Spouse abuse and other domestic violence.

Concern about the different forms of domestic violence continues to escalate. Beginning with identification of child abuse in the 1960s; spouse abuse, primarily of women, in the 1970s; and, most recently, identification of the rising incidence of elder abuse and neglect, the medical community, state, local, and federal governmental agencies and the public continue to promote joint programs to identify, guide to treatment, and simultaneously develop prevention and early intervention programs. Emphasis initially on the use of legal systems to stop, the abuse must almost be mandatory, because numerous studies show that treatment is most successful when abusers are forced to admit to themselves and others that they have, in fact, committed crimes. For women victims, safe refuge, self-help, and advocacy-support groups were found to be effective, whereas children first need the same protection and a great deal of empathy and explanation. Psychiatrists' roles lie in the important area of early diagnosis and treatment, as most domestic abuse victims do not readily admit to this violence, primarily out of shame, guilt, and fear. Numerous studies demonstrate that following a protocol with every patient, in every setting and under every circumstance, psychiatrists must ask about domestic violence when they least suspect it and when other diagnoses are obvious. The multiple etiologies include general sociocultural pressures, such as poverty and crowding, stereotypic sex role socialization, alcohol and drug abuse, history of head injury, and personal childhood abuse. Psychiatric treatment modalities must occur within a framework of acknowledging that domestic violence victims suffer from post-traumatic stress disorder. Psychiatrists can serve as leaders in coordinating multi-pronged treatment options for the victims: advocacy groups; alcohol and drug detoxification; and individual, couple, and family therapy. Psychiatrists can also serve as consultants, leaders, and educators in prevention and early intervention programs to educate the public and all levels of professionals who work with victims: police and legal systems, social service workers, teachers, religious leaders, essentially all who touch the lives of people of all ages who are supposed to live together in domestic mutual respect and caring but do not.