lower. In addition to common findings of abuse, perpetrators may try to control their partners by threatening to make their sexual preferences public.
The provider should be aware there are fewer resources available to help victims; further, the perpetrator and victim may have the same friends or support groups.
Intimate Partner Abuse: Men
Men represent as much as 15% of all cases of domestic partner violence. Male victims are also less likely to seek medical care, so that the incidence may be underreported. These victims may have a history of child abuse.
Elderly Abuse
Health professionals should ask geriatric patients about abuse, even if signs are absent.
Risk Factors
Dementia
Pathologic characteristics of perpetrators including dementia, mental illness, and drug and alcohol abuse
A shared living situation with the abuser
Social isolation
Evaluation
Establishing that injuries are related to domestic abuse is a challenging task. Life and limb-threatening injuries are the priority, person in custody over campus dating violence. After stabilization and physical evaluation, laboratory tests, x-rays, CT, or MRI may be indicated. It is important that healthcare professionals first attend to the underlying issue that brought the victim to the emergency department.[1][16][17][18]
The evaluation should start with a detailed history and physical examination. Clinicians should screen all females for domestic violence and refer females who screen positive. This includes females who do not have signs or symptoms of abuse. All healthcare facilities should have a plan in place that provides for assessing, screening, person in custody over campus dating violence, and referring patients for intimate partner violence. Protocols should include referral, documentation, and follow-up.
Health professionals and administrators should be aware of challenges such as barriers to screening for domestic violence: lack of training, time constraints, the sensitive nature of issues, and a lack of privacy to address the issues.
Although professional and public awareness has increased, many patients and providers are still hesitant to discuss abuse.
Patients with signs and symptoms of domestic violence should be evaluated. The obvious cues are physical: bruises, bites, cuts, broken bones, concussions, burns, knife or gunshot wounds.
Typical domestic injury patterns include contusions to the head, face, neck, breast, chest, abdomen, and musculoskeletal injuries. Accidental injuries more commonly involve the extremities of the body. Abuse victims tend to have multiple injuries in various stages of healing, from acute to chronic.
Domestic violence victims may have emotional and psychological issues such as anxiety and depression. Complaints may include backaches, stomachaches, headaches, fatigue, restlessness, decreased appetite, and insomnia. Women are more likely to experience asthma, irritable bowel syndrome, and diabetes.
Assessment
Assuming the patient is stable and not in pain, a detailed assessment of victims should occur after disclosure of abuse. Person in custody over campus dating violence safety person in custody over campus dating violence the priority. A list of standard prepared questions can help alleviate the uncertainty in the patient's evaluation. If there are signs of immediate danger, refer to advocate support, shelter, a hotline for victims, or legal authorities.
If there is no immediate danger, the assessment should focus on mental and physical health and establish the history of current or past abuse. These responses determine the appropriate intervention.
During the initial assessment, a practitioner must be sensitive to the patient’s cultural beliefs. Incorporating a cultural sensitivity assessment with a history of being victims of domestic violence may allow more effective treatment.
Patients that have suffered domestic violence may or may not want a referral. Many are fearful of their lives and financial well-being. They hence may be weighing the tradeoff in leaving the abuser leading to loss of support and perhaps the responsibility of caring for children alone, person in custody over campus dating violence. The healthcare provider needs to assure the patient that the decision is voluntary and that the provider will help regardless of the decision. The goal is to make resources accessible, safe, and enhance support.
If the patient elects person in custody over campus dating violence leave their current situation, information for referral to a local domestic violence shelter to assist the victim should be given.
If there is a risk to life or limb, or evidence of injury, the patient should be referred to local law enforcement officials.
Counselors often include social workers, psychiatrists, and psychologists that specialize in the care of battered partners and children.
Testing
Children
A detailed history and careful physical exam should be performed. If head trauma is suspected, consider an ophthalmology consultation to obtain indirect ophthalmoscopy.
Laboratory
Laboratory studies person in custody over campus dating violence often important for forensic evaluation and criminal prosecution. On occasion, certain diseases may mimic findings similar to child abuse. As a consequence, they must be ruled out.
Urine
A urine test may be used as a screen for sexually transmitted disease, bladder or kidney trauma, and toxicology screening.
Hematology
If bruises or contusions are present, there is no need to evaluate for a bleeding disorder if the injuries are consistent with an abuse history. Some tests can be falsely elevated, so a child abuse-specialist pediatrician or hematologist should review or follow-up these tests.
Gastrointestinal and Chest Trauma
Consider liver and pancreas screening tests such as AST, ALT, and lipase. If the AST or ALT is greater than 80 IU/L, or lipase greater than 100 IU/L, consider an abdomen and pelvis CT with intravenous contrast.
