Florida Domestic Violence

What is Florida Domestic Violence?

Family violence and domestic violence, including harm towards children, partners, and elderly people, is a widespread issue in the United States, particularly in Florida. It’s estimated that about 10 million people in the US experience this type of violence every year. So it’s likely that healthcare professionals will come across patients who have experienced some form of family or domestic violence. Sadly, this violence often continues throughout the victim’s life, starting in childhood, continuing into adult relationships, and extending into old age.

Domestic and family violence can take many forms, including economic, physical, sexual, emotional and psychological abuse. Anyone can be affected, regardless of age. Intimate partner violence can include stalking, physical or sexual violence, or psychological aggression from a current or former partner. In the United States, as many as 1 in 4 women and 1 in 9 men are affected by domestic violence. However, this number is likely larger since many cases likely go unreported. This violence doesn’t just affect the victim; it impacts their families, coworkers, and communities as well. It can lead to mental and physical health problems, decrease quality of life, and reduce productivity. This is also an issue for the economy; the national cost of domestic and family violence is more than $12 billion per year. And this problem is expected to get worse over the next two decades, especially when it comes to the abuse of older adults.

Medical professionals, including psychologists, nurses, pharmacists, dentists, doctors, physician assistants, and nurse practitioners, often struggle to identify domestic or family violence, and many cases go unreported. When healthcare professionals do identify cases of abuse, they need to provide resources to relevant community services, including shelters, counseling, advocacy groups, child protection, and legal aid.

In general, family and domestic violence is defined as abusive behavior that’s used to gain power over someone else. For example, intimate partner violence might includes physical or sexual violence, psychological aggression, or stalking from a current or former partner. Child abuse can include emotional, sexual, or physical harm by a parent, custodian, or caregiver that has the potential to cause actual harm or pose a threat to the child. Elder abuse can be intentional or arise from a caregiver’s failure to act. This can cause harm or pose a risk to an older person’s safety.

Healthcare professionals must recognize the signs of domestic violence and understand its prevalence in society. Then, they can start to take proper action. For example, they might need to be prepared to counsel patients, assess them for abuse, provide education or referral for further help. They might also be responsible for recognizing the signs and symptoms of mental and physical health problems related to domestic and family violence. From there, they can provide initial counseling and direct the patient toward the appropriate resources.

There are also specific laws in each state–like Florida–that further define what constitutes domestic violence. In Florida, it includes violent acts between family or household members who live in the same dwelling, even if they don’t have a child together. The law also expands the definition to include acts like threats, isolation, pet abuse, and manipulation using children.

Abuse can vary greatly in its forms, affecting people across all races, ages, and sexes without any cultural, socioeconomic, educational, religious, or geographic limitations. For example, stalking includes behavior like unwelcome letters, emails, texts, or phone calls; spying, following or spying on a person; damaging property, and making threats. Economic abuse can occur when a person is forced to rely on their abuser due to their misuse of money. This control could even include preventing the person from working or studying.

It’s also important to remember that abuse tends to follow an endless cycle of tension-building, explosive incidents followed by a ‘honeymoon’ period where the abuser apologizes and makes promises that the behavior will change. Unfortunately, these promises are often empty, and the cycle continues. This makes it crucial for healthcare professionals to be aware of and work towards breaking this cycle when treating patients affected by domestic and family violence.

What Causes Florida Domestic Violence?

Domestic and family violence often start when someone in a position of power, like a partner, parent, or care provider, feels a need to control others. This abuse can begin as emotional or verbal threats, but may then escalate to physical violence. This leaves the victim living in constant fear, never knowing when the abuser might explode into violence. After a violent incident, the abuser often apologizes, but the cycle of violence usually starts up again.

The reasons abusers may want to control others are varied. They can include difficulties with managing anger, feelings of jealousy, low self-esteem, feeling less worthy due to a lack of education or a poor financial background. Some abusers hold cultural beliefs that lead them to control their partner, while others may have a personality or mental health disorder. Some people learn to be abusive from their own families, or may turn violent under the influence of alcohol and drugs.

Some risk factors can make a person more likely to be involved in domestic or family violence. These can be personal factors, relationship troubles, community issues or broader social factors. For instance, there is evidence that people with less education are more likely to become involved in domestic violence. Childhood abuse can also increase the chance of someone becoming violent as an adult. Substance use, such as drugs and alcohol, can also lead to more violence.

Children who experience or witness domestic violence may come to believe that being violent is a normal way to solve problems. Men who are taught not to respect women are more likely to become abusive later in life. Women who see domestic violence as children are more likely to experience trauma or violence from future partners. Though women are more often victims of domestic violence, it’s important to remember that men can be victims too.

Other risk factors can include aggressive behavior as a child, antisocial personality disorder, having a disability, being punished harshly as a child, pregnancy, financial stress, and differences in education or job levels. Having low self-esteem, experiencing violence in the family, receiving limited education, poor parenting, having psychiatric issues, marital problems, having multiple children, poor enforcement of laws, a history of childhood abuse, and unemployment can also lead to violence.

Drug and alcohol use can greatly increase the risk of violence. About half of all domestic violence incidents involve a partner who has been drinking. Violence from a partner can also increase the chance of getting HIV.

An abuser might use emotional, physical, or sexual abuse to dominate others for many reasons. Understanding what these reasons are can help us understand why the abuser acts this way. By separating the abuser from potential victims and getting them help, we can stop the cycle of violence and prevent harm to everyone involved.

Risk Factors and Frequency for Florida Domestic Violence

In 2020, the state of Florida saw over 100,000 instances of reported domestic violence, resulting in more than 63,000 arrests. The state’s certified domestic violence centers provided over 410,000 nights of emergency shelter to over 10,000 survivors and their children in the fiscal year 2020 to 2021. Over 150,000 safety plans were developed, and more than 190,000 hours of advocacy and counseling services were provided, with advocates responding to over 70,000 hotline calls. However, it’s important to understand that some survivors don’t report their experiences due to fear, shame, or interference from their abusers, meaning the actual rates of domestic violence may be higher.

Domestic violence is a significant public health issue: 1 in 3 women and 1 in 10 men over the age of 18 experience it. This violence leads to more than 1,500 deaths nationwide each year, including up to 200 in Florida. Over a third of women and a quarter of men in Florida experience physical violence, stalking, or rape. The impacts of domestic violence, both physiological and financial, are substantial. For example, the national annual cost of healthcare related to domestic violence is over $8 billion.

Economic hardship, unemployment, and national downturns are linked to increased domestic violence rates. Nevertheless, non-fatal domestic violence rates are declining nationally due to factors like reduced marriage rates, improved access to shelters, and better economic conditions. Despite this positive trend, many people involved in domestic violence cases do not seek help. Healthcare professionals, often the first point of contact for survivors, need to stay alert to potential signs of domestic violence.

In Florida, several measures have been enacted to address the issue of domestic violence:

• A state task force has recommended steps to measure the prevalence of domestic violence and increase public awareness.
• Various healthcare professionals must receive domestic violence training every third renewal period.
• The Domestic Violence Data Resource Center and National Domestic Violence Fatality Review teams review cases resulting in fatalities to inform policy changes.
• The Family Protection Act mandates a five-day jail term for any domestic violence perpetrator who intentionally causes injury. A second offense is considered a felony.
• Judges must inform survivors of their rights, including their rights to appear in court, receive notifications, seek restitution, and make statements.
• The Domestic Violence Leave Act requires employers with 50 or more employees to provide leave for domestic violence issues.

Approximately 200 deaths in Florida each year are linked to domestic violence. Men are typically perpetrators, and women are primarily survivors. Many perpetrators have “do not contact” orders against them or documented mental health or substance use disorders. Ethnicity, gender, and income are all risk factors for child abuse, with women more often being the perpetrators. Although healthcare professionals are often the first to interact with survivors, they only contribute to about 10% of referrals to child protective services.

The impact of abuse on children can range from minor injuries to serious health conditions and death. Long-term consequences may include mental health disorders, substance abuse, self-harming behaviors, and even increased risks of certain physical health issues. Homicides are the leading cause of death among children aged one to four, with a majority of deaths from abuse occurring in children aged four or younger.

Domestic violence, including sexual violence and stalking, affects millions of men and women each year. The majority of those subjected to stalking know their perpetrator, who is often an intimate partner. In the U.S., women are six times more susceptible to violence from an intimate partner than men. In homosexual relationships, both women and men report high levels of domestic violence. Domestic violence is a leading cause of homelessness among women and families. Among survivors of domestic violence, women are much more likely to sustain injuries than men.

Elder abuse is another significant yet under-reported issue, with an estimated 3% to 10% of the population over 65 experiencing abuse.

Signs and Symptoms of Florida Domestic Violence

Child abuse can result in various injuries like fractures, bruises, internal bleeding, and others. In infants, injuries that are unexplained or unusual should be noticed and investigated. Other indicators of child abuse include poor hygiene, malnutrition, behavioral changes like aggression or withdrawal, and poor school attendance. Specific physical signs of abuse can include:

• Bites
• Chipped teeth
• Burns from cigarettes or cigars
• Injuries on the face or neck
• Friction burns
• Different injuries in various stages of healing
• Injuries to multiple organs
• Bleeding inside the skull
• Long bone fractures
• Marks shaped like belt buckles and cords
• Mouth burns, bruises, or cuts
• Patterned injuries
• Poor dental health
• Sexually transmitted diseases
• Skull fractures
• Strangulation injuries
• Unusual injuries

Abuse by an intimate partner affects both women and men, with injuries often occurring on the head, neck, and face. Other signs of intimate partner abuse can include:

• Abdominal bruises or cuts
• Injuries on both sides
• Bites
• Black eyes
• Bruises
• Burns
• Cigarette burns
• Fractured bones
• Fractured teeth
• Rope burns
• Wounds in various stages of healing

Abuse during pregnancy is another serious problem. Some potential signs of abuse in pregnant individuals include:

• Overly attentive, hostile, or controlling behavior from the partner
• Signs of anxiety or depression
• Unexplained long-term pain
• Lack of trust
• Flat emotional response
• Signs of fear
• Substance use disorder
• Attempted suicide
• Delayed prenatal care
• Frequent emergency room or doctor’s office visits
• Over compliance
• Symptoms of posttraumatic stress
• History of abuse
• Unplanned pregnancy
• Youthful age

Abuse is also prevalent in male individuals and in same-sex relationships. A history of child abuse is often common in male survivors. In same-sex relationships, threats of disclosing sexual preferences can be used as a means of control. Elder abuse is another issue that can often go unnoticed. Risk factors can include dementia, mental health issues, and shared living situations with the abuser. Some common signs of elder abuse may include:

• Agitation
• Bruises
• Burns
• Bed sores
• Dehydration
• Depression
• Injuries in various stages of healing
• Cuts
• Unexplained injuries
• Delays in treatment
• Poor hygiene
• Inconsistent accounts from caregivers and patients
• Untreated medical conditions
• Rope marks
• Sexually transmitted diseases
• Welts

When evaluating elderly patients, it’s essential to document the size, shape, and location of injuries accurately. Detailed notes, photographs, or drawings can be helpful for documentation. It’s important to be aware that elder abuse can occur in both domestic and institutional settings.

Testing for Florida Domestic Violence

If you’re a victim of domestic violence, it may be difficult to admit, especially if you’re scared such as when you go to an emergency room or doctor’s office. It’s important that healthcare providers have a system set up to notice when a patient’s injuries and symptoms might be due to domestic violence. Regular checks for signs of abuse should be done in places like primary care settings, women’s health and psychological clinics, pediatric care, urgent care, and emergency rooms.

Knowing that injuries are related to domestic violence can be difficult. The first thing doctors need to do is to treat any life-threatening injuries. Once the patient is stable, they can perform lab tests and imagery like x-rays, MRIs, or CT scans if needed. Most importantly, they need to address whatever medical reasons brought the patient to seek help.

Doctors should ask all patients about potential domestic violence, even if they don’t have any signs of abuse. They should also have a system in place to help patients who admit to being victims. This could include a plan to refer the patient to helpful resources, how to properly document such cases, and how to follow up on care. It’s important to remember that screening for domestic violence can be challenging due to lack of training, limited time, sensitivity of the subject, and privacy issues. Discussing abuse can also be hard for both doctors and patients.

If a patient has signs of potential domestic violence, they should be evaluated. Physical signs could include bruises, bites, cuts, broken bones, concussions, injuries from burning or weapons. Domestic violence often results in injuries to the head, face, neck, chest, and muscles. People who have experienced abuse often have multiple injuries in different stages of healing, ranging from new to old.

Victims of domestic violence often show signs of stress disorders like anxiety and depression. Symptoms might be vague and hard to directly connect to abuse such as back pain, stomachaches, headaches, fatigue, restlessness, lack of appetite, and problems sleeping. Women are also more likely to experience conditions like asthma, irritable bowel syndrome, and diabetes.

A full examination of the patient should be undertaken after they’ve admitted to abuse. If the patient is in immediate danger, they should be referred to resources like advocate support, shelters, hotlines for survivors, or law enforcement.

If they are not in immediate danger, doctors should shift their focus to evaluating the patient’s mental and physical health. The doctors should ask about any current or past experiences with abuse. This information guides what interventions should be taken. Doctors should consider the patient’s cultural beliefs during the examination. Sometimes patients may be afraid to accept resources because they are afraid for their safety or financial stability. This fear can keep them from leaving their abuser. Doctors should reassure these patients that help is available and their decision to take it is optional. They should also ensure the patients know that they are acting as neutral professionals.

If the patient decides to leave their situation, it’s good to provide referral information for a local domestic violence shelter to assist the survivor. If there is risk to life, or evidence of injury, the patient should be referred to local law enforcement. Counselors are often available and can include social workers, psychiatrists, or psychologists who are trained in helping victims of abuse.

If doctors suspect a child has been abused, they need to perform a thorough examination. If head trauma is suspected, they might consider consulting an eye doctor. Lab tests can help figure out what happened and may be important in possible legal cases. Doctors should also remember that some medical conditions can look like child abuse. Depending on symptoms, they may need to test the child’s urine, blood, or liver and pancreas enzymes. They may also need to perform imaging like x-rays or CT scans. It’s important that the doctor accurately documents any injuries, as photos may be used in court.

If doctors suspect an adult has been abused, lab tests can show signs of dehydration, electrolyte imbalances, infection, substance use, improper medication use, and malnutrition. Imaging might include x-rays of bruised or tender parts of the body to look for fractures. A CT scan of the head might be performed if there’s a chance of bleeding in the brain due to abuse or if the patient’s mental state has changed. Other considerations include doing a pelvic exam with evidence collected in cases of suspected sexual assault.

Domestic and family violence cases may result in legal action, so it’s often a good idea to involve a special team in collecting evidence. Each healthcare facility should have written procedures for how to package, label, and preserve specimens in a secure way. Law enforcement often help with collecting evidence by providing special kits. Evidence could include tissue specimens, blood, urine, and saliva, vaginal and rectal specimens, and saliva from bite marks. Blood, saliva, semen, or vomit stained clothing should also potentially be kept for forensic analysis.

Treatment Options for Florida Domestic Violence

Whenever someone is seriously injured, the first goal of healthcare providers is to address any threats to the person’s life and stabilize their health. This is the case for victims of violence as well, as their physical health needs can be immediate and severe. Prehospital care professionals, such as paramedics and EMTs, have a particularly important role in these situations. They are often the first to enter a scene where violence has occurred and can gather crucial information that needs to be reported to the doctors who will later treat the patients, or even to the police.

Interestingly, some people who have survived domestic violence may decline transportation to the hospital after being evaluated by prehospital healthcare providers. This puts a responsibility on these professionals to recognize signs of domestic violence and suggest steps the individual can take to get help. This could include reporting the violence to the proper authorities or directing the person to local support services.

Once a patient arrives at the hospital’s emergency department, other steps are taken to help address their situation. This includes treating any injuries, assessing their emotional state, and making sure they feel safe and reassured. A major goal of this care process is to determine if the patient’s injuries are a result of violence, particularly domestic violence. Legal action may be necessary in these instances, especially if the violence they have experienced is severe or ongoing.

It’s important that hospitals create an environment that respects and listens to patients while encouraging them to make choices about their care. This is particularly relevant for victims of domestic violence, who should be offered support and advice in simple, clear language. Healthcare providers aim to reinforce that violence is not the patient’s fault and that no one deserves to be abused. Counselling is also provided to help reduce the likelihood of mental health challenges such as anxiety, depression, and post traumatic stress disorder.

When it comes to documenting these cases in medical records, attention to detail is key. Since these records may be used in court, healthcare providers should provide a detailed account of the patient’s experience, their physical examination, and any other relevant information. This includes the specifics of the patient’s injuries, their state of mind, any related health problems, and information about the person alleged to have committed the abuse. Additionally, they should take photographs of any visible injuries and document them with anatomical diagrams.

Assessing potential risks is a crucial step before discharging a patient. The hospital team should determine if the patient is in danger at home and whether the individual causing harm has the potential access to weapons, or history of escalating violence. The patient’s willingness to accept help also needs to be considered.

Before the patient is discharged, healthcare providers offer them resources to use for later, including telephone numbers for domestic violence hotlines and support services. They also make sure that a safety plan is put into place, which includes practical strategies to keep the patient safe.

If the patient is in immediate danger, hospitals should connect them with domestic violence shelters, legal assistance, social services, and support groups. If outpatient facilities are not available overnight hospitalization can be considered.

If the patient is in a severe emotional state, a consultation with a mental health professional may be needed. This is particularly important if the patient is expressing a desire to harm themselves or someone else.

For individuals who decide to return to a situation where they are experiencing domestic violence, the risk of further harm is high. Thankfully, help is available in many communities through prevention programs, which often focus services on high-risk families.

Key points to bear in mind include that around 40% of people experiencing domestic violence never report it to the police, and nearly half of women killed due to domestic violence had visited an emergency department within two years before their deaths. That’s why healthcare professionals play such an important role in supporting survivors of domestic violence.

What else can Florida Domestic Violence be?

Different potential diagnoses that may be considered in cases of suspected child abuse include:

Head trauma could be from:

• Accidental injury
• Arteriovenous malformations
• Bacterial meningitis
• Birth trauma
• Cerebral sinovenous thrombosis
• Hemophilia
• Leukemia
• Neonatal alloimmune thrombocytopenia
• Metabolic diseases
• Solid brain tumors
• Unintentional asphyxia
• Vitamin K deficiencies

Bruises and contusions could be caused by:

• Accidental bruises
• Birth trauma
• Bleeding disorder
• Coining
• Cupping
• Congenital dermal melanocytosis (Mongolian spots)
• Erythema multiforme
• Hemangioma
• Hemophilia
• Hemorrhagic disease
• Henoch-Schonlein purpura
• Idiopathic thrombocytopenic purpura
• Insect bites
• Malignancy
• Nevi
• Phytophotodermatitis
• Subconjunctival hemorrhage from vomiting or coughing

The cause of Burns could be from:

• Accidental burns
• Atopic dermatitis
• Contact dermatitis
• Impetigo
• Inflammatory skin conditions
• Sunburn

Fractures may stem from:

• Accidental incidents
• Birth trauma
• Bone fragility with chronic disease
• Caffey disease
• Congenital syphilis
• Hypervitaminosis A
• Malignancy
• Osteogenesis imperfecta
• Osteomyelitis
• Osteopenia
• Osteopenia of prematurity
• Physiological subperiosteal new bone
• Rickets
• Scurvy
• Toddler fracture

Differentials considered for Adult abuse include:

• Accidental burns
• Alcohol use disorder
• Accidental fall
• Acute subdural hematoma
• Consensual intercourse
• Depression
• Suicidal attempt
• Substance use disorder

What to expect with Florida Domestic Violence

Without community support, mental health counseling, and treatment, forms of abuse, including domestic and family violence, often worsen. Both the recurrence and severity of abuse escalate, resulting in a challenging path to recovery. Statistics reveal that:

• Almost 75% of abuse survivors continue to face abuse.
• Over half of abused women who attempt suicide will try again, often with tragic outcomes.

Children, in particular, are at high risk for adverse repercussions due to the long-lasting effects of abuse. Besides the physical injuries, the psychological impact can be devastating. Studies show a strong link between child sexual abuse and increased risk of mental illness in adulthood. In addition, these children are very likely to continue the cycle of violence in their later life.

Kids growing up in abusive families may develop several mental health conditions, including:

• Attention-deficit hyperactivity disorder (ADHD), a condition affecting a child’s ability to focus and control behavior.
• Conduct disorder, a severe behavior problem marked by aggressive and disruptive behaviors.
• Depression, an overwhelming feeling of sadness and lack of interest.
• Bipolar disorder, a mental disorder causing extreme mood swings.
• Panic disorder, a type of anxiety disorder marked by recurrent panic attacks.
• Sleep disorders, conditions that disrupt a person’s sleep pattern.
• Attempts at suicide.
• Post-traumatic stress disorder (PTSD), a condition triggered by terrifying events causing flashbacks and severe anxiety.

Family and domestic violence lead to numerous negative health consequences. Long-term effects may include physical injuries like broken bones, traumatic brain injuries, and internal injuries.

Patients may also develop various additional health problems, such as:

• Asthma, a condition that causes breathing difficulties.
• Insomnia, a sleep disorder where people have trouble sleeping.
• Fibromyalgia, a condition causing widespread pain.
• Headaches.
• High blood pressure, a significant risk factor for heart disease.
• Chronic pain.
• Gastrointestinal disorders, conditions affecting the digestive system.
• Gynecologic disorders, problems related to female reproductive system.
• Depression.
• Panic attacks, sudden episodes of intense fear.
• PTSD, an anxiety disorder caused by stressful, frightening or distressing events.