Doctors Hospital Family Practice Residency
Grant Family Practice Residency
Columbus, Ohio
Behavioral Case of the Month
(©2006 Doctors/Grant Family Practice Residencies)
Interpersonal Violence
Pat Martin, MA, LPCC, Jeri A. O’Donnell, MA, LPCC
CASE: A young college couple have been seen several times at the family practice
center. The young man usually attends his girlfriend’s office visits which have increased
in frequency lately. Recently, she came alone with a complaint of ankle pain. An x-ray
revealed a spiral fracture. During the visit she admitted that her boyfriend had twisted
her ankle in a fit of anger. As the story unfolded, it became clear that she was in an
abusive relationship, but did not feel that she had a way out at this time.
DISCUSSION:
1. AAFP, ACOG, AMA, AAP recommend that everyone be screened for interpersonal
violence. Note that the term is interpersonal violence which includes domestic
violence, child abuse, elder abuse, same sex partner abuse.
2. Statistics on victims of interpersonal violence: 33% of women in their lifetime; 2235% of women seeking OB care (violence often begins in pregnancy); 37% of
women seen in ED; 1 in 10 high school students (date violence); 22% of college
students; over 1 million children; at least ½ million elderly; 13% in male-male
relationship.
3. Red flags: frequent missed appointments or work loss; vague somatic complaints;
“bad nerves”/request for tranquilizers; depression; “accident prone”; isolation from
friends/family; sleep disturbance; injury explanation doesn’t match story.
4. Abusive men: rigid sex role stereotypes; strong need for power/control; family of
origin history of violence ;minimization/denial of problems; overprotection of
partner; overly solicitous toward physician; often very articulate/presents favorably
5. Factors increasing risk of violence: substance abuse/alcoholism; external stressors;
financial difficulties; losses; family dysfunction; work stress; life style changes, e.g.
pregnancy; rigid family rules; past history of abusive relationships; mental or physical
disability in family; social isolation
6. Documentation: patient’s own words in quotation marks; detailed description of
injuries, diagrams (body map), photos. Encourage a safety plan, document in chart the
plan.
7. Reporting: In Ohio mandatory reporting of elder abuse (462-4348) and child abuse
(229-7000). There is no mandatory reporting of partner violence, unless a felony has
been committed, e.g. stab wound, gun shot wound then you must report to law
enforcement authorities.
8. Bullying: Ask children if they are bullied in the neighborhood, or at school. (Do they
feel safe?)
9. Weapons: Ask if there are guns in the home; for children, ask the same and also ask if
there are guns in their friends’ homes. Do they know where they are kept in their
home/friends’ homes?
RESOURCES:
1. Screening tools: You can ease into this discussion by asking how they resolve
conflicts; how they and their partner deal with frustration/anger.
H.I.T.S.: How often does your partner hurt, insult, threaten, swear or curse
at you.
PVS: Have you been hit, kicked, punched or otherwise hurt by someone in
the past year? Who? Do you feel safe in current relationship? Is there a partner
from previous relationship making you feel unsafe now?
2. Resources: CHOICES (shelter for women and their children, counseling) 2244663, 24 hr. hotline; Columbus City Prosecutors Office 645-7483; Legal Aid
Society of Columbus 241-2001 or 645-1597; BRAVO 294-7867 (Gary) same sex
partner violence.
3. Websites for more information: www.womenslaw.org/OH/OHhow to.htm
www.odvn.org; www.sexualityandu.ca/eng/includes/health/pdf/wasttool.pdf
www.ohioafp.org/members/resourcesreferences/domesticviolence/DV-Screening
tool.pdf
www.uihealthcare.com/depts/med/familymedicine/reserach/geriatrics/eldermistre
atment/partner.pdf
www.femalepatient.com/html/arc/sig/screening/articles/029 04 039.asp
www.bravo-ohio.org.