Domestic Violence (cont.)

Medical Author:

Roxanne Dryden-Edwards, MD

Roxanne Dryden-Edwards, MD

Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Domestic violence may lead to both physical and psychological signs and symptoms in the victim. Victims may have obvious physical signs of traumatic injury, but they may also complain of noninjury signs and symptoms, such as chronic abdominal pain, that may seem unrelated to an abusive relationship. Family and friends, even coworkers, may see the following signs and symptoms. You may recognize some of them if you are a survivor of domestic violence. These are also signs that doctors look for in assessing potential victims of domestic abuse.

• Psychological signs and symptoms:
• Recognizing the signs and symptoms of domestic violence begins by observing the behavior of both the abuser and the person being abused. The abuser may appear overly controlling or coercive, attempting to answer all questions for the victim or isolating him or her from others. This type of behavior may occur in the context of a visit to the doctor where the abuser refuses to let the victim out of his sight and attempts to answer all questions for the victim. You may even note emotional abuse actually taking place. In stark contrast, the person being abused may appear quiet and passive. He or she may show outward signs of depression such as crying and poor eye contact.
• Other psychological signs of domestic violence range from anxiety, depression, and chronic fatigue to suicidal tendencies and the battered woman syndrome—a syndrome similar to the post-traumatic stress disorder seen in people threatened with death or serious injury in extremely stressful situations (such as war).
• Substance abuse is also more common in the person enduring domestic violence than in the general adult population. The abuse of alcohol, prescription drugs, and illicit drugs may happen as a result of the violent relationship rather than being the cause of the violence.
• Physical signs and symptoms:
• Domestic violence assault may lead to specific injury types and distributions.
• These injury types and patterns may result from things other than domestic violence but should raise suspicion of abuse when present.
• Injury types seen more commonly in domestic-violence injuries than in injuries caused by other means are these:
• Tympanic membrane (eardrum) rupture
• Rectal or genital injury
• Facial scrapes, bruises, cuts, or fractures
• Neck scrapes or bruises
• Abdominal cuts or bruises
• Tooth loose or broken
• Head scrapes or bruises
• Body scrapes or bruises
• Arm scrapes or bruises
• Physical signs and symptoms of domestic violence that result from traumatic injury may seem similar to injuries resulting from other causes. But some injury types and locations may increase the suspicion of assaultive violence.

  The distribution of injuries on the body that typically occurs in the domestic-violence assault may follow certain patterns. Some frequently seen patterns of injury are as follows:

  • Centrally located injuries:
  • Injury distribution is in a bathing-suit pattern, primarily involving the breasts, body, buttocks, and genitals.
  • These areas are usually covered by clothing, concealing obvious signs of injury.
  • Another central location is the head and neck, which is the site of up to 50% of abusive injuries.
  • Characteristic domestic violence injuries
  • Cigarette burns
  • Bite marks
  • Rope burns
  • Bruises
  • Welts with the outline of a recognizable weapon (such as a belt buckle)
  • Bilateral injuries: Injuries involving both sides of the body, usually the arms and legs
  • Defensive posture injuries: These injuries are to the parts of the body used by the woman to fend off an attack.
  • The small finger side of the forearm or the palms when used to block blows to the head and chest
  • The bottoms of the feet when used to kick away an assailant
  • The back, legs, buttocks, and back of the head when the woman is crouched on the floor
  • Injuries inconsistent with the explanation given:
  • The injury type or severity does not fit with the reported cause.
  • The mechanism of injury reported would not produce the signs of injury found on physical examination.
  • Injuries in various stages of healing:
  • Signs of both recent and old injuries may represent a history of ongoing abuse.
  • Delay in seeking medical attention for injuries may indicate either the victim's reluctance to involve doctors or his or her inability to leave home to seek needed care.
• Noninjury physical signs and symptoms:
• Individuals experiencing ongoing abuse and stress in their lives may develop medical complaints as a direct or indirect result.
• Often, the person enduring domestic violence goes to the emergency department or clinic on multiple occasions with no physical examination findings to account for his or her symptoms.
• Some typical medical complaints:
• Headache
• Neck pain
• Chest pain
• Heart beating too fast
• Choking sensations
• Numbness and tingling
• Painful sexual intercourse
• Pelvic pain
• Urinary tract infection
• Vaginal pain

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