Dating Violence

Dating Violence as a Public Health Issue:

• Dating violence is a critical public health concern affecting Australian young people, leading to both immediate and long-term health consequences.
• It is often underreported due to social stigma, normalization, or lack of awareness, especially among young women.

Health and Behavioral Presentations:

• Young people involved in dating violence may present with symptoms across multiple domains, including:
  • Physical symptoms: Chronic pain, headaches, fatigue, or symptoms of reproductive coercion (e.g., unintended pregnancies).
  • Mental health issues: Depression, anxiety, suicidal ideation, and trauma-related symptoms.
  • Risky behaviors: Substance abuse, risky sexual behaviors, and self-harm.
  • Social and behavioral issues: Isolation, low academic performance, strained family relationships.

Gender Dynamics:

• Research indicates that while both young women and men can experience dating violence, it is predominantly young men who are the perpetrators in heterosexual relationships, with young women more frequently being victims.
• Young women also face higher risks of coercive control, reproductive coercion, and emotional abuse.

Technology-Facilitated Abuse:

• Digital abuse has become a prevalent aspect of dating violence, impacting both young and older individuals.
• Technology-facilitated abuse can involve monitoring, harassment, control over online interactions, threats to share personal images, and restrictions on social media usage.
• This form of abuse can hinder the victim’s access to social support networks and their ability to seek help discreetly.

Supportive Care Pathways:

• Victims/survivors benefit from trauma-informed, youth-centered counselling and supportive care that addresses physical, psychological, and social health concerns.
• General Practitioners (GPs) play a central role in early identification, offering a non-judgmental listening space, and providing or facilitating referrals to support services.

Clinical Context and Identification in General Practice

• Defining Dating Violence:
  • Dating violence encompasses various forms of intimate partner abuse/violence (IPAV) in young relationships, excluding marriage or cohabitation.
  • It includes physical, emotional, sexual abuse, and coercive control, distinct from adult IPAV due to developmental, social, and relationship dynamics.
• Recognizing the Prevalence and Risk Factors:
  • An estimated 1 in 4 young Australian women may experience dating violence, though true prevalence may be higher due to factors like underreporting and societal normalization.
  • Dating violence has associations with mental health issues, risk-taking behaviors, and can lead to a higher risk of IPAV in future relationships.
• Technology’s Role in Dating Violence:
  • Technology facilitates connection and control, becoming an avenue for dating abuse.
  • Abuse through technology includes tracking and monitoring locations, coercion into “sexting,” control over digital interactions, and threats involving shared images.
• Identifying Signs of Abuse:
  • Young patients affected by dating violence often seek care for symptoms like depression, anxiety, or somatic complaints.
  • Practitioners should consider dating violence as a possible underlying issue in cases of chronic physical symptoms, frequent reproductive health concerns, or changes in mood and behavior.
  • Tools like the HEEADSSS assessment (covering Home, Education, Employment, Activities, Drugs, Sexuality, Suicide/Depression, and Safety) can aid in evaluating risk factors and identifying abuse.

Technology-Facilitated Abuse

• Scope and Types of Digital Abuse:
  • Technology-facilitated dating abuse encompasses digital surveillance, coercive communication, and threats to control a partner’s actions or choices.
  • Digital abuse may manifest as control over online interactions, restrictions on communication with friends or family, and pressure for “sexting” and image-sharing.
  • Young women are disproportionately affected by digital abuse, experiencing more severe consequences like social isolation, fear, and impact on self-esteem.
• Practitioner Awareness and Intervention:
  • GPs should be aware that technology-facilitated abuse can limit the victim’s ability to access support discreetly.
  • Advising safe avenues for help-seeking, including non-digital methods, may be crucial for those under surveillance or digitally controlled.

In Practice: Identification and Case-Finding

• Screening and Case Identification:
  • While universal screening for dating violence is debated, case-finding may be appropriate, especially when young women present with mental health or behavioral symptoms.
  • Incorporating questions about safety and relationship health into routine assessments, especially through the HEEADSSS tool, can be beneficial.
• Supportive Frameworks for Management:
  • Utilize trauma-informed frameworks like the LIVES framework (Listen, Inquire about needs, Validate experiences, Enhance safety, and Support) and CARE approach (Communicate, Ask, Respect, Empower).
  • Establish a non-judgmental, empathetic rapport to encourage young patients to share their experiences openly.
• Referral and Support Pathways:
  • Referral to psychologists trained in trauma-informed practice can provide targeted support.
  • GPs may also collaborate with school counselors or social workers, when safe and with patient consent, to create a supportive network for the young person.

Managing Privacy and Safety in Telehealth

• Telehealth Privacy Concerns:
  • While telehealth can enhance access, privacy cannot always be guaranteed.
  • Begin sessions by checking if the young person is alone, and assess if they feel safe to discuss sensitive topics.
  • If privacy cannot be assured, consider arranging an in-person appointment, and use safety protocols such as “code words” if there are ongoing safety concerns.
• Management Strategies:
  • Use a trauma- and violence-informed approach: acknowledge the role of trauma, provide extended consultation time, and focus on positive social and emotional connections.
  • Involve a trusted adult (with patient consent) for additional support, especially in cases where social isolation or risk of harm is evident.

Practical Tips for GPs

• Adopt a youth-friendly approach: Explain confidentiality clearly, with its limits, and create a safe, welcoming environment.
• Use open-ended questions: Encourage discussion about relationship dynamics with questions such as, “Do you feel safe in your relationship?” or “Has your partner ever made you feel afraid?”
• Establish rapport and non-judgmental communication: Respect the young person’s pace in disclosing experiences and avoid pressuring them to disclose more than they feel comfortable sharing.
• Encourage involvement of a trusted adult: For patients under 18, support them in involving a trusted adult in their care journey, if they feel comfortable.
• Use structured frameworks (LIVES and CARE): Guide responses with empathy, validation, and collaborative problem-solving to help the young person build self-efficacy and resilience.
• Maintain continuity of care: Offer follow-up appointments and continuity of support, and if feasible, integrate telehealth check-ins to provide accessible, ongoing care.