Study ties abuse to host of ailments Hopkins researchers queried 2,000 women at doctors' offices

Ills of domestic violence

Information fuels model for physicians to identify victims

November 15, 1995|By Diana K. Sugg | Diana K. Sugg,SUN STAFF

By going into doctor's offices and surveying women, researchers have linked domestic violence victims to a range of chronic health problems such as severe headaches and chest pain -- conditions that seemed to persist despite treatment.

Researchers at Johns Hopkins Bayview Medical Center discovered that so many physical and psychological symptoms were associated with continuing domestic violence that they created a model physicians can use to identify possible victims. The psychological clues include nightmares, anxiety and binge eating.

Published yesterday in the Annals of Internal Medicine, the study surveyed nearly 2,000 Baltimore women in doctor's offices and reinforces similar but smaller studies also done through primary care practices.

The researchers found that one in three women had experienced domestic violence either as an adult or a child, a number consistent with many other studies. Hopkins researchers also concluded that one in 20 women had been victims of violence within the past year.

"This study suggests that this is a huge public health problem," said Dr. Jeanne McCauley, the principal investigator and an assistant professor of medicine at the Johns Hopkins University School of Medicine.

The women who were categorized as abused were those who reported being hit, slapped, kicked, or otherwise physically hurt by someone, or being forced to engage in sexual activities. The women identified the aggressors as a husband, ex-husband, boyfriend or relative.

The data were collected anonymously through surveys the women filled out when they showed up to see a doctor in four community-based primary care practices. Little medical research has been done on domestic violence, much of it in emergency rooms and hospitals, where the victims had acute injuries.

In the Hopkins study, women were able to check off symptoms from a long list. Researchers expected maybe one or two to be linked with abuse. Instead, they discovered 20. They included abdominal pain, diarrhea and shortness of breath.

Victims of domestic violence were also more likely to be emotionally distressed, involved in substance abuse and have attempted suicide.

The women may not realize that abuse is causing their health problems, are ashamed to speak up, or are afraid of repercussions, including disclosure through a spouse's health insurance.

In the first question of the survey, an open-ended one that asked why they were at the doctor's office, just one of the 1,952 female patients cited domestic violence.

"It's very sad to me that a lot of women seem to be suffering a great deal, and physicians have not done a good job for a variety of reasons," said Dr. McCauley, who has changed her own internal medicine practice because of what she has learned. "People have not known that this is a problem."

For the women who are victims -- who struggle to hold in their emotions while they are treated at emergency rooms or in doctor's offices -- having a respected authority like a physician question them and give advice could be crucial.

"If someone in the health care world would have helped me see the pattern, or see the potential for the pattern, then maybe it would have helped to stop it," said a Baltimore woman, 40, who asked not to be identified.

She said she endured abuse until she was ultimately stabbed a dozen times in the head and neck by her former husband, who had broken into her apartment one night.

She describes the shame, and the feeling that it was her fault.

"It's not black and white to you, because it progresses over a long period of time," she said. "It doesn't matter how intelligent or how educated you are, you don't see it coming. That's why it's so much more important for these professionals to recognize the possibilities and to help these victims and extract that information from them."

Even though former U.S. Surgeon General C. Everett Koop called attention to domestic violence a decade ago, pronouncing it the leading cause of injury in women, only in the past few years has the medical community begun to tackle it.

The American Medical Association developed specific treatment guidelines for abuse. Locally, the Maryland Alliance Against Family Violence, together with the Medical and Chirurgical Faculty of Maryland, has trained 3,000 health care providers -- including 912 physicians -- in the past few years. They are taught what to look for and how to help domestic violence victims.

Joanne Tulonen, the Alliance's executive director, who has done much of the training, said she often must confront the same biases among physicians that the public has, including that helping victims is a waste of time because they will just go back to the abuser.

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