Recognizing and Preventing Domestic Violence

A teenage girl and her boyfriend express different feelings about an issue. He perceives her disagreement as the start of a fight, so he responds aggressively to silence her.

A married woman notices that her husband is increasingly controlling and critical. After the birth of their child, there’s more emotional abuse and the threat of physical violence looms. She loves him, but she fears him more.

Both of these scenarios are real examples of domestic violence. March is Women’s History Month, and in addition to recognizing females’ successes, this month is an appropriate time to address an important health and human rights issue – women living free from violence.

“Domestic violence occurs in all types of intimate relationships, and victims can be male or female,” says Elaine Hewins, CSW, DVS, Domestic Violence Education & Awareness Program Coordinator at Robert Wood Johnson University Hospital (RWJUH), “but the bulk of domestic violence victims are females.”

Domestic violence is a pattern of assaultive and coercive behavior that may include psychological, emotional, physical, sexual or fiscal attacks among intimate partners. According to Hewins, estimates are that:

•          1.5 to 4.4 million women in the United States are battered each year by an intimate partner.
•          An estimated 700,000 health care visits are the result of domestic violence-related physical assaults.
•          Thirty-one percent of American women report being abused at some point in their lives.
•          Forty percent of assaults on women by their male partners begin during pregnancy; pregnant women are at twice the risk of battery as non-pregnant women.

“Recognizing the dynamics of an abusive relationship is key,” Hewins says. “Cues may include marks or injuries and explanations about how they happened that don’t quite fit, or victims may claim to be accident prone. She could be a friend who must answer a call from her partner or exhibits anxiety if she misses that call. She could be the woman who used to go out with her friends but doesn’t anymore because her boyfriend is hypervigilent about where she is, who she’s with and when she has to be home,” Hewins explains.

There is no stereotype when it comes to domestic violence. “One commonly held belief is that domestic violence affects mostly poor, middle class and minority women. That’s myth,” says Awina Nueva, RNC, Head Labor and Delivery Nurse at RWJUH. “It happens to affluent, middle class and poor women from all cultural, religious and economic backgrounds.”

Young women are especially at risk, Hewins says. “They may think a partner is so in love and caring because he’s always checking in or checking her phone, but that’s controlling behavior, a potential sign of domestic violence.”

Separated or former spouses also are especially at risk, Hewins says. “Many women are injured or killed when they separate,” she explains. “It’s important to understand that the time when a relationship ends can be dangerous.”

The long-held notion that domestic violence happens only to women with low self-esteem is false, she adds. “Emotional and verbal abuse can erode self esteem, and when it’s worn down, people question themselves.”

Support is especially important for victims of domestic violence. “Abused women feel shame and embarrassment, and there’s a lot of blame,” Hewins says. Here are some ways to provide support:

•          Let her know that the abuse isn’t her fault. Nobody has the right to abuse another.
•          Give her a safe place to talk confidentially.
•          Listen attentively.
•          Understand that it’s complicated. The abuser is someone with whom she has an emotional bond. No one wants to be abused, but survivors may stay married or in a committed relationship because of other factors including religious or economic reasons, cultural influences or children in common.
•          Provide information about resources to give them options that could be good choices. The New Jersey Coalition for Battered Women may be reached at (609) 584-8107, www.njcbw.org or call the statewide hotline: 1-800-572-7233. E-mail info@njcbw.org. In Middlesex County, Women Aware, Inc., provides a 24 hour hotline, (732) 249-4504 and other services for survivors of domestic violence.

Those who witness an incidence of domestic violence can assess the situation and determine whether it’s safe to approach and say something. Call 9-1-1.

Nueva recommends that women who are in an abusive relationship but are not ready to leave that partner empower themselves. “It’s a touchy situation, but confide in someone you trust, be it a family member, friend or colleague, and establish a safety net. Get counseling, join a support group or take advantage of employer mental health resources where available,” she recommends. “By empowering herself, the victim becomes a survivor.”

Healthcare providers also can be a resource. This year, Robert Wood Johnson University Hospital (RWJUH) embarked on a mission to provide training to help healthcare providers in different settings recognize domestic violence.

“Victims of domestic violence are not always the patients that have lacerations or broken ribs and visit the emergency department. She may appear to be a non-compliant patient who misses office appointments or is overtly anxious about how long a visit will take,” Hewins says. “Research has shown that screening all women and having posters, literature and other resources in a health care environment can create a space where a survivor of domestic violence may feel comfortable talking about what’s happening.”

For more information about “Domestic Violence and the Role of the Healthcare Provider Training,” a program sponsored in part by the Verizon Foundation, or to attend upcoming sessions on April 4th or May 3rd, call 1-888-MD-RWJUH.
For more general information about domestic violence and resources, contact the RWJUH Community Health Dept. at (732) 247-2050.