Vague physical symptoms or symptoms that don’t make sense are red flags for possible abuse, as are chronic pain symptoms (especially headaches), or unexplained worsening of chronic illness. New sexually transmitted infections, an unplanned pregnancy, or a request for emergency contraception open a window to ask about abuse.
Suspicious injuries may result from abuse. Slap marks, scratches, bruises, welts, cuts, or muscle sprains are typical signs in adolescents, but most common are soft tissue injuries of the forearms (held up to defend against blows), face, head, and neck, Dr. Stein said.
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Dr. Harise Stein
The prevalence of being choked to unconsciousness is "very underappreciated by health care workers" because half the time choking leaves no immediate external signs on the neck, she said. The teenager may wake up on the floor and not remember what happened. Only 10 seconds of strangulation can induce unconsciousness, and every second after that causes brain damage. Laryngeal edema over the following 24-48 hours can create airway emergencies. Brain cell death from the choking may cause problems in memory, reasoning, and concentration for several weeks. At least 10% of adult abused women who obtain restraining orders are estimated to have been choked to unconsciousness. Data are lacking for teens.
Teens in abusive relationships are four to six times more likely to get pregnant than are other teens, and 25% of pregnant teens are in abusive relationships, compared with 4%-8% of pregnant adults, Dr. Stein said.
The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists (ACOG) recommend screening for dating abuse (Pediatrics 2009;124:393-402; Obstet. Gynecol. 2012;119:412-7) – perhaps starting as early at age 11, according to AAP’s Bright Futures – and educating preteens and teens about healthy relationships, she said.
Remember a key lesson from Adolescence 101: Teens are more likely to open up if you start with open-ended questions like "How’s school?" instead of pointed questions, or if you approach the topic obliquely by bringing up bullying as something a lot of people are talking about, and use that as a lead-in to talking about relationships. Focus on behaviors, not "abuse," Dr. Stein said.