What are the signs?

At least 54% of all women who have visited hospital Emergency Departments have experienced DVA at some point in their life. However, only 5% of these victims will be identified by healthcare professionals and a large majority will remain unnoticed.

There are a whole range of markers that can alert you that a person is experiencing DVA. Some are explicit and some could be very subtle. It is vital that you are aware of these markers so that you can provide appropriate support as early as possible.

Practitioners such as healthcare professionals, social workers and the police, in particular, are in a unique position to screen potential victims and spot the signs of DVA early.

Frequent visits to healthcare services

Those affected by DVA are often frequent visitors to health services. Patients with a history of frequently seeking medical care for vague or unusual complaints may be trying to make contact and somehow ‘tell’ someone there is something wrong (NICE, 2014).

The following behaviours could indicate that there is abuse happening:

• They book appointments but don’t turn up.
• They have inconsistent reasons for not attending appointments.
• They present with varied and vague health issues.
• They do not follow treatment plans.
• They always attend their appointments accompanied by someone else.

A controlling partner or relative, who may be reluctant to let you see the patient alone or not let the patient speak or make decisions, even when capable of doing so, should ring alarm bells.

Physical injuries

A patient could present with multiple injuries at different stages of healing, repeated injuries (particularly to breast and abdomen) and injuries with ambiguous or implausible explanations.

They may provide an inconsistent explanation of the cause of the injury in an attempt to hide or minimise the extent of injuries.

Obvious manifestations include:

• Visible injuries on the body (cuts, bruises, burns)
• Broken teeth
• Bite or grip marks
• Marks/injuries on wrists or ankle joints

Other manifestations are not as easily attributable to DVA:

• Headaches
• Hearing loss
• Unexplained and long-term gastrointestinal symptoms such as abdominal pain and indigestion
• Genitourinary symptoms such as urinary tract infections
• Vaginal or anal bleeding
• Unexplained reproductive symptoms, including pelvic pain, sexual dysfunction and STIs

Behaviour and communication

At times, victims can provide subtle and implicit hints to alert the professional, but may not feel ready to openly disclose it.

Their behaviour and communication should encourage professionals to use their judgement. For example:

• Lacking confidence
• Low self-esteem
• Withdrawn
• Fearful
• Depressed
• Anxious

They may have a history of alcohol or substance misuse or there could be signs and symptoms of self-harm.

Don’t expect people to conform to a stereotype of a victim

It’s important not to expect people to conform to a stereotype of a victim. Someone may appear forceful or even intimidating – this does not mean they have not been victimised, and indeed it could be their defence mechanism.

Be careful not to make assumptions, for example, if it is a same sex relationship, don’t assume the person that appears bigger or stronger is the abuser.

All these manifestations on their own do not necessarily indicate DVA. Further exploration would be needed to understand the individual context of each patient. However, these manifestations should alert you to the possibility of DVA.

What do you think?

What signs would alert you that someone was experiencing DVA? Are there any signs or symptoms that we have not mentioned?