Introduction to Domestic Violence:

One Hour Training

for Medical Professionals

National Prevention Toolkit on Domestic

Violence for Medical Professionals

1
 Overview
• This training educates medical professionals about the
dynamics and impact of domestic violence. We use the term
“domestic violence” to refer to the following:
- Interpersonal Abuse - Relationship Abuse
- Dating Violence - Domestic Abuse

• Domestic violence is an epidemic in the United States that is

not only pervasive, but also extremely costly in human and
financial capital.
• It is a serious public health problem that can be prevented.

2
 Overview (continued)
• It affects victims, as well as families, children, friends,
and communities.
• Victims are affected physically, as well as mentally,
during and after abuse.
• Providing victims with information and connection to
resources in the community can help prevent further
abuse.
• Every medical professional will encounter victims of
domestic violence.

3
 Objectives
After completing this training, medical professionals will
be able to do the following:

• Understand the dynamics and impact of domestic violence.

• Know the prevalence and incidence of domestic violence in
the United States.
• Recognize batterer behaviors.
• Be aware of the risk factors among perpetrators and victims.

4
 Objectives (continued)
• Understand the physical and mental health
consequences of domestic violence.
• Understand some of the reasons why victims stay.
• Learn ways to become part of the solution to end
domestic violence in your community.
• Understand myths associated with domestic
violence.
• Understand interventions to help domestic violence
victims.

5
 State Laws
• Every state defines domestic violence differently,
pursuant to code or statute.
• Every medical professional should be familiar with
the state laws regarding domestic violence and any
mandatory reporting laws.

View our Resource Page for a list of state laws about domestic violence.
[Link]/resources
6
 What is domestic violence?
A descriptive, non-legal definition of domestic violence is:
“the pattern of abusive behavior in any relationship that is used by one
partner to gain or maintain power and control over another partner.”

– It can happen to anyone regardless of race, age, education

level, sexual orientation, occupation, religion, or gender.
– Domestic violence can occur in an intimate, co-habiting,
dating, engagement, marriage, post-separation, or post-
divorce relationship.
– Some domestic violence acts are not considered crimes on
their own, but all contribute to a pattern of behavior that
seeks to control victims.

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 The Public Health Crisis of
Domestic Violence
According to the US Centers for Disease Control:
• 24 people per minute are victims of rape, physical violence,
or stalking.
• More than 1 in 3 women and 1 in 4 men have experienced
rape, physical violence, and/or stalking by an intimate
partner.
• 1 in 10 women have been raped by an intimate
partner.
• 1 in 4 women experience severe physical violence.
• 10.7% of women are stalked by an intimate partner.
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 The Public Health Crisis of
Domestic Violence (continued)
• Nearly half of all female victims are psychologically abused.
• 3 in 10 women who have experienced rape, physical violence,
and/or stalking reported at least 1 impact:
• Fear, concern for safety, PTSD, need for health care,
injury, contacting crisis hotline, need for housing,
advocate services, legal services, missed work or
school.
• Victims of severe domestic violence collectively lose nearly 8
million days of paid work.
• In 2010 1,095 women were murdered by an intimate partner.
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 The Financial Cost of
Domestic Violence
• In 2003 alone, the cost for medical and mental
health services and lost productivity was equal to
8.3 billion dollars.
– Cost of rape = $460 million
– Cost of stalking = $461 million
– Cost of lives lost = $1.2 billion
– Cost of physical assault = $6.2 billion
• These costs are probably much greater because
domestic violence is a chronically underreported
crime.
10
 Affects on Children Who
Witness Domestic Violence
Below are statistics on how many children are affected by
domestic violence:
• Each year an estimated 3.3 million children are exposed to
violence against their mothers or female caretakers.
• The number-one predictor of child abuse is domestic abuse of
women.
• Studies indicate that child abuse occurs in 30 to 60 percent of
homes where domestic violence occurs.
• Victim advocates agree: the key to keeping children safe is to
keep their victimized parent safe.

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 Affects on Children Who Witness
Domestic Violence (continued)
• Children have different coping mechanisms and resiliency skills
that impact how they are affected by domestic violence.
• However, the APA states that overall, children who witness
domestic violence often:
– Live in constant fear for themselves and abused parents.
– Are affected in similar ways to children who are physically
abused.
– Are more likely to develop social, emotional, psychological, or
behavioral problems which can continue into adulthood.

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 Rebutting Myths
It is important to be able to distinguish between myths and facts
about domestic violence.
Myths Facts
“She deserved it.” No one deserves to be punished with
abuse.
“You can’t rape a significant other.” Even if someone is your significant
other, consent is always needed.

“I was teaching her a lesson.” Abuse is never a lesson.

“I was drunk/high, I didn’t know Alcohol and drugs do not cause

what I was doing.” someone to be abusive. It is only a risk
factor and can make abuse more lethal.

“They’re gay/lesbians, so it’s not Violence can occur in all types of

domestic violence.” relationships, regardless of gender or
sexual identity.

13
 Rebutting Myths
(continued)
Myths Facts
“Women are just as likely to be Some women do commit domestic violence.
abusers.” However, men abuse their partners at a much
higher rate. Women are also more likely to be
seriously injured, stalked, experience sexual
violence, and be murdered by male partners.

“It was one isolated incident.” One time is too many times, and abusers often
plead for forgiveness, only to repeat violence.
“If it were so bad, she would Victims do not always have the resources or
leave.” support to leave a dangerous situation or are
afraid of the consequences.
“Mental illness causes domestic Being abusive is not a mental illness, it is a
violence.” choice. While abusers and victims may have a
mental illness, it is not an excuse for violence
perpetration or victimization.

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 Abuser Behaviors
• Abusers use violence and threats
to establish power and control
over their partners through fear
and intimidation.
• The abuser’s pattern of abusive
acts is used to gain control and
compliance of the victim.
• The tactics are selectively
chosen and purposeful.
• It is impossible to appease
abusers. They never have
enough control over their
victims.

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Different Types of Domestic Violence
Domestic violence often encompasses many different
types of abuse. The violence can include:

o Physical Abuse
o Sexual Abuse
o Verbal Abuse
o Financial Abuse
o Stalking

The abuser uses whatever works to assert power and

control through fear and intimidation.
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 Physical Abuse
Physical abuse is the intentional use of physical force with
the potential for causing injury, harm, disability, or death.

• Punching, Slapping, and Hitting

• Kicking, Cutting, and Stabbing
• Weapon Use
• Biting, Scratching, and Burning
• Pushing and Shoving
• Restraining, Strangling, and
Holding Down

17
 Psychological/Emotional Abuse
Psychological or emotional abuse is any behavior that
threatens, intimidates, undermines the victim’s self-worth
or self-esteem, or controls the victim’s freedom.

• Humiliation
• Isolation
• Degradation
• Diminishing self-worth and self-esteem
• Control of victim behavior
• Blackmail
• Intimidation
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 Sexual Abuse
Sexual abuse is the use of physical force, coercion, or
threats to force a person to have sex against his or her
will.

• Rape and sexual assault

• Forcing the victim to watch or create pornography
• Forced pregnancy
• Forced anal or oral sex
• Unwanted touching
• Reproductive coercion

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Defining Sexual Assault and Rape
Sexual assault is the most inclusive term that includes
sex-related behaviors from unwanted sexual contact
through sexual intercourse.
Rape refers to some form of bodily penetration.
– Vaginal rape
– Anal rape
– Digital rape
– Oral rape
– Use of an object to penetrate

Check your state’s individual laws for more information.

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 Economic/Financial Abuse
Economic abuse occurs when an abuser controls finances and the
victim’s ability to obtain money or control over his or her finances.

• Preventing the victim from • Taking the victim’s money

having or keeping a job • Demanding an account of
• Interfering with the victim’s everything the victim buys
efforts to maintain a job
• Controlling the victim’s access to
– Sabotaging childcare,
financial information
transportation, or other
arrangements • Not allowing the victim’s name
• Harassing the victim at work to be on accounts
• Refusing to work • Not allowing the victim to obtain
• Not allowing the victim access health insurance, Medicare,
to the family finances welfare, disability, etc.
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 Verbal Abuse
Verbal abuse is the perpetrator humiliating and threatening
the victim.

• Degrading the victim in • Criticizing

front of friends and family • Blaming
• Telling hurtful “jokes” • Accusing
despite the victim’s • Questioning the victim’s
requests to stop sanity
• Taking the victim’s • Threats of physical abuse
statements out of context
• Coercing or forcing the
• Name calling victim to do things he or
• Insulting she does not want to do.
• Humiliation
22
 Stalking
• Stalking is harassing or threatening behavior
that an individual engages in repeatedly.
• Stalking can be carried out in person or via
electronic mechanisms.
• Types of stalking behaviors include:
– Following a person
– Appearing uninvited at a victim’s home or work
– Harassing phone calls, text messages, and
electronic messages
– Vandalizing property
– Giving constant unwanted gifts, messages,
flowers, etc., to convince the victim to forgive or
return to the abuser.
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 Cyber-stalking
Cyber-stalking is the use of technology to stalk victims. It involves
the pursuit, harassment, or contact of a victim in an unsolicited
way initially via the internet and electronic devices.

Cyber-stalking may be used through:

• Email: Constant emails harassing the victim
• Chat rooms: Constant bombarding of messages
• Social networking sites (Facebook, Twitter, Instagram): Following
what the victim is saying, doing, and places he or she is visiting
and sending repeated unwanted messages
• GPS System (On-Star): Following the victim through access of his
or her GPS
• Portraying the Victim: Assuming the victim’s identity to portray
him or her in a negative light online
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 Common Characteristics of
Abusers
Medical professionals should know the following:
• Most abusers are not mentally ill.
• Abuse is not caused by anger management problems
or stress.
• Abusers deny responsibility of abuse and often blame
the victim for the abuse.
• Abusers choose to abuse victims.
Although abusers may have a substance abuse issue or
have been abused in the past, this does not cause abuse.
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 Common Characteristics of
Victims
Research has indicated that victims of domestic violence may
demonstrate one or more of the following characteristics:

• Many victims feel helpless and cannot safely leave an

unhealthy relationship.
• Many victims have been shamed or embarrassed about abuse,
and keep it a secret to protect themselves.
• Many victims fear for the safety of themselves, but also their
children, family members, pets, and belonging.

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 Domestic Violence:
Often About Power and Control

• Battering is one form of domestic violence that is characterized by

the pattern of actions that someone uses to control or dominate his
or her partner.
– The abuser systematically uses threats, intimidation, and coercion to
create fear. These behaviors are the spokes of the wheel.
• Physical and sexual violence are what holds the wheel together,
creating the rim of the wheel.

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 Consequences of
Domestic Violence
Violence affects people and changes them forever. The most immediate feelings
following domestic violence are a sense of helplessness, anger, anxiety, depression,
and fear. Domestic violence can cause very serious health and mental health
consequences. A few of the most common consequences are listed below.

• Health • Mental Health

– Injuries to extremities – Anxiety
• Broken bones, cuts, scratches, bruises,
strangulation marks
– Depression
– Chronic pain – PTSD
– Gastrointestinal problems – Chronic Stress
– Chest pain – Alcohol/Drug abuse
– Gynecological problems
– Poor pregnancy outcomes
For more information on negative physical and mental health conditions
related to domestic violence, see the Basics of Screening Training at
[Link]/medicalprofessionals/screening 28
 Why Some Victims Stay with
•
Abusers
Fear of Further Violence
Victims may fear that:
– The abuser may harm children,
– There will be more abuse
pets, and other family
– The abuser may carry out threats members
to kill
– She won’t be able to see children
– The abuser may destroy her
– The abuser may kill the victim or
belongings
him/herself
– Her reputation will be ruined

• Isolation and Lack of Resources

Victims may have: The most dangerous time for a
– No money or income woman is immediately after
– No safe place to go to leaving an abuser. Her risk of
– Few people to ask for help serious injury or death is highest
– No transportation at this time, when the abuser
does not have access to her.
– No ability to leave
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 Why Some Victims Stay with Abusers
• Lack of Support:
– No friends or family to turn to
– Ashamed or embarrassed to ask for help
– Afraid of being alone
– Worry that they won’t be believed

• Beliefs and Feelings:

– Feel responsible for abuse
– Love the abuser
– Have children with the abuser
– Religious or social beliefs that divorce is wrong
– Religious or social beliefs that must obey and
support the man
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 Victim Coping Mechanisms
• Minimizing: Downplaying the importance or
severity of abusive behaviors
• Denial: Refusing to admit or pretends that abuse is
not happening
• Rationalization: Victims find reasonable
explanations for the abuser’s behavior
• Stress, work, lack of sleep
• Drug/Alcohol Use: Numb the pain from abuse
• Self Blame: Blame themselves for the actions of the
perpetrators
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 Avoiding Negative Reactions to
Victims Who Don’t Leave
• Many professionals who interact with
victims become frustrated with victims.
• They think victims are putting
themselves in a dangerous situation and
being reckless.
• Medical professionals may suggest that
the victim leave the abuser and when
he or she doesn’t, consider him or her
noncompliant.
• Victims may not leave for a multitude of
reasons, including that they do not
know the resources available to them or
are afraid of what could happen if they
are caught.
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 Why Blaming the Victim is
Wrong
• People blame victims to distance themselves from
domestic violence so they feel more in control of
their own safety.
• The problem of victim blaming is that it
marginalizes the victim and makes it harder to
come forward and report the abuse.
• Victim-blaming attitudes also reinforce what the
abuser has been saying to the victim: that it is the
victim’s fault.
• Victim blaming allows the abuser to perpetrate the
victim while avoiding accountability.
• It is NEVER the victim’s fault. It is always the
abuser’s choice to take advantage of another
human being.

