CONTENTS

About This Course

Table of Contents

1. Introduction to the Issues
2. Understanding Alcohol Abuse
3. Understanding Violence Against Women
4. Alcohol and Domestic Violence
5. Alcohol, Sexual Assault, and Rape
6. Prevention and Early Intervention
7. Screening and Assessment
8. Diagnosis and Treatment
9. Legal and Ethical Issues

Supplements
Fact Sheets
Videos
Resources

Silence Hurts
Alcohol Abuse and Violence Against Women

Injuries Needing Medical Attention

The following common types of injury may also indicate abuse:

• Contusions, abrasions, and minor lacerations, as well as fractures or sprains
• Injuries to the neck, abdomen, breasts (especially when pregnant), or chest
• Multiple injury sites
• Chronic injuries²⁹

The stress of repeatedly living in a violent home also may cause:

• Chronic pain without visible evidence
• Gynecologic problems and urinary tract infections
• Anxiety disorders or symptoms of depression such as:
  • Sleep and appetite disturbances
  • Fatigue
  • Sexual disturbances
  • Chronic headaches
  • Abdominal and gastrointestinal complaints
  • Palpitations
  • Dizziness
  • Paresthesias (unexplained numbness or prickly sensations)
  • Dyspnea (difficulty breathing)
  • A typical chest pain
  • Frequent use of prescribed minor tranquilizers or pain medications³⁰

Although hospitals are often the first to see abused women, studies have found that many emergency room staff do not check for abuse or follow guidelines for referral or social service consultation. In fact, in one study, one in four women seeking emergency medical services were identified as having been battered-approximately nine times the number identified by emergency service staff.³¹

Battered women are referred to psychiatric staff five times more frequently than nonbattered victims. The battered women often complain of frequent headaches, stomach disorders, intercourse discomfort, and muscle pains, but their x-rays and lab tests do not reveal anything. Therefore, many of the woman are labeled "neurotic, "hypochondriac, or "a well-known patient with multiple vague complaints." At the conclusion of a psychiatric assessment, just one in 50 nonbattered women (2 percent) is assigned one of these labels, compared with one in four battered women (25 percent).³²

Multiple emergency room visits lead to ongoing questions focused primarily on obtaining diagnostic information. Social problems or concerns of the woman often get interrupted or cut off, since they do not seem relevant to diagnostic reasoning. So, the woman is left feeling helpless, isolated, unheard, and frustrated-feelings similar to those she experiences at home with the abusive partner. Eventually, a set of complex problems are recognized and diagnosed as alcohol abuse, drug abuse, depression, or a variety of other mental illnesses.³³

To improve health care response to domestic violence, the Agency for Healthcare Research and Quality (AHRQ) developed an assessment tool hospitals can use to evaluate their domestic violence programs. For more information, and to download the evaluation tool, visit the AHRQ Web site.