Domestic abuse describes a continuum of behaviour ranging from verbal abuse, threats and intimidation, manipulative behaviour, physical and sexual assault, through to rape and homicide.
It is a complex issue that all health care professionals should have some understanding about. They should be aware of who is affected, how individual victims may present in differing health care settings, how the subject could be approached, and most importantly what professionals can do to help and support victims of abuse.
The term Intimate Partner Violence (IPV) is also often used interchangeably with domestic abuse, as a collective term used to describe domestic abuse, sexual assault and stalking. The term domestic abuse has been used throughout this resource which discusses all types of abuse within a domestic setting and not just between partners or ex partners.
In April 2021 the new Domestic Abuse Bill, which will lead to the creation of new Statutory guidance. For more information, see: Domestic Abuse Act: Factsheet (Home Office in the media).
In May 2020 the RCN signed a collaborative letter in support of the reintroduction of the Domestic Abuse Bill and the Government’s ambition to transform the national response to this public health epidemic – an epidemic which has heightened during the current pandemic.
Domestic violence and abuse:
is not exclusively male against female
is not gender, race, sexual orientation, religion, culture or age specific
children growing up exposed to domestic abuse may suffer a range of behavioural and emotional disturbances. These can also be associated with perpetrating or experiencing violence later in life
the victim and the perpetrator are known to each other but not necessarily partners. Other family members, children and parents can be the perpetrators
victims and perpetrators may be among the health care professional community
it is a major safeguarding issue and all health care professionals have a role in increasing awareness, and being inquiring when confronted with behaviours that raise concerns and alarm.
Definition of domestic violence and abuse
The cross-government definition of domestic violence and abuse is:
“Any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged 16 or over who are, or have been, intimate partners or family members regardless of gender or sexuality.”
Abuse can take many forms such as:
Characteristics of domestic abuse
Domestic abuse is essentially a pattern of behaviour not generally limited to a one-off incident. The key differences between it and other forms of abuse are:
the survivor and the perpetrator are known to each other
unlike stranger abuse or violence, domestic abuse takes place largely in private and behind closed doors
there is often a lack of objective evidence that abuse has taken place
outsiders may take the view that that domestic abuse is less serious
the abuse rarely happens once and tends to increase in frequency and severity over time
the abuser may have a great deal of intimate knowledge about their victim and hurt them in subtle ways that may not be understood by others
physical injuries can easily be targeted on places on the body where they are unlikely to be seen by others
it is less likely to be reported to the police.
Five Rs for asking about Domestic Abuse
Safe Lives has published guidance to support health professionals to safely ask patients about domestic abuse (DA) in virtual settings for example on the telephone or online. It sets out five simple steps to help you identify and respond to people who might be at risk. It can be applied in services which use routine enquiry, for example maternity services, as well as services using clinical enquiry, such as general practice. See: Five Rs for asking about Domestic Abuse.