Domestic violence or Intimate Partner Violence (IPV)
By definition, any act of violence, like that of physical, sexual, verbal or emotional abuse, or any kind against the woman by a person whom she is legally married, or in a family or domestic relation falls under domestic violence. Domestic violence is a type of sexual assault.
Domestic violence is an issue of concern that is trending across the globe, and is highly prevalent in Indian households where married girls are tortured, both physically and mentally.
People across the globe, regardless of their ethnicity, gender, race, sexual identity, social status or caste, religion are victims of domestic violence – physical, emotional and sexual. However, the risk increases under the influence of poverty and alcohol. About 45 percent of men under the influence of alcohol abuse their spouse, both verbally and sexually. The risk also arises when a partner wants to walk out of the relationship, or if the person is mentally unfit. But in a conserved social set up like that in India, victims are traumatized or assaulted to death for dowry.
According to WHO, violence against women is an important health issue – one in three women globally experience physical or/and sexual violence from their partners.
Clinical presentation / Signs and symptoms:
A victim of domestic violence shows both physical and psychological symptoms. The physical symptoms can be identified by a health care worker while examining the victim. In most of these cases, the victim complaints of abdominal pain, has poor appetite, seems clumsy and nervous or low on self-esteem; is unable to make eye contact, or is quiet and shows passive behaviour. A victim may also show signs of depression, and battered woman syndrome, a syndrome similar to post-traumatic stress disorder.
Physical examination may reveal injuries in different stages of healing – from rectal/genital injuries to bruises, scrapes, cuts and marks on body parts covered by clothing. Black eyes, red/purple marks around the neck and sprained wrists.
Some characteristics of physical injury include: cigarette burns, bite marks, rope burns, bruises, marks of a weapon (belt), bilateral injuries and defensive posture injuries.
Apart from these, non-injury symptoms can be – headache, neck and chest pain, high heart rate, choking, tingling and numbness of limbs, urinary tract infection, pelvic and vaginal infections.
Prolonged abuse can result in many physical and psychological complications – panic attacks, severe depression, post traumatic disorder, irritable bowel syndrome (IBS), fibromyalgia. It may even have adverse effects during pregnancy and overall well being of the child. During pregnancy it may result in low weight gain, anaemia, infections and bleeding. It is commonly observed that children who witness domestic violence poorly perform in school; have behavioural problems and suffer depression.
To identify victims of domestic violence is a challenge. In most cases, the victims are always accompanied by the spouse, and are seldom left alone. Also in absence of confidential public health centres and trained health professionals, screening of these cases gets extremely difficult.
Sometimes the victims are so scared that they attempt to hide bruises with makeup or clothing and even make excuses like tripping or being accident prone. However, it is noticeable that the explanations these victims provide do not match the seriousness of the injury.
Another factor that makes screening difficult is the conflicting nature of the victim, who struggle with their emotions. These victims fall under cultural/religious pressure to stay with an abusive partner. At times, feeling of shame, lack of money, shelter and resources or fear of being deported, also prevents the victims to open up.
Treatment, Counselling and Management:
Besides emergency antenatal or gynaecology or surgical interventions, the victims of domestic violence should be handled with care. The health care professionals and hospitals should create a friendly environment to make the victim comfortable. The staff should follow non-judgemental approach and counsel patient by listening to them without being hostile to them.
Intervention and education or creating awareness about legal aspects is important to help victims of domestic violence. Counsellors also help devise safety plans – whom to contact in emergency or when to alert someone close if the spouse shows signs of getting violent.
To treat domestic abuse families, a well-known model called the Duluth Model or the Domestic Abuse Intervention Project (DAIP) is used. It focuses on women as the victims and men as the perpetrators of domestic violence. The model aims to empower women by providing them information, resources, and support. It has been found to significantly decrease the violence in victims’ lives over time. It also uses legal resources as a means of keeping women safe and giving consequences to the tormentors.
Besides emergency, antenatal or gynaecology or surgical clinics, screening and counselling facilities are also provided at the Integrated Counselling and Testing Centre (ICTC).