J Oral Maxillofac 48:1250-1253,
Surg
1990
Facial Trauma in Women Resulting Violence by Men
From
NICHOLAS ZACHARIADES, DDS, MD,* FANI KOUMOURA, DDS,t AND ELINA KONSOLAKI-AGOURIDAKI, DDSS In a 2Syear period, 546 women with facial injuries were treated. In 8.2%, the injury was related to some form of violence exerted by a man. In cases where the individual was known, it was usually the husband or boyfriend (almost 67%). The assault consisted of a beating with the hands in over 70% of the cases. Fracture of the mandible was the most common injury. There were also 62 cases of home accidents.
Results
In an effort to establish the profile of patients with facial fractures, a peculiarity concerning facial trauma in women was noticed; from the patients’ histories, it was evident that on a number of occasions violence by a man was the causative factor. In these situations, the associated degradation requires immediate care. The closest person who can create the appropriate intrapersonal relation is the oral and maxillofacial surgeon.
In the 2Sstudy period, 2,308 patients with facial injuries were treated. Five hundred forty-six were women aged 16 to 62 years. In 51 of the cases the injury could be related directly (45 cases) or indirectly (6 cases) to some form of violence exerted by a man. There were 62 home accidents; 34 involved working women, and 28 involved housewives. In the group where the violence was related directly to a known individual, that person was the husband in 26 cases (51%), the boyfriend in 8 (15.7%), and a blood-related relative in 5 cases (10%). The assault was made with the hands in 36 cases (70.6%) and with a gun in 3 (6%). The resulting injuries were simple bruises in 11 cases (21.6%), fracture of the mandible in 20 cases (39%), fracture of the zygomaticomaxillary complex in 5 cases (lo%), fracture of the nasal bones in 1 case (2%), fracture of the alveolar process in 1 case, and a Le Fort III fracture in 1 case. There were six cases (12%) in which the assaulting individual was an unknown person. In these cases, the aim was robbery (three) and rape (three) and the assaulting instrument was a gun, heavy articles, fists, or a kick. There were two cases (4%) of multiple bruises and four cases (8%) of fractures (two mandibular and two of the zygomaticomaxillary complex). Six women were severely injured following a suicidal attempt, but they all survived.
Materials and Methods Trauma cases over a 2YSyear period starting June 1986 and ending May 1989 were studied with particular emphasis on women and the injuries related directly or indirectly to some form of violence exerted by a man. The injuries directly related were divided into those caused by known and those caused by unknown individuals. Those indirectly related were the result of suicide attempts. In addition, we studied the accidents sustained at home. To assure accuracy of the findings, patients were asked to repeat the history of the accident two or three times because the real causes of injury in such cases are often hidden because of fear or shame.’ Received from the Oral and Maxillofacial Clinic, Peripheral Hospital of Attica-K.A.T. (formerly, “Apostle Paul’s” Accidents Hospital), Kifissia, Athens, Greece. * Head. t Senior Registrar. f Assistant. Address correspondence and reprint requests to Dr Zachariades: 40 Papadiamantopoulou St, 157 71 Athens, Greece. 0 1990 American
Association
of Oral
and Maxillofacial
Discussion
Sur-
Almost one fifth of our total cases (23.6%) were women, with 8.2% of them direct victims of a man’s
geons 0278-2391/90/4812-0002$3.00/O
1250
ZACHARIADES
1251
ET AL
abuse. Most of the women were assaulted by a known individual who, in most of the cases (58%), was their husband. Only in six cases was the assaulting person unknown. Six women (12%) were injured in their attempt to commit suicide as a result of an unhappy love affair. In all cases, the attempt was a fall from two to six stories. They all had histories of neurotic behavior. Most of the injured women in the study period (315, or 57.7% of cases) were injured in road traffic accidents, followed in number by those who were injured in falls (137, or 25.2% of cases), and those who were victims of abuse by a man (9% of cases) (Table I). It is interesting that only five cases (0.9%) were the result of sports activity and four (0.7%) were due to industrial accidents. This makes man’s violence the third most important cause of women’s facial trauma in our series. In a previous study* including 10,491 patients with facial fractures treated in a 15-year period (1979 to 1984), we found that 57% of the cases were the result of road traffic accidents, 20% the result of falls, and 9% the result of violence. However, that study covered both men and women and every form of violence. In a study published in 1980,3 it was found that 44% of facial fractures in women were the result of road traffic accidents and 16% (twice our figure) were the result of violence. In 1986, Thorn4 found that in almost one half of cases the assaulting person was the husband, who, in our report, was responsible in 67% of the cases where the assaulting individual was known to the victim, or 58% of the total. In other words, close family ties seem to extend to the use of force by blood-related relatives. That force is usually exerted with fists, resulting in fracture of the mandibular body or angle.5,6 However, in the group where the assaulting individual was an unknown person, the assault was made with any available means, the aim was different (robbery or rape), and the results were more generalized. The most serious injuries were sustained in suicide attempts,7 which, in our series, were all associated with a love affair and were all the result of intentional falls. Violence associated with marriage or cohabitaTable 1. Maxillofaclal Injurles in Women According to Etiology No. of Cases (%) Road traffic accidents Falls Abuse by a man sports Industrial accident Miscellaneous
315 (57.7) 137 (25.2) 51 (9) 5 (0.9) 4 (0.7) 14 (6.5)
tion is a major cause of injury in women.8 It is an extreme consequence of a woman’s position in a male-dominated society’ and it is a myth that it occurs in only a small percentage of the female population. lo In fact, it has been estimated that women are battered in 5% to 19% of marriages in the United Kingdom and the United States,‘but the exact extent of the phenomenon cannot be precisely described, as only extreme cases can be verified from statistics. lo It has been estimated that only 25% of cases are reported to the authorities because a large percentage of women (49%) consider battering a personal problem and only call the police to avoid further violence. lo Violence can be behavioral (ie, deprivation of sleep, food, money, and contact with friends or relatives, isolation at home for a period of time),’ psychological (ie, humiliation, degradation, threats),” or physical (ie, fists, kicks, knocking of the head against the wall, pushing over the stairs, breaking of bones, attempts at strangulation).’ Psychological violence usually precedes physical violence. lo A particular form of physical abuse (with very serious psychological implications) is sexual abuse. In fact, a substantially higher rate of sexual abuse was found in patients who had been directly asked about sexual molestation (70%) than in a random sample (6%).” It also has been found’* that 51% of 105 female state hospital patients had been sexually abused as children or adolescents and that 66% of the abused met the diagnostic criteria for posttraumatic stress disorder. Psychiatric treatment almost always follows, rather than precedes, battering.* In neurological clinics, however, women are treated as if they themselves were sick.’ On the other hand, a woman’s admission to a psychiatric institution may be considered as a cause for divorce.’ Traumatic injuries caused by violence, which can be quite serious, are often repeated.**” Patients are frequently reluctant or too frightened to reveal the true cause of their injury.’ A patient’s childhood often includes similar situations.9’13 The prevailing feelings on the part of the abused usually are fear, insecurity, shame, desperation, and anger. They believe that they are not liked and feel guilty that they cannot function properly in their roles as wives and mothers and that they have failed in these roles. They believe they are responsible for what is happening to them and are embarrassed, as they believe that such situations only occur with them.’ They cannot help thinking that next time it could be worse’ and may also be afraid for their children’s future. Initially, women try to avoid what may be considered as pretext, or an opportunity, by their hus-
1252 bands or boyfriends for an attack.’ However, they gradually fail to react and feel helpless, passively accepting the situation; this worsens the vicious cycle, as an even greater dependence of their husband or boyfriend is established9~*0 and episodes of domestic violence tend to increase in both frequency and severity.14 Self-esteem is reduced, the women become nervous, and their behavior is often offensive, they suffer from insomnia and melancholia, and may suddenly break into tears. They hate their husband or boyfriend and think of taking revenge, although they seldom do so. They may also try to justify the man’s behavior, attributing it to the difficulties of life and they occasionally hope that he may change. The situation does not change until the man assumes the responsibility for what is happening. Women usually choose to stay with their husbands for their children’s sake and because of economic dependence. lo A woman’s attempt at selfdefense may occasionally lead to her death.” Mental health is of crucial importance in a woman’s ability to break away from an abusive male.13 The causes of male-inflicted violence include psychological and cultural factors, psychopathic personality, jealousy, family background, and social deprivation (although this behavior is not restricted to the lower social echelons and is documented throughout the social spectrum*), financial problems, unemployment, overcrowded conditions, use of alcohol or drugs, and destructive attitudes.8*‘0*‘4 It should be mentioned that alcoholics may also batter their wives when they are not under the influence of alcohol. lo Religious faith is not of paramount importance, as there have been priests who batter their wives.” Wife abuse may be one of the most significant precipitants of female suicide.” Indeed, in primitive societies, if a woman’s support group does not defend her when she is the victim of violence that passes the bounds of normative behavior, her suicide may be revenge suicide, intended to force others to take revenge on the abusive husband.15 According to Shepherd et al,8 violence within marriage initially occurs after the man’s 40th birthday. They also mention that a great percentage of husbands who battered their wives also had been exposed themselves to violence as children. The same men may also be violent towards their children or may have normal relations with them.’ In a study performed by Bergman et al, i9 two thirds of 49 women alcoholics had been battered; the women in these groups were also similar in that many of them had experienced violence in their own childhood environment and in that they had cohabited with more men than had women in the control group.
FACIAL TRAUMA IN WOMEN FROM VIOLENCE
BY MEN
Early recognition of the patient who has been the victim of physical abuse by a familiar person can be difficult and is often obscured because of embarassment or frank reluctance to discuss the circumstances leading to the injuries.14 The reluctance of patients to discuss the true cause of injuries is owing not only to shame but to a real fear of further assault. l4 Police, and authorities in general, do not easily intervene, as they consider such situations family affairs. They underestimate the dangers and give advice. They usually consider a crime something that happens in the streets or in a public place. In hospitals, such cases are often not recorded for reasons of discretion.’ Besides, they often cannot be proved as they derive from the patient’s history. In Greece, the law does not obligate the physician to report such cases to the authorities, as the patient’s problem is considered very personal and something that should be kept confidential by the doctor. Besides, adult patients are considered able to report the events to the authorities themselves, if they so choose. The same does not apply to cases of battered children, as they usually cannot report it to the police themselves. As the oral and maxillofacial surgeon may be the first and, occasionally, the only person to come in contact with such victims, it is important to understand the possible causes, to discuss the social background, and to know when to offer help and where this help can be found. The violent husband or boyfriend only rarely presents for help or counseling, ‘,I4 although he needs it as much as the victim because he usually has low self-esteem and feels insecure about his role in society.” Factors helpful in identifying the victim are the history, which may be incompatible with the injuries sustained, a significant delay between the injury occurring and the subsequent presentation for advice or treatment, and a history or clinical evidence of previous similar injuries. l4 References 1. Laskin D: Looking out for the battered woman. .I Oral Surg 39:1981 2. Zachariades N, Papavassihou D, Vairaktaris E: Fractures of the facial skeleton. Greek Iatrika Chronica 12:783, 1989 3. Afrelius L, Rosen C: Facial fractures: A review of 368 cases. Int J Oral Surg 9:25, 1980 4. Thorn J, Mogeltoft M, Hansen P: Incidence and aetiological pattern of jaw fractures in Greenland. Int J Oral Surg 15:372, 1986 5. Brook I, Wood N: Aetiology and incidence of facial fractures in adults. J Oral Surg 12:293, 1983 6. Busuito M, Smith D, Robson M: Mandibular fractures in an urban trauma center. J Trauma 26:826, 1986
ZACHARIADES
ET AL
7. Katz K, Gotten N, Goldberg 1, et al: Injuries in attempted 8.
9. 10. 11.
12.
suicide by jumping from a height. Injury 19:371, 1988 Shepherd J, Gayford J, Leslie J, et al: Female victims of assault: A study of hospital attenders. J Craniomaxillofac Surg 16:233, 1988 Triantafyllidou J: Battered women. A current approach. Sot Work 1:243, 1986 Mouzakitis C: Marital violence. Etiology, sequelae, intervention. Sot Work 16:217, 1989 Briere J, Zaidi LY: Sexual abuse histories and sequelae in female psychiatric emergency room patients. Am J Psychiatry 146:X02, 1989 Craine LS. Henson CE, Colliver JA, et al: Prevalence of a
1253
history of sexual abuse among female psychiatric patients in a state hospital system. Hosp Community Psychiatry 39:300, 1988 13. Bergman B, Larsson G, B&mar B, et al: Battered wives and female alcoholics: A comparative social and psychiatric study. J Adv Nurs 14:727, 1989 14. Bailey BMW, Berm&ham DF, Shepherd RG: A comparative study of psychological data on patients with maxillofacial injuries in an urban population-A preliminary report. Br J Oral Maxillofac Surg 26:199, 1988 15. Counts DA: Female suicide and wife abuse: A cross-cultural perspective. Suicide Life Threat Behav 17:194, 1987
Surg
1990
Facial Trauma in Women Resulting Violence by Men
From
NICHOLAS ZACHARIADES, DDS, MD,* FANI KOUMOURA, DDS,t AND ELINA KONSOLAKI-AGOURIDAKI, DDSS In a 2Syear period, 546 women with facial injuries were treated. In 8.2%, the injury was related to some form of violence exerted by a man. In cases where the individual was known, it was usually the husband or boyfriend (almost 67%). The assault consisted of a beating with the hands in over 70% of the cases. Fracture of the mandible was the most common injury. There were also 62 cases of home accidents.
Results
In an effort to establish the profile of patients with facial fractures, a peculiarity concerning facial trauma in women was noticed; from the patients’ histories, it was evident that on a number of occasions violence by a man was the causative factor. In these situations, the associated degradation requires immediate care. The closest person who can create the appropriate intrapersonal relation is the oral and maxillofacial surgeon.
In the 2Sstudy period, 2,308 patients with facial injuries were treated. Five hundred forty-six were women aged 16 to 62 years. In 51 of the cases the injury could be related directly (45 cases) or indirectly (6 cases) to some form of violence exerted by a man. There were 62 home accidents; 34 involved working women, and 28 involved housewives. In the group where the violence was related directly to a known individual, that person was the husband in 26 cases (51%), the boyfriend in 8 (15.7%), and a blood-related relative in 5 cases (10%). The assault was made with the hands in 36 cases (70.6%) and with a gun in 3 (6%). The resulting injuries were simple bruises in 11 cases (21.6%), fracture of the mandible in 20 cases (39%), fracture of the zygomaticomaxillary complex in 5 cases (lo%), fracture of the nasal bones in 1 case (2%), fracture of the alveolar process in 1 case, and a Le Fort III fracture in 1 case. There were six cases (12%) in which the assaulting individual was an unknown person. In these cases, the aim was robbery (three) and rape (three) and the assaulting instrument was a gun, heavy articles, fists, or a kick. There were two cases (4%) of multiple bruises and four cases (8%) of fractures (two mandibular and two of the zygomaticomaxillary complex). Six women were severely injured following a suicidal attempt, but they all survived.
Materials and Methods Trauma cases over a 2YSyear period starting June 1986 and ending May 1989 were studied with particular emphasis on women and the injuries related directly or indirectly to some form of violence exerted by a man. The injuries directly related were divided into those caused by known and those caused by unknown individuals. Those indirectly related were the result of suicide attempts. In addition, we studied the accidents sustained at home. To assure accuracy of the findings, patients were asked to repeat the history of the accident two or three times because the real causes of injury in such cases are often hidden because of fear or shame.’ Received from the Oral and Maxillofacial Clinic, Peripheral Hospital of Attica-K.A.T. (formerly, “Apostle Paul’s” Accidents Hospital), Kifissia, Athens, Greece. * Head. t Senior Registrar. f Assistant. Address correspondence and reprint requests to Dr Zachariades: 40 Papadiamantopoulou St, 157 71 Athens, Greece. 0 1990 American
Association
of Oral
and Maxillofacial
Discussion
Sur-
Almost one fifth of our total cases (23.6%) were women, with 8.2% of them direct victims of a man’s
geons 0278-2391/90/4812-0002$3.00/O
1250
ZACHARIADES
1251
ET AL
abuse. Most of the women were assaulted by a known individual who, in most of the cases (58%), was their husband. Only in six cases was the assaulting person unknown. Six women (12%) were injured in their attempt to commit suicide as a result of an unhappy love affair. In all cases, the attempt was a fall from two to six stories. They all had histories of neurotic behavior. Most of the injured women in the study period (315, or 57.7% of cases) were injured in road traffic accidents, followed in number by those who were injured in falls (137, or 25.2% of cases), and those who were victims of abuse by a man (9% of cases) (Table I). It is interesting that only five cases (0.9%) were the result of sports activity and four (0.7%) were due to industrial accidents. This makes man’s violence the third most important cause of women’s facial trauma in our series. In a previous study* including 10,491 patients with facial fractures treated in a 15-year period (1979 to 1984), we found that 57% of the cases were the result of road traffic accidents, 20% the result of falls, and 9% the result of violence. However, that study covered both men and women and every form of violence. In a study published in 1980,3 it was found that 44% of facial fractures in women were the result of road traffic accidents and 16% (twice our figure) were the result of violence. In 1986, Thorn4 found that in almost one half of cases the assaulting person was the husband, who, in our report, was responsible in 67% of the cases where the assaulting individual was known to the victim, or 58% of the total. In other words, close family ties seem to extend to the use of force by blood-related relatives. That force is usually exerted with fists, resulting in fracture of the mandibular body or angle.5,6 However, in the group where the assaulting individual was an unknown person, the assault was made with any available means, the aim was different (robbery or rape), and the results were more generalized. The most serious injuries were sustained in suicide attempts,7 which, in our series, were all associated with a love affair and were all the result of intentional falls. Violence associated with marriage or cohabitaTable 1. Maxillofaclal Injurles in Women According to Etiology No. of Cases (%) Road traffic accidents Falls Abuse by a man sports Industrial accident Miscellaneous
315 (57.7) 137 (25.2) 51 (9) 5 (0.9) 4 (0.7) 14 (6.5)
tion is a major cause of injury in women.8 It is an extreme consequence of a woman’s position in a male-dominated society’ and it is a myth that it occurs in only a small percentage of the female population. lo In fact, it has been estimated that women are battered in 5% to 19% of marriages in the United Kingdom and the United States,‘but the exact extent of the phenomenon cannot be precisely described, as only extreme cases can be verified from statistics. lo It has been estimated that only 25% of cases are reported to the authorities because a large percentage of women (49%) consider battering a personal problem and only call the police to avoid further violence. lo Violence can be behavioral (ie, deprivation of sleep, food, money, and contact with friends or relatives, isolation at home for a period of time),’ psychological (ie, humiliation, degradation, threats),” or physical (ie, fists, kicks, knocking of the head against the wall, pushing over the stairs, breaking of bones, attempts at strangulation).’ Psychological violence usually precedes physical violence. lo A particular form of physical abuse (with very serious psychological implications) is sexual abuse. In fact, a substantially higher rate of sexual abuse was found in patients who had been directly asked about sexual molestation (70%) than in a random sample (6%).” It also has been found’* that 51% of 105 female state hospital patients had been sexually abused as children or adolescents and that 66% of the abused met the diagnostic criteria for posttraumatic stress disorder. Psychiatric treatment almost always follows, rather than precedes, battering.* In neurological clinics, however, women are treated as if they themselves were sick.’ On the other hand, a woman’s admission to a psychiatric institution may be considered as a cause for divorce.’ Traumatic injuries caused by violence, which can be quite serious, are often repeated.**” Patients are frequently reluctant or too frightened to reveal the true cause of their injury.’ A patient’s childhood often includes similar situations.9’13 The prevailing feelings on the part of the abused usually are fear, insecurity, shame, desperation, and anger. They believe that they are not liked and feel guilty that they cannot function properly in their roles as wives and mothers and that they have failed in these roles. They believe they are responsible for what is happening to them and are embarrassed, as they believe that such situations only occur with them.’ They cannot help thinking that next time it could be worse’ and may also be afraid for their children’s future. Initially, women try to avoid what may be considered as pretext, or an opportunity, by their hus-
1252 bands or boyfriends for an attack.’ However, they gradually fail to react and feel helpless, passively accepting the situation; this worsens the vicious cycle, as an even greater dependence of their husband or boyfriend is established9~*0 and episodes of domestic violence tend to increase in both frequency and severity.14 Self-esteem is reduced, the women become nervous, and their behavior is often offensive, they suffer from insomnia and melancholia, and may suddenly break into tears. They hate their husband or boyfriend and think of taking revenge, although they seldom do so. They may also try to justify the man’s behavior, attributing it to the difficulties of life and they occasionally hope that he may change. The situation does not change until the man assumes the responsibility for what is happening. Women usually choose to stay with their husbands for their children’s sake and because of economic dependence. lo A woman’s attempt at selfdefense may occasionally lead to her death.” Mental health is of crucial importance in a woman’s ability to break away from an abusive male.13 The causes of male-inflicted violence include psychological and cultural factors, psychopathic personality, jealousy, family background, and social deprivation (although this behavior is not restricted to the lower social echelons and is documented throughout the social spectrum*), financial problems, unemployment, overcrowded conditions, use of alcohol or drugs, and destructive attitudes.8*‘0*‘4 It should be mentioned that alcoholics may also batter their wives when they are not under the influence of alcohol. lo Religious faith is not of paramount importance, as there have been priests who batter their wives.” Wife abuse may be one of the most significant precipitants of female suicide.” Indeed, in primitive societies, if a woman’s support group does not defend her when she is the victim of violence that passes the bounds of normative behavior, her suicide may be revenge suicide, intended to force others to take revenge on the abusive husband.15 According to Shepherd et al,8 violence within marriage initially occurs after the man’s 40th birthday. They also mention that a great percentage of husbands who battered their wives also had been exposed themselves to violence as children. The same men may also be violent towards their children or may have normal relations with them.’ In a study performed by Bergman et al, i9 two thirds of 49 women alcoholics had been battered; the women in these groups were also similar in that many of them had experienced violence in their own childhood environment and in that they had cohabited with more men than had women in the control group.
