Welcome to the fifth edition of Abuse and violence: Working with our patients in general practice (White Book). We have added six new chapters since the fourth edition and updated all chapters with the latest evidence on abuse and violence, most of which occurs within the family or by someone the victim/survivor knows.
In this edition we use the term ‘victim/survivor’ for patients who experience abuse and violence and ‘perpetrator’ for patients who use abuse and violence (although we acknowledge these terms are not always preferred by some people).
Chapters are presented under six topics:
- ‘domestic’ or intimate partner abuse/violence
- trauma- and violence-informed care
- children and young people
- specific abuse issues for adults and older people
- specific populations
- system issues.
The World Health Organization (WHO) categorises interpersonal violence into that perpetrated by family, partners, community, acquaintances or strangers across the life course (Figure 1.1).
The White Book focuses on family violence across the life course, which is a broader term than IPAV or child abuse. Family violence also includes any violence or abuse occurring within a family – between, for example, siblings, uncles, aunts, cousins, grandparents and in-laws. The White Book does not address acquaintance or stranger violence to any great extent (apart from sexual assaults by acquaintances and strangers). It also does not cover the large burden of abuse and violence that occurs in global conflict zones, refugee camps and asylum-seeker detention centres.
Figure 1.1. Typology of interpersonal violence1
The White Book concentrates on the more prevalent form of interpersonal violence – that of violence against women by someone they know. A national survey conducted in Australia indicated both men and women were more likely to experience physical violence than sexual violence. Sexual violence was four times more common for women than men. Adult women were more likely to have experienced violence from someone they knew than by a stranger, while the reverse was true for men. Perpetrators of violence were more likely to be male than female, with one in three Australians experiencing violence by a male perpetrator compared to one in 10 by a female perpetrator.2
In particular, the White Book addresses specific populations, including women with disability, women from culturally and linguistically diverse (CALD) populations, and Aboriginal and Torres Strait Islander women, all of whom may be subjected to a higher prevalence of abuse and violence.2 The complex and cumulative way in which the effects of multiple forms of discrimination (eg racism, sexism and classism) combine, overlap or intersect – especially in the experiences of marginalised individuals or groups – should be acknowledged.
The White Book provides guidance on different types of abuse and violence, as discussed below.
‘Domestic’ or intimate partner abuse/violence
IPAV is any behaviour within an intimate relationship that causes physical, emotional, sexual, economic and/or social harm to those in the relationship.4 It may include a current or former intimate relationship and includes heterosexual, same-sex and gender-diverse relationships. Chapters on this topic are:
Trauma- and violence-informed care
Trauma- and violence-informed care enacts policies and practices that recognise the connections between violence, trauma, negative health outcomes and behaviours. These approaches increase safety, control and resilience for staff who are delivering care and people who are seeking care in relation to experiences of violence and/or have a history of experiencing violence.5 Chapters on this topic are:
Children and young people
Child abuse and neglect includes any type of abuse involving physical, emotional, sexual, economic abuse or neglect of a child under 18 years of age (16 years in New South Wales, 17 years in Victoria). It may include children exposed to IPAV. Chapters on this topic are:
Specific abuse issues for adults and older people
- Adult survivors of child abuse are adults who experienced physical, sexual or emotional abuse or neglect during their childhood or adolescence. Refer to Chapter 13: Adult survivors of child abuse
- Sexual violence is any sexual act, attempt to obtain a sexual act, or other act directed against a person’s sexuality using coercion, by any person regardless of their relationship to the victim/survivor, in any setting. This includes rape, defined as the physically forced or otherwise coerced penetration of the vulva or anus with a penis, other body part or object.2 Refer to Chapter 14: Adult sexual assault
- Abuse of older people is any type of abuse (physical, emotional, sexual, economic) or neglect of a person 65 years of age or over, either in a residential aged care facility, in private care, or living independently. It can be a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person. Refer to Chapter 15: Abuse of older people
The White Book also provides guidance on abuse and violence in specific communities:
The White Book also provides guidance on system issues, notably the law, and education and training: