Domestic Abuse Cycle

During the tension building stage tension in the relationship gradually increases

over time. During the acute battering stage tension erupts and results in threats

or use of violence and abuse. During the honeymoon stage the batterer may be

apologetic and remorseful and promises not to do it again. It’s this stage that

gives the victim hope and contributes to them staying in the relationship.

o Note that the cycle continuous throughout the relationship and the

honeymoon stage shortens over time and battering becomes more

frequent or severe.

Traumatic bonding is the strong emotional connection that develops in the

abusive relationship

o Often the victim is torn between love and economic support and fear and

humiliation

Screening Time Periods

Primary Care Every first visit, new rtnshp, new

complaint, all periodics

ER and UC All women all visits

OBGYN Prenatal and postpartum, new rtchp, all

gyn visits, and all STD center visits

Mental Health Every initial assessment, each new rltn,

and annually if ongoing treatment

Inpatient All admissions and discharges

Physical Exam

Note that dating of bruising is very important although there exists no scientific

evidence of accuracy. Look for age consistency based on these guidelines

o New: red

o 12-36 hr: turns blue-purple

o Progresses to blue-green, green-brown, brown- yellow, before going

away

DEV: elderly bruise more readily and more severely r/t meds,

hematologic disorders, abnormal cbc.

o Additional tests are urinalysis, CBC, platelets, BUN, creatinine, protein,

albumin, serum liver function, and coagulation panel.

What to know about the DA

The danger assessment maps abuse on a calendar and we can note the score

overall.