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 Prevention of
Domestic Violence
For medical professionals,
preventing domestic
violence includes
educating patients about is
and helping victims access
resources to help stop it.

34
 Prevention:
What Medical Professionals Can Do
Medical professionals can help victims of domestic violence by:
• Screening patients for domestic violence.
– Many medical associations have recommended screening patients
for domestic violence, including the following: The American Medical
Association, the American Academy of Family Physicians, American
Academy of Neurology, American College of Emergency Physicians,
American College of Nurse-Midwives, American College of
Obstetricians and Gynecologists, American Nurses Association,
American Public Health Association, Emergency Nurses Association,
American Medical Association, American Dental Association, and the
American Academy of Orthopaedic Surgeons
Please view the training “Screening Patients for Domestic
Violence” to learn more about the importance of screening.
35
 Prevention:
What Medical Professionals Can Do
(continued)
Medical professionals can help victims of domestic violence by:
• Understanding the definition and • Understanding how to screen
dynamics of domestic violence patients for domestic violence
• Explaining to all patients that no victimization
one deserves to be abused • Learning how to follow up with
patients who are victimized by
• Providing all patients with
their partners
information about community
• Knowing the resources available
resources
in the community so that they
• Understanding why victims may can be recommended to help
stay with their abusers and why victims
this does not mean they are • Evaluating your own attitudes on
noncompliant with professional abuse and how you feel and think
requests about victims and abusers 36
 Community Resources How Medical Professionals
Can Help

Shelters: Place of temporary refuge • Become familiar with shelters in your

and support for women escaping community.
violent or abusive situations • Obtain a contact of an advocate at the
shelter.
• Connect patients directly with the advocate.
Injunctions: Court orders that require • Connect patients with someone who can
a party to do or refrain from doing assist them in the injunction process (usually
specific acts an advocate or a police department or
agency)

Crisis Intervention: Emergency • Become familiar with crisis hotlines in your

psychological care to assist individuals area.
in a crisis situation to restore balance • Provide information to patients on these
to their biopsychosocial functioning services and allow them to call when and if
they are ready.

37
 Resources How Medical Professionals
Can Help
Advocacy: Provide a range of • Connect patients with advocates in the
supportive services to help individuals community, through hotlines, or in your own
involved in domestic abuse situations medical facility.
to become self-sufficient • Advocates can include domestic violence
workers, counselors, social workers,
psychologists, etc.

Safety Plan: Coming up with a • Connect patients with a shelter advocate or

detailed plan on how to leave an domestic violence hotline advocate to help
abuser safely plan.

Law Enforcement: Some victims may • Talk with patients about the option of calling
seek the assistance of law law enforcement.
enforcement. • Do not force patients to report abuse.
• If you are a mandatory reporter, let patients
know if you will be contacting law
enforcement.

38
 The National Domestic Violence
Hotline
If you or a patient have any questions
about domestic violence, or need help,
call:

1-800-799-
7233
39
 Conclusion
• Domestic violence can affect anyone, no
matter their gender, race, ethnicity, sexual
orientation, or socioeconomic background.
• It is a preventable health problem.
• Medical professionals should be willing and
able to take steps to inform patients about
domestic violence and community resources
to address it.
40
 References
• Family Violence Across the Lifespan
– Barnett, O. W., & Perrin, R. D. (2011). Family violence across the lifespan: An introduction (3rd ed.). Los
Angeles, CA: Sage Publications, Inc.
• Family Violence: Legal, Medical, and Social Perspectives
– Wallace, H. (1996). Family violence: Legal, medical, and social perspectives (6th ed.). Boston: Allyn and
Bacon.
• DV101: Dynamics of Domestic Violence
– [Link]
• Futures Without Violence
– [Link]
• Center for Disease Control: Intimate Partner Violence
– [Link]
• Center for Disease Control: Fact Sheet
– [Link]
• NISVS 2010 Summary Report
– [Link]
• National Coalition Against Domestic Violence
– [Link]
• Center for Relationship Abuse Awareness
– [Link] 41
You Have Completed the
Basic Training!

42