Domestic violence against women is among the key problems surrounding the relationships between sexes in the United States and other countries. The above issue is widely recognized all over the world since its negative consequences for women’s mental, physical, and reproductive health are numerous. The assigned reading refers to the case of a young woman (primigravida, nullipara, 16 weeks pregnant) who visits a family physician with her boyfriend.
DV can be real or potential, and both elements are presented in the case. In terms of real violence, the woman discloses certain facts about her father’s physical aggression (she was systematically beaten before her parents’ divorce). Importantly, the client also reports more than two episodes of her present partner’s violent behavior. As the patient reports, they have arguments quite often, and it happens that her partner is unable to cope with his aggression. The man, however, claims that any physical harm that the patient reports is unintentional.
The signs of potential DV are also present in the case. Prior to conducting direct physical attacks, many individuals who are prone to deviant behavior tend to damage property or perform other actions to redirect aggression and make its manifestation more socially appropriate (Cronholm, Fogarty, Ambuel, & Harrison, 2011). Given that the patient discloses at least one case of potential aggression (the situation with the truck), it can be supposed that there have been more incidents with properly damage. Continuing on potential threats, the woman claims that she is unhappy and does not feel safe, which can be a result of verbal aggression, sexual abuse, or even reproductive coercion.
The situation under analysis is complicated by the fact that the patient is pregnant and, therefore, has increased risks of physical and mental problems due to the changing needs of her body. Unfortunately, pregnant women often become the victims of domestic violence because of the growing dependence on their boyfriends and husbands (ASPE, 2013). According to modern researchers interested in the unique features of domestic violence in pregnancy, more than 40% of pregnant women experience DV (Almeida et al., 2017). It is important that the majority of victims report the cases of psychological violence, the most underestimated type of aggression. According to common stereotypes, pregnancy is regarded as a “special” and positive period, whereas in real life, it is associated with the greater prevalence of DV.
Pregnant women who experience DV often misunderstand the true intentions of their male partners or fail to recognize the signs of psychological violence. In certain cases, the victims of DV (especially pregnant women) construct any ideas to normalize violence or even “explain” its causes, and this phenomenon is inherent in identification with aggressors. In general, denial as a form of self-defense is often observed in victims who are dependent on their offenders financially or emotionally, and this is why many cases of DV in pregnancy remain unreported (Almeida et al., 2017). In reference to pregnant women and new mothers, the prevalence of DV is greater in those younger than 30, which can be related to psychological immaturity, the lack of financial resources to separate from aggressors, and poor psychological self-protection skills (Almeida et al., 2017).
To better understand the client’s situation and provide appropriate care, it would be paramount to clarify with her the following things during a private conversation:
- Any previous medical visits (chronic health issues, emergency issues, etc.);
- Patient’s mental health problems (mood swings, suicidal thoughts) and similar issues in her boyfriend;
- Current financial position;
- Any issues related to pregnancy (bleeding, severe abdominal pain, high blood pressure, menstrual cramps, etc.) (Cronholm et al., 2011);
- Her and her intimate partner’s pernicious habits;
- The history of venereal diseases;
- Basic information about previous partners, relationships, sexual abuse;
- Current relationships with the partner (conflict frequency, common causes of conflicts, verbal/physical/psychological aggression and its manifestations);
- What makes her partner more aggressive;
- Any approaches to handling conflicts used.
Differential diagnosis appropriate for the scenario:
- Sexual abuse;
- Anxiety disorders;
- Panic attacks.
To begin with, in order to clarify the situation with domestic violence, it will be necessary to conduct a thorough physical examination (detect any signs of genital area traumas, bleeding from anus/vagina, bruises, etc.) (Iskandar, Braun, & Katz, 2015). The possibility of reproductive coercion cannot be excluded, and this is why the patient will need to be interviewed about her readiness to become a mother, her partner’s perspective, birth control methods used and who was the key decision maker, and unwanted sexual practices.
In case of any physical traumas and obvious signs of physical or sexual violence, it is pivotal to assist the patient in verifying the injuries. Importantly, she should be encouraged to focus on her and her future child’s needs. Specific psychotherapeutic interventions may be required to help her deal with stress and guilt to prevent her from protecting her abuser. Obstetric examinations are to be conducted to ensure the normal development of the fetus and develop recommendations. Apart from that, the patient may need to get psychological help to make an informed decision concerning her pregnancy.
Almeida, F. S. J., Coutinho, E. C., Duarte, J. C., Chaves, C. M. B., Nelas, P. A. B., Amaral, O. P., & Parreira, V. C. (2017). Domestic violence in pregnancy: Prevalence and characteristics of the pregnant woman. Journal of Clinical Nursing, 26(15-16), 2417-2425.
ASPE. (2013). Screening for domestic violence in health care settings. Web.
Cronholm, P. F., Fogarty, C. T., Ambuel, B., & Harrison, S. L. (2011). Intimate partner violence. American Family Physician, 83(10), 1165-1172.
Iskandar, L., Braun, K. L., & Katz, A. R. (2015). Testing the Woman Abuse Screening Tool to identify intimate partner violence in Indonesia. Journal of Interpersonal Violence, 30(7), 1208-1225.