Module 2: Indicators of domestic violence

1. Signs of unhealthy relationships
2. Impact of domestic violence
3. Excursus: Outsiders as witnesses of domestic violence
4. General domestic violence indicators in adults

Introduction to the topic

Welcome to Module 2 on “Indicators of domestic violence”. In this module you will dive into the wide-ranging health consequences of domestic violence, learn about its identification by gaining knowledge about indicators encompassing behavioural, physical, and emotional aspects. Moreover, the role of and impact on those witnessing domestic violence will be also presented in an excursus.

Learning objectives

+ Understand the multifaceted consequences of domestic violence on victims, families, and communities, including physical, psychological, and social impacts.

+ Acquire the skills to identify potential indicators and “red flags” – using behavioural, physical, and emotional cues.

+ Recognise the emotional and psychological effects of witnessing domestic violence, particularly on children, and understand the importance of creating safe environments for all family members.

1. Signs of unhealthy relationships

Some relationships can have a negative impact on our overall well-being rather than improving it. Some may even reach a level of toxicity, and it’s crucial to be able to identify warning signs.

These warning signs, often referred to as “red flags”, serve as indicators of unhealthy or manipulative behaviour. They are not always recognisable at first — which is part of what makes them so dangerous.

Toxicity can be present in all forms of close relationships e.g. between friends, at work with colleagues, between family members, or in romantic partnerships.

2. Impact of domestic violence

“Experiencing violence or abuse by an intimate partner increases the risk of developing a mental health disorder by almost three times and the risk of developing a chronic physical illness by almost twice.”

Mellar BM, Hashemi L, Selak V, Gulliver PJ, McIntosh TK, Fanslow JL (2023) (1)

Every victim is different and the individual and cumulative impact of each act of violence depends on many complex factors. While each individual will experience domestic violence uniquely, there are many common consequences of living in an environment with violence and/or living in fear. Often the short and long-term physical, emotional, psychological, financial and other effects on individuals are quite similar.

It is important to understand the effects of domestic violence on victims, because those effects are responsible for many indictors they present to us.

Please note that all the following lists are not exhaustive; it represents only a selection.

Impact of domestic violence on a child (witnessing or experiencing)

“Some of the biggest victims of
domestic violence are the smallest.”

United Nations Children’s Fund (UNICEF)
This video shows how domestic trauma affects children’s brain development and their behaviour (both in and out of the home).

“The way childhood abuse and/or neglect is remembered and processed has a greater impact on later mental health than the experience itself.”

Danese A., Widom CS. (2023) (2)

“People who have experienced challenging or traumatic experiences in their childhood are more likely to exhibit both physical and cognitive impairments in old age.”(7) In the following table you will find more examples of short-term and long-term impact of domestic violence on a child experience or witnessing domestic violence:

  • Children who have experienced violence and have mental health problems (e.g. psychosomatic symptoms, depression, or suicidal tendencies), are at greater risk for substance abuse, juvenile pregnancy and criminal behaviour. (8)
  • Children may learn that it is acceptable to exert control or relieve stress by using violence, or that violence appears to be linked to expressions of intimacy and affection. This can have a strong negative impact on children in social situations and in relationships throughout childhood and in later life.
  • Children may also have to cope with temporary homelessness, change of physical location and schools, loss of friends, pets, and personal belongings, continued harassment by the perpetrator and the stress of making new relationships.

3. Excursus: Outsiders as witnesses of domestic violence

Image by macrovector on Freepik

Given the short- and long-lasting negative impact on individuals living in an environment with DV and given that most never tell anyone, it is important that caregivers and family members, as well as neighbours or work colleagues which are potential witnesses of domestic violence don´t look away.

“What would you do?”

Tasks for reflection

(1)  What are the “red flags” presented in this video that indicate that this is a toxic relationship where DV is present and someone needs help?
(2) What would you do?

The victim’s cooperation and consent are the most important prerequisites for intervening as a witness. An intervention by a witness can include talking to the victim, helping to access help services, or e.g. supporting the reporting of DV to the police.

Factors that may inhibit or encourage intervention by witnesses:

More information on the decisive factors for witness intervention in domestic violence can be found here:

4. General domestic violence indicators in adults

There is a whole range of indicators to serve as “red flags” that a person may be experiencing domestic violence. Some of these are quite subtle. Thus, it is important that professionals remain alert to the potential signs and respond appropriately. Please note that none or all of these might be present and be indicators of other issues. Some victims also drop hints in their interactions and their behaviour may also be telling. Find detailed information to communication in Module 3.

Victims rely on professionals to listen, persist, and enquire about signs and cues. They need them to follow-up on conversations in private, record details of behaviours, feelings and injuries seen and reported, and support them in line with their organisation’s systems and local pathways.

Individuals from diverse cultural backgrounds may manifest their symptoms differently. Please remain conscious of your own perspective, biases, and stereotypes when communicating with a potential victim, as these factors can impact how you assess the symptoms. Find more information in Module 8.

Please note that none or all of these indicators might be present and be indicators of other issues, but they can serve as warning signs and a reason for increased attention and can point towards a history of DV.

Here, you will find a range of potential health indicators, psychological indicators for adults, and specific indicators pertaining to vulnerable groups.

For better clarity, the indicators are categorised by colour: Yellow: General indicators; Green: Behavioural indicators; Blue: Psychological indicators.

Possible health indicators
  • Chronic conditions including headaches, pain and aches in muscles, joints and back
  • Difficulty eating/sleeping
  • Cardiologic symptoms without evidence of cardiac disease (heart palpitation, arterial hypertension, myocardial infarction without obstructive disease)
Possible psychological indicators
  • Emotional distress, e.g., anxiety, indecisiveness, confusion, and hostility
  • Self-harm or suicide attempts
  • Psychosomatic complaints
  • Sleeping and eating disorders (e.g. anorexia, bulimia, binge eating)
  • Depression/pre-natal depression
  • Social isolation/no access to transport or money
  • Submissive behaviour/low self-esteem
  • Fear of physical contact
  • Alcohol or drug abuse
Possible behavioural indicators
  • Frequent use of medical treatment in various facilities
  • The constant change of doctors
  • Disproportionately long-time interval between the occurrence of injury and treatment
  • Faltering response when being asked about medical history
  • Denial, conflicting explanations about the cause of the injury
  • Overprotective behaviour of the accompanying person, controlling behaviour
  • Frequent absence from work or studies
  • Evasive or ashamed about injuries
  • Seeming anxious in the presence of their partner or family members
  • Nervous reactions to physical contact/quick and unexpected movements
  • Easily startled behaviour
  • Easily crying when being asked questions
  • Extreme defensive reactions when asked specific questions

Possible indicators which apply specifically to the vulnerable group of the elderly:

Possible indicators of domestic violence against the elderly
  • Lack of basic hygiene
  • Wet diapers
  • Missing medical aids like walkers, dentures
  • Bedsores, pressure ulcers
  • Caregiver speaks about the elder as if he/she was a burden

Some professionals worry that discussing suicide may trigger the person at risk, but in reality, addressing suicide can reduce their anxiety and foster understanding. If someone currently has thoughts or plans of self-harm or has a recent history of self-harm and is in extreme distress or agitation, do not leave them alone. Immediately refer them to a specialist or emergency healthcare facility.


1. Signs of unhealthy relationships
2. Impact of domestic violence

(1) Mellar, B. M., Hashemi, L., Selak, V., Gulliver, P. J., McIntosh, T. K. D., & Fanslow, J. L. (2023). Association Between Women’s Exposure to Intimate Partner Violence and Self-reported Health Outcomes in New Zealand. JAMA network open, 6(3), e231311.

(2) Danese A, Widom CS (2023). Associations Between Objective and Subjective Experiences of Childhood Maltreatment and the Course of Emotional Disorders in Adulthood. JAMA Psychiatry. Published online July 05, doi:10.1001/jamapsychiatry.2023.2140

(3) Stiles, Melissa. (2003). Witnessing domestic violence: The effect on children. American family physician. 66. 2052, 2055-6, 2058 passim.

(4) Moylan CA, Herrenkohl TI, Sousa C, Tajima EA, Herrenkohl RC, Russo MJ (2010). The Effects of Child Abuse and Exposure to Domestic Violence on Adolescent Internalizing and Externalizing Behavior Problems. J Fam Violence. 25(1):53-63. doi:10.1007/s10896-009-9269-9

(5) Monnat SM, Chandler RF (2015). Long Term Physical Health Consequences of Adverse Childhood Experiences. Sociol Q. 56(4):723-752. doi:10.1111/tsq.12107

(6) Vargas, L. Cataldo, J., Dickson, S. (2005). Domestic Violence and Children . In G.R. Walz & R.K. Yep (Eds.), VISTAS: Compelling Perspectives on Counseling. Alexandria, VA: American Counseling Association; 67-69.

(7) Lee, V.M., Hargrave, A.S., Lisha, N.E. et al (2023). Adverse Childhood Experiences and Aging-Associated Functional Impairment in a National Sample of Older Community-Dwelling Adults. J GEN INTERN MED

(8) Felitti V.J. et al (1998), ‘The Relationship of Adult Health Status to Childhood Abuse and Household Dysfunction’, American Journal of Preventive Medicine, Vol. 14, pp. 245-258

James, M. (2001), ‘Domestic Violence as a Form of Child Abuse: Identification and Prevention’, Issues in Child Abuse Prevention, 1994; Herrera, V. and McCloskey, L. ‘Gender Differentials in the Risk for Delinquency among Youth Exposed to Family Violence’, Child Abuse and Neglect, Vol. 25, no.8, pp. 1037-1051

Anda, R.F., Felitti, V.J. et al. (2001)‘Abused Boys, Battered Mothers, and Male Involvement in Teen Pregnancy’, Pediatrics, Vol. 107, no. 2, pp.19-27.

4. Indicators

Mota-Rojas D, Monsalve S, Lezama-García K, Mora-Medina P, Domínguez-Oliva A, Ramírez-Necoechea R, Garcia RdCM (2022). Animal Abuse as an Indicator of Domestic Violence: One Health, One Welfare Approach. Animals. 12(8):977.

Hegarty (2011): Intimate partner violence – Identification and response in general practice, Aust Fam Physician. 2011 Nov;40(11):852-6.

Ali, McGarry (2019): Domestic Violence in Health Contexts: A Guide for Healthcare Professions, DOI:10.1007/978-3-030-29361-1

Department of Health and Social Care (2017): Responding to domestic abuse: A resource for health professionals:

RACGP (2014): Abuse and Violence: Working with our patients in general practice:

UN Women, UNFPA, WHO, UNDP and UNODC (2015): Essential services package for women and girls subject to violence – Module 2: Health essential services.

Women’s Legal Service NSW (2019): When she talks to you about the violence – A toolkit for GPs in NSW:

Western Australian Family and Domestic Violence Common Risk Assessment and Risk Management Framework (2023), Factsheet: