The impact of domestic violence on health - recognising physical injury
There are a number of features that may alert us to the fact the client is being physically abuse, including:
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The injuries are not consistent with the account of how they occurred.
The woman had attended with similar injuries before.
There are signs of old bruising, old scars or, in severe cases, old fractures.
There are injuries at varies stages of healing.
Bite marks are not an uncommon feature of intimate partner violence.
The bruising may be extensive with a range of injuries occurring simultaneously. The British Crime Survey
(1996) showed that almost one-third of the women interviewed required medical attention, with 69 per cent
of incidents leading to injury and 13 per cent resulting in broken bones.
The bruise may occur in unusual places; for example bruises on the inner thigh are rarely a result of
accidently injury.
Women more frequently have injuries to the breast, chest, and abdomen (Stark and Flitcraft 1996), including
fractured ribs.
Facial injuries are common, including broken noses, jaws, teeth and cheekbones, split lips.
Signs of attempted strangulation or asphyxiation may be present; this is a significant sign that the abuser is
dangerous (Berry 2000).
The woman may be pregnant or experiencing pains associated with premature labour.
There may be signs of injurious sexual activity.
Abused women more often have internal injuries than do accident victims (Burge 1989).
The woman may present with a sexually transmitted disease.
Psychological and emotional abuse
As we have already identified, women who have been abused often say that the emotional and psychological abuse
they experience is for them the most destructive element. Similarly, studies of abuse against men have intimated
that the mental cruelty is often what is most difficult to endure. Once a woman has been beaten it is not difficult to
see how subsequent threats of more beatings might be sufficient to achieve submissiveness. Psychological and
emotional abuse includes those acts designed to control, intimidate, ensure compliance. It may comprise:
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Constant threats of violence against the women, the children and pets.
Constant ridicule about almost all aspects of the woman’s self and her ability to undertake tasks effectively.
Ridiculing her looks, dress sense, sexual worth, intelligence, parenting abilities, housekeeping, driving - the
list is endless.
Expectation of total compliance within the home.
Humiliation, especially in front of other people, including friend’s family member’s children, work colleagues
and others.
Social isolation from friends and family, including preventing the woman from going out unaccompanied.
This may include prohibiting the woman from employment outside the home.
Compelling the woman to account for her time throughout the day including: timing visits to the doctor,
dentists, shops, picking up the children from school and other activities.
Ensuring economic dependency (Financial abuse).
Controlling the manner in which the woman dresses, behaves, interacts with others.
Name calling, use of abusive terms, often of a sexual nature designed to humiliate.
Making her feel guilty. Persuading her that if she was a ‘better wife and mother’ then he would not need to
be abusive.
Playing mind games.
Making her think she is mentally unstable.
Source: Domestic Violence – A handbook for health professional – Lyn Shipway (2004) p22/23 Published by Taylor and Francis (UK) - Used with permission
Ricky Hunter & Associates PO Box 4525 Forest Lake 4078 QLD Australia M: 0414 436 755 W: www.rickyhunter.org
The impact of domestic violence on health - recognising physical injury
Other signs that the woman may be in an abusive relationship include the following:
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There may be a delay in seeking healthcare intervention for injuries.
The woman may be lethargic, unable to account for the injuries or unwilling to give details.
She may be quiet, withdrawn and reluctant to discuss the problem.
The partner may stay at her side constantly.
The woman may not attend for follow-up appointments.
The woman may be under the influence of alcohol or drugs.
The woman may not appear in the least intimidated or downtrodden but that does not mean she is not being
brutalized.
Source: Domestic Violence – A handbook for health professional – Lyn Shipway (2004) p22/23 Published by Taylor and Francis (UK) - Used with permission
Ricky Hunter & Associates PO Box 4525 Forest Lake 4078 QLD Australia M: 0414 436 755 W: www.rickyhunter.org