Family physicians must maintain a high index of suspicion for interpersonal violence in their patients. Despite growing public awareness, community advocacy, and education about this endemic public health problem, victims of interpersonal violence may be difficult to detect in the healthcare setting. Shame, fear, self-blame, and other cultural and social factors may limit the manner and nature of presentation and disclosure to the physician. Despite these challenges, the family physician is in a unique position to make a meaningful impact and potentially intervene before violence escalates.
Interpersonal violence includes the following:
Neglect (of dependent person).
Stalking, bullying, or cyberbullying/electronic aggression.
Those at greatest risk for violence are children, the elderly, pregnant women, persons who are physically or mentally challenged, immigrants, members of racial or cultural minorities, and sexual minorities.
Emotional/psychological abuse includes humiliation, controlling behavior, repeated verbal assaults (name-calling), isolation (rejection, withholding attention and affection), threats, and public harassment; all of which can produce psychological trauma that reduces a person’s self-worth perception, value, and sense of efficacy. Emotional/psychological violence often coexists with chronic physical or sexual violence, but can also stand alone.
Financial abuse is when a person withholds resources such as money or transportation, or limits freedom of movement or association (eg, domination, isolation) of another person—a tactic often found in abusive relationships. Financial abuse most often involves the inappropriate transfer or use of an elder’s funds for the caregiver’s purposes.
Neglect is the chronic failure of a person who is responsible for the physical and emotional needs of another person to provide for those needs. This form of abuse most often occurs in family relationships and is directed at children, elders, or disabled family members. However, caregivers in other social/community settings, including child and adult daycare, schools, group homes, nursing facilities, and hospitals, may be involved in neglect of a dependent person.
Physical violence, as defined by the Centers for Disease Control and Prevention (CDC), is the “intentional use of physical force with the potential for causing death, disability, injury, or harm.” This includes, but is not limited to scratching, pushing, shoving, throwing, grabbing, biting, choking, shaking, slapping, punching, or burning; or use of a weapon, and use of restraints or one’s body, size, or strength against another person. In the most extreme cases, physical violence may involve homicide.
Sexual violence, according to the CDC, is defined as “any sexual act that is perpetrated against someone’s will.” Sexual violence may include a completed nonconsensual sex act (ie, rape), an attempted nonconsensual sex act, abusive sexual contact (ie, unwanted touching), and noncontact sexual abuse (eg, threatened sexual violence, exhibitionism, verbal sexual harassment). It includes the following four types: