Family dysfunction - abuse

Forms of abuse

Family dysfunction - abuse: physical, sexual, emotional/psychological, and financial abuse across the lifespan (child, intimate partner, elder abuse)
Intimate partner violence (IPV) most commonly affects women as victims, but occurs across all demographics and relationship types

~1 in 4 Australian women have experienced physical/sexual violence by an intimate partner since age 15
Elder abuse - estimated ~1 in 6 older Australians, commonly financial and psychological, often perpetrated by family members
Child abuse frequently under-reported and under-recognised in medical settings

Power/control dynamics, social isolation, financial dependence, substance use, intergenerational trauma
Disclosure barriers: fear, shame, dependence on the perpetrator, normalisation, cultural/language factors, disability/cognitive impairment increasing vulnerability and reducing disclosure capacity

Clinical suspicion from injury pattern (inconsistent with explanation, different stages of healing, defensive-pattern bruising), frequent presentations, vague somatic symptoms, non-attendance/cancelled appointments, controlling partner/carer present at consultations
Routine enquiry in relevant contexts (antenatal care, mental health presentations) improves detection
Direct, non-judgemental questioning in a private setting - "Are you afraid of anyone at home?"
Document objectively (patient's own words, injury description/photographs with consent) - documentation may later support legal proceedings

Safety first - assess immediate danger, safety planning, provide crisis contact information (police, domestic violence services)
Mandatory reporting obligations for suspected child abuse in all Australian jurisdictions; elder abuse reporting varies by state - know local requirements
Respect adult patient autonomy where no mandatory reporting obligation applies and capacity is intact - forced disclosure/action can increase danger
Multidisciplinary approach - social work, family violence services, legal support, GP-coordinated follow-up
Document thoroughly and objectively regardless of whether the patient wishes to act immediately

Chronic pain, unexplained somatic symptoms, depression, anxiety, PTSD, substance use disorder
Pregnancy - IPV often begins or escalates during pregnancy
Child witnesses of IPV - long-term psychological sequelae even without direct abuse

Abuse commonly escalates in frequency and severity over time without intervention
Leaving an abusive relationship is the highest-risk period for serious harm/homicide - safety planning is essential before any action is taken
Early identification and support materially improve long-term psychological and physical outcomes

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