Encountering a patient with an injury due to potential interpersonal violence can be a challenging experience for trauma professionals. Beyond addressing the physical injury, navigating a situation with a patients safety in the balance as well as legal implications can be complex.

Domestic abuse encompasses everything, because more often than not, it has emotional, psychological and sexual aspects that go along with the physical abuse of someone with whom you have an intimate or familial relationship, says Morse, who facilitates a men domestic abuse treatment group for perpetrators.

Typically, providers learn about other aspects of abuse — the emotional and mental aspects — as they evaluate a patient with potential physical assault.

Incidence of domestic abuse
Domestic abuse is common, according to Morse and Graham. In the U.S., though statistics are elusive, the Centers for Disease Control and Prevention estimates 1 in 4 women and nearly 1 in 10 men are affected by sexual or physical violence, stalking by an intimate partner, or both. Presentation of domestic abuse-related injuries has increased in hospitals. In Olmsted County, Minnesota, for instance, cases with an ICD-10 code indicating confirmed physical abuse occurred as follows: 55 cases in 2014, 91 in 2015 and 93 in 2016. Morse notes that in the same county, the women shelter is often full. Overall, however, seeking treatment for domestic abuse remains fairly rare, due to fear of reprisal, says Graham. So often, it goes unreported. Its so hard for the victims to decide to report due to fear of not being believed, making things worse or nothing being done. Its challenging to show evidence, making it hard to prosecute."


Determinants of domestic abuse

Some key factors contributing to domestic abuse in the U.S., according to Morse, include the lack of training for children in interpersonal relationship skills and cultural normalization of controlling behaviors. She and Graham also believe the rise of cellphones and the internet have led to increased emotional, mental and psychological abuse due to easier access to victims in multiple ways.

While indicating that domestic abuse boils down to power and control, the Mayo Clinic social workers point to the following as particular domestic abuse risk factors:

  1. Adverse childhood events
  2. Unemployment
  3. Chemical dependency
  4. Pregnancy
  5. Mental health issues
Signs of domestic abuse

Key tipoffs for a domestic abuse situation include:

  1. Frequent emergency department visits
  2. Unexplained injuries or a story that seems inappropriate to the injury presented
  3. Injured patient acting timid
  4. Behavior change when a partner enters the room
  5. One partner in a relationship acting more overbearing
  6. Patient indicating that his or her partner does not allow the patient to have money or visits with family


If a survivor is not currently in therapy, help him or her find a therapist specializing in domestic abuse, if one is available in your area. Therapy can educate the survivor about appropriate interactions in a relationship and how to vocalize concerns if disrespected or harmed.

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