Risk groups, signs & symptoms

Who are the patients at risk of domestic violence, and what are the signs and symptoms that we should look for?

Spend a few minutes watching this interview with Dr Davina Kaur Patel, a medical doctor and field practitioner from the UK, before moving onto the text below.

As Dr Davina Kaur Patel explained, there is wide variety clinical conditions associated with intimate partner violence. Below is a list of the most common presentations:

• Symptoms of depression, anxiety, PTSD, and sleep disorders
• Suicidality or self-harm
• Alcohol and other substance use
• Unexplained chronic gastrointestinal symptoms
• Unexplained genitourinary symptoms, including frequent bladder or kidney infections or other
• Unexplained reproductive symptoms, including pelvic pain and sexual dysfunction
• Adverse reproductive outcomes, including multiple unintended pregnancies and/or terminations, delayed pregnancy care, adverse birth outcomes
• Repeated vaginal bleeding and sexually transmitted infections
• Unexplained chronic pain
• Traumatic injury, particularly if repeated and with vague or implausible explanations
• Problems with the central nervous system – headaches, cognitive problems, and hearing loss
• Repeated health consultations with no clear diagnosis
• Intrusive partner or husband in consultations

Source: World Health Organization 2013. Responding to intimate partner violence and sexual violence against women: WHO clinical and policy guidelines, p. 19

The list above clearly demonstrates that domestic violence results in a large amount of physical and mental health problems. Therefore, healthcare workers should always keep this diagnosis at the back of their minds, especially when there are unexplained symptoms, or when you sense there maybe a part of the medical history which seems “hidden”.

Reflection point

The World Health Organization does not recommend screening (asking every patient) for domestic violence, but case finding instead.

1. What are pros and cons for this recommendation?
2. If you don’t perform screening, then how do you conduct case finding – whom should you ask?
3. Why should health professionals be aware of patient groups who are at risk for domestic violence?

Please use the general discussion area below to discuss your reflections. Afterwards, continue on to the next step.