Victimization of women and its impact on assessment and treatment in the psychiatric emergency setting.
An understanding of victimization is critical to the practice of emergency psychiatry. Victimization histories are disturbingly common among women presenting to the PES, particularly among frequent service users. The sequelae of victimization are both psychological and physical and often impair health and functioning across numerous domains. PTSD, BPD, and substance-use disorders are often seen among women with victimization histories, which can be particularly challenging for PES providers. Screening for trauma on PES presentation or history should not be overlooked in any person, including severely mentally ill, homeless, disabled, or elderly women. PES clinicians should remember to ask about victimization and pose questions privately in a direct and an open-ended format while conveying empathic validation. Clinical assessment of women with victimization histories in the PES should be guided by the principles of standard emergency psychiatry and be informed by an understanding of trauma. This includes a working knowledge of trauma dynamics, adherence to sound professional boundaries, and care not to retraumatize patients or re-enact perpetrator-victim dynamics. Voyeurism and regression should be avoided, particularly when eliciting trauma history. The PES should be a place for screening and acute intervention, not for conducting intensive trauma therapy. In the PES, the focus should remain on triage and treatment priorities, those of safety and stabilization, and carefully evaluating for substance use and psychosis. The PES ideally provides a "holding environment" that affords a balance of nurturing, limits, consistency, and communication. A basic knowledge of cognitive-behavioral interventions affording "crisis survival strategies," such as DBT, can be particularly useful to PES clinicians. Clinicians also need to monitor issues of countertransference and the potential to be dismissive to these women with complex, comorbid, and chronic problems and diseases. The role for the use of psychotropic medication in PES cohorts with victimization histories should target acute symptoms. Involving regular providers of these decisions is advised to coordinate care and minimize splitting and risks of polypharmacy. Although the SSRIs are effective in symptom management of disorders related to victimization, patients must be reminded of the side-effect profile, particularly sexual dysfunction and withdrawal and discontinuation syndromes.
Butterfield
M I
MI
Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA.
Panzer
P G
PG
Forneris
C A
CA
D000367:Age Factors; D019548:Crime Victims; D004637:Emergency Services, Psychiatric / Q000458:organization & administration* / Q000592:standards; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D011619:Psychotropic Drugs / Q000627:therapeutic use; D014481:United States / Q000453:epidemiology; D016387:Women's Health
D011619:Psychotropic Drugs