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Domestic or intimate partner violence is defined by the WHO as ‘any behaviour within an intimate relationship that causes physical, psychological or sexual harm to those in the relationship’. However, the abuse can be of an elderly parent by the children or from some other member of the household to another member. The usual focus is on women and children who are subjected to violence and men who use violence.
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A major problem in dealing with domestic violence is that it is hidden and the victims are reluctant to divulge the cause of their injuries when visiting medical practitioners.
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Frequent presentations of non-specific symptoms
Psychological problems
Physical injuries: usually bruising caused by punching, kicking or biting
Unintended pregnancy, poor antenatal care
Drug and alcohol abuse
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Cycle of violence A predictable pattern that is referred to as the ‘cycle of violence’ has been identified. The cycle repeats itself with a tendency for the violence to increase in severity (see Fig. D10).
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Diagnosis If you suspect domestic violence—ASK! The doctor has to take the initiative because patients rarely complain. Ensure the man leaves the room to talk to the woman alone. It is recommended to ask all pregnant women about violence during antenatal care.
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Management The key to successful management is initial recognition of the problem and establishment of empathetic caring and support for the victim and family. The immediate safety of women and any children is always the priority. A management strategy is presented in Figure D11.
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Suggested safety plan for an abusive incident:
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Compile a list of emergency numbers
Identify family and friends who can provide support
Put aside emergency money and pack a bag of clothing and toiletries
Be aware of all exit routes and safety areas
Safely exit the house
Identify a safe place to go and how to get there