THE EFFECTS OF DOMESTIC VIOLENCE ON CHILD WITNESSES

Abstract

In recent years, awareness about domestic violence has dramatically increased in the medical community and in our broader communities. Domestic violence is recognized by public health officials as a health care issue of epidemic proportions, occurring in one in four American families [1]. The family physician has a unique opportunity to help break the cycle of violence inherent in domestic violence relationships by recognizing and intervening to help victims of the violence (ie, the abused woman) and the silent witnesses (ie, the children). A large gap continues to exist between what is well recognized as a public health epidemic and how domestic violence is managed in clinical practice. For example, although domestic violence affects at least one third of the patients cared for by family physicians, it is estimated that only 10% of family physicians routinely screen for domestic violence [2,3]. In addition, only 1 in 35 cases of domestic violence is correctly identified by health care providers [4]. Domestic violence is usually defined as a pattern of intentional violent, coercive, or controlling behaviors perpetrated by someone who is currently, or was previously, in an intimate relationship with the victim [5]. In the majority of cases, the victims of domestic violence are women, and the batterers are men. In 1998, the Bureau of Justice estimated that more than half of female victims of intimate violence lived in households with children under 12 years of age. Given that such violence occurs in the home, the children in these families are involved as victims or, more often, as witnesses. The effects on children of witnessing violence are many and depend on the child’s age and gender and on the severity and duration of the violence. Research suggests that witnessing violence in the home may be as traumatic for children as being physically abused and may have more severe long-term consequences than physical abuse [6,7]. Because of the