Public Violence Dominates The Media, Domestic Violence Often Goes Unnoticed

Increased attention has been focused on violence in public places. It is now nearly commonplace to hear and read of devastating school violence. We are becoming accustomed to reports of people heavily armed storming into public places ranging from daycare centers to places of worship, firing off a storm of bullets. Reports of hate-related violence are appearing all too frequently.

These public displays of violence do not go unnoticed. They reach the consciousness of the media, the community and on an individual level they cause alarm as we question our perception of safety in an increasingly more violent world.

Many of us may think of public places as dangerous, but rarely do we think of home as a place of danger. Violence that goes on behind closed doors in homes against a spouse or a child known as domestic violence often goes unnoticed by the media, neighbors and co-workers. This tears apart our conception of safety and rips apart the lives of its victim through dangerous physical and emotional scarring and even death.

Domestic Abuse

Writing in The New England Journal of Medicine on Sept. 16, 1999, Eisenstat and Bancroft give this definition: "Domestic abuse, or battering, is a pattern of psychological, economic and sexual coercion of one partner in a relationship by the other that is punctuated by physical assaults or threats of bodily harm."

The authors examine the magnitude of domestic violence in America. They note that more than 90 percent of cases of partner violence involve women being abused by men. Domestic violence is also perpetrated against women in same sex relationships. Women are not the only victims of domestic violence. Men are physically abused by women and in same sex relationships. Older adults are victims of domestic violence with more cases of abuse against older women being reported.

The signs of domestic violence can be recognized in health settings when the victims seek care. Through routine medical, gynecological and pediatric visits, physicians and other healthworkers have the opportunity to prescreen for domestic violence. By identifying the signs of domestic violence, there is a chance to offer the victim early help. All too frequently these signs are only identified later by police in calls for domestic violence and in homicide cases by coroners.

The New England Journal of Medicine article indicates the prevalence of domestic violence in the health care setting as follows:

Emergency Medicine

One in four women seeking care in the emergency department is a victim of domestic violence. The incidence of domestic violence against women often increases when they are pregnant.

Obstetrics and Gynecology

One in six pregnant women is abused during her pregnancy. A women's refusal to seek prenatal care may be a sign of possible domestic violence.

Primary Care

One in four women has been abused at some point in her life; with one in seven reporting have been abused within the past 12 months.

Psychiatry

One in four women seeking psychiatric care is a victim of domestic violence.

Suicide is seen as a way out for many women that are physically abused. The New England Journal Of Medicine article notes that one in four women who attempt suicide is a victim of abuse.

Pediatrics

Violence between domestic partners occurs in one in six U.S. homes. According to the New England Journal of Medicine, 3.3 million children in the United States between 3 and 17 years of age each year witness parental abuse. Fifty to seventy percent of the mothers of abused children are abused by their partners.

The way to safety is not easy for victims of domestic violence. For many, the threat of danger increases after they have left the abuser. This factor combined with the financial, legal and emotional ties to the abuser keep many victims captive to the wims of the abuser. It is hoped with increased public awareness about domestic violence that more victims will be noticed and shown a path toward a safer place.

Resource: The National Domestic Violence Hotline (1-800-799- SAFE) can provide information on hospital and community-based resources.

Source: Eisenstat SA, Bancroft L: Domestic violence, New Engl J Med 341: 886-892, September 16, 1999.

For more information, please visit the MedicineNet.com Child Abuse Center for more information about this aspect of domestic violence.