Week 3: Domestic Abuse

Question 1

Define violence

Answer 1

The intentional use or threatening to use physical force or power against oneself or another person or group.
Results in a high likelihood of injury, death, psychological harm, ladevelopment or deprivation

Question 2

What are the difference types of violence?

Answer 2

Family and intimate partener violence
Community violence
Social agenda
Political violence
Economic violence

Question 3

What is family and intimate partner violence?

Answer 3

Violence between famiily members and intimate partners at or outside of home

Question 4

What is community violence?

Answer 4

Violence between unrelated individuals, may not know each other, takes place outside of the home

Question 5

What is social agenda violence?

Answer 5

Crimes of hate comminted by organised groups, terrorist acts and mod violence.

Question 6

What is political violence?

Answer 6

War-related violent conflict such as state violence and similar acts carried out by larger groups, typically with political motivations.

Question 7

What is economic violence?

Answer 7

Attacks by large groups motivated by economic gain - attempt to disrupt economic activity, deny access to essential services to create economic division,

Question 8

What are the different types of self-directed violence?

Answer 8

Suicidal behaviour
Self - abuse

Question 9

What are the three main types of violence?

Answer 9

Self-directed
INterpersonal
Collective (members of groups against individuals or other groups)

Question 10

What are the four key goals given by the GMC to use when dealing with a patient suspected of suffering from domestic abuse?

Answer 10

Protection - prompt action should be taken to protect a patient whose safety, dignity or comfort is threatened

Empowerment - individuals should have their dignity and privacy respected, should encourage to improve and maintain own health

Proportionality - information should remain confidential, info should be handled lawfully, minimal info should be disclosed

Partnership - patients should be made aware of all info available, patients views should be considered, treat patients with honesty, Keep up to date on local procedure and guidance

Question 11

What types of abuse/neglat might a GP need to safeguard against?

Answer 11

Self neglect
Psychological abuse
Domestic violence
Discriminatory abuse
Acts of omission
Modern slavery
Secual abuse
Organisational abuse (mistreatment of people in their place of work or care)
Finanical abuse
Physical abuse

Question 12

Define domestic abuse

Answer 12

A pattern or incidence of behaviour in a relationship that is controlling, coercive, threatening or violent between those aged 16 or over who are intimate partners of family members, who currently or who have lived together.

Question 13

What is Intimate Partner Violence?

Answer 13

A form of dometic abuse, where the individual is 16yrs plus and are having or have had an intimate relationship regardless of gender or sexuality

Question 14

What kind of things are included as domestic abuse?

Answer 14

Coercive control
Psychological/emotional abuse
Physical abuse
Sexual abuse
Financial abuse
Harrassment and stalking
Online or digital abuse

Question 15

What are the key features of how women feature in domestic violence?

Answer 15

More likely to be the victim. (1 in 3 women)
More likely to suffer repeat incidents or be seriously injured/killed
More likely to experience fear or be coercively controlled
20% of victims are pregnant or have recently given birth
More likely between lesbian couples than heterosexual male on female abuse

Question 16

What are the key features of domestic abuse in males?

Answer 16

Males are three times less likley to report an incident
25% of domestic abuse cases men are the victime

Question 17

How does domestic abuse present in minortiy communities?

Answer 17

BAME communities are more likley to suffer domestic abuse
80% Transgender people

Question 18

What characteristics are considered most common in IPV victims?

Answer 18

Female
Younger age
Lower household income
Liver in area of high physical disorder
Alcohol consumption
Childhood abuse
Cultural norms tolerant of violence

Question 19

What characteristics are common of IPV perpetrators?

Answer 19

Experience violence as a child
Fear of abdondoment/rejection
Youth
Lower socioeconomic status
Unemployment
Prior assault for violent crime
Underlying psyche mechanisms poorly understand
Likley due to social pressure and individual psychology

Question 20

What is the I3 theory of agression?

Answer 20

‘Perfect storm model’ - explains why intimate partner abuse occurs
When IPA-impelling forces are greater than IPA-inhibiting forces
Impelling forces include instigation and impelling
Instigation - provoking circumstances that normally triggers violent behaviour e.g girlfriend wanting to go out without you.
Impelling factors - psychologically prepares an individual for a strong urge to agress in a situation (more likely as a person) e.g fear of abondonment
Inhibiting factors - are our self regulatory mechanisms and counteract the violent urge.

Question 21

What is the Duluth model of domestic abuse?

