45 / 62
DCMS online
. org
Northeast Florida Medicine
Vol. 67, No. 1 2016
45
CME
percent of women who experience domestic violence have
an intimate relationship with the perpetrator; however,
only 16.2 percent of men have an intimate relationship
with their perpetrator.
7
It is difficult to estimate the
percentage of perpetrators because victims historically
underreport given the consequences of admitting to such
actions. These statistics are alarming since most acts of
domestic violence are not reported, likely making the
actual numbers much higher.
Intimate partner abuse often starts or escalates during
pregnancy or the postpartum period.
8
Physical abuse is
estimated to occur in approximately 7 to 20 percent of
pregnancies, making it more prevalent than preeclampsia
or gestational diabetes. Pregnancy may lead the woman
to focus her attention on her unborn child and thus
less attention may be given to her partner. When the
pregnancy is unintended the risk of domestic violence is
three times greater.
9
Even more alarming is that abused
pregnant women have a threefold higher risk of becoming
a victim of homicide or attempted homicide.
10
Pathophysiology of an
Unhealthy Relationship
To better understand the relationship between a victim
and his or her abuser, it is important to understand the
pathophysiology of an unhealthy relationship. Abusive
relationships develop because one individual in the rela-
tionship exerts his or her power over the other. As shown
in The DuluthWheel of Power and Control, the methods
of abuse used by an abusive individual are numerous (Fig-
ure 1) and their use is unpredictable. The abuse begins
with a tension building phase. This may include threats,
intimidation, fear and guilt (described in the wheel),
followed by physical or sexual abuse.
11
Many times the
abuser will blame their abusive behavior on the victim and
the victim may ignore or deny the abuse until it recurs.
Because the abusive behavior is unpredictable, women
may feel as though they are “walking on eggshells.”
12
Figure 1:
The Duluth
Wheel of Power
and Control