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Domestic Violence

Main Points
Emergency physicians are patient advocates who see the problem firsthand and can play an important role in breaking the cycle of family violence. Violence against women is an urgent public health problem with devastating consequences for women, children and families.

Family violence is a widespread problem that affects all ages, genders, races, educational backgrounds and socioeconomic groups.

ACEP does not support mandatory reporting of domestic violence, because it can put victims at greater risk of injury and death. ACEP encourages reporting and referral in accordance with the patient’s wishes.

Q. What is family violence and who are its victims?
A. It is a pattern of coercive behavior, including physical, sexual and psychological abuse of a partner or family member by another. It occurs between married and un-married (current or former) partners, parents and children, children and grandparents and siblings. Victims can be any age, race or gender. The key point is the establishment of power and control of one individual over another.

Q. What is intimate partner violence?
A. Intimate partner violence, often called domestic violence, is also known as partner abuse, spouse abuse or battering. It occurs when one person uses force to inflict injury, either emotional or physical, upon another person they have, or had, a relationship with. The objective is establishment of power and control of one individual over the other in the context of an intimate relationship.

There is no typical victim. Intimate partner violence occurs among all ages, races and socioeconomic classes. It occurs in families of all educational backgrounds. People may be living together or separated, divorced or prohibited from contact by temporary or permanent restraining orders.

Q. How extensive is the problem of intimate partner violence?
A. Nearly 5.3 million incidents of intimate partner violence occur each year among U.S. women ages 18 and older, and 3.2 million incidents occur among men, according to the CDC National Center for Injury Prevention and Control. These incidents result in nearly 2 million injuries and 1,300 deaths nationwide every year. Violence against men by women and same-sex IPV are also problems, although women report significantly more past and present nonphysical violence than men.

More than three-fourths (76 percent) of intimate partner violence homicide victims were female in 2002. Although the number of intimate partner homicides decreased 14 percent overall in the span of about 20 years, the decline was much sharper for men (67 percent decrease) than for women (25 percent decrease).

Research shows nearly half (44 percent) of women murdered by their intimate partner had visited an emergency department within two years of the homicide. Intimate partner violence costs exceed $8.3 billion. Victims of severe intimate partner violence lose nearly eight million days of paid work, the equivalent of more than 32,000 full-time jobs, and almost 5.6 million days of household productivity each year.

Q. How extensive is the problem of elder abuse and maltreatment?
A. According to the best available estimates, between one and two million Americans aged 65 and older have been injured, exploited or otherwise mistreated by someone on whom they depended for care and protection. The majority of abuse is physical.

Q. When emergency physicians know or suspect abuse, are they required to report it?
A. Battery is a crime, and yet few states specifically require reporting of domestic violence. A small number of states require mandatory arrest of batterers, and a few jurisdictions aggressively pursue cases of domestic violence and prosecute batterers even when victims refuse to press charges.

Even when emergency physicians detect abuse, mandatory reporting to authorities-especially against a victim's will-may not be the best thing to do because it can put the victim at greater risk of injury and even death. Studies show that women who leave batterers are at a 75-percent greater risk of being killed by them. Virtually all jurisdictions impose civil or criminal penalties for failing to report suspected incidents of child abuse or neglect.

It is extremely important for emergency physicians to know their state laws and how their local criminal justice systems deal with the issue so they can properly and adequately inform their patients.

Q. How extensive is the problem of child abuse and maltreatment?
A. Approximately 3 million cases of child abuse are reported every year in, and four children die every day as a result of child abuse. The rate of child abuse is estimated to be three times greater than what is reported. The majority of child abuse occurs in children from birth to three years old. Eighty-three percent of victims were abused by a parent. Of the reported rapes of children under the age of 12, 90 percent knew the perpetrator.

Two-thirds of murders of children under the age of five were committed by a parent or other family member. More than three-quarters of the children who die are younger than four and 43 percent of the children who die are under the age of one. The rate of infant homicide reached a 30-year high in the year 2000.

Child abuse occurs at every socio-economic level, across ethnic and cultural lines, within all religions and at all levels of education. While 90 percent of Americans polled regard child abuse as a serious problem, only one-third report abuse when confronted with an actual situation.

Q. What are the laws about reporting abuse?
A. Physicians are required to report cases of child and elder abuse and maltreatment. Few states specifically require reporting of intimate partner violence. A small number of states require mandatory arrest of abusers, and a few jurisdictions aggressively pursue cases of intimate partner violence and prosecute abusers even when victims refuse to press charges.

When emergency physicians detect intimate partner violence, mandatory reporting to authorities — especially against a victim’s will — may not be the best thing to do because it can put the victim at greater risk of injury and even death. Studies show that women who leave abusers are at a 75-percent greater risk of being killed by them.

Virtually all jurisdictions impose civil or criminal penalties for failing to report suspected child abuse or neglect. It is extremely important for emergency physicians to know their state laws and how their local criminal justice systems deal with the issue so they can properly and adequately inform their patients.