It has been estimated that a GP may see as many as five women a week who present with symptoms of violence in the home. Yet often the GP is unaware of the violence.

Symptoms could include depression, anxiety and long-term headaches. Pregnant women who are stressed by abuse could present with premature labour or miscarriage.

Family violence is coercive and controlling behaviours by a family member which cause physical, sexual and /or emotional damage to others in the family. While some men are affected, children and women are the most likely victims.

Women face many barriers to discussing family violence. They might feel shame, or they worry that they will be judged, disbelieved or the information won’t be treated confidentially. Yet, 2001 research showed GPs are the professional group a woman experiencing violence is most likely to turn to.

Symptoms of family violence

The Victorian Domestic Violence Resource Centre’s Guide for General Practitioners notes GPs should consider whether family violence may be occurring if the women present with the following injuries or symptoms:

• bruising in the chest and abdomen
• multiple injuries
• minor laceration
• injuries during pregnancy
• ruptured eardrums
• delay in seeking medical attention
• patterns of repeated injury
• anxiety, panic attacks, stress and/or depression
• stress-related illness
• drug abuse, including dependency on tranquillisers
• and alcohol
• chronic headaches, asthma, vague aches and pains
• abdominal pain, chronic diarrhoea
• complaints of sexual dysfunction, vaginal discharge
• joint pain, muscle pain
• sleeping and eating disorders
• suicide attempts, psychiatric illness
• gynaecological problems, miscarriages, chronic pelvic pain.

Children may present with:

• aggressive behaviour and language
• anxiety, appearing nervous and withdrawn
• difficulty adjusting to change
• psychosomatic illness
• restlessness
• bedwetting and sleeping disorders
• ‘acting out’, such as cruelty to animals.

Asking about violence

Many patients won’t disclose violence unless they are prompted. Patients are more likely to discuss it with a trusted GP who is not perceived as fixing just medical problems.

GPs can encourage disclosure by asking open-ended questions such as ‘How are things at home?’ or ‘When I see injuries like this, I wonder if someone could have hurt you?”.

Responding to a disclosure of violence

If a patient discloses violence, the best response is to show empathy, belief and to emphasise that violence is unacceptable.

Avoid suggesting the patient is responsible for the violence. Instead, help her to assess whether she and any children are safe or whether they need urgent help.

It is helpful to have printed information available about specialised family violence services.

Resources:* Doctors in NSW have the power to notify welfare services about patients who they suspect may be the victims of domestic violence, without that patient’s consent. However, the Australian Medical Association urges doctors to be careful, as non-consensual reporting may actually decrease a patient’s safety.

• RACGP Clinical guidelines
• Domestic Violence Resource Centre Victoria

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