Kentucky Domestic Violence

Family and domestic violence (including child abuse, intimate partner abuse, and elder abuse) is a common problem in the United States and Kentucky. Family and domestic health violence are estimated to affect 10 million people in the United States every year. It is a national public health problem, and virtually all healthcare professionals will, at some point, evaluate or treat a patient who is a victim of some form of domestic or family violence. Unfortunately, each form of family violence begets interrelated forms of violence. The "cycle of abuse" is often continued from exposed children into their adult relationships and finally to the care of the elderly. Domestic and family violence includes a range of abuse including economic, physical, sexual, emotional, and psychological toward children, adults, and elders. Intimate partner violence includes stalking, sexual and physical violence, and psychological aggression by a current or former partner. In the United States, as many as one in four women and one in nine men are domestic violence victims. Domestic violence is thought to be underreported. Domestic violence affects the victim, families, co-workers, and community. It causes diminished psychological and physical health, decreases the quality of life, and results in decreased productivity. The national economic cost of domestic and family violence is estimated to be over 12 billion dollars per year. The number of individuals affected is expected to rise over the next 20 years, with the biggest increase in the elderly population. Family and domestic violence are abusive behaviors in which one individual gains power over another individual. Intimate partner violence typically includes sexual or physical violence, psychological aggression, and stalking. This may include former or current intimate partners. Child abuse involves the emotional, sexual, physical, or neglect of a child under the age of 18 by a parent, custodian, or caregiver that results in potential harm, harm, or a threat of harm. Elder abuse is a failure to act or an intentional act by a caregiver that causes or creates a risk of harm to an elder. Domestic violence, spousal abuse, battering, or intimate partner violence, is typically the victimization of an individual with whom the abuser has an intimate or romantic relationship. The Centers for Disease Control and Prevention defines domestic as "physical violence, sexual violence, stalking, and psychological aggression (including coercive acts) by a current or former intimate partner." Domestic and family violence has no boundaries. It occurs in intimate relationships regardless of culture, race, religion, or socioeconomic status. All healthcare professionals must understand that domestic violence, whether in the form of emotional, psychological, sexual, or physical violence, is common in our society and should develop the ability to recognize it and make the appropriate referral. Domestic violence in Kentucky falls under the Kentucky Cabinet for Health and Family Services and the Division of Protection and Permanency.  Domestic violence under KRS 403.715 to 403.785 is defined as "physical injury, serious physical injury, sexual abuse, assault, or the infliction of fear of imminent physical injury, serious physical injury, sexual abuse, or assault between family members or members of an unmarried couple." The types of violence include stalking, economic, emotional or psychological, sexual, neglect, physical, and Munchausen syndrome by proxy (aka factitious disorder imposed on another or FDIA). Domestic and family violence occurs in all races, ages, and sexes. It knows no cultural, socioeconomic, educational, religious, or geographic limitation. It may occur in individuals with different sexual orientations. Stalking is defined as repeated, unwanted attention that causes fear or concern for safety. This includes unwanted letters, emails, texts, or phone calls; watching, following, or spying; showing up repeatedly in the same place as the victim; damaging the victim’s property; making threats of harm. Financial abuse occurs when an individual is forced to become dependent through the improper use of money by a person in a trusting relationship. The abuser may also forbid employment or education to gain additional financial control. Examples include coercion to surrender, forgery, theft of possessions, and improper use of guardianship or power of attorney. Emotional or psychologic domestic violence includes verbal and non-verbal communication, which inflicts emotional or mental harm. Emotional or psychologic violence may be subtle, but it is often very harmful to the victim, resulting in depression and suicide. Emotional or physical abuse may involve convincing the victim that the violence is their fault, there is no way out of their situation, and the victim is worthless and needs the abuser to exist. Many abusers will isolate their victims from friends, family, school, and work. Examples: Child Relationship Control: Deliberately damaging relationship with a child. Coercive: Limiting resource access, possessiveness, and constant monitoring. Exploitation: Use of consequence to control choices, for example, “If you call the protective service, I could go to jail, and you will have no financial support.”. Expressive: Name-calling, degradation, and threats. Gaslighting: Presenting false information making the victim doubt his or her memory and perception; making victims question their sanity . Reproductive Control: Refusing birth control or forced pregnancy terminations. Threats: Use of gestures, words, or weapons that future harm may occur. Sexual violence is using physical coercion to force participation in unwanted sex acts. Perpetrators often incapacitate victims with alcohol or drugs. Some victims may be nursing home patients with mental disabilities or dementia. Categories: Forced anal, oral, or vaginal penetration of a victim. Forced penetration of someone else. Sexual coercion involving intimidation to pressure consent. Unwanted exposure to pornography, harassment, sexual violence, filming, taking, or disseminating sexual photograph or video. Unwanted sexual contact.   Neglect occurs when a child or elder's well-being is ignored by an individual responsible for that well-being. Neglect is defined as a failure to provide for a dependent’s emotional, physical, or social needs, including hygiene, nutrition, clothing, shelter, and access to health care. The dependent is placed in a harmful situation. Abandonment is also a form of neglect. Munchausen syndrome by proxy is a factitious disorder where an individual fabricates or exaggerates mental or physical health problems in the person for whom he or she cares. The primary motive is to gain attention or sympathy. Unlike Munchausen syndrome, the deception involves not themselves, but someone under the person's care. The use of physical power resulting in injury, disability, or death is physical violence. Other forms of physical violence include coercion, administering drugs or alcohol without permission, and denying medical care. Usually, abuse begins with verbal threats that escalate to physical violence. Violent events are often unpredictable, and the triggers are unclear to the victims. The victims live in constant fear of the next violent attack. Violence and abuse are perpetrated in an endless cycle involving three phases: tension-building, explosive, and honeymoon.