PSYCHOLOGICAL COMPLICATIONS OF DOMESTIC ABUSE

The psychological complications of domestic violence are complex and involve a range of behaviors. These include self-injurious actions, dissociation, and substance abuse. Common psychiatric diagnoses are Post Traumatic Stress Disorder, Major Depression, with and with out Psychosis, and the range of Anxiety and Dissociative states.

Women enrolled in domestic violence programs have rates of serious mental illness that are twice as high as women in community out-patient programs. These women can be particularly vulnerable to physical illness, social stress, financial hardship and job loss, and are disadvantaged in the health and social care system. Maladaptive behaviors such as self mutilation, suicide attempts, criminal activity and addictive or compulsive activities can occur. The most ominous behaviors, such as perpetuation of the abuse on other partners or children are a serious consequence.

For practitioners a differential diagnosis is important, as symptoms may not conform to a particular category and may seem delusional or fabricated. Often, there is discordance between the symptoms and historical material and the patients’ mood, affect and presentation.

There are estimates that 10 million children a year are exposed to violent domestic households. Children who are exposed to domestic violence are susceptible to a wide range of developmental and psychiatric problems. These children can manifest Post Traumatic Stress Disorder, Major Depression with out without Psychosis, Insomnia, Phobias, Aggression, and Anxiety. They may do poorly in school and have peer-to-peer relationship problems. The difficulty these children encounter is due to a dependency on an emotionally or physically abused parent and identification with the aggressive or violent parent, particularly if there is a same gender relationship. Other concerns are for protection of siblings, and fear of direct violence to the individual child. Treatment should be focused on the child specifically with regards to possible medication and counseling, and therapy for the siblings and identified abused parent. Safety matters, educational and social issues need to be considered and most mental health agencies are the appropriate setting for this type of care.

In all treating situations, the safety of the patient and dependents in the household is a matter of urgent concern. Knowledge of appropriate legal and social service and counseling agencies is part of the delivery of proper care. For help in these areas, call the National Domestic Violence Hotline at 1-800-799-7233 (SAFE)