Survivors of DV often present with medical and psychiatric disorders, which can serve as additional “red flags”— especially if there are frequent seemingly vague conditions. (Table 2)  

Table 2


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Medical and Psychiatric Presentations of Domestic Violence

Common Medical Presentations Common Psychiatric Disorders
Digestive problems
Sexual dysfunction
Hypertension
Chronic pain
Asthma
Vaginal infections
STDs
Urinary problems Vaginal infections
Pregnancy complications
Insomnia
Autoimmune disorders
Fainting
Cervical cancer
Alcohol abuse/dependence
Depression
Substance abuse
Posttraumatic stress disorder
Suicidality
Anxiety
Panic disorder

STDs=sexually transmitted diseases

Source: Zink T. Current Psychiatry. 2003;2(9):53-65; Carole Warshaw, MD

Your patient may not disclose DV to you immediately, Bernstein pointed out. “Be aware of domestic violence as a potential issue and develop a therapeutic relationship with the patient so she — usually, but not always, it is ‘she’ — will be comfortable enough to reveal what is going on.” And do not tell the patient what to do. Some individuals experiencing DV are not yet ready to act.3

Common barriers to disclosure — especially in psychiatric settings — is fear of consequences (e.g., the involvement of social services and child protection proceedings), fear that disclosure will not be believed, and fear that the disclosure will lead to further violence.4