The highest-risk are those with abusive head trauma, fractures, nausea, vomiting, or an abnormal Glasgow Coma Scale score of less than 15.
Imaging
The evaluation of the pediatric skeleton can prove challenging for a non-specialist as there are subtle differences from adults, such as cranial sutures and incomplete bone growth. A fracture can be misinterpreted. If there is a concern for abuse, consider consulting a radiologist.
Imaging: Skeletal Survey
A skeletal person in custody over campus dating violence is indicated in children younger than 2 years with suspected physical abuse. The incidence of occult fractures is as high as 1 in 4 in physically abused children younger than 2 years. The clinician should consider screening all siblings younger than 2 years.
The skeletal survey should include 2 views of each extremity; anteroposterior and lateral skull; and lateral chest, spine, abdomen, pelvis, hands, and feet. A radiologist should review the films for classic metaphyseal lesions and healing fractures, most often involving the posterior ribs. A “babygram” that includes only 1 film of the entire body is not an adequate skeletal survey.
Skeletal fractures will remodel at different rates, which are dependent on the age, location, person in custody over campus dating violence, and nutritional status of the patient.
Imaging: CT
If abuse or head trauma is suspected, a CT scan of the head should be performed on all children aged six months or younger or children younger than 24 months if intracranial trauma is suspected. Clinicians should have a low threshold to obtain a CT scan of the head when abuse is suspected, especially in an infant younger than 12 months.
CT of the abdomen and pelvis with intravenous contrast is indicated in unconscious children, have traumatic abdominal findings such as abrasions, bruises, tenderness, person in custody over campus dating violence, absent or decreased bowel sounds, abdominal pain, nausea, or vomiting, or have elevation of the AST, an ALT greater than 80 IU/L, or lipase greater than 100 IU/L.
Special Documentation
Photographs should be taken before treatment of injuries.
Intimate Partner and Elder
Laboratory
Evaluate for evidence of dehydration, electrolyte abnormalities, infection, substance abuse, person in custody over campus dating violence, improper medication administration, and malnutrition.
Imaging
X-rays of bruised of tender body parts to detect fractures
Head CT scan to evaluate for intracranial bleeding as a result of abuse or the causes of altered mental status
Other
Pelvic examination with evidence collection if sexual assault
Evidence Collection
Domestic and family violence commonly results in the legal prosecution of the perpetrator. Preferably, a team specializing in domestic violence is called in to assist with evidence collection.
Each health facility should have a written procedure for how to package and label specimens and maintain a chain of custody. Law enforcement personnel will often assist with evidence collection and provide specific kits.
It is important to avoid destroying evidence. Evidence includes tissue specimens, blood, urine, saliva, person in custody over campus dating violence, and vaginal and rectal specimens. Saliva from bites can be collected; the bite mark is swabbed with a water-moistened cotton-tipped swab.
Clothing stained with blood, saliva, semen, and vomit should be retained for forensic analysis.
Treatment / Management
The priority is the ABCs and appropriate treatment of the presenting complaints. However, once the patient is stabilized, emergency medical services personnel may identify problems associated with violence.[19][20][21]
Emergency Department and Office Care
Interventions to consider include:
Make sure a safe person in custody over campus dating violence is provided.
Diagnose physical injuries and other medical or surgical problems.
Treat acute physical or life-threatening injuries.
Identify possible sources of domestic violence.
Establish domestic violence as a diagnosis.
Reassure the patient that he is not at fault.
Evaluate the emotional status and treat.
Document the history, physical, and interventions.
Determine the risks to the victim and assess safety options.
Counsel the patient that violence may escalate.
Determine if legal intervention is needed and report abuse when appropriate or mandated.
Develop a follow-up plan.
Offer shelter options, legal services, counseling, and facilitate such referral.
Medical Record
The medical record is often evidence used to convict an abuser. A poorly document chart may result in an abuser going free and assaulting again.
Charting should include detailed documentation of evaluation, treatment, and referrals.
Describe the abusive event and current complaints using the patient's own words.
Include the behavior of the patient in the record.
Include health problems related to the abuse.
Include the alleged perpetrator's name, relationship, and address.
The physical exam should include a description of the patient's injuries including location, color, size, amount, and degree of age bruises and contusions.
Document injuries with anatomical person in custody over campus dating violence and photographs.
Include the name of the patient, medical record number, date, and time of the photograph, and witnesses on the back of each photograph.
Torn and damaged clothing should also be photographed.
Document injuries not shown clearly by photographs with line drawings.
With sexual assault, follow protocols for physical examination and evidence collection.
Disposition
If the patient does not want to go to a shelter, provide telephone numbers for domestic violence or crisis hotlines and support services for potential later use. Provide the patient with instructions but be mindful that written materials may pose a danger once the patient returns home.
A referral should be made to primary care or another appropriate resource.
Advise the patient to have a safety plan and provide examples.
Remember
Forty percent of domestic violence victims never contact the police.
Of female victims of domestic homicide, 44% had visited a hospital emergency department within 2 years of their murder.
Health professionals provide an opportunity for victims of domestic violence to obtain help.
Differential Diagnosis
The differential diagnosis varies with the injury type person in custody over campus dating violence injury and age.
Child
Head Trauma
Accidental injury
Arteriovenous malformations
Bacterial meningitis
Birth trauma
Cerebral sinovenous thrombosis
Hemophilia
Solid brain tumors
Bruises and Contusions
Accidental bruises
Birth trauma
Bleeding disorder
Coining
Cupping
Congenital dermal melanocytosis (Mongolian spots)
Erythema multiforme
Hemangioma
Hemophilia
Burns
Accidental burns
Atopic dermatitis
Contact dermatitis
Impetigo
Inflammatory skin conditions
Sunburn
Fractures
Accidental
Birth trauma
Congenital syphilis
Malignancy
Osteogenesis imperfecta
Osteomyelitis
Rickets
Scurvy
Toddler’s fracture
Prognosis
Without proper social service and mental health intervention, all forms of abuse can be recurrent and escalating problems, and the prognosis for recovery is poor. Without treatment, domestic and family violence usually recurs and escalates in both frequency and severity.[3][22][23]
Of those injured by domestic violence, over 75% continue to experience abuse.
Over half of battered women who attempt suicide will try again; often they are successful with the second attempt.
In children, the potential for poor outcomes is particularly high as abuse inflicts lifelong effects. In addition to dealing with the sequelae of physical injury, the mental consequences may be catastrophic. Studies indicate a person in custody over campus dating violence association between child sexual abuse and increased risk of psychiatric disorders in later life. The potential for the cycle of violence to continued from childhood is very high.
Children raised in families of sexual abuse may develop:
Attention deficit hyperactivity disorder (ADHD)
Conduct disorder
Depression
Bipolar disorder
Panic disorder
Sleep disorders
Suicide attempts
Post-traumatic stress disorder (PTSD)
Health Outcomes
There are multiple known and suspected negative health outcomes of family and domestic violence. There are long-term consequences to broken bones, traumatic brain injuries, and internal injuries.
Patients may also develop multiple comorbidities such as:
Asthma
Insomnia
Fibromyalgia
Headaches
High blood pressure
Chronic pain
Gastrointestinal disorders
Gynecologic disorders
Depression
Panic attacks
PTSD
Pearls and Other Issues
Screening: Tools
The American Academy of Pediatricians has free guides for the history, physical, diagnostic testing, documentation, treatment, and legal issues in cases of suspected child abuse.
The Center for Disease Control and Prevention (CDC) provides several scales assessing family relationships, including child abuse risks.
The physical examination is still the most significant diagnostic tool to detect abuse. A child or adult with suspected abuse should be undressed, and a comprehensive physical exam should be performed. The skin should be examined for bruises, bites, burns, and injuries in different stages of healing. Examine for retinal hemorrhages, subdural hemorrhages, tympanic membrane rupture, soft tissue swelling, oral bruising, fractured teeth, and organ injury.
Screening: Recommendations
Evaluate for organic conditions and medications that mimic abuse.
Evaluate patients and caregivers separately
Clinicians should regularly screen for family and domestic violence and elder abuse
The Elder Abuse Suspicion Index can be used to assess for elder abuse
Screen for cognitive impairment before screening for abuse in the elderly
Pattern injury is more suspicious
Risks
Failure to report child abuse is illegal in most states.
Failure to report intimate partner and elder abuse is illegal in many states.
Legal
It is important to be aware of federal and state statutes governing domestic and family abuse. Remember that reporting domestic and family violence to law enforcement does not obviate detailed documentation in the medical record.
Battering is a dirty dating apps, and the patient should be made aware that help is available. If the patient wants legal help, the local police should be called.
In some jurisdictions, domestic violence reporting is mandated. The legal obligation to report abuse should be explained to the patient.
The patient should be informed how local authorities typically respond to such reports and provide follow-up procedures. Address the risk of reprisal, need for shelter, and possibly an emergency protective order (available in every state and the District of Columbia).
If there is a possibility the patient’s safety will be jeopardized, the clinician should work with the patient and authorities to best protect the patient while meeting legal reporting obligations.
The clinical role in managing an abused patient goes beyond obeying the laws that mandate reporting; there is a primary obligation to protect the life of the patient.
