It's not rage, alcohol or stress that causes one partner to lash out against another, said Delores Abney, training coordinator for the Alabama Coalition Against Domestic Violence.

"The true cause of domestic violence is power and control," she said.

Abney spoke at April's meeting of Crenshaw County's Domestic Violence Task Force. Her topic was aimed at helping healthcare personnel understand what actions are necessary when dealing with potential abuse victims. She cited several specific controlling behaviors that typify domestic violence, the majority of which does not involve physical assault of the victim. Abusers can intimidate through gestures or stares, emotionally abuse the victim by calling her names, or use coercion by threatening violence against her, her children or even the family pet.

Abney was a first hand witness to domestic violence, not only from her ex-husband but also when her sister became caught in an abusive cycle from her spouse. Her sister was abused and her partner also threatened to sexually assault her child.

"He said he'd rape and kill the child, which was under five years old at the time," Abney said.

On the outside looking in, Abney said it's easy for people to pass judgment on a woman victimized by her husband or boyfriend.

"People say, 'why doesn't she just leave him?' But it's much more difficult than that," said Abney. "Fear of the abuser and fear in general are big barriers to leaving. Also financial problems may play a role, as well as the shame of having to face family and friends. And believe it or not, these women may still have feelings toward their abuser."

Husbands can be abused as well as wives, said Abney, but national statistics indicate that women are the ones most likely to suffer in domestic violence cases. Annually, approximately 1.5 million women are raped or physically assaulted by an intimate partner. At least 37 percent who sought care in an emergency department for violence related injuries were injured by a current or former boyfriend or spouse, one of the reasons medical personnel should be aware of the signs of domestic abuse, said Abney.

"Women have repeated contacts with the healthcare community," she said. "Those encounters put healthcare providers in a unique position."

Abney said healthcare professionals should universally screen all female patients 19 and over for signs or abuse. Victims of abuse are not all alike and cannot be screened by grouped in a specific age category, race, socioeconomic status or sexual orientation, she said.

Abney said privacy is the most important issue when screening a potential abuse patient.

"If privacy is not allowed a victim will cannot speak freely about the abuse," she said.

Abney illustrated a number of different questions a screener can ask a patient, some straightforward and others indirect, including, "Sometimes the people we care about hurt us. Has that happened to you?", or "Are you ever afraid? If so, what makes you afraid?"

Abney said healthcare professionals have a responsibility to help victims of domestic violence.

"Just the fact that you care and want to help may be enough to give someone the courage to speak out against her abuser," she said.