Treating Survivors of Domestic Violence:Characteristics and Resultant Implications for Dental Treatment Guide
The residual effects of domestic violence last long after the physical wounds are healed.
Domestic Violence happens on many levels and rarely begins with the physical beating of a partner. Abuse can be physical, emotional, sexual, spiritual, social and/or economic.
It is entirely a dynamic of power and control in relationships that affects more than one's overall physical well-being.
In one's home/social environment, domestic violence usually begins with isolating behaviors. Victims are often not allowed to leave the house for work, not given access to money or household finances and/or have their phone calls/car mileage monitored. These individuals live in a climate of constant suspicion, jealousy and degradation. Issues of concern include housing, financial self-sufficiency and safety of self and children from further abuse.
While there are a number of labels/diagnoses that have been developed over the years, the dental professional needs to be aware of those characteristics associated with each of these classifications and how they might affect dental treatment.
Battered Women's Syndrome, Dr. Leonore E. Walker, 1979. Characteristics of this syndrome include "learned helplessness" in which the individual is used to not being in charge. Other qualities include low self-esteem, self-blame, breaking down of self-confidence and self-respect, depression, anxiety and passivity.
Post-Traumatic Stress Disorder. The characteristics associated with a survivor of abuse align with those associated with the stress disorder more often associated with combat or imprisonment. The irrational belief that the abuser is omnipresent/omniscient and the resulting fear for her life and those of her children result in an overall suspiciousness, social withdrawal and/or feelings of inadequacy, stupidity or going crazy.
In dental treatment, the patient is being asked to take charge of his/her physical well-being and to trust a professional who is unknown to them - all in the context of an intimate physical environment.
When treating survivors of domestic violence...
- Be sensitive to physical contact.
- It is important to keep reassuring the patient of your concern for them and to ask them if they have any questions. The patient may believe that they deserve deteriorated oral health/ugly teeth as a punishment for involvment in “bad relationships.”
- Remember that the patient may never have been instructed on how to care for their oral health. Please take the time to educate them on the importance of home care and maintenance.
- It is possible the patient may never have been to a dental office before. Certainly any positive interaction with the doctor/staff will go a long way to restoring the patient's trust, enhancing self-esteem and developing self-confidence.
- If you participate in the Metro Denver Dental Foundation’s DVDCP and a patient requests additional services or dental resources for family/friends, please refer them to (303) 488-9700, ext. 3270. Please do not accept referrals from program patients. Many patients have never known kindness, and can become overwhelmed in its presence. We educate the patient that the generous care provided through the DVDCP is for them only.
- -Be aware that substance abuse may be a concurrent issue with domestic abuse in some patients.
Dental professionals involved should be sensitive to the magnitude of the trauma experienced by the patient. It is entirely possible that seeking help from other professionals previously has resulted in a negative experience - particularly if the abuse continued. Continue to let the patient know that you care and that you can partner with them to improve appearance and overall health. You may need to work to gain trust and to empower them to take charge of their oral health including keeping appointments and following through on home care.
We are asking for the patient to change their way of thinking about their own self-worth and their ability to take charge of their lives. They must be responsible for making and keeping appointments and to trust professionals and a system that, in the past, may have let them down. The care provided by you and your staff will contribute significantly to their recovery both psychologically, emotionally as well as financially.
Other resources: Please contact the Colorado Coalition Against Domestic Violence at (303) 831-9632.
