Psychological abuse is a pattern of threats, humiliation, isolation and control used to harm or dominate another person, such as a partner, child or older adult. It leaves no bruises, yet it causes lasting depression, anxiety and physical complaints and often comes before physical violence.
Key symptoms
- Feeling worthless, afraid or always walking on eggshells
- Depression, anxiety, panic or sleep problems
- Headaches, stomach pain or other unexplained symptoms
- Isolation from friends and family; no control over money or phone
- Substance use or thoughts of self-harm
What you find on exam
- Interview the patient alone and in a safe, private setting
- Notice a partner or caregiver who speaks for the patient or controls the visit
- Mental status exam: mood, anxiety and suicidal thoughts
- Look for hidden physical injuries as well
Tests
- Validated screening questions for intimate partner violence or elder abuse
- PHQ-9 and anxiety screening
- Careful documentation in the patient's own words
- Tests only for medical complaints, not to prove abuse
Treatment basics
- Listen, validate and tell the patient it is not their fault
- Safety planning and referral to advocacy services and hotlines
- Counseling or therapy for depression, anxiety or PTSD
- Report as required by law for children and vulnerable or older adults
Red flags
- Threats to kill, or access to firearms
- Escalation to physical or sexual violence
- Suicidal thoughts
Practice it in Making Synapses
Making Synapses cases
Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.