Domestic & Family Violence

Red flags

• Non-fatal strangulation — a recognised risk factor for carotid dissection and a strong predictor of future lethality
• Any disclosure involving a child or young person → report to child protection

Prevalence

Common — a full-time GP would see 5 or more women per week who have experienced intimate partner abuse in the last 12 months. 1 in 4 women and 1 in 14 men report intimate partner abuse since age 15.

Domestic/family violence is any behaviour that is threatening, controlling, coercive, or causes a person to live in fear — including physical abuse, emotional/verbal abuse, sexual assault or coercive sexual behaviour, financial abuse/control, neglect, stalking/intimidation, deliberate isolation from family/friends, cruelty to pets, property damage, and technology-facilitated abuse/harassment.

Coercive control (AJGP 2025)

Coercive control is “a course of conduct aimed at dominating and controlling another” — it can cause profound harm without any physical violence, creating a “condition of unfreedom” through both coercion (indirect deprivation) and control (direct threats). Most domestic homicides are preceded by escalating non-violent coercive control, making early recognition genuinely important, not just an academic distinction from physical abuse.

The Sense of Safety Framework groups recognisable relational patterns into three destructive categories:

Pattern	Loss	Features
Invasion	Loss of freedom	Stalking, intimidation, threats, deprivation, violation, enslaving
Confusion	Loss of clarity	Gaslighting, betrayal, deception, love-bombing, image management
Isolation	Loss of belonging	Ostracising, shaming, threatening loved ones, counterfeit connection

What a GP might notice: apologetic behaviour, unusually high medical compliance, inability to make independent decisions, minimising their own needs; children may show dysregulated emotions.

Practice points: a GP’s longitudinal relationship with a patient is a genuine strength — use it to notice shifts away from a healthy relationship over time. Watch for “image management” — perpetrators presenting as the hero or victim, subtly manipulating the clinician. Avoid couple/relationship therapy where coercive control exists — it can be actively unsafe. Seek clinical supervision to process vicarious trauma. You don’t need to become a detective — witnessing and early intervention are enough.

Risk factors

Mental illness, alcohol/drug abuse, or gambling issues within the family; Aboriginal and Torres Strait Islander background (women experience ~32× the hospitalisation rate for family violence); stressors at home (recent separation, financial issues); pregnancy; women aged 18–24; prior exposure to abuse/violence as a child; international marriages facilitated by agencies; migrant/refugee populations.

Depression is the strongest predictor of intimate partner abuse in the presenting patient.

Asking about suspected abuse

Most women would not object to being asked about abuse — but they’re rarely asked directly.

• “Has your partner ever physically threatened or hurt you?”
• “Is there a lot of tension in your relationship? How do you resolve arguments?”
• “Sometimes partners react strongly in arguments and use physical force. Is this happening to you?”
• “Are you afraid of your partner? Have you ever been?”
• “Have you ever felt unsafe at home?”
• Violence is common at home. “I ask a lot of my patients about abuse because no one should have to live in fear of their partner.”

Responding to a disclosure — the LIVES framework (WHO)

Listen, Inquire about needs, Validate, Enhance safety, offer Support. Use trauma-informed care; avoid pressuring for details; believe the patient — this validation may be their first affirmation that the abuse isn’t their fault.

Risk assessment (four components)

1. The survivor’s self-assessment (most important) — ask directly: “How safe do you feel? and “Do you feel safe to go home today?” “They are the expert on their own situation, though some may minimise risk due to psychological abuse tactics.
2. Evidence-based risk factors — escalating frequency/severity of violence, strangulation, sexual assault, weapon threats, obsessive jealousy, substance misuse, unemployment, recent separation. These significantly increase lethality risk.
3. Information sharing — with consent, coordinate with family violence services or police for broader context on perpetrator behaviour.
4. Intersectionality — consider specific barriers for Aboriginal/Torres Strait Islander women, migrants, LGBTQIA+ people, people with disability, and rural populations.

Practice-changing documentation and management points

• Don’t manage both the survivor and the perpetrator as patients where there’s a confidentiality-breach risk.
• Document carefully with specific, neutral terms (e.g. “presenting with bruising”) rather than “domestic violence” — records may later be subpoenaed, and neutral wording avoids inadvertent disclosure.
• The CARE model for restoring agency: Choice and control, Action and advocacy, Recognition and understanding, Emotional connection.
• Warm referrals — help the patient call a family violence service while you’re still together, especially for higher-risk cases, rather than just handing over a phone number.
• Follow-up regardless of service uptake — arrange a further appointment whether or not the patient engages with referral, and consider safety implications for telehealth consultations specifically.
• Children: ask directly about their safety. If mandatory reporting thresholds are met, inform the protective parent before reporting so they can take steps to enhance their own safety — disclosure can escalate perpetrator behaviour.

Safety planning

May be as simple as checking whether the patient feels safe to go home, or more detailed — looking for escalating violence, the red flags above, weapons in the home, prior threats with a weapon, prior violence-related hospital presentations, and perpetrator drug/alcohol use, stressors (job loss, recent loss), or mental illness/personality disorder.

A safety plan may include: identifying where to go and how to get there; family/friends who can help; ensuring cash is available; a safe place for valuables and important documents.

Safety behaviours to discuss: hide money and a spare set of house/car keys; ask neighbours to call police if violence begins; establish a code word with family/friends signalling the need for help; remove weapons; ensure quick access to Medicare/tax file numbers, rent/utility receipts, birth certificates, ID/driver’s licence, bank account/insurance policy numbers, marriage certificate, valuable jewellery, and a hidden bag with spare clothing.

Referral to support services

Counselling and information: 1800RESPECT (1800 737 732), 24/7 counselling; text support also available on 0458 737 732.

Legal/police: local police station (Domestic Violence Liaison Officer); Legal Aid NSW Women’s Domestic Violence Court Advocacy Service; NSW domestic violence legal advice line.

Accommodation: local domestic violence accommodation support services (e.g. NOVA for Women and Children, Jenny’s Place, Link2Home statewide).

Financial support: Centrelink; NSW Victims Services for victims of crime.

From AJGP December 2025 (coercive control, LIVES/CARE frameworks) and 1800RESPECT.