FACIAL TRAUMA IN WOMEN FROM VIOLENCE
BY MEN
Early recognition of the patient who has been the victim of physical abuse by a familiar person can be difficult and is often obscured because of embarassment or frank reluctance to discuss the circumstances leading to the injuries.14 The reluctance of patients to discuss the true cause of injuries is owing not only to shame but to a real fear of further assault. l4 Police, and authorities in general, do not easily intervene, as they consider such situations family affairs. They underestimate the dangers and give advice. They usually consider a crime something that happens in the streets or in a public place. In hospitals, such cases are often not recorded for reasons of discretion.’ Besides, they often cannot be proved as they derive from the patient’s history. In Greece, the law does not obligate the physician to report such cases to the authorities, as the patient’s problem is considered very personal and something that should be kept confidential by the doctor. Besides, adult patients are considered able to report the events to the authorities themselves, if they so choose. The same does not apply to cases of battered children, as they usually cannot report it to the police themselves. As the oral and maxillofacial surgeon may be the first and, occasionally, the only person to come in contact with such victims, it is important to understand the possible causes, to discuss the social background, and to know when to offer help and where this help can be found. The violent husband or boyfriend only rarely presents for help or counseling, ‘,I4 although he needs it as much as the victim because he usually has low self-esteem and feels insecure about his role in society.” Factors helpful in identifying the victim are the history, which may be incompatible with the injuries sustained, a significant delay between the injury occurring and the subsequent presentation for advice or treatment, and a history or clinical evidence of previous similar injuries. l4 References 1. Laskin D: Looking out for the battered woman. .I Oral Surg 39:1981 2. Zachariades N, Papavassihou D, Vairaktaris E: Fractures of the facial skeleton. Greek Iatrika Chronica 12:783, 1989 3. Afrelius L, Rosen C: Facial fractures: A review of 368 cases. Int J Oral Surg 9:25, 1980 4. Thorn J, Mogeltoft M, Hansen P: Incidence and aetiological pattern of jaw fractures in Greenland. Int J Oral Surg 15:372, 1986 5. Brook I, Wood N: Aetiology and incidence of facial fractures in adults. J Oral Surg 12:293, 1983 6. Busuito M, Smith D, Robson M: Mandibular fractures in an urban trauma center. J Trauma 26:826, 1986
ZACHARIADES
ET AL
7. Katz K, Gotten N, Goldberg 1, et al: Injuries in attempted 8.
9. 10. 11.
12.
suicide by jumping from a height. Injury 19:371, 1988 Shepherd J, Gayford J, Leslie J, et al: Female victims of assault: A study of hospital attenders. J Craniomaxillofac Surg 16:233, 1988 Triantafyllidou J: Battered women. A current approach. Sot Work 1:243, 1986 Mouzakitis C: Marital violence. Etiology, sequelae, intervention. Sot Work 16:217, 1989 Briere J, Zaidi LY: Sexual abuse histories and sequelae in female psychiatric emergency room patients. Am J Psychiatry 146:X02, 1989 Craine LS. Henson CE, Colliver JA, et al: Prevalence of a
1253
history of sexual abuse among female psychiatric patients in a state hospital system. Hosp Community Psychiatry 39:300, 1988 13. Bergman B, Larsson G, B&mar B, et al: Battered wives and female alcoholics: A comparative social and psychiatric study. J Adv Nurs 14:727, 1989 14. Bailey BMW, Berm&ham DF, Shepherd RG: A comparative study of psychological data on patients with maxillofacial injuries in an urban population-A preliminary report. Br J Oral Maxillofac Surg 26:199, 1988 15. Counts DA: Female suicide and wife abuse: A cross-cultural perspective. Suicide Life Threat Behav 17:194, 1987
