Teen Domestic Violence

SARA LOMAX-REESE: We are joined in studio by Dr. Donee Patterson. She is a family medicine physician with Einstein Department of Medicine. Welcome.

DONEE PATTERSON, MD: Thank you.

LOMAX-REESE: And Dr. Anita Robinson, who is Assistant Director of the Teen Clinic at Einstein's Pediatric Department. Welcome Dr. Robinson.

ANITA ROBINSON, MD: Thank you.

LOMAX-REESE: So why don't you set the stage for us, Dr. Donee, because domestic violence is rampant, sadly across the age span, across the gender span, so why don't you tell us why you selected domestic violence as a focal point for today's show?

PATTERSON: April is Domestic Violence Awareness Month and I think that we often hear about domestic violence and we know some of the statistics, but I don't think parents actually think about their teens being part of domestic violence. I know for myself, I never really talked to my parents when I started to date about domestic violence. It wasn't really an issue for me but it has been becoming something on the rise and so I want parents and grandparents and aunts and uncles and godparents to really think about talking to their adolescents about domestic violence and when they start to date and when they start to meet people from the opposite sex, really encourage them to learn some of the healthy relationship tips that will help them and carry them throughout their lives.

LOMAX-REESE: So let me ask you, Dr. Robinson, how widespread is domestic violence, particularly teen domestic violence that you see in the pediatric department?

ROBINSON: Most of my patients are from the northern part of Philadelphia and we screen for teen domestic violence with each visit of our patients and I can't give you a number, but it is fairly common.

LOMAX-REESE: How do you screen for domestic violence for teens?

ROBINSON: One of the social screening tools we use for adolescents is called a HEADS interview and HEADS stands for H is home, education, activities, diet, drugs depression suicide, sex safety issues.  So the safety part we always ask them, have you been hit, kicked, punched, by someone. Have you been isolated from your family, friends, by someone or has someone called you out of your name? In other words, cursed at you and frequently done that and if there is a yes answer to that we will sit and talk about partner violence. We are fortunate to have a domestic violence counselor for our teen clinic and we do a lot of referrals, in fact, we refer more I think than the Adult GYN Department and the Pediatric Department, simply because we do screen for it on a regular basis. It is there if you look for it.

LOMAX-REESE: So let me just ask you if you can define domestic violence, particularly as it relates to teens because when I think of domestic violence, I think of like partner violence, whether it is spousal or boyfriend/girlfriend, that kind of thing. I am wondering, for teens, if that also encompasses parents abusing because I am thinking domestic, if you live in the household, is it more broad if it's teens or is it still partner violence?

PATTERSON: Domestic violence is any type of violence, whether it is in the home or whether it is with a partner. We kind of wanted to focus on partner violence because I just don't think that is something parents really think about as their teens go out and try to be independent and figure this out. I do want to step back and just mention that it is estimated that about 5 million domestic violence situations occur a year. When they study high schoolers, they say about 54% of high schoolers say that they've been involved in some type of domestic violence situation amongst their peers. So you ask, well what exactly is…so we want to focus on partner violence in teens. What is it exactly? It has to do with coercion, so if someone is coercing you or forcing you to do things that you don't want to do, that is a form of domestic violence or partner violence. Physical injury, psychological abuse and also sexual abuse, all for of those things kind of combine into partner violence.

LOMAX-REESE: I am curious because we are coming up on prom season and it's a joyful and exciting time, but it also seems like it might be a time that is ripe for this kind of coercion or psychological abuse and things like that. So what should parents be saying to their boys and girls, because of the statistics that I thought was really interesting that I saw that unlike adult domestic violence in which women are more often the victims, in teen relationships abuse both girls and boys report abuse about equally. So this isn't just about teen girls, it is also about boys so what should parents be looking for, what should they be doing, Dr. Robinson?

ROBINSON: I was just thinking of something when you were listing the types of abuse; we also have to include financial abuse because that is an issue also.

LOMAX-REESE: What is financial abuse?

ROBINSON: You are in a relationship and the partner asks for money and you give it to them, and it doesn't just stop there. It keeps going on and on and on so it is either male or female, it doesn’t have to be a male financially abusing a female, it could be a female financially abusing a male.

PATTERSON:  So on the flip side of that it also can be, when you make a paycheck, you have to give all of your money to your partner. It is expected and if not you will be in trouble and then it is also controlling that you have to ask your partner for money in order to do anything, to buy shoes, to eat out, you have to ask them for money so they are controlling you by controlling the money.

LOMAX-REESE: OK. So what should parents look for, particular as we are heading into prom season?

ROBINSON: Well I am thinking about this. Those who live in a situation where there is domestic violence among the adults are more at risk of going into relationships where there is domestic violence. Sometimes a daughter in that situation, the woman or the male wants to shelter their young person so they will either overly give them information or not give them information. Sometimes I will say I don't want you to be in the same situation that I'm in, so don't let anybody hit you, don't let anybody cuss at you, so they might give that kind of advice, or they may not give any advice at all because they are ashamed of the situation that they are in and they don't want to see themselves as little in their kids mind because of the shameful situation that they are in so they may not say anything at all. I just wanted to make another point, it is not just partner relationships where you have male/female relationships, but there are also violence with same sex relationships. I've seen this with patients that I have had with same sex relationships where, I don't know if it tends to be a little bit more violence in those relationships, I'm not sure, I haven't studied it, but you do hear violence with same sex relationships. It is all over.

LOMAX-REESE: Let me just reintroduce you. We are talking about domestic violence today with our Einstein docs. We've got Dr. Anita Robinson, who was just speaking, she is   Assistant Director of the Teen Clinic at Einstein's Pediatric Department and Dr. Donee Patterson, who is our regular contributor, and she is a family medicine physician with the Einstein Department of Medicine. Dr. Donee, did you want to say something?

PATTERSON:  I did. So some specific things that you want to look for. If your teen is regularly coming and they have bruises and there is always an excuse, I want that to be a red flag, because the teen won't tell you. If you notice that the partner doesn't want your child to have friends, or they don't want the child to ever do anything without them, those are coercion, that is a problem, they don’t even want you to work, they humiliate you in any way, they threaten you by threatening to hurt your family or your pet. That is a problem or they have reckless driving and they are threatening you in the car or if that person leaves your teen somewhere in a strange or unfamiliar place, those things are red flags and should be red flags to parents. It is a whole list of things but I want this show just to be a reminder to parents to think about where your teen is going and what kind of relationship they are in and what kind of things they are telling you is happening in these relationships.

ROBINSON: You talk about prom coming up. It is absolutely right. What should a parent be preparing for in prom? So they go out and buy these beautiful dresses, the shoes, the hair, that's only part of the preparation. The other part of the preparation is the parent needs to know who the date is. The parent needs to know who the family of the date is. The parent needs to know where they are going; what's going to happen where they are going; are there any adult supervision; what time are they coming home and give them some guidance around time to be in. So a parent, if they really are a parent, they need to know all of that information and be able to ask their teen and it should be something that should be automatic.

LOMAX-REESE: I want to invite callers, because I want to make sure we have time to take some questions from the listening audience. If you have a question about teen domestic violence or adult domestic violence, you can give us a call at 215-634-8065; toll free, 866-361-0900. One of the stats or facts that I read was that the most dangerous time in an abusive relationship is when the abused partner tries to leave. Is that true for teens as well as adults?

PATTERSON: It often is because as the teen or young woman is leaving, that sometimes really angers someone so I want parents to hear, you don't just want to take a sigh at that point and say OK, the relationship is over, I can relax. You just really need to pay attention because that person can come and try to abuse them, try to get them back into their control.

LOMAX-REESE: I think one of the most high profile cases that really rocked the media was Chris Brown and Rihanna. It is very complicated because she essentially, I guess, has taken him back and there is a lot of conversation that has been had around what kind of message that really sends to young women and I think that there is, especially when you are young, there is a sense that I can change him or there is almost a seductive kind of energy around that abuse. Talk to us about the psychological impact of abuse, particular in new, young relationships.

ROBINSON: One of the things you have to be aware of is the fact that it is not unusual for the abused person to go back into the abuse relationship. In fact, you see that more than not. So the female or the male who is in an abusive relationship they have to get to a point within themselves that they recognize that it is OK for me to leave or I need to leave. Their friends can tell them to leave, their parents can tell them to leave, but they have to get there themselves and that takes a lot of maturity, a lot of thinking, which you don't have a lot in teenagers. Developmentally, they haven't developed that ability to make that kind of decision at 15 or 16 years of age, because the brain is just not there. So it is a more difficult problem to psychologically prepare them to move them out of an abusive relationship. 9 times out of 10 they go back into the relationship because that is what they know. It is difficult for them to come out of that into an unknown feeling that they are safe because a lot of times they don't feel they are safe because they have been in this situation that has been so fearful, but there has been this needy kind of connection and the teen has to recognize that they need to be able to get of that, but it's hard.

LOMAX-REESE: Dr. Donee?

PATTERSON: Unfortunately, a lot of our teens or young women haven't seen healthy relationships at home and that goes for our guys as well. I want us to emphasize that there is a difference between loving this person because they may actually feel that they love this person and recognizing that there is something that they deserve more. You can love someone but also recognize I absolutely deserve more than this relationship is giving me and it's OK not to be in that relationship even if you love that person, you have to give yourself permission because if that person is hitting you, controlling you, sexually assaulting you, you have to say for yourself, I deserve more and get yourself out of it.

LOMAX-REESE: I think one of the problems and I am looking at it from the female standpoint, is that we still live in a patriarchal society that still validates women by whether or not they are in a relationship and that can be really, really damaging from a self-esteem standpoint because it is almost like I am more valuable or validated if I am with this person even if I am not being treated right.

PATTERSON:  Sure, loneliness is tough at any age and people want to feel loved or want to feel needed, but we have to emphasize that you deserve a healthy relationship and we have to explain to teens what exactly a healthy relationship is.

LOMAX-REESE: When we get back, we are going to take a quick break; I want to talk a little bit about treatment. You guys are the doctors and how do you even go about creating a treatment strategy and plan for a young person or an adult who has been in this situation? We are talking with the Einstein docs today, Dr. Donee Patterson and Dr. Anita Robinson. We are talking about domestic abuse, particularly focused on teens today. We will be right back in just a moment.

LOMAX-REESE: And we are back. We are talking about domestic violence today, particularly focused on teens and we are talking to Dr. Anita Robinson, Assistant Director of the Teen Clinic at Einstein's Pediatric Department and Dr. Donee Patterson, a family medicine physician with Einstein Department of Medicine. Before we went to break, I was asking about treatment, but before we get to that, Dr. Robinson, you have worked all over the country dealing with these kinds of issues but during the break you were saying that there is something unique, a thing called play fighting that you've seen that is somewhat unique to Philadelphia. Can you talk about what that is and what you see is the problem with that?

ROBINSON: It was very interesting. I saw a kid who came in and she had bruises and I asked her where the bruises came from and of course the usual response is I walked into a door, etc. and then she really started talking and it came out that it was her boyfriend who they were play fighting and she had to explain it to me because I had never heard of that term. What is play fighting? Well you know, we box, we hit. You actually hit one another? Yes, hit, slap, punch, kick one another, but it is all in a giggling kind of humor approach and unfortunately, about two weeks ago I was on the Broad Street Line subway and there were a bunch of kids, and they were all in a group, all laughing and talking, and all of a sudden this one girl, they pushed her in the seat and two guys were on her punching at her, and they were laughing the whole time. The girl jumped up and she was laughing too. That is not right. Do not play fight, there is no such thing as play fight. Violence is an expression of inward anger, you never know where the lead opens up with that inward anger and something else begins to happen other than what you thought it was, so be very careful.

LOMAX-REESE: Dr. Donee, during the break, we were also talking about that same kind of blurred lines in terms of marriage and sexual relations within the context of a marriage and that rape can actually occur within the context of a marriage. Can you talk about that?

PATTERSON:  Absolutely. People don't feel like rape can occur in the context of marriage, but it's a woman's body, it's her choice so if she is choosing to say no, and there is any forcing of sex or abuse towards it, then that is actually considered rape. There are a lot of fine lines here. Some people may say that play fighting that just seems so simple, I've boxed with guys, I've boxed with my cousins and my brothers, but we are talking about something a little bit different. You are in a relationship with a partner and you are constantly hitting them and constantly boxing and constantly wrestling, and so what we are trying to say those lines between a healthy relationship where you are really not supposed to put your hands on each other, are kind of blurred. So when you are angry it doesn't seem so awful; it doesn't seem so bad to continue that hitting and fighting. We really want people to be careful about that, whether you are adult or not. Also, go a further step and teach your children that is something you probably should refrain from.

LOMAX-REESE: Domestic violence is a huge, huge issue. One of the stats is that 1 in 4 women have a lifetime risk of being a victim of domestic violence, making domestic violence the leading cause of injury to women, more than car accidents, muggings and rape combined. So this is not something that is happening in very isolated pockets, it affects many, many women and there are so many different categories of it. Let's get to the treatment question. What are some strategies if someone is really identified as abused, how do they get treated. Dr. Robinson?

ROBINSON: I wish I could say give them some penicillin and they are fine. It's not that simple. This has to do with your perception of yourself, who you are, what you are doing, what you are about. You go into therapy, you have to; you have to go into healthy therapy, building up who you are, enhancing that self-esteem. It can't be just treatment, isolated to the teen; it has to be a family that gets involved in this treatment. The mother, the sisters, everybody has to work with this teen to move that teen along in a more healthy environment, not just in relationships with sexual partners, but also within the family. It is tough, there is no good answer because sometimes you have to move that teen out of the household, put them in another household that is a little more loving, if they don't have that in their household, it's tough. There is no easy answer to that question.

LOMAX-REESE: Dr. Donee?

PATTERSON: I think that it starts with recognition. A lot of times you don't even… it is so subtle, the hitting is subtle or the hitting or the coercion or the isolation, the isolation from your friends is so subtle. It starts with recognizing and then you continue to talk to your friend or your child about you know these are dangerous behaviors.  There are actually long term healthcare consequences to this and it shows that women who are victims of domestic violence, they have poor healthcare outcomes. Although they may access healthcare more frequently, they actually tend to be more sick and then their children tend to be more sick. There are lots of statistics about that. We are not just talking about violence, we are talking about actual healthcare outcomes and they tend not to have more advancement in careers and they tend to be controlled by money, so this is a generational thing that we really want to stop by recognizing if it is happening in our teens and preparing them for healthy relationships early so it's not a problem in the further end.

LOMAX-REESE: Dr. Robinson?

ROBINSON: So what can the adults do? What can parents do? Grandparents, adults do? One thing that I think is really, really key you have to help build your teens self esteem and you do that by getting them involved in activities, something they like, but getting them involved, so on weekends you find something for them to do on Saturdays. During the summer you find something for them to do, and I don't mean get them a job. That is not the answer although a lot of my patients say I am going to get a job. You really have got to move them into another environment, move them from where they are into something that is new that they may like. If the kid likes broadcasting, then call here see if there is a volunteer program for the teen. I tell parents you never know what door is going to open until you knock on that door. You've got to get your kids involved in activities because that helps build the self esteem, it also has them to begin to look at their relationship. It helps them sort of do an anatomy of the relationship that they are in and the parents too.

LOMAX-REESE: It opens up their world so it's not just about this relationship, it's about their life.

ROBINSON: Exactly.

LOMAX-REESE: So we are out of time for this segment, I really appreciate both of you for putting a spotlight on this particular issue because this is something, particularly as it relates to teens, that we don't necessarily pay that close of attention to because we just assume that they will mature and grow into the healthy young people that we hope they will be but there are real symptoms and signs that we need to be looking for in terms of whether something is out of wack and out of balance in terms of these relationships.  So final thought, Dr. Donee?

PATTERSON: So we have questions on Facebook, so the person who answers the questions correctly, the first person will get a $25 gift card so you can go to Einstein Health, and follow us on Facebook and follow us on Twitter as well.  My last thought would be teen dating can be this wonderful time for teens to find themselves and figure out how to build healthy relationships and so we want to continue that healthy relationship and really, really pay attention to trying to teach them how to avoid falling into the traps of unhealthy relationships.

LOMAX-REESE: Absolutely. Again, I want to thank you Dr. Donee Patterson, family medicine physician at Einstein Department of Medicine, and Dr. Anita Robinson, Assistant Director of the Teen Clinic at Einstein Pediatric Department. Thank you very much.