Magazine article Clinical Psychiatry News

Intimate Partner Violence

Magazine article Clinical Psychiatry News

Intimate Partner Violence

Article excerpt

Intimate partner violence in the United States affects 25% of women and 7.6% of men reporting physical abuse (Issues Ment. Health Nurs. 2005;26:281-97). Recognizing patients who are the victims of intimate partner violence tends to fall to our colleagues in primary care. But those who physically survive such abuse and seek to heal emotionally are more likely to be seen by psychiatrists and other mental health professionals. What therapeutic approaches have you used to help patients overcome the shame and humiliation left behind by physical and verbal abuse?

Consider Aggression

I held a traditional view of domestic violence until completing a study of the prevalence of intimate partner violence in patients admitted with suicidality (J. Clin. Psychiatry 2006;67:23-9). We found that over 91% of patients reported physical violence in their relationships, with equal prevalence of perpetration and victimization for men and women. Unhealthy relationships were reported by 79% of male patients and 68% of female patients. These couples were in relationships with a mean duration of 15 years and actually reported many relationship strengths.

Patients do not share this information with us freely and their shame may be lessened when questionnaires rather than interviews are used to assess relationship violence (J. Fam. Psychol. 1996;10:443-53). Patients also are more likely to be honest in an interview if they are asked about relationship "aggression" rather than relationship "violence." We do not routinely assess for relationship violence in our inpatients, and even if we do, few treatment options are available to offer these couples. Many readers will now be anxious remembering the age-old maxim "Don't treat couples when there is violence," but with rates of bidirectional physical violence over 90% in our inpatients, can we afford to ignore this problem?

Alison M. Heru, M.D.

Providence, R.I.

Address Readiness for Change

Treatment methods for intimate partner violence (IPV) that address a patient's fears and shame through education and assess a patient's readiness for change help to make a patient feel comfortable enough to accept and receive individualized care.

Clinicians can destigmatize the topic of victimization by first giving the patient the rationale for questions about IPV. For example, in an effort to decrease intimate partner violence and foster healthy relationships, I ask all of my patients about their relationships. You may not be aware, but intimate partner violence, formally called domestic violence, affects 20%-30% of American women.

The educational approach allows clinician and patient to address the topic from a level field. Giving a reason for asking about IPV reduces the victims' suspicions and demonstrates that you have a tolerance/compassion/ability to hear their experience. I quote the prevalence of IPV to "normalize" the patients' experiences and allow them to explain how they arrived at a seemingly "shameful" position in life.

Approach each patient as you would a patient with an addiction--recognize the complexity of IPV, the patient's concerns, and her stage of readiness. As the patients are educated about IPV and its effects, I begin to explore their readiness for change. Most patients feel shameful because they have "allowed" the situation to continue. My task is to understand the patients' ambivalence and locate their readiness for change.

Patients feel "listened to" when their treatment is tailored to their needs. They are less likely to feel judged if we allow for multiple modalities of treatment.

Renee Sorrentino, M.D.

Shirley, Mass.

Dr. Fink replies:

Recently, I worked on a task force appointed by Dr. Steven Sharfstein, then president of the American Psychiatric Association, to report on the sequelae of childhood trauma and abuse. The group made many recommendations, but the most important was that all physicians, health workers, psychiatrists, and other mental health professionals take an abuse history. …

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