Psychiatric Aspects of Domestic Violence

	Prof. Dr. Donna E. Stewart: Psychiatric Aspects of Domestic Violence
Gewalt steht an 10ter Stelle der Todesursachen von Frauen zwischen 15 und 44.	We live in a violent world where war, civil and racial strife, and crime diminish our health and well being in varying degrees. However, regardless of where we live, family violence is endemic in our society and differentialiy disadvantages women. Women are more likely to be beaten or murdered by a family member, usually a partner, than by any other person. Interpersonal violence is the10 th Ieading cause of death of women internationally, between 15-44 years of age.
UN-Definition von Gewalt gegen Frauen:	The UN Declaration on the Elimination of Violence (1993) defines violence against women as "any act of gender-based violence that results in, or is Iikely to result in, physical, sexual, or mental harm, or suffering to women, including threats of such acts, coercion, or arbitrary deprivation of Iiberty, whether it occurs in public or private life."
Psychische Erkrankungen sind oft die Folge.	In addition to the physical health effects of domestic violence, psychological sequel often occur but may be Iess obvious. These include among many others, depression, anxiety, post-traumatic stress disorder (PTSD), somatization, borderline personality disorder, and substance abuse. Persistent low self esteem, inability to trust and feelings of powerlessness are often pervasive in abused women and may impair their ability to extricate themselves from violent relationships. Chronic depression and self-harm may present as psychiatric management problems without the underlying abuse ever being disclosed.
Frauen werden beim Arzt oft nicht nach Gewalt als Ursache ihrer Beschwerden gefragt.	lmproved awareness of the health effects of domestic violence and routine inquiries about its possible presence are critical for optimal psychiatric practice. We must also work towards primary, secondary, and tertiary prevention in our families and communities to reduce societal tolerance of domestic violence and prevent its transgenerational contagion.