The clinician must help mitigate the potential harm that results from reporting, provide appropriate ongoing care, and preserve the safety of the patient.
If the patient desires, and it is acceptable to the police, a health professional should remain during the interview.
The medical record should reflect the incident as described by the patient and any physical exam findings. Include the date and time the report was taken and the officer's name and badge number.
National Statutes
Federal Child Abuse Prevention and Treatment Act (CAPTA)
Each state has specific child abuse statutes, person in custody over campus dating violence. Federal legislation provides guidelines for defining acts that constitute child abuse. The guidelines suggest that child abuse includes an act or failure recent act that presents an imminent risk of serious harm. This includes any recent act person in custody over campus dating violence failure to act on the part of a parent or caretaker that results in death, physical or emotional harm, sexual abuse, or exploitation.
Elder Justice Act
The Elder Justice Act provides strategies to decrease the likelihood of elder abuse, neglect, and exploitation. The Act utilizes three significant approaches:
Patient Safety and Abuse Act
The Violence Against Woman Act makes it a federal crime to cross state lines to stalk, harass, or physically injure a partner; or enter or leave the country violating a protective order. It is a violation to possess a firearm or ammunition while subject to a protective order or if convicted of a qualifying crime of domestic violence.
Enhancing Healthcare Team Outcomes
Domestic violence may be difficult to uncover when the victim is frightened, especially when he or she presents to an emergency department or healthcare practitioner's office. The key is to online dating sites guy responds with one liners an assessment protocol and maintain an awareness of the possibility that domestic and family violence may be the cause of the patient’s signs and symptoms.
Over 80% of victims of domestic and family violence seek care in a hospital; others may dating a woman with trust issues care in health professional offices, including dentists, therapists, and other medical offices. Routine screening should be conducted by all healthcare practitioners including nurses, physicians, physician assistants, dentists, nurse practitioners, and pharmacists. Interprofessional coordination of screening is a critical component of protecting victims and minimizing negative health outcomes. Health professional team interventions reduce the incidence of morbidity and mortality associated with domestic violence. Documentation is vital and a legal obligation.
Healthcare professionals including the nurse should document all findings and recommendations in the medical record, including statements made denying abuse
If domestic violence is admitted, documentation should include the history, physical examination findings, laboratory and radiographic finds, any interventions, and the referrals made.
If there are significant findings that can be recorded, pictures should be included.
The medical record may become a court document; be objective and accurate.
Healthcare professionals should provide a follow-up appointment.
Reassurance that additional assistance is available at any time is critical to protect the patient from harm and break the cycle of abuse.
Involve the social worker early
Do not discharge the patient until a safe haven has been established.
Resources
National
The following agencies provide national assistance for victims of domestic and family violence:
Centers for Disease Control and Prevention (800-CDC-INFO (232-4636)/TTY: 888-232-6348
Childhelp: National Child Abuse Hotline: (800-4-A-CHILD (2-24453))
The coalition of Labor Union Women (cluw.org): 202-466-4615
Corporate Alliance to End Partner Violence: 309-664-0667
Employers Against Domestic Violence: 508-894-6322
Futures without Violence: 415-678-5500/TTY 800-595-4889
Love Is Respect: National Teen Dating Abuse Helpline: 866-331-9474 /TTY: 866-331-8453
National Center on Domestic and Sexual Violence
National Center on Elder Abuse
National Coalition Against Domestic Violence (www.ncadv.org)
National Network to End Domestic Violence: 202-543-5566
National Organization for Victim Assistance
National Resource Center on Domestic Violence: 800-537-2238
National Sexual Violence Resource Center: 717-909-0710
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Stone LB, Amole Person in custody over campus dating violence, Cyranowski JM, Swartz HA. History of childhood emotional abuse predicts lower resting-state high-frequency heart rate variability in depressed women. Psychiatry Res. 2018 Nov;269:681-687. [PMC free article: PMC6223021] [PubMed: 30273892]
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Jordan KS, Steelman SH, Leary M, Varela-Gonzalez L, Lassiter SL, Montminy L, Bellow EF. Pediatric Sexual Abuse: An Interprofessional Approach to Optimizing Emergency Care. J Forensic Nurs. 2019 Jan/Mar;15(1):18-25. [PubMed: 30789466]
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US Preventive Services Task Force. Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, Doubeni CA, Epling JW, Grossman DC, Kemper AR, Kubik M, Landefeld CS, Mangione CM, Silverstein M, Simon MA, Tseng CW, person in custody over campus dating violence, Wong JB. Interventions to Prevent Child Maltreatment: US Preventive Services Task Force Recommendation Statement. JAMA. 2018 Nov 27;320(20):2122-2128. [PubMed: 30480735]
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Content warning: This page contains information about relationship and sexual violence.
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Dating and relationship violence is a pattern of coercive and abusive tactics employed by one person in a relationship to gain power and control over another person. It can take many forms, including physical violence, coercion, threats, intimidation, isolation, and emotional, sexual or economic abuse.
Abusive relationships may include sexual violence, which person in custody over campus dating violence a form of physical violence. Loving someone does not mean that you can never say “no” to sex. No matter what kind of relationship you have, if you are forced to have sex, it is rape. If you are humiliated or forced to be sexual in any way, that is sexual abuse.
Relationship violence is a set of behaviors that are commonly misunderstood in our society. You may have heard people say things like, “Why would she/he/they stay with him/her/them if they are abusing them?” or “Why doesn’t she/he/they leave?” These comments and questions can be hurtful and blaming of the person who is experiencing the violence. They suggest that the survivor is doing something wrong, rather than that the perpetrator of the violence is at fault. In reality, there are a myriad of reasons why it is difficult to leave abusive relationships, and the person being abused is the expert of their own situation.
Definitions
Definitions under the Campus SaVE/Clery Act/VAWA regulations, 34 C.F.R. Section 668.46
Dating Violence
Violence committed by a person who is or has been in a social relationship of a romantic or intimate nature with the victim.
- The existence of such a relationship shall be determined based on the reporting party’s statement and with consideration of the length of the relationship, the type of relationship, and the frequency of interaction between the persons involved in the relationship.
- For the purposes of this definition:
- Dating violence includes, but is not limited to, sexual or physical abuse or the threat of such abuse.
- Dating violence does not include acts covered under the definition of domestic violence.
Domestic Violence
A felony or misdemeanor crime of violence committed:
- By a current or former spouse or intimate partner of the victim;
- By a person with whom the victim shares a child in common;
- By a person who is cohabitating with, or has cohabitated with, the victim as a spouse or intimate partner;
- By a person similarly situated to a spouse of the victim under the domestic or family violence laws of the jurisdiction in which the crime of violence occurred, or
- By any other person against an adult or youth victim who is protected from that person’s acts under the domestic or family violence laws of the jurisdiction in which the crime of violence occurred.
Abusive Behaviors
- Destructive criticism and verbal attack: Name person in custody over campus dating violence, mocking, accusing, swearing, making humiliating remarks or gestures, ridiculing your most valued beliefs.
- Pressure tactics or threats: Rushing you to make decisions using guilt, fear or intimidation; regularly threatening to leave or telling you to leave; making and/or carrying out threats to hurt you or others; threatening you with a weapon, etc.; locking you in or out of the house; taking the children; threatening suicide; reporting you to the Department of Social Services; putting your job or other things that are important to you at risk.
- Emotional abuse: Manipulating you with lies or contradictions (playing “mind games”); making you feel stupid/crazy (usually this is specific to whatever makes you feel the worst); not following through on agreements; manipulating shared children; abandoning you in a dangerous place; refusing to take care of you or get help when you are sick or hurt; destroying your possessions.
- Stalking: Following, harassing or threatening you repeatedly; telephoning and text messaging constantly; waiting on you outside or inside places; watching you from afar, or sending
- Unwanted letters or emails.
- Sexual violence: Degrading treatment; forcing you to have sex; using threats or coercion to obtain sex or perform sexual acts; coercing sex during or after a violent incident.
- Minimizing, denying and blaming: Making light of behavior; insisting it’s not serious; denying the abuse happened; shifting responsibility for abusive behavior (“It’s your fault, you made me do it.”)
- Physical violence: Being violent to you, others or household pets; slapping; punching; grabbing; kicking; choking; pushing; biting; holding you to prevent your leaving.
- Harassment: Making uninvited visits; following you; embarrassing you in public; refusing to leave when asked; accusing you of seeing someone else (being overly jealous); obsessive web communication, such as e-mails, person in custody over campus dating violence, instant messages, Facebook and cell phone calls and text messages.
- Economic person in custody over campus dating violence Interfering with your work or not letting you work; threatening to withhold money; refusing to give you money or taking your money; taking your car keys or otherwise preventing you from using the car; ruining person in custody over campus dating violence credit; forcing you to do illegal acts for money.
- Isolation: Preventing or making it difficult for you to see friends or relatives; making family and friends so uncomfortable they do not want to visit; monitoring phone calls; telling you where you can and cannot go; moving to a place where you have no support; not letting you have a phone or access to the car.
- Intimidation: Person in custody over campus dating violence looks, actions or gestures to make you scared to do something differently; making angry or threatening gestures; acting “crazy” or out of control; subjecting you to reckless driving; using physical size to intimidate (such as standing in the doorway during arguments); out-shouting you.
LGBTQIA Relationship Violence
While many aspects of relationship violence against Lesbian, Gay Bisexual, Trans or Queer individuals are similar to those experienced by heterosexual victims, it is not in all ways identical. Perpetrators often attempt highly specific forms of abuse based on identity and community dynamics, including:
- Outing or threatening to out a partner’s sexual orientation or gender identity to family, employers, police, religious institutions, communities, in child custody disputes or in other situations where this may pose a threat.
- Reinforcing fears that no one will help the victim because s/he/they is lesbian, gay, bisexual or transgender, or that for this reason, the partner deserves the abuse.
- Alternatively, justifying abuse with the notion that a partner is not really lesbian, gay, bisexual or transgender (i.e. the victim may once have had, or may still have relationships, or express a gender identity, inconsistent with the abuser’s definitions of these terms). This can be used both as a tool in person in custody over campus dating violence and emotional abuse as well as to further the isolation of a victim from community.
- Using the victim’s fluid orientation against them- this can be in the form of telling bisexual men or women that they are not “really” queer or that their orientation is a betrayal of the same-sex partner. It can also be used against bisexual and queer people in different-sex relationships, through threats of outing, or questioning the abused partner’s commitment to the relationship because of their sexual orientation of gender identity.
According to the CDC, 44% of lesbian women, 61% of bisexual women, 26% of gay men, and 37% of bisexual men report being the victim of rape, physical violence and/or stalking by an intimate partner.
But I’m a college student… I don’t have to worry about relationship abuse, right?
Unfortunately, dating and domestic abuse is a problem for college students and is often a risk factor of abuse in subsequent relationships and marriages. Below is a list of warning signs of abusive behaviors. If these behaviors appear in your or a friend’s relationship, it’s important to remember that they are not the fault of the victim–the perpetrator is solely responsible for his/her/their actions. It is also important to remember that while these behaviors may indicate an abusive relationship, not all of them need to be present for a relationship to be abusive, person in custody over campus dating violence. Everyone in a relationship has the right to set their own boundaries with their partner in a way that feels safe and supportive for them.
Warning Signs of Abusive Behaviors
- Exhibits jealousy when you talk to others. May say that his/her jealousy is a sign of love.
- Consistently accuses a partner of flirting or cheating, or treats other important relationships in a partner’s life with suspicion.
- Tries to control where you go, whom you go with, what you wear, say, do, etc.
- Attempts to isolate you from loved ones. May try to cut you off from resources, friends and family.
- Uses force, coercion or manipulation in sexual activity.
- Degrades or puts you down. Dismisses accomplishments that you achieve.
- Displays frequent mood or behavior swings. May be kind one minute and exploding the next; charming in public and cruel in private.
- Threatens to use physical force. Breaks or strikes objects to intimidate you.
- Physically restrains you from leaving the room, pushes, shoves you, etc.
- Has hit other partners in the past but assures you that the violence was provoked.
- May exhibit economic control by not allowing you to go to work, have access or control of your money or paycheck, or access to your car.
Why They Don’t Leave
There is a pervasive myth that a person who is in an abusive relationship doesn’t leave because they enjoy the abuse. This is false. People who are abused by their dating or domestic partner do not stay in the relationship because they enjoy the maltreatment. The victim may stay for practical or emotional reasons including feelings of love and attachment, social isolation or shame, economic factors, or a fear of retaliation for leaving, through physical violence or homicide.
Another pervasive myth is that emotional abuse is not serious or “real abuse.” However, emotional abuse not only impacts the victim’s self-esteem, it can cause long- term psychological trauma. For many victims it is the most damaging aspect of abusive relationships.
Remember, when someone hits or degrades their partner, that behavior is not provoked. While anger can be provoked during an argument, abuse is a choice the perpetrator makes to establish control. It is an intentional act or set of acts designed to force the abused partner to submit to the will of the abuser.
How You Can Take Care of Yourself
- Don’t blame yourself and don’t excuse your partner’s behavior.
- Think about your safety and create a plan. Seek help from friends, family or your healthcare truly free dating sites what you need person in custody over campus dating violence be safe- what are the risks you are facing and how can they be mitigated, even temporarily?
- Consider who may be able to help support you (friends, family, staff members, etc.) and how you might reach out to them.
- If you want to leave the relationship, consider what you may need to be able to successfully do that.
- If you are experiencing sexual violence or reproductive abuse, consider strategies for protecting your sexual health.
- Call a crisis helpline like S.A.R.A.H. 314-935-8080 or Uncle Joe’s 314-935-5099, or a women’s shelter, for advice. These are available during the academic year.
