Intimate Partner Violence Flashcards Preview

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Flashcards in Intimate Partner Violence Deck (32)
1

What is Intimate Partner Violence? 

Assaultive behavior that functions to dominate, control or punish another in an intimate, supposedly peer, relationship

2

What are the 4 types of Intimate Partner Violence?

  • Physical
    • grabbing & restraining --> using a weapon
  • Sexual
  • Property/pet destruction
  • Psychological battering/terrorism 

3

Incidence of Partner Violence

  • Lifetime physical violence: ___%
  • Lifetime injury: ___%

  • Lifetime physical violence: 39%
  • Lifetime injury: 25%

4

____% of women has been raped by an intimate partner in her lifetime

____% of women have experience an intimate partner sexual violence other than rape 

  • 9.4% of women has been raped by an intimate partner in her lifetime
  • 16.9% of women have experience an intimate partner sexual violence other than rape 

5

What is the difference between female & male intentional injury?

  • Violence against women: primarily IPV
    • 64% of women who reported rape, physical assault, and/or stalking since age 18 were victimized by a current or former partner (husband, cohabiting partner, boyfriend or date)
  • Violence against men: primarily non-IPV
    • 84% of men who reported rape and/or physical assault since age 18 were victimized by non-partner
    • Only 16% of men who reported rape and/or physical assault were victimized by a current/former partner 

6

Compared to men, women in violent intimate relationships experience more...

  • Fear
  • Need for medical care
  • Injury
  • Negative psychological impact
    • depression, PTSD
  • Absence from work or school due to IPV 

7

Men are most at risk for violence perpetrated by...

  • Male friends
  • Male acquaintances
  • Male strangers 

8

Women in lesbian relationships experience IPV at a rate _______ to women in heterosexual relationships
Men in homosexual relationships experience IPV at rates _______ to men in heterosexual relationships
Bisexual men & women experience ____ rates of IPV 

comparable

comparable 

higher 

9

What are the Relationship Dynamics of Intimate Partner Violence?

  • Intimate relationship context
    • IPV vs. stranger violence
    • Very reluctant to call police
    • Constant abuse, attachment, excuses
  • Temporal pattern
  • Injury risk
  • Fear
  • Isolation
  • Dynamics for adolescent girls different than for adult women 

10

What is the importance of a cycle of violence with IPV?

  • Transgenerational
    • Biggest risk for boy is seeing violence in his parent’s relationship
  • Cycle of violence w/i the relationship
    • Explosion-tension phases repeating 

11

What are the Societal Dynamics of Intimate Partner Violence?

  • Institutional/structural sexism
  • Legislative factors
  • Law enforcement/criminal justice
  • Social services
  • Medicine 

12

_____ & _____ injuries more characteristic of blunt intentional trauma than car crashes or falls 

Facial & head injuries more characteristic of blunt intentional trauma than car crashes or falls 

13

Battered women experience more hospitalizations for...

  • Trauma
  • Surgical disorder, non-trauma
  • Gynecological disorder
  • Induced abortion
  • Medical disorder
  • Observation of undefined condition 

14

With more recent research, compared to controls, victims of IPV have...

Significantly more health problems due to any disease

  • More induced abortions
  • More gynecological disease
  • More mental illness 

15

10 Adverse Childhood Events 

  • Child abuse
    • Physical abuse
    • Sexual abuse
    • Emotional abuse
    • Physical neglect
    • Emotional neglect
  • Family dysfunction
    • Intimate partner violence
    • Mental illness
    • Substance abuse
    • Imprisonment
    • Marital discord

16

What is the dose-response relationship between adverse childhood events & adult disorders?

*sorry long card*

  • Smoking
  • Alcoholism
  • Drug use
  • Injected drug use
  • STIs
  • # sexual partners
  • Severe obesity
  • Depression
  • Anxiety
  • Panic Disorder
  • Suicide
  • IHD
  • COPD
  • Stroke
  • Idiopathic myocarditis
  • Myasthenia gravis
  • Rheumatoid arthritis
  • Autoimmune hemolytic anemia 

17

What are the distinguished presentations of IPV?

  • As a Mental Health problem
  • As a Relationship problem
  • As a Child-Related problem

 

  • As a Mental Health problem
    • Depression, Anxiety
    • Alcohol/drug abuse
  • As a Relationship problem
    • Sexual dysfunction
    • Partner as identified patient
  • As a Child-Related problem
    • Suspected child abuse
    • Child behavior problem 

18

What are the CLINICAL PATHWAYS between abuse & health?

  • Psychopathology mediates btwn trauma exposure & poor health outcomes through
    • Elevated symptom reporting
    • Medical adherence & coping
    • Coping strategies for coping (ex: PTSD)
      • Risky behaviors
      • Low self-efficacy to change and/or maintain preventative health regimens
      • Increased risk of re-victimization

19

What are the PHYSIOLOGICAL PATHWAYS between abuse & health?

  • Chronic stress disrupts the normal neurochemical mechanisms of coping & stress responding
  • Catecholamine, HPA axis, & immune response
    • Trauma disregulated these physiologic processes
    • Increase in proinflammatory cytokines
      • Creates wear on the system
      • Increases vulnerability to disease
  • Negative effects of sleep disruption
    • Immune function
    • Metabolic changes
    • Chronic HPA axis activation
  • Sleep deprived persons have more:
    • Inflammation
    • Greater functional disability
    • Decreased quality of life 

20

What are some patient barriers to diagnosing & treating partner violence?

  • Lack of trust
  • Safety jeopardized
  • Financial support jeopardized
  • Shame & humiliation
  • Futile resignation

21

What are some barriers health professionals face in diagnosing & treating partner violence?

  • Lack of knowledge
  • Lack of clinical skills & training
  • Fear of offending the patient
  • Too close for comfort
  • Pandora’s Box: powerlessness & loss of control 

22

What is the Partner Violence Screen?

  • In my practice I’m concerned about prevention & safety, especially in the family
  • Have you been hit, kicked, punched or otherwise hurt by someone w/i the past yr? If so, by whom?
  • Do you feel safe in your current relationship?
  • Is there a partner from a previous relationship who is making you feel unsafe now?
    • Risk of homicide is greatest 2 yrs after violent relationship

23

How would you incorporate questions about IPV into the family/relationship history interview?

Begin w/ open-ended questions, then be specific

  • “When did you and your partner meet?”
  • “What was your attraction?”
  • “What happens when you argue or fight?” followed by:
  • “Has your partner ever pushed, kicked or grabbed you?” 

24

What are some characteristics of effective interview questions?

  • Ask about specific behaviors
  • Avoid general, emotionally charged terms like abuse, violence & victimization
  • Ask about various types of violence & responses to it: fear, injury, sexual assault, control
  • Ask about current problems from previous relationships

25

When should you ask about partner violence?

  • Annual or general exams
  • Initial visit w/ 1st time patients
  • As part of the initial assessment at a specialist
  • Well child exams
  • Adolescent & sports physicals
  • OB visits
    • Pregnancy: 4 times
    • Each trimester & post-partum visit
  • Whenever you suspect it 

26

What is the S-O-S Doc Intervention?

  • Support, belief, confidentiality
  • Safety: help assess danger
  • Options: safety planning & follow-up
  • Strengths to build upon
  • Document
  • Continuity 

27

S-O-S Doc Intervention

Support, belief, confidentiality 

  • Talk privately
  • Make eye contact
  • I’m sorry you have been treated this way
  • Nobody deserves to be hit or hurt
  • You have a right to be safe & respected
  • The abuse is not your fault 

28

S-O-S Doc Intervention

Safety

  • Do you feel safe going home?
  • Are your children safe?
  • Indicators of Danger
    • Increasing frequency or severity
    • Weapons used
    • Drug & alcohol abuse
    • Forced or threatened sexual acts
    • Life transitions: pregnancy, separation, divorce
    • History of past violence or suicide attempts
    • Threats to kill 

29

S-O-S Doc Intervention

Options

  • Local or regional woman’s shelters
  • Legal advocacy
  • Police
  • 911
  • Emergency plan 

30

S-O-S Doc Intervention

Strengths

  • Identify & validate patient strengths
    • You are facing a very tough situation w/ a great deal of courage
    • I can see that you care deeply about your children
    • You have shown great strength in very tough circumstances 

31

S-O-S Doc Intervention

History 

  • History
    • Describe what the patient said using direct quotes
    • Add other historical data
    • Avoid pejorative language
    • Use “Patient said ‘my husband hit me in the head with a pan’”
    • DO NOT use “Patient claimed..” or “Patient alleged..”
  • Observations
    • Behavior
    • Injuries
      • Location & quality
      • Use drawings, body charts or photos
      • In photos use ruler for scale; victim’s face for identity
  • Assessment
    • Your assessment of potential partner violence
    • “Injury inconsistent w/ reported mechanism of injury”
    • “Injury & history consistent w/ intentional injury”
    • Include name of perpetrator if reported by patient 

32

S-O-S Doc Intervention

Continuity 

  • Encourage & schedule follow-up appts
  • Connect to community resources
  • Assess barriers to follow up
    • Will you have transportation for the next appt?
    • Will your partner try to prevent you from returning?