Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Noncompliance Masking Domestic Violence

I have found that when an injured worker claims to have psychological problems as a result of physical injury, they often then are not compliant with a psychological referral.

There are those patients for whom domestic violence may be the main issue.

This violence can arise from substance abuse after injury and/or frustration in dealing with pain.

The pattern goes as follows:

There is a violent outburst.

The patient (chiefly male) then asks their case manager, adjustor or primary provider for a psychological referral.

The referral is made,

The abused spouse feels “reassured” that the injured worker is no longer violent.

The pressure/urgency for the appointment is removed, and

the patient then fails to show.

Most people are not skilled at identifying domestic violence. Recent research indicates that even after 3 hours of training on how to recognize women who are victims of domestic violence, not a single patient seen in the ob/gyn outpatient clinic (in one large study) had been screened for this problem.

The reason why: Health care providers lack the confidence to intervene or provide appropriate help to victims.

When there is pain, financial problems, and substance abuse, the probability of masked-violence increases.

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