Office assessment for abuse and management of the battered patient

Domestic violence is an enormous public health problem that is frequently encountered in health care settings, but often not recognized. In addition to physical injuries directly related to maltreatment, there is a growing scientific literature demonstrating that abuse and neglect, particularly when beginning early in life, results in brain functional, structural, and even epigenetic changes that have enduring effects. This article reviews the definitions and prevalence of domestic violence, summarizes the known neurobiological effects, and describes the fundamentals of office assessment for abuse and the management of the battered patient. Ethical challenges with regards to abuse assessment and reporting, particularly in states with mandatory reporting laws, are discussed. Comprehensive resources for both patients and clinicians are included.