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Education alone is rarely enough to prevent or stop any adverse health behavior. People are complex, and as such, their exposure to multiple risk and protective factors steers them toward certain behaviors.

In some cases, domestic violence can be directly attributable to a mental illness that might be amenable to treatment. More often, however, it is an outgrowth of the dynamics of power, and control and what I call "male entitlement dysfunction," whereby men are raised to believe that they somehow own their wives or partners and thus are entitled to transgress their boundaries.

To avoid this, women should be taught to establish boundaries and to make it clear at the beginning of a relationship that they will not allow those boundaries to be crossed.

Other key intervention elements include keeping at-risk families from becoming socially isolated, establishing screening protocols in emergency departments and health clinics, and offering resources for crisis intervention, needs assessment, and treatment.

Ensuring that women get equal pay for equal work is also a protective factor. If a woman has a job and an income, it is far easier for her to leave an abusive situation than if she does not.

Domestic violence interventions should also embrace modern health behavior change research. One impressive example of such research is the Adverse Childhood Experiences study conducted by the Kaiser Permanente Medical Care Program in San Diego in collaboration with the Centers for Disease Control and Prevention, Emory University in Atlanta, and the University of Arizona Health Sciences Center in Tucson. The study found that exposure to multiple adverse childhood experiences puts people at risk for several poor health behavior outcomes.

Every psychiatrist should take trauma histories from every patient. Unfortunately, these histories are often not collected. As a result, the roots of low self esteem, of not having boundaries, and the many other factors that lead to the risk of abuse, are never addressed.

DR. BELL is chief executive officer and president of Community Mental Health Services Inc. in Chicago and serves as director of public and community psychiatry at the University of Illinois at Chicago.

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Title Annotation:Community Psychiatry; role of psychiatrists in preventing domestic violence
Author:Bell, Carl C.
Publication:Clinical Psychiatry News
Geographic Code:1USA
Date:Dec 1, 2005
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