Abuse and violence in families

The purpose of this activity is to show general practitioners some of the ways that family or intimate partner violence might present, how to ask pertinent questions and how to manage patients experiencing domestic and family violence.

Abuse and violence are common. In Australia, one in four women and one in eight men report being affected by abuse from an intimate partner or family member. The average full-time Australian general practitioner will see approximately five women each week who have been affected by intimate partner violence in the past 12 months.

Therefore, general practitioners can play a crucial role in early intervention and the provision of ongoing support for people experiencing abuse and violence. General practitioners care for the whole family, including children exposed to domestic violence and the person using violence.

It might not be apparent that abuse or violence are underlying the presentation. Universal screening for intimate partner violence is not recommended. Rather, the recommendation is that general practitioners be mindful of presentations that raise suspicion of underlying abuse.

Abuse and violence can affect individuals at any point across their lifespan and can be inter-generational. There might be multiple sociocultural influences. These might include normalisation of violence within the family or subculture, gendered roles, discrimination and inequity, and acute stressors such as housing insecurity, unemployment or bereavement. Domestic abuse refers to abuse within a household and can be from an intimate partner or family member. Intimate partner violence might occur even when partners are not living together and can be perpetrated through an intermediary such as technology.

Children living in a household are affected by abuse even if it is not physically directed towards them. They may witness violence, which can have an emotional impact, and be influenced by modelling of behaviour and security of attachment. Caregivers affected by violence might have compromised capacity to parent to their best ability due to the impact of the violence. Screening during the pregnancy and perinatal period is recommended. This period is recognised as high risk for family violence escalating.

The cases in this unit explore some of the ways that family or intimate partner violence might present, how to ask pertinent questions and how to manage patients experiencing domestic and family violence.

Learning outcomes

At the end of this activity, participants will be able to:

• describe presentations within general practice that might indicate someone is using or experiencing abuse or violence
• outline and implement strategies (eg funnelling questions) to enquire about family or intimate partner abuse
• discuss and implement an evidence-based approach (eg LIVES) as a way of responding to a disclosure of family or intimate partner violence
• identify a best practice approach in response to specific contexts (eg for young people and LGBTQA+ individuals experiencing abuse or violence)
• explain the role of a general practitioner in recognising and responding to children affected by domestic violence.

Case studies