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abuse of spouse or partner

Alternative Names 
wife beating, battering, family violence, domestic abuse

Definition
Abuse of spouse or partner is the abuse of one partner by another in a relationship where the two adults are dating, married, or living together. This abuse can be emotional abuse, physical abuse, or sexual abuse. An emotional abuser might make angry remarks in private or public to cause the victim to feel worthless and ashamed. Physical abuse can include hitting, slapping, punching, or beating. Sexual abuse means forcing a partner to have sex against his or her will. It can also include making a partner do sexual acts that he or she finds degrading, or forcing a woman to risk pregnancy or sexually transmitted disease.

What are the signs and symptoms of the injury? 
The physical signs of spousal abuse can include:
  • bruises
  • broken bones, known as bone fractures
  • injuries on different parts of the body, in various stages of healing
The emotional signs of abuse are not as obvious. The victim may
  • be depressed
  • have low self esteem
  • feel anxious
What are the causes and risks of the injury? 
Spousal abuse happens to people of all religions, ethnic origins, and income levels. It happens in both heterosexual and same-sex relationships. Women are the victims of domestic violence in nine out of 10 cases, especially women between the ages of 19 and 29.

According to recent studies, a man is more likely to abuse his spouse or partner if he has been violent in the past. A relationship also has a higher chance of becoming violent if one or more of these risk factors are present:
  • at least one partner is unemployed
  • at least one partner has problems with drug abuse or addiction
  • each partner has a different religion
  • the male partner saw his father hit his mother
  • the couple live together unmarried
  • at least one partner is a blue collar worker
  • at least one partner has not finished high school
  • at least one partner is between the ages of 18 and 30
  • at least one partner has committed child abuse before
  • the couple lives in poverty
When two of these factors are present in a relationship, the risk of violence doubles. A couple who has seven or more of these risk factors is 40 times more likely to have an abusive relationship.

Studies show that half of men who abuse their partners also abuse their children. Abused mothers often have trouble holding jobs. They also are more likely to need welfare. This means that children from abusive homes are at a greater risk of being poor and homeless.

Long-term effects can include post traumatic stress disorder. Although this nervous disorder can have many causes, in this case it is always a result of physical, mental, or sexual violence. The victim may:
  • have nightmares and flashbacks
  • be irritable
  • feel anxious
  • be depressed
  • feel isolated
  • avoid other people
Even if the victim doesn't suffer from post traumatic stress disorder, he or she may have other long-term effects. For instance, he or she may:
  • have poor self-esteem
  • have trouble staying in school or keeping a job
  • live in poverty
What can be done to prevent the injury? 
The best way to prevent abuse is to teach children how to solve problems without using violence. Teenagers and young adults should be taught that it's never okay to abuse a partner.

Society can also help prevent the cycle of abuse by:
  • having judges and police officers enforce domestic violence laws. This tells abusers that their actions have consequences. It also helps victims feel safer about reporting their abuse.
  • teaching abusers how to vent their anger without using violence and offering drug and alcohol treatment when needed.
  • providing shelters and other support programs that enable victims to leave an unsafe home and avoid further abuse.
  • training doctors to ask the person they are treating about abuse if they suspect it, and to keep careful records of any physical evidence.
How is the injury recognised? 
There are not always physical signs to spousal abuse. While cuts and bruises may cause suspicion, other emotional symptoms may not. Victims of abuse are often too afraid to report their abuse. An overly jealous partner who is controlling or hostile in public may alert others that abuse is present. When a friend, family member, or caregiver suspects abuse, he or she should ask if there is abuse occurring and offer to help.

What are the treatments for the injury? 
Victims who are physically hurt may need treatment for their injuries. Counselling and psychiatric treatment for any victim of abuse may prevent long-term effects. This treatment may include:
  • support groups
  • individual psychotherapy and group therapy
  • medication, such as antidepressants
  • job, welfare, and housing assistance to help the victim become independent
The abuser may need:
  • alcohol and drug treatment
  • treatment to learn how to control his or her anger
What are the side effects of the treatments? 
Antidepressants, called selective serotonin reuptake inhibitors or SSRIs, are often used to treat symptoms of depression, anxiety, and post traumatic stress disorder. The most common side effects are:
  • upset stomach
  • drowsiness
  • headache
  • dry mouth

Some people also become more anxious or irritable. Others may develop sexual problems such as erectile dysfunction.

None of the side effects are long-lasting. Within weeks of starting an SSRI, most people can tolerate them. For other people, side effects disappear. When they are constant and uncomfortable, a change in the medication, it's dosing, or the addition of another drug often helps.

What happens after treatment for the injury? 
The emotional consequences of abuse may be longstanding and long term follow up may be required. Unless an independent major psychiatric illness develops use of medication should not be long term. If the marriage remains intact, marital counselling with periodic reassessment of progress is essential.

Author: Karl M. Jacobs, MD
Reviewer: eknowhow Medical Review Panel
Editor: Dr John Hearne

Last Updated: 25/04/2005
Contributors
Potential conflict of interest information for reviewers available on request
 


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