Mayumi Okuda, MD: Identifying Victims of Intimate Partner Violence

Mayumi Okuda, MD, a practicing psychiatrist and assistant professor of psychiatry at Columbia University Medical Center, sat with MD Magazine at the American Psychiatric Association's Annual Meeting in New York City to talk about what clinicians need to be doing and aware of in the identification of patients experiencing intimate partner violence.

Commonly referred to as domestic violence, the situation is a difficult one to spot, and Okuda stressed asking questions and providing creative ways for patients to reach out to mental health professionals and services when they do not feel safe. These victims are most often women and children, and many times they do not feel comfortable or safe enough to share information with their health providers. Additionally, Okuda noted that while many of these patients will be unable to completely hide clear-cut signs of violence, there are oftentimes no visible indications of abuse, as intimate partner violence extends beyond just physical abuse.

Medicine as a whole is trending toward team-based care, and while more institutions adopt interdisciplinary teams and more specialties begin to interact, it appears that trend is only growing. Okuda noted that a team-based approach between primary care physicians, psychiatrists, therapists, and other health care professionals, can really aid in helping to identify these victims and get them the resources that they need without pressuring them to open up or feel unsafe.

Mayumi Okuda, MD:

One of the highlights of our presentation was just increasing the awareness of how common domestic violence is in the community. There are, depending on the survey [and] depending on the country, but in the US, 1 in 4 women have experienced intimate partner violence at some point in their lives, which is a really high [number].

The first thing is to acknowledge is that right now, there is no mandate for universal screening, so people are not asking [about it]. And it's the type of thing that you don't know until you ask, right? So I would say the first—the biggest—barrier probably is that we don't know, and when we, as clinicians, as mental health professionals, when we're interacting with people, we're not typically asking about these things. I mean, of course, if there's physical abuse, you might see signs of physical abuse—but that's not necessarily the case for the vast majority of people.

I would say we are, in mental health [care], in a very privileged position, and we have a great opportunity to actually screen for that. We do know, and the World Health Organization does acknowledge, that for mental health professionals it would be good clinical care to ask because it would have repercussions in terms of what we see, the symptoms that we see, and things will make more sense. We will know what to do with [patients and victims] better if we know that there's violence behind all the symptoms.

Typically, now and then, [when] I interact with people who had never disclosed the violence or the abuse that they were experiencing before, and [often] we're receiving diagnoses that were really misunderstood because if somebody's getting threats constantly from a partner, if they're scared for their safety, then I would hear people complaining of things that were quoted or reported as hypervigilance or psychosis or paranoia, when [in reality] it made so much sense that these people were very afraid for their safety. [Once you know that] I would say that for us, it makes a lot of sense. The main step [for clinicians to take] would be to make sure that we're screening, that we're asking people about this.

Another recommendation that comes out of the of the talk today [at the APA’s annual meeting] is that it's a very complex problem. A lot of women or men who are in abusive relationships are not able to leave or don't want to leave the relationship, and that doesn't mean that they're not going to find our services very helpful. So it's important to assess their safety, understand that not everybody's ready to leave—sometimes there are safety concerns and reasons where they can't leave.

Since the problem is really complex, it really requires a team to work under to address this complex issue. For psychiatrists or therapists, making sure that [in] your work, you're not working in isolation. That you have a team, or you're working with an agency that has experience dealing with these type of issues. For people who need emergent housing or who are really [in] need [of] resources, to be able to leave the relationship, [and for] all this [to] make sense—you really need to work in a team.

Transcript edited for clarity.

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