1. What are some common symptoms that indicate to a provider the patient may be abused?
Barnes: Frequent treatment in the emergency department for injuries; patient reports multiple “accidents.” Patient tells stories of how injuries occurred that seem incongruent with the physical exam findings. For example, bruises inconsistent with the type of accident. Woman dresses in clothing designed to hide bruises or scars (e.g. wearing long sleeves in the summer or sunglasses indoors).
Thacker: Abused women are often withdrawn from healthcare workers, teachers or others in authority. They appear more fearful than what is normal for other women seen in the emergency department.
2. What is hospital protocol if the provider suspects the patient is being abused? What is the protocol if the patient admits to abuse?
Barnes: Contact law enforcement! Contact law enforcement! The law requires us to report suspected abuse. It is imperative that women who admit to being abused are assured that they will be safe from further harm or fear of retribution. We also involve the experienced staff from our social services and case management departments as often as possible. They are often able to spend additional time with victims to build rapport, so the women feel more comfortable while disclosing information.
3. Is it rare that a patient admits to being abused?
Barnes: Yes. Not only do victims fear retribution if they confess, they too often believe that leaving an abusive situation and being alone are more frightening than remaining in an abusive relationship. Also, victims frequently feel a need to protect the abuser.
4. Describe the relationship between hospital staff and police investigators/prosecutors.
Barnes: Dissemination of accurate information is imperative. As is often the case with abuse, reports are created on the basis of suspicion only. Due to the sensitivity of these cases, they receive top priority and commitment of multiple resources that must be immediately available.
Wilding: The one thing that’s very helpful is if there was an incident of abuse and the person doesn’t feel safe … that’s where law enforcement is critical to make sure they don’t get into some sort of a problem where they get home and they abuser is more angry, more drunk … We want to make sure they have a safe place to go.
5. Do providers ever refer patients to shelter, like Valley Crisis or Hope’s Door?
Barnes: Absolutely! Local women’s shelters are critical partners in delivering care to victims of abuse and doing what we can to ensure their wellbeing, now and in the future.
6. What are some of the long-term health effects of repeated physical abuse, particularly strangulation, which occurs most commonly in domestic violence situations?
Banta: Strangulation can cause vocal cord damage, bruising and swelling around the neck, possibly contributing to chronic pain. If hypoxia (lower than normal blood oxygen ) from the strangulation is prolonged then damage in the hippocampus (major component of the brain ) and other oxygen sensitive areas of the brain may occur resulting in memory problems and emotional dyscontrol. Other complications of abuse would include the effects of repeated concussion. This can result in actually a type of dementia (no different than dementia pugilistica, which boxers sometimes get) in the worst case. Other effects of concussion may result in motor, visual, learning, or emotional control deficits affecting adjustment to normal life and responsibilities. Severe or repeated head trauma can produce bipolar or schizophrenic like illnesses that can be quite severe. Other physical concerns would include back and neck injuries resulting in nerve damage, paralysis and chronic pain syndromes.
Wilding: The chronic problem you see from abusive relationships is usually psychiatric in nature. People will have depression, have self-esteem problems, have suicidal thoughts. There is a correlation to all the psychiatric illnesses and domestic violence.
7. What about the long-term effects of repeated mental/emotional abuse?
Wilding: With physical abuse, you can get injuries, you can get some bruising. Those things will heal. But the psychological scarring is very real and it’s virtually imperceptible.
Banta: Repeated mental/emotional abuse often is used to control the individual. This destroys the self-esteem which produces a broken psychologically dependent and weak individual who may require years of therapy to regain their former sense of self and confidence. This may also produce symptoms of posttraumatic stress which also need to be addressed psychologically and psychiatrically.