Answer 21

Based on the explanation that the perpetrate acts violently in order to gain power and control over the victim
This is no longer recognised as the correct explanation

Question 22

What are the different methods that an abuser might use to establish power and control over a victim as set out in the Duluth model?

Answer 22

Using isolation
Using emotional abuse
Minimizing denying and blaming
Using children
Using male privlege
Using economic abuse
Using coercion and threats
Using intimidation
Using emotional abuse

Question 23

What does the cycle of abuse model help explain about domestic abuse?

Answer 23

Understand why victims stay, abuse continues and abuse is often underreported.
1. Tensions build - survivor is stressed and abuser has high urge
2. Incident - abuser urge overtakes inhibiting factors
3. Reconciliation - abuser makes excuses or apologises, often gaslighting the victim
4. Calm - more peaceful potentially better than before
Cycle then repeats

Question 24

What are some of the suggested reasons why people underreport domestic abuse?

Answer 24

Fear wont be believed
Too trivial to bother the police
Underestimate the frequency or severity of abuse
Consider a private matter that the police can do little about
Feel scared, shamed or embarrassed worried they have done something wrong
Fear that children will be taken away in any ensuing legal battle
Violent partner is full of remorse and apologies

Question 25

What health disparities can IPV cause?

Answer 25

Increased needs of episodic healthcare Decreased usage of preventative healthcare increased risk of illness If women are pregnant when abused report increased risk of high BP, odema, vaginal bleeding, severe nausea, vomiting or dehydration, kidney infection or UTI. Decreased mental wellbeing.

Question 26

What is the link between alcohol and domestic abuse?

Answer 26

No clear relationship but there is a strong correlation - there is a correlation but this is not causative or determinalistic Alcohol related incidents of domestic abuse are more common later at night Alcohol related events are more likely to have male victims

Question 27

What is the link between substance misuse and domestic abuse?

Answer 27

High association Complex relationship - problematic use can exist before, alongside or after an experience of abuse Is common in violence and murders Abuse perpetratures are common among men requiring treatment for substance use Used as a coping mechanism for survivors and long term for perpetrators Decreases inhibitions - more likely to abuse Often used as a bonding mechanism between partners before abuse started

Question 28

How does attachment theory link to domestic abuse?

Answer 28

Disrupted attachement patterns from childhood are a risk factor for domestic abuse A lack of coping in adulthood can result in violent behaviour Insecure attachment in particular has an increased risk of substance abuse, anger management problems, risky behaviour, relationship problems, addiction and disordered eating.

Question 29

What are the different types of attachment in an infant? What do they mean?

Answer 29

Secure - confident needs will be met Insecure ambivalent - unsure if needs will be met tends to be comfort seeking Insecure avoidant - believes needs will not be met and is independence seeking Disorganised - desiring but fearful of close relationships

Question 30

What are the different types of attachment in adults and what do they mean?

Answer 30

Secure - self assured, direct and responsive Anxious-preoccupided - self doubting, anxious and sensitive, more likely to abuse or be abused Dismissive-avoidant - self reliant, avoidant and distant Fearful-avoidant - self sobatagings, unpredictable, isolated - more likely to be an abuser

Question 31

What are the health outcomes associated with alcohol use?

Answer 31

Associated with mental health problems - service users often also attend drug and alcohol treatment services Alcohol misuse is strongly associated with suicide risk

Question 32

What is the toxic trio in relation to child outcomes in domestic abuse cases?

Answer 32

Domestic abuse, parental mental ill health and drug/alcohol miuses are significant patterns in families where children have died or been seriously harmed

Question 33

What are some of the explanations why domestic abuse and substance misuse are often linked?

Answer 33

Substance use was used as a form of bonding with the partner During times or turmoil substances can bring familiarity and consistency Perpetrators can use substances to control victims by limiting their access Relationship with partner is often intertwined with substance use - makes separation more difficult

Question 34

What should all staff working in health service be trained and educated about in domestic abuse cases?

Answer 34

Information on the risks and warning signs Health consequences Ways of dealing with disclosure What specialist services exist to help

Question 35

What are some useful charities for people suffering from domestic abuse?

Answer 35

Womens Aid Mens Aid Galop - for LGBT+ Karma Nirvana - forced marriage and honour crimes Freephone National Domestic Abuse Helpline run by refuge

Question 36

What is the most dangerous time in a domestic abuse case?

Answer 36

When the victim decides to leave - the highest risk of murder Must ensure the victim is safe and has somewhere safe to go where they would not be found.