The Professional View in Detection

Clinical Observation: Somatic Symptomatology and Behavior

For health, social work, or legal professionals, screening often depends on the acuity to observe what is not said verbally.

Victims of domestic violence rarely enter a consultation openly stating "I am abused," due to shame and fear.

Instead, the body speaks through nonspecific and recurrent psychosomatic symptoms: chronic pelvic pain, tension headaches, gastrointestinal problems (such as irritable bowel), rebellious insomnia, or anxiety crises with no apparent trigger.

A critical behavioral indicator occurs when the partner accompanies the victim to the consultation: the practitioner should observe the dynamics of the interaction.

If the companion answers the physician's questions for her, constantly interrupts, does not let her speak, or if the patient seeks his visual approval (fearful eye contact) before answering simple questions, the internal coercive control alert should be activated.

Likewise, the discrepancy between a physical injury and the explanation offered ("I hit the door" for a bilateral hematoma), coupled with a body language of cringing or hypervigilance, are clues that ethically compel inquiry beyond the superficial reason for consultation.

The Strategic Interview and the Creation of a Safe Environment

Interview technique can close or open the door to disclosure of abuse. Direct, confrontational or implicitly judgmental questions such as "Does your husband hit you?" or "Why do you stay with him if he treats you badly?" are often counterproductive, generating defensive denial out of shame or traumatic loyalty.

Proper professional technique involves "universalization" and validation to normalize the conversation.

Bridging phrases such as, "Given the stress and symptoms you tell me about, many patients in your situation experience tension or problems at home, do you feel safe at home?" or "How do you resolve disagreements when you and your partner argue?" are less threatening and allow the victim to speak without feeling interrogated.

It is an absolute safety imperative to ensure confidentiality and, crucially, never ask these screening questions in front of the partner or companion.

If clues are detected, a medical or administrative excuse should be sought to separate the patient from the companion (e.g..

"I need to perform a private physical examination" or "come with me to reception for some paperwork"), since questioning in front of the aggressor could trigger a severe punish