Spouse abuse: physician guidelines to identification, diagnosis, and management in the uniformed services

Spouse abuse is a major social issue in our country. Based on national samples, between 10 and 20% of couples report some type of violence during the course of their marriage. In the United States, 1.8 million women are physically abused by their spouses each year. Within the military, it is estimated that the incidence of spouse abuse is even greater than in the civilian sector. Estimates suggest that one-third of military spouses experience abuse during their marriage. Although 87% of women prefer discussing their victimization with their physician, physicians, as a group, have been least effective in helping them. Recently, several barriers to physician recognition and intervention in domestic violence have been identified, and recommendations for specific training on abuse have been published. This paper provides military physicians an in-depth review of the guidelines to identification, diagnosis, and management of spouse abuse, with a special emphasis on their implementation within the uniformed services.