DOMESTIC VIOLENCE SUMMARY

WHAT IS INTIMATE PARTNER VIOLENCE? Also known as domestic violence or abuse, battering, intimate partner abuse,

dating violence IPV is a pattern of coercive control involving physical, sexual, psychological,

cultural and/or economic abuse. IPV is perpetrated in the context of a current or former intimate relationship. Power/Control + Fear = Abuse

LEGAL DEFINITION OF ABUSE Attempting to cause physical harm Causing physical harm Placing another in fear of imminent physical harm (threats, verbal abuse

etc.) Sexual assault Economic and emotional abuse

SOCIOLOGICAL DEFINITION One person systematically abusing another to gain power and control in a

relationship.PREVALENCE OF IPV

Anyone can be a victim and anyone can be a perpetrator, regardless of age, race, sex, income, education level, gender, ability, and sexual orientation

Around the world AND in the United States, at least 1 in 3 adult women has been physically or sexually abused by a husband or boyfriend at some point in her life.

One in four gay men and lesbian women have experienced domestic violence.

While men can be the victims of abuse, women are more likely to be assaulted and killed by an intimate partner, and they sustain far more frequent and far more serious injuries than men who have been assaulted by a woman.

MEDICAL ISSUESAmong women who are physically assaulted or raped by an intimate partner, one in three is injured. Each year, more than 500,000 women injured as a result of IPV require medical treatment.Nearly two-thirds of women who reported being raped, physically assaulted, or stalked since age 18 were victimized by a current or former husband, cohabiting partner, boyfriend, or date.And about half of all injuries are in the head and neck area—which obviously means that in your practice, you will be one of the most likely people to see the physical signs of violence.

IPV IS NOT A loss of control or uncontrolled anger

The victim’s fault or responsibility An isolated incident or accident Caused by substance use or mental illness Limited to certain cultural, races, or classes Pre-destined or unavoidable

WHY IS IPV A PUBLIC HEALTH ISSUE? Prevalence Leading cause of injury and death, associated with numerous negative health

conditions Incurs significant cost to society, affecting individuals, families and the

community Some groups are at higher risk and have less access to help due to language,

cultural, economic, physical, and other barriers It is Preventable

WHY IS IPV A DENTAL HEALTH ISSUE? 65-75% of injuries from family violence are visible in the head, face and neck

region. Abuse impacts oral health in many ways. Oral health and overall health and well-being are inseparable. Dental professionals are legally and ethically required to respond to and/or

report abuse of vulnerable patients.

HEALTH EFFECTS OF IPVFATAL

Homicide Suicide Maternal and Infant Mortality Any death resulting from issues at right

NON-FATAL Physical injury, disability Chronic conditions Mental Illness Reproductive health problems Negative/Harmful Health Behaviors

ORAL HEALTH EFFECTS OF IPA Injuries to the teeth, soft tissue, jaw, face, head, neck Difficulty eating Dependency on pain medication Non-compliance, neglect of oral hygiene Dental fear resulting from trauma

TYPES OF ABUSE/VIOLENCE

Physical Overt or threatened: against victim or others

Cultural Racial slurs, prohibiting someone from practicingtheir cultural traditions, immigration status

Emotional/Verbal Isolation, humiliation, intimidation, deprivation

Sexual Coerced sex, rape, forced prostitution

Financial Interference with work/school; ruined credit

CYCLE THEORY OF VIOLENCE Tension-Building

criticism, yelling, swearing, using angry gestures, coercion, threats Violence

physical and sexual attacks and threats Seduction

apologies, blaming, promises to change, gifts MAKE CLEAR that this is just one way of thinking about an abusive relationship, not all relationships or individual experiences are the same, cycle changes over time (i.e., seduction phase gets shorter or disappears altogether) Relationships usually start in the Seduction phase, making it confusing to victim when first violence occurs.Tension BuildingVictim“Walking on eggshells”, tries to compensate, appeases to prove trust/love, hypervigilantAbuserHas dramatic mood swings, accuses jealous, paranoid, monitors victim’s behavior, intimidatesViolenceVictimFeels trapped, at most vulnerable, self-medicates/punishes, shame, self-defenseAbuserDirect verbal/emotional/ physical abuse, violence is more intense than the last time, rape, may be drunk/high Seduction/Honeymoon/Hearts and FlowersVictimTries to understand, to reconcile the “2 personalities”, forgives, focuses on good traits, feels paranoid (maybe it didn’t happen the way s/he remembers), minimizesAbuserApologizes, shows remorse, “I’ll never do it again,” it was the drugs/alcohol/job, tells partner how to handle him/her the next time s/he “loses control,” minimizes (“you really thought I was going to hurt/kill you?”)

SIGNS OF ABUSE Depression Suicidal thoughts Eating disorders Bruises/cuts “Choke” marks Unseasonable clothing Drug & alcohol abuse Medical/dental problems Absences/tardiness (appointments, work, school) Low self-esteem Isolation Obsessive compulsive behavior Fear of partner Personality change

WARNING SIGNS OF ABUSIVE BEHAVIOR Entitled Self-centered Controlling Extreme jealousy Possessiveness Blaming others Unrealistic expectations Isolation Blaming others for feelings Cruelty to animals/children Using sex as a way of power and control Mood swings Past relationship violence Breaking or striking objects Using force in arguments

WHY MIGHT VICTIMS STAY? Financial or physical dependence on abuser Loss of benefits or immigration status for self or children Love, hope, confusion, shame, believe abuse is their fault Unaware of legal rights, fear that protection will be inadequate Fear of retaliation by abuser (separation violence) Cultural pressure to keep marriage and family together, language Fears and barriers related to racism, homophobia, etc Co-occurring addictions or mental illness, trapped in cycle

DENTAL PROVIDER’S ROLE Educate yourself about IPV and local resources

Inquire about abuse as part of the dental exam Respond in a sensitive way when violence is disclosed Learn techniques to lessen the negative impact of the dental visit on patients

with a history of trauma Refrain from judgment or telling clients what to do Advocate for laws and policies that empower victims and hold batterers

accountable Collaborate with trauma and IPV experts