1 Abuse and Violence (escalante-saac)

ABUSE AND VIOLENCE

*Spouse assault
*Physical and sexual assaults in children
*Sibling assault
*Physical and sexual assaults of other
relatives who reside in the household

I. FAMILY VIOLENCE: All violent behavior that occur w/in household w/c include:

A. Clinical picture of abuse and violence:

*They may have physical injuries needing medical attention
*Psychological injuries like signs of being upset, agitated, w/drawn, aloof, oblivious to surroundings
*Survivors supress their resentment and anger and dont tell anyone especially in cases of childhood sexual abuse
*Domestic violence remains undisclose for mos or even yrs because of fear
B. As adults they usually feel guilt or shame for not trying to stop the abuse
*Survivors feel degraded, humiliated, and dehumanized
*Self esteem is low, and view themselves unlovable
*They have the feeling of being unacceptable to others, contaminated and ruined
*They have problems relating to others and trusting others
*Their emotional reactions are erratic, intense and perceived as unpredictable
C. Roles of the nurse
*Sