A series of letters published in the New England Journal of Medicine for February 17 throws some light on aspects of domestic violence, a phenomenon which is difficult to investigate and even more difficult to influence. The risk factors for family violence are considered to include low socio-economic and low educational levels, residence within a city, a personal history of violent behaviour, younger age, and an irregular familial relationship between the abuser and the victim. The abuser has been found to be almost as likely to be the woman of the family as the man, but women are found to be more likely to initiate the violent behaviour and are responsible for more instances of child abuse. On the other hand, men perpetrate more sexual abuse, as distinguished from physical battering and neglectful behaviour.
One problem complicating any attempt to get to grips with familial violence is the difficulty of unearthing the facts, without provoking further violence from an aggrieved partner. If an attempt of a victim to report maltreatment is detected, or if documentation in medical notes reveals such an attempt to the abuser, provocation to worse violence is likely to result. It is suggested that part of a physician's approach to a situation of domestic violence should be to educate patients in the reasons for it, offering help to the abuser to improve his or her attitude towards the victim. This, it is admitted, is more easily said than done.