Case Study

Denise is a 30-year-old woman living with her husband and 10-year-old son. She presented to her family physician complaining of severe migraines and insomnia over the past week after having a positive home pregnancy test. She feared that having another child would make her permanently dependent on her husband. The couple met while she was a college student living with her parents. They married within weeks and moved frequently because of his jobs. She lost weight with each move and was eventually diagnosed with irritable bowel syndrome (IBS). He managed their finances and believed that women should not work outside the home. She was so afraid of him that she quickly abandoned her secret plans to become a teacher. When she was 7 months pregnant, her husband saw her talking with a male neighbor and accused her of infidelity. He then hit her for the first time.

Denise witnessed her alcoholic father physically abusing her mother throughout her childhood. Her father favored her brothers and spared them any abuse, while verbally and emotionally abusing her and her mother. When Denise left home, she and her mother remained close allies and maintained a lifelong bond. Denise's relationship with her father continued to be strained.

Since moving to the area 6 months ago, Denise and her husband argued daily about finances and her desire to move closer to her parents. One month ago, he threatened to kill her and their child. She had called the police twice in the past month, but she never pressed charges. In the past 6 months she had visited her physician 10 times, with various complaints (headaches, IBS, emotional symptoms). Ultimately, her physical injuries alerted the physician to abuse. He had asked about domestic violence during past visits, but she disclosed nothing. When she told her husband of the pregnancy, he became enraged, blamed her for getting pregnant, and hit her in the face and belly while threatening to kill her. During her appointment the next day, she was tearful and scared. Her physician asked her again if she was safe and when she said "no," they were able to discuss the beatings.

Police 1

KEY:

KEY:

Police 1

Figure 45-3 Eco-map (ecologic support network): Case Study 3.

Complete Neutral border relationship

Dotted Conflicted border relationship

Figure 45-3 Eco-map (ecologic support network): Case Study 3.

Denise, her crisis was both becoming pregnant and being assaulted and threatened by her husband. During the office visit, her physician helped her build her timeline. Denise was able to recognize how her migraines and IBS were related to her growing anger at her husband for controlling and isolating her. The timeline highlighted the pattern of her husband's escalating abuse and how this endangered her and her pregnancy. This awareness enabled her to accept her physician's help. They developed a safety plan to move her and her child into a shelter for battered pregnant women.

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