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The #MeToo movement may have shifted the balance of credibility on sexual abuse and harassment at work more toward victims and away from alleged perpetrators. But the same cannot be said regarding men’s violence and abuse at home: In fact, women’s reports of domestic violence are still widely rejected, especially in one critical setting: the family court.
When women, children or both report abuse by a father in a case person in custody over campus dating violence child custody or visitation, courts often refuse to believe them. Judges even sometimes “shoot the messenger” by removing custody from the mother and awarding it to the allegedly abusive person in custody over campus dating violence.
For instance, courts reject 81% of mothers’ allegations of child sexual abuse, 79% of their allegations of child physical person in custody over campus dating violence, and 57% of their allegations of partner abuse. Overall, 28% of mothers alleging a father is abusive lose custody to that father; this percentage rises to 50% when an allegedly abusive father accuses the mother of “parental alienation” (more on this below).
Family courts’ hostility – both in the U.S. and abroad – toward claims of paternal or spousal abuse has been widely reported by scholarsand litigants. But it’s only recently that empirical data has been produced that validates the growing chorus of distress.
‘Dynamic of resistance’
I am a scholar of domestic violence person in custody over campus dating violence the law. Working with four other researchers, I conducted a federally funded study that reviewed all electronically published family court cases between parents in the U.S. between 2005 and 2014 related to custody or visitation that involved abuse or alienation claims.
Among the results from this analysis of thousands of cases: Courts rejected women’s claims of partner violence and child abuse by men, on average, roughly two-thirds of the time. They rejected mothers’ claims of child abuse by fathers approximately 80% of the time. And they reversed custody from mothers alleging abuse to the allegedly abusive fathers at rates ranging from 22% – for partner violence claims – to 56% when mothers alleged both sexual and physical child abuse.
The same dynamic of resistance to mothers’ abuse claims against fathers in custody cases has been documented across the globe.
Courts’ skepticism in these cases is due to many factors, but a key driving force is the concept of “parental alienation” or “parental alienation syndrome,” which was invented in the 1980s by a psychiatrist named Richard Gardner.
Gardner claimed that the vast majority of child sexual abuse claims in custody court were false, person in custody over campus dating violence. In addition to attributing false allegations to mothers’ vengeance against their ex-husbands, he theorized that mentally unbalanced mothers also convince themselves (falsely) that their children are being abused by their fathers.
Gardner’s “parental alienation syndrome” (“PAS”) was eventually discredited by courts and scholars. But the notion of parental alienation as the toxic influence of a primary parent that turns children against the other parent continues to profoundly influence family courts’ responses to women’s claims of abuse, especially child sexual abuse.
Thus, dating site for people with social anxiety study found, consistent with Gardner and parental alienation theory, that when a father accused of sexual abuse responded by accusing the mother of parental alienation, 50 out of 51 courts sided with the father and complete free dating sites without payment to believe the sexual abuse claim.
Our study also found that when allegedly abusive fathers respond to any type of abuse allegations by accusing mothers of alienation, mothers are roughly twice as likely to be disbelieved, and their rate of custody losses doubles to roughly 50%.
While Gardner’s syndrome theory has been repudiated as unscientific, parental alienation writ large continues to be treated by many family court professionals and judges as quasi-scientific, even though there is no credible scientific research to support the theory.
More specifically, there is no empirical research supporting the idea that, when one parent bad-mouths the other or takes other steps to undermine the other’s relationship with a child, the child actually turns against the “targeted” parent. In fact, research has found the opposite: that bad-mouthing can actually backfire, by turning the child against the bad-mouthing parent.
Nor is there any objective way to distinguish a child’s legitimate dating jewish men justified estrangement due to the avoided parent’s own behaviors from an estrangement unjustifiably fueled by the other parent.
In short, there is no scientific or objective means of applying the alienation label. Rather, it is applied whenever an evaluator or court subjectively chooses not to believe a mother and/or a child’s abuse claims and chooses to instead believe the mother is malicious or sick and the child is not in reality.
Who gets protected?
Most people presume that family courts are protective of children and responsive to abuse concerns. This assumption persists in part because society underestimates abusers’ manipulations of the legal system, courts’ inclination to prioritize fathers’ rights and access above most other concerns, and the backlash against women who are seen as not wanting to share the kids.
The belief that it is fathers, not mothers, person in custody over campus dating violence, who can’t get a fair shake in custody cases is further fueled by fathers’ rights groups’ claims that courts are biased against fathers.
This common assertion helps fathers whose parenting may be indian girl for dating near me or destructive cast themselves as victims while casting mothers who raise such concerns as perpetrators. And it encourages courts to view their prioritization of fathers’ rights as progressive and egalitarian.
Indeed, the scholarly literature surrounding custody court decision-making routinely emphasizes the importance of fathers and shared parenting. These articles often reiterate that fathering is critically important to children, without much attention to the specifics of individual parents’ past behaviors and impacts on their children. This pro-father sentiment translates into treating mothers as personae non gratae when they seek to restrict paternal access or claim a father is dangerous or harmful.
In fact, while family courts’ special valuation of fathering is difficult to prove empirically, our study did find that protective fathers are not penalized for accusing the mother of abuse, as are mothers who accuse fathers of abuse. The study also found that parental alienation claims benefit fathers more than mothers.
Deadly consequences
The harm to both children and their protective mothers from these family court practices is significant.
One study of what are why online dating is bad for guys “turned-around” cases involved allegations of child abuse that were at first viewed as false and later judged to be valid. This study found that a majority of children in these cases were forced to live with their abusive fathers, that the vast majority reported new incidents of abuse and that children’s mental and physical health significantly deteriorated before a second court finally sent them back to their safe mothers.
Worst of all, family courts’ refusals to take seriously one parent’s claims that the other parent is dangerous have enabled over 100 child homicides.
Perhaps it is time for #MeTooHome.
Man charged with domestic violence at campus apartments
An Indianapolis man was arrested by Vanderburgh County Sheriff’s deputies Monday night for dating violence that occurred in the O’Daniel South Apartments.
Twenty-year-old Demond Lamont Glover was charged with multiple accounts of battery, as well as criminal mischief and intimidation.
A Rave Alert issued by Public Safety said Glover had fled the scene, but was apprehended and eventually taken into custody. He was booked into the Vanderburgh County Jail at 10:08 p.m. and is being held without bond.
Glover was plot generator for online dating to leave his girlfriend’s apartment according to the probable cause affidavit. Police say the victim had a large knot over her right eye and said that Glover had beaten her up in the apartment.
There were broken items person in custody over campus dating violence the living room and bedroom and damage to the ceiling light in the bedroom and the wall near the bathroom, indicating a sign of a struggle and fight.
The victim told police that Glover had forced her against the bedroom wall and started choking her with both his hands. She also said Glover had punched her in her right jaw.
The victim was able to get away from Glover and locked herself in the bathroom. He eventually got into the bathroom to try and talk to the victim, but she left the scene to talk to a friend.
After about 30 minutes, the victim returned to the apartment to find Glover had put holes in the walls and smashed a ceiling light in her bedroom.
The victim then called her relatives to come and get her but was attacked by Glover, who banged her head against the wall and punched her with both fists.
Police say the victim told them Glover was trying to kick her in the head while she was seated in a chair. She also told police that Glover was yelling at her, person in custody over campus dating violence he was going to kill her.
The victim fled the scene and was trying to call 911 before she ran into her Person in custody over campus dating violence Assistant, who then called Public Safety.
A Vanderburgh County K9 tracked Glover down into the wood line near the apartment, where he was taken into custody without incident.
1 person in custody after domestic violence incident near WTAMU campus
CANYON, Texas (KAMR/KCIT) — One person is in custody after a domestic violence incident near the West Texas A&M University campus.
WTAMU University Police responded to a call at McClaslin Apartments, in the 2400 block of 4th Avenue, around 11:30 p.m., Saturday, July 24. According to UPD, the caller said roommates were fighting. When officers arrived, they found two people at dating apps for sex reddit scene, one with visible injuries.
WT police said one person appeared to be highly intoxicated and was combative toward officers. That person was arrested for Assault Family Violence and Resisting Arrest, and transported to the Randall County Jail.
WTAMUPD said neither person associated with the incident are students or employees of WT. The incident was reported in accordance with the Jeanne Clery Disclosure of Campus Security Police and Campus Crime Statistics Act (Clery Act). The Clery Act is a federal law mandating U.S. colleges and universities to disclose information about crime on and around their campuses. A requirement of this law is timely notification to the campus community of certain crimes in a manner that will aid in the prevention of similar crimes.
The Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act (Clery Act) is a federal law that requires colleges and universities across the United States to disclose information about crime on person in custody over campus dating violence around their campuses. A requirement of this law is timely notification to the campus community of certain crimes in a manner that will aid in the prevention of similar crimes.
WTAMU Police remind citizens of the following:
- Assaultive abuse may be physical, emotional and/or verbal.
- Assaultive abuse may include damaging your property, including throwing objects, punching walls, kicking doors, etc.
- Assaultive abuse may include damaging your property, including throwing objects, punching walls, kicking doors, etc.
- Believe someone who discloses sexual assault, abusive behavior, or experience with stalking.
- Watch out for friends and fellow students or employees who look like they could be in trouble or need help. Ask if they are ok.
Copyright 2022 Nexstar Media Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
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