Key elements for providing care and support : Recognising signs of violence

MdM, Regional workshop on providing care and support to women victims
of violence, Latin America/ Caribbean, 18 – 21 November 2008.

Evelyne Josse, 2008

1. Physical/health related signs

Highly suspicious signs
– Where the injuries are situated: cuts (contusions, burns,
bruises, scratch marks, bites, lacerations, alopecia),
fractures, dislocations, internal lesions
(visceral and thoracic), deafness (torture);
– Injuries from varying points in time;
– The injury doesn’t fit the explanation given for it;
– The woman refuses to disclose the cause of the injury
or of the sexually transmitted infection;
– The woman hasn’t mentioned traumatic injuries
(unexpected discovery);
– The woman offers vague, confused and changeable
explanations as to the aetiology of the symptoms;
– The woman sees the doctor repeatedly for the same reasons;
– The woman claims that she has had an accident
or that she caused herself the injuries (self harming);
– The woman leaves visiting the doctor until late despite
how serious her injuries are or if she is suddenly taken
into hospital (complications following infection or surgery,
or haemorrhaging for injuries that could have been
dealt with sooner);
– Sexually transmitted infections in young people.

Signs that are not specific
– Recurring genital or urinary disorders, complaints
or injuries: pelvic pain, dysuria, infections, dyspareunia,
issues surrounding sex drive, etc.;
– Request for HIV test (low occurrence in married women);
– Somatic disorders without any physical manifestations:
headaches, chronic pain (anal, abdominal or back pain);
difficulty breathing, fever, tiredness, etc.;
-Repeated visits with several members of the team
for physical or gynaecological problems;
– Difficulties coming to terms with a pregnancy, either
in denial or delaying announcement, absent father
(or identity concealed), requests for a termination
(especially in the presence of family members),
complications following a termination (haemorrhaging,
infections), haemorrhaging prior to giving birth, rupture
of the uterus, placental abruption, miscarriage;
– Long term complaints: hypertension, diabetes, gastric
or intestinal complaints, asthma.

2. Signs of a psychosocial nature

– Mood and behaviour : State of shock, disorientation, confusion, demonstrates
a slowness in their behaviour, anxiety (phobias, panic
attacks, avoidant responses), depression (sadness, selfharming,
suicidal tendencies), is on edge, insomnia, loss of
appetite, memory and concentration issues, mutism, abusing
psychoactive drugs, excessive concerns about hygiene,
isolation, etc.;
– Language : puts herself down or blames herself (indicating lowered self
esteem) and / or isolation, expresses issues of atonement,
carries out rituals, feels like giving up;
– Attitude towards healthcare workers :
embarrassment, worry, seeks to protect. A spouse
who is too overbearing / considerate and speaks for his wife.