Domestic violence is one of the experienced by women across the world. According to the National Family Health Survey (2015-2016), in India have experienced intimate partner violence (IPV).
Exposure to violence is known to have immediate as well as long-term on women’s health, which persist long after the violence has stopped. Physical effects can range from wounds and injuries, to long-term disabilities, and chronic pain syndromes. It can also severely impact a woman’s sexual and reproductive health, including unintended and unwanted pregnancies, abortion and unsafe abortion, and sexually transmitted infections.
Although survivors of domestic violence are more likely to have poor mental health, they are about domestic violence or abuse when they get mental health treatment, consequently, they’re not provided with appropriate referrals or support. As a mental health practitioner, it is important that you look out for signs of abuse while interacting with your clients.
What signs should a mental health practitioner look for, when screening or assessing clients for domestic violence?
Women who are subject to violence in relationships often seek healthcare for related emotional or physical conditions that occur as a result of the violence. But they may not talk about the violence due to shame, fear of being judged, or because they are scared of their partner or partner’s family.
Assessing for domestic violence involves being aware, and looking for signs of physical, emotional, financial, and sexual violence.
As a mental health practitioner, you may suspect that a woman has been subject to violence if she has any of the following:
Ongoing emotional health issues, such as stress, anxiety, or depression.
Harmful behaviours, such as misuse of alcohol or drugs.
Thoughts, plans, or acts of self-harm, or (attempted) suicide.
Injuries that are repeated or not well explained; or injuries like burns, bite marks; injuries on the back and/or inside of the arms, pointing to having used a defensive position to cover the face; injuries around the face, neck, chest, stomach, reproductive parts.
Repeated instances of sexually transmitted infections (STIs).
Unwanted pregnancies or miscarriages.
Unexplained chronic pain or conditions (pelvic pain or sexual problems, gastrointestinal problems, kidney or bladder infections, headaches).
Repeated health consultations, with no clear diagnosis.
Your instincts might also tell you that your client is at risk.
There could also be other indicators in your client’s behaviour that point towards abuse:
Is she covering her body, or wearing long sleeves and scarves to hide the marks?
Is she late for appointments, or missing appointments?
Does she visit the hospital/clinic frequently with vague complaints or different symptoms?
Does she seem anxious, fearful, or passive (particularly in presence of others)?
Does she not want to be contacted at home?
Does she exhibit an exaggerated sense of personal responsibility for the relationship, including self-blame for her partner’s violence?
Is she reluctant to speak when her partner is present?
Being watchful of possible indicators in the partner’s/partner’s family’s behavior can also help you identify signs of violence:
Cancellation of appointments on behalf of the client.
Always attends sessions, insists on staying close, speaks on behalf of the client, or appears overly protective.
Bullying or aggressive; critical, judgemental or insulting about the client.
Intense irrational jealousy or possessiveness expressed by the partner, or reported by the client.
Vehement denial of violence, or minimises its severity.
Doesn’t consider the client’s wishes, needs, or feelings.
The client’s children exhibit disturbing behaviour.
What are some commonly identified barriers to disclosure?
There are many barriers that may discourage the client from reporting or talking about abuse. Some of these are:
Not realizing that it is abuse. This is seen particularly in the case of emotional violence
Intimidation by the perpetrator/s, or fear of threat and further violence from the perpetrator/s
Fear of confinement at home/not being allowed to come for further check-ups
Pressure, both family and societal, to stay in the relationship
Perpetrator accompanying the client to sessions
Gender or cultural differences with the mental health practitioner
Shame and embarrassment, or self-blame
Fear that the disclosure won’t be believed
Isolation from friends and family
LGBTQIA—fear of being ‘outed’, internalized homophobia, guilt
Fear of re-traumatization
Hopelessness about the situation getting any better even after disclosing
Stigma associated with mental illness—many women with a mental illness feel that their illness will reduce their credibility in the eyes of the healthcare provider
Lack of privacy
Handling abuse-related trauma in therapy is a series by White Swan Foundation in collaboration with . This series is a guide for mental health practitioners to help survivors of abuse heal with therapy. This series refers to survivors as women, however, we acknowledge that survivors can belong to any identity. The usage of the word "women" has been used to reflect laws that are focused on women as survivors of domestic violence, and other guidelines that are framed keeping women in mind.
Written by Bhumika Sahani, journalist and social worker by training; consultant at Shakti; and Dr Parul Mathur, resident doctor, Department of Psychiatry, NIMHANS
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