Journal of General Internal Medicine

, Volume 13, Issue 8, pp 549–555 | Cite as

Inside “Pandora’s box”

Abused women’s experiences with clinicians and health services
  • Jeanne McCauley
  • Robin A. Yurk
  • Mollie W. Jenckes
  • Daniel E. Ford
Original Articles


OBJECTIVE: To explore the attitudes and experiences of abused women to identify characteristics that helped or hindered abuse disclosure to clinicians and to determine how women viewed potential interventions to improve detection and treatment in a medical setting.

DESIGN: Focus group data conducted and analyzed with qualitative methodology.

SETTING: Three community-based mental health centers and one women’s shelter.

PARTICIPANTS: Twenty-one women in group therapy for domestic violence.

MAIN RESULTS: Eighteen (86%) of the 21 women had seen their “regular doctor” in the prior year; only 1 in 3 had discussed the abuse with the clinician. The major discussion themes were medical problems that were exacerbated with abuse, lack of ability to access medical care due to abuser interference, emotional attitudes about abuse that acted as barriers to disclosure, clinician characteristics that helped or hindered disclosure, and treatment experiences and preferences. Women described how their medical problems began or worsened during the abusive period. one in three women described how abusers blocked them from receiving medical care. Women reported intense shame about the abuse and described their self-denial of abuse. Women stated they were inclined to discuss abuse if they felt the clinician was perceived to be caring, was easy to talk to, had a protective manner, or if the clinician offered a follow-up visit. There was no consistent clinician gender preference among the women. One in four women had received psychotropic medication for problems associated with abuse. Many feared addiction, or a loss of alertness, increasing their risk for more abuse.

CONCLUSIONS: Many abused women experience worsening health and seek medical care; most do not volunteer a history of violence even to their regular clinicians. Many of the barriers to disclosure of abuse could be overcome by a physician’s knowledge of the link between abuse and medical illness, an understanding of the women’s emotions about abuse, and her treatment preferences.

Key Words

women physical abuse sexual abuse domestic violence 


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  1. 1.
    Novello AC, Rosenberg M, Saltzmann L, Shosky J. From the Surgeon General: a medical response to domestic violence. JAMA. 1992;267:31–2.Google Scholar
  2. 2.
    McCauley JM, Kern DE, Kolodner K, et al. The battering syndrome: prevalence and clinical characteristics of domestic violence in primary care internal medicine practices. Ann Intern Med. 1995;123(10):737–46.PubMedGoogle Scholar
  3. 3.
    McCauley J, Kern DE, Kolodner K, et al. Clinical characteristics of women with a history of childhood abuse: unhealed wounds. JAMA. 1997;277:1362–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Plichta S. The effects of women abuse on health care utilization and health status: a literature review. Women’s Health Issues. 1992;2:154–63.PubMedCrossRefGoogle Scholar
  5. 5.
    Drossman DA, Leserman J, Nachman G, et al. Sexual and physical abuse in women with functional or organic gastrointestinal disorder. Ann Intern Med. 1990;113:828–33.PubMedGoogle Scholar
  6. 6.
    Scarinci IC, McDonald-Haile J, Bradley LA, Richter JE. Altered pain perception and psychosocial features among women with gastrointestinal disorders and history of abuse: a preliminary model. Am J Med. 1994;97:108–18.PubMedCrossRefGoogle Scholar
  7. 7.
    Walker E, Katon W, Harrop-Griffiths J, Holm L, Russo J, Hickok LR. Relationship of chronic pelvic pain to psychiatric diagnoses and childhood sexual abuse. Am J Phychiatry. 1988;145:75–80.Google Scholar
  8. 8.
    Jaffe P, Wolfe DA, Wilson S, Zak L. Emotional and physical health problems of battered women. Can J Psychiatry. 1986;625–9.Google Scholar
  9. 9.
    Briere J, Runtz M. Symptomatology associated with childhood sexual victimization in a nonclinical adult sample. Child Abuse Neglect. 1988;12:51–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Schei B, Bakketeig LS. Gynecological impact and sexual and physical abuse by spouse: a study of intrafamily conflict and violence: the conflict tactics (CT) scale. J Marriage Fam. 1979;41:75–88.CrossRefGoogle Scholar
  11. 11.
    Felitti VJ. Long-term medical consequences of incest, rape, and molestation. South Med J. 1991;84:328–31.PubMedGoogle Scholar
  12. 12.
    Bullock L, McFarlane J, Bateman LH, Miller V. The prevalence and characteristics of battered women in a primary care setting. Nurse Pract. 1989;14:47–55.PubMedCrossRefGoogle Scholar
  13. 13.
    Domino JV, Haber JD. Prior physical and sexual abuse in women with chronic headache: clinical correlates. Headache. 1987;27(6):310–4.PubMedCrossRefGoogle Scholar
  14. 14.
    Mullen PE, Romans-Clarkson SE, Walton VA, Herbison GP. Impact of sexual and physical abuse on women’s mental health. Lancet. 1988;12:51–9.Google Scholar
  15. 15.
    Bergman B, Brismar B. A 5-year follow-up study of 118 battered women. Am J Public Health. 1991;81:1486–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Koss MP, Koss PG, Woodruff WJ. Deleterious effects of criminal victimization on women’s health and medical utilization. Arch Intern Med. 1991;151:342–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Miller TR, Cohen MA, Wiersema B. Victim costs and consequences: a new look. National Institute of Justice Report 1996. NCJ 155282:1–28.Google Scholar
  18. 18.
    Gin NE, Ruker L, Frayne J, Cygan R, Hubbel FA. Prevalence of domestic violence among patients in three ambulatory care internal medicine practices. J Gen Intern Med. 1991;6:317–20.PubMedCrossRefGoogle Scholar
  19. 19.
    Hamberger LK, Saunders DG, Hovey M. Prevalence of domestic violence in community practice and rate of physician inquiry. Fam Med. 1992;24:283–7.PubMedGoogle Scholar
  20. 20.
    Rath GD, Jarratt LG, Leonardson G. Rates of domestic violence against women by male partners. J Am Board Fam Pract. 1989;2:227–33.PubMedGoogle Scholar
  21. 21.
    Elliot BA, Johnson MM. Domestic violence in a primary care setting. Arch Fam Med. 1995;4:113–9.CrossRefGoogle Scholar
  22. 22.
    Sugg NK, Inui T. Primary care physicians’ response to domestic violence—opening Pandora’s box. JAMA. 1992;267(23):3157–60.PubMedCrossRefGoogle Scholar
  23. 23.
    Loring MT, Smith RW. Health care barriers and interventions for battered women. Public Health Rep. 1994;109:328–38.PubMedGoogle Scholar
  24. 24.
    Friedman LS, Samet JH, Roberts MS, Hudlin M, Hans P. Inquiry about victimization experiences: a survey of patient preferences and physician practices. Arch Intern Med. 1992;152:1186–90.PubMedCrossRefGoogle Scholar
  25. 25.
    Plichta SB, Duncan MM, Plichta L. Spouse abuse, patient-physician communication, and patient satisfaction. Am J Prev Med. 1996;12:297–303.PubMedGoogle Scholar
  26. 26.
    Ferris LE. Canadian family physicians’ and general practitioners’ perceptions of their effectiveness in identifying and treating wife abuse. Med Care. 1994;32(12):1163–72.PubMedCrossRefGoogle Scholar
  27. 27.
    Saunders DG, Kindy P. Predictors of physicians’ response to woman abuse: the role of gender, background and brief training. J Gen Intern Med. 1993;8:606–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Rodriguez MA, Quiroga SS, Bauer HM. Breaking the silence: battered women’s perspectives on health care. Arch Fam Med. 1996;5:153–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Cooper-Patrick L, Powe NR, Jenckes MW, Gonzales JJ, Levine DM, Ford DE. Identification of patient attitudes and preferences regarding treatment of depression. J Gen Intern Med. 1997;12(7):431–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Limandri BJ. Disclosure of stigmatizing conditions: the discloser’s perspective. Arch Psychiatr Nurs. 1989;2:69–78.Google Scholar
  31. 31.
    Sussman LK, Robins LN, Earls F. Treatment seeking for depression by black and white Americans. Soc Sci Med. 1987;24:187–96.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 1998

Authors and Affiliations

  • Jeanne McCauley
    • 1
  • Robin A. Yurk
    • 1
  • Mollie W. Jenckes
    • 1
  • Daniel E. Ford
    • 1
  1. 1.the Division of General Internal MedicineJohns Hopkins University School of MedicineBaltimore

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