The prevalence of domestic violence in the United States is much higher than people like to believe. According to the CDC, 41% of women and 26% of men experience intimate partner violence during their lifetime. 27 million of these men and women report experiencing these problems before the age of 18.  

Sexual violence statistics are equally concerning, with 1 in 5 women experiencing attempted or completed rape in their lifetime. 51% of these women report that their attacker was an intimate partner, and another 40.8% knew their attacker. One in three of these women became victims of sexual assault between the ages of 11 and 17 years old.  

Related CE for nurses: Domestic and Sexual Violence

Domestic violence in the media

The media does not do much to help victims of sexual assault. It may even perpetuate the thought processes that make it so common. Having a controlling and jealous partner is often romanticized in books, television shows, songs, and movies. Shouting, breaking objects, and even violence are twisted to become displays of passion, making identifying abuse confusing, especially for teens and young adults.  

Not only do victims learn to romanticize abuse, but abusers, primarily boys and men, learn that they must be tough and should try to control their wives and girlfriends. These actions are even given praise and glorification.  

Related CE course for nurses: Digital Technology and Domestic Violence

Barriers to reporting

Survivors of domestic violence or sexual abuse are often hesitant to seek help. Unfortunately, survivors of domestic abuse have several reasons not to report their abusers.  

1. Many may feel protective of their abuser. Their abuser has told them that the abuse was their own fault, and that the abuse wouldn’t have happened if they had behaved differently. Of course, this is not true, but many people experiencing domestic abuse have become conditioned to believe their abuser.  
2. People who experience sexual violence may fear that they will not be believed, or they may feel guilt and shame over the attack.  
3. Victims of domestic violence and sexual violence typically have some kind of relationship with their abuser. It can be hard for them to imagine calling the police to arrest someone they have or once had a close and even loving relationship with.  
4. In some cases, sending an abuser to jail means a family will lose their primary source of income.  

Post-traumatic stress disorder after domestic and sexual violence

PTSD and C-PTSD are common side effects of domestic and sexual abuse. PTSD often results from a single traumatic event, while Complex PTSD results from repeated or prolonged trauma. Because most survivors of domestic and sexual abuse know or have a relationship with their abuser, C-PTSD is the more common problem.

Symptoms of PTSD and C-PTSD include:

• Reexperiencing the event through intrusive thoughts or memories, flashbacks, or dreams 
• Avoiding people and places that trigger memories of the experienced trauma.  
• Hypervigilance or an exaggerated sense of current threat 
• Depressive feelings and shame 
• Withdrawal from social groups 
• Substance abuse

At-risk populations

Intimate partner violence, domestic abuse, and sexual violence can happen to anyone. Healthcare providers should exercise caution and avoid prejudice when screening for signs of violence and victimization. However, there are some groups of people who are at a higher risk of experiencing sexual and intimate partner violence. These include:  

• Women 
• High school and college age individuals 
• People under economic stress 
• Those living in homes with illicit substance use  
• Individuals who use or abuse alcohol 
• Anyone with a lack of social support 
• Adults with less than a high school education 
• Families experiencing divorce and separation 

Laws against domestic and sexual violence

In 1994, Congress passed the Violence Against Women Act, which states that victims of domestic and sexual violence have the following rights:  

1. The right to be treated with fairness and with respect for the victim's dignity and privacy; 
2. Reasonable protection from the accused offender; 
3. The right to be notified of court proceedings; 
4. The right to be present at all public court proceedings related to the offense, unless the court determines that testimony by the victim would be materially affected if the victim heard other testimony at the trial; 
5. Ability to confer with the attorney for the Government in the case; 
6. The right to restitution; 
7. The right to information about the conviction, sentencing, imprisonment, and release of the offender. 

Barriers to justice for domestic abuse victims

In addition to decent pay and flexible scheduling, home health is one of the most rewarding nursing specialties. Because they enter people’s homes and often care for the same patients over long periods of time, home health nurses build close relationships with patients and families.

Statistically, perpetrators of intimate partner violence are given shorter and less severe penalties than those who assault strangers. Abusers are frequently given the benefit of the doubt, and the burden of proof falls on the already struggling victim. In addition, even after a victim leaves their abuser, they may have to keep in contact due to shared children, family members, or assets. Leaving an abuser is never as easy as it seems.  

Survivors and the healthcare system

Healthcare providers are often in a perfect position to identify and help survivors of domestic and sexual abuse. Healthcare providers often give patients the opportunity to have private conversations, ensure confidentiality, and build trust.  

One of the best things that a healthcare provider can do is ask their patients direct questions about domestic and sexual violence in the home. Many healthcare clinics, especially women's health and pediatric offices, give questionnaires to each patient at the beginning of the visit. These simple yes/no questions about safety in the home, physical violence, and sexual violence can get important conversations started, and may encourage victims to disclose more about their experience. 

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