The American Academy of Neurology position statement on abuse and violence

Abstract

Neurologists see patients with neurologic disabilities that render them susceptible to abuse or neglect. They also encounter patients with neurologic dysfunction that may be either directly or indirectly related to mal-treatment. In 2008, the American Medical Association (AMA) encouraged physicians to “routinely in-quire about the family violence histories of their patients, as this knowledge is essential for effective di-agnosis and care.”1 Consensus-based guidelines for identification of intimate partner violence (IPV) have been adopted by numerous medical specialty organiza-tions.2–11 The US Department of Health and Human Services has recommended that women be screened and counseled for domestic abuse.12 PURPOSE OF THE POSITION STATEMENT The consequences of not asking about IPV might include further physical and emotional harm, treatment fail-ure, and when children are exposed, perpetuation of the intergenerational cycle of abuse.13–15 Providing resources to those being abused can result in im-proved outcomes.16 Further, identification of an abuse history may influence the assessment and treat-ment of presenting health concerns.17,18 By identify-ing this issue, and providing an appropriate referral, neurologists may improve quality of life and poten-tially ameliorate neurologic disability. The AAN is endorsing the assessment of abuse and neglect in our patients and supports the education of the neurologic community to achieve this end. Additional research on the physiologic and psychological consequences of abuse may lead to better treatment strategies to prevent related adverse health outcomes. DEFINITIONS OF ABUSE Abuse may be defined in a variety of ways. The following definitions are from Kruger and Moon.19 • Physical abuse: A willful act carried out with the intent of causing pain or injury. • Emotional abuse (including bullying and finan-cial abuse): Willful act executed to cause emo-tional pain, injury, or mental anguish.

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