Interpersonal violence is endemic in the United States. There has been growing public awareness through the media, community advocacy groups, and education in the schools to address this family-based problem. Inextricably tied to social, economic, cultural, and behavioral factors, interpersonal violence requires a multidisciplinary approach by the physician that addresses prevention, detection, intervention, and resolution.
Family physicians must maintain a high index of suspicion for interpersonal violence in their patient populations. Subtle presentations in patient behavior are often difficult to detect, and cultural and social factors may limit the manner and nature of presentation to the physician. Although challenges and opportunities for prevention and intervention are available on a societal level, the family physician is in a unique position to make a meaningful impact before violence escalates.
Interpersonal violence encompasses a wide variety of circumstances. These include:
- Emotional/psychological abuse.
- Financial abuse.
- Neglect (of dependent person).
- Physical violence.
- Sexual violence.
- Stalking, bullying, or internet aggression.
These manifestations can be further characterized by the status of the individual vulnerable to such acts. Those at greatest risk include children, the elderly, pregnant women, persons who are physically or mentally challenged, immigrants, and members of racial or cultural 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, 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 day care, 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, the following acts: scratching, pushing, shoving, throwing, grabbing, biting, choking, shaking, slapping, punching, burning, 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. ...