The battered woman: is she a silent victim?

Although hardly a recent phenomenon, the battered woman has still not been a clearly recognizable presence to primary caregivers. Unawareness of actual victims stems from an incomplete understanding of the reality of the "battered wife syndrome," lack of knowledge about the various forms of abuse and the silence of the victims themselves. The victim rarely reports abuse to the primary care provider without being asked. She does, however, present with common psychosomatic complaints, such as choking, gastrointestinal disorders or nervousness. Her injuries may range from bruises to fractures, and the explanation of these injuries is usually inappropriate. Characteristically, the victim of abuse has low self-esteem and anger that has been internalized. These lead to self-destructive behaviors such as alcohol or drug abuse. Many of the victim's behaviors are predictable and best understood in the contexts of learned helplessness, a cycle of violence or anticipatory fear. Recognizing that child abuse and spouse abuse often occur within the same family, the nurse practitioner can play a vital role in halting the cycle of family violence. Early recognition, knowledge of the forms of legal recourse in the community and intervention by the nurse practitioner will have an impact on the morbidity and mortality of this social problem.