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This discussion paper reviews the health impacts, physical and mental, of domestic violence and explores the link between domestic violence and psychological symptoms. This paper focuses more on posttraumatic stress disorder (PTSD) than depression and low self-esteem because doctors are less familiar with PTSD. The barriers preventing health workers from detecting domestic violence are reviewed and the fear of health professionals that asking about trauma can harm patients is explored. The article then outlines practical strategies to improve detection of domestic violence using patients' presenting psychological symptoms and the diagnoses frequently associated with domestic violence namely, PTSD, depression and low self-esteem. It is argued that it is inadvisable to try to implement a policy of screening for domestic violence in general practice when the public health model is currently inappropriate. The paper discusses why the diagnostic frameworks of depression and PTSD are helpful in general practice, not only in detecting domestic violence but in working with the patient to establish trust and ways forward that can be tailored to meet the needs of the patient and their children. Patients' and professionals' dilemmas about what to do once domestic violence is detected are briefly explored.
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PMID:Recognising domestic violence in clinical practice using the diagnoses of posttraumatic stress disorder, depression and low self-esteem. 1661 20

To explore cognitive and emotional factors that may exacerbate child-abuse potential among domestic violence victims, 80 participants reported on their depression, hopelessness, anxiety, and anger as well as their attachment style and attributional style. Increased emotional difficulties as well as insecure attachment styles were significantly positively correlated with child abuse potential, although depression and anxiety were the strongest predictors. Externalizing blame for the spousal abuse was not associated with abuse risk. Women residing in shelters demonstrated significantly greater abuse risk than those in transitional housing programs, suggesting that greater temporal proximity to the spousal abuse may in part account for the increased abuse potential. Depression and hopelessness, however, appeared particularly relevant to increased abuse risk in domestic violence victims in the transitional housing system. Implications of these findings for working with battered women in terms of their emotional functioning and attachment style are discussed.
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PMID:Emotional functioning, attachment style, and attributions as predictors of child abuse potential in domestic violence victims. 1664 39

Posttraumatic stress disorder (PSTD), classified as an anxiety disorder, has become increasingly important because of wars overseas, natural disasters, and domestic violence. After trauma exposes the victim to actual or threatened death or serious injury, 3 dimensions of PTSD unfold: (1) reexperiencing the event with distressing recollections, dreams, flashbacks, and/or psychologic and physical distress; (2) persistent avoidance of stimuli that might invite memories or experiences of the trauma; and (3) increased arousal. Traumatic events sufficient to produce PTSD in susceptible subjects may reach a lifetime prevalence of 50% to 90%. The actual lifetime prevalence of PTSD among US citizens is approximately 8%, with the clinical course driven by pathophysiologic changes in the amygdala and hippocampus. Comorbid depression and other anxiety disorders are common. General principles of treatment include the immediate management of PTSD symptoms and signs; management of any trauma-related comorbid conditions; nonpharmacologic interventions including cognitive behavioral treatment; and psychopharmacologic agents including antidepressants (selective serotonin reuptake inhibitors most commonly), antianxiety medications, mood stabilizing drugs, and antipsychotics. This review of PTSD will provide the reader with a clearer understanding of this condition, an increased capacity to recognize and treat this syndrome, and a greater appreciation for the role of the internist in PTSD.
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PMID:Posttraumatic stress disorder: clinical features, pathophysiology, and treatment. 1665 Oct 48

Research suggests that the use of disengaged or avoidant strategies to cope with interpersonal violence contributes to the development of depressive symptoms and other psychological difficulties. Survivors of childhood sexual abuse (CSA) who are exposed to subsequent episodes of abuse may be more likely to rely on disengaged coping strategies, placing them at elevated risk of psychological symptomatology. In this study, we explored the interrelationships between coping, depression, and self-esteem in an ethnically diverse sample of domestic violence survivors (N = 219) with and without a history of CSA. As predicted, CSA survivors (n = 86) reported significantly greater use of disengaged coping strategies (wishful thinking, self-criticism, and social withdrawal) than non-CSA survivors (n = 133). As hypothesized, both a CSA history and the use of disengaged coping significantly predicted higher levels of depression and lower self- esteem. Clinical implications of the findings are discussed.
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PMID:The process of coping with domestic violence in adult survivors of childhood sexual abuse. 1670 45

The investigation examined religious involvement, spirituality, religious coping, and social support as correlates of posttraumatic stress symptoms and depression symptoms in African American survivors of domestic violence. Sixty-five African American women who experienced domestic violence in the past year provided data on demographics, severity and frequency of physical and psychological abuse during the past year, aspects of current social support, types of current coping activities, religious involvement, spiritual experiences, and symptoms related to depression and posttraumatic stress disorder. Women who evinced higher levels of spirituality and greater religious involvement reported fewer depression symptoms. Religious involvement was also found to be negatively associated with posttraumatic stress symptoms. Women who reported higher levels of spirituality reported utilizing higher levels of religious coping strategies, and women who reported higher levels of religious involvement reported higher levels of social support. Results did not support hypotheses regarding social support and religious coping as mediators of the associations between mental health variables, religious involvement, and spirituality.
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PMID:The roles of religion and spirituality among African American survivors of domestic violence. 1670 3

Few studies have examined the adjustment of battered women and their children after exiting domestic violence shelters. Participants were 62 women who had endured severe partner abuse, completed a shelter program with their children, and resided in the community for at least 6 months. Field interviews concerned mothers' and children's abuse histories and included measures of maternal depression, maternal trauma, and child behavior problems. Nearly all women had lived violence free since shelter exit. Child internalizing behaviors were associated with direct abuse, maternal depression, and shelter program. Externalizing behaviors were related to maternal depression and shelter program. Neither severity of interparental violence nor maternal trauma symptoms was related to child behavior problems. Mothers' family of-origin abuse predicted current satisfaction with child functioning, beyond the effects of maternal depression and child behavioral problems. Findings suggest a need for postshelter therapeutic services and further research addressing the adjustment of such families.
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PMID:Postshelter adjustment of children from violent families. 1682 66

This study examines the psychological health correlates of domestic violence in a large random sample of mid-aged Australian women (N = 11,310, age 47 to 52 years). Logistic regressions were used to investigate the associations between domestic violence and depression, anxiety, and psychological wellbeing, after adjusting for demographic variables (marital status, income management, area). Results indicate increased odds of having experienced domestic violence for those who had: ever experienced a diagnosis of depression, anxiety, or an "other" psychiatric disorder; recent symptoms of depression and anxiety; used psychoactive medication for depression or anxiety in the 4 weeks prior to the survey; and who reported current depression. Current psychological well-being had an inverse association with a history of domestic violence: As psychological well-being decreased, the odds of having ever experienced domestic violence increased. The results indicate that a history of domestic violence is associated with decreased psychological well-being in mid-aged Australian women.
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PMID:Psychological health in midlife among women who have ever lived with a violent partner or spouse. 1682 69

The first 131 traumatized refugee children evaluated and treated in a child specialty clinic indicated a wide variety of trauma including war-related traumas (21%) for areas of recent conflict and domestic violence (28%) predominantly occurring in patients from Mexico and Latin America. Clinical diagnoses indicate PTSD was common (63%) in the war trauma group but was found less (25%) in the domestic violence group. Otherwise, the refugee clinic population showed a wide variety of diagnoses, including 20% having learning or cognitive disability or clear mental retardation. The traumatized refugee children had a similar prevalence of PTSD and depression to a comparable group of American child psychiatry patients. Refugee children have faced a variety of traumas and have a variety of diagnoses. All traumatized refugee children need an individualized evaluation and treatment plan. Trauma focused therapy is not appropriate for all refugee children.
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PMID:Traumatized refugee children: the case for individualized diagnosis and treatment. 1684 Aug 51

HIV and violence are two major public health problems increasingly shown to be connected and relevant to international mental health issues and HIV-related services. Qualitative research is important due to the dearth of literature on this association in developing countries, cultural influences on mental health syndromes and presentations, and the sensitive nature of the topic. The study presented in this paper sought to investigate the mental health issues of an HIV-affected population of women and children in Lusaka, Zambia, through a systematic qualitative study. Two qualitative methods resulted in the identification of three major problems for women: domestic violence (DV), depression-like syndrome, and alcohol abuse; and children: defilement, DV, and behavior problems. DV and sexual abuse were found to be closely linked to HIV and alcohol abuse. This study shows the local perspective of the overlap between violence and HIV. Results are discussed in relation to the need for violence and abuse to be addressed as HIV services are implemented in sub-Saharan Africa.
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PMID:Violence and abuse among HIV-infected women and their children in Zambia: a qualitative study. 1690 70

Reports have appeared in the popular press in recent years concluding that women are just as violent as men. These reports stem from acontextual survey studies comparing prevalence rates of women's and men's physical violence. The authors contend that the above conclusion is simplistic and misleading, and that a theoretical framework that embeds women's violence in the context in which it occurs is sorely needed. This article proposes a model that includes women's violence in the context of their victimization by male partners, motivations for violent behavior and how they cope with relationship problems, experiences of childhood trauma, and outcomes of depression, anxiety, posttraumatic stress disorder, and substance use. The model is then examined within the context of gender, race, and class. The cultural context of domestic violence for African American and Latina women is reviewed. This literature reinforces the need to place women's violence in a broader sociocultural context.
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PMID:The development of a theory of women's use of violence in intimate relationships. 1704 66


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