Shame, denial and fear that doctors don't care prevent most abused women from confiding in their physicians. The women's distrust is especially tragic because they are likely to suffer ill health and thus be under a doctor's care.
These and other findings are reported by Jeanne McCauley, MD, MPH, and colleagues at Johns Hopkins University School of Medicine in Baltimore in the August issue of the Journal of General Internal Medicine.
"Many abused women experience worsening health and seek medical care," write McCauley and her colleagues. "Many of the barriers to discussion of abuse could be overcome by a physician's understanding of the emotions surrounding abuse and the unique treatment concerns of abused women."
The researchers used questionnaires and focus groups to obtain comprehensive, in-depth information on the opinions of 21 Baltimore-area victims of domestic violence who already were participating in group therapy. Of the 21 women, 18 (88 percent) had sought out their regular doctor within the previous year, yet only one in three discussed the abuse.
Their symptoms, which either began or worsened with abuse, included asthma, hypertension, headaches, eye pain, massive weight change, depression, and others.
At first, women failed to see the link between abuse and their medical conditions. However, one in three noticed improvement when she left the relationship or discussed it with a health professional.
Shame and denial were the most important factors keeping them from talking with doctors, but about a third of the women also said their abusers blocked them from seeking care, intercepted mail and phone calls, or, at the doctor's office, prevented them from being alone with a clinician. Even when they could speak privately with a doctor, many of the women remained silent for fear of being blamed or scorned by their own doctors.
More important than the doctor's gender was whether he or she appeared caring, easy to talk with, and supportive. Unfortunately, many abuse victims perceived their doctors as too busy, unconcerned, and uncomfortable with the topic.
"Some women hinted to their physicians about a stressful personal problem in the hope that physicians would 'invite' them to give more details," write McCauley and colleagues. Such women expressed disappointment that doctors failed to probe more deeply into their situations.
Domestic violence posters displayed in the medical office helped prompt some victims to speak up. Questionnaires, when administered in a private area, also helped.
Medication for depression, anxiety, or sleep disturbances had been prescribed to one-fourth of the group. Nearly all found the drugs helpful, but many feared becoming addicted to them. Many also feared loss of control or strength in relation to the abusive partner.
Most study participants were divorced, separated, or single. They reported a wide range of incomes, but fear, shame, and distrust crossed all class lines.
The Journal of General Internal Medicine, a monthly peer-reviewed journal of the Society of General Internal Medicine, publishes original articles on research and education in primary care. For information about the Journal, contact: Margo Glen Alderton, (215) 823-4471.