Routinely asking women about domestic violence

Editor—We fail to detect partner abuse because we do not ask.¹,²Inability to accurately diagnose partner abuse prevents screening criteria being met. Taket et al propose routine inquiry to improve detection. However, one of these authors showed how difficult asking about partner abuse is. Exhortation to ask routinely will not overcome professional reluctance.

More research about acceptability to women³, and what happens after disclosure, is needed before routine inquiry is instigated. Old fashioned diagnostic inquiry may suffice, provided diagnostic skills are improved by training to spot post-traumatic stress disorder. Physical signs fade long before the psychological scars of partner abuse¹. Post-traumatic stress disorder is present in 35% of those who have experienced partner abuse, is often comorbid with depression, and is indicative of experiencing the severe end of the domestic violence spectrum¹,⁴.

Symptoms include panic attacks, flashbacks, nightmares, hypervigilance, and poor sleep. Among clinical indicators of intimate or partner abuse (thick files, multiple injuries, drunkenness, depression, and post-traumatic stress disorder¹) only post-traumatic stress disorder specifically identifies and acknowledges the type of trauma experienced during the diagnostic process. The causative role of that trauma in patients' subsequent distress becomes clear. A non-blaming attitude is engendered towards patients whose traumatic experiences may leave them feeling shame and self-blame, as well as severe anxiety. The abused faces complex decisions about what to do next.

Seeking the causes of disease is consistent with good diagnostic medical practice, whereas routinely asking people about trauma feels inappropriate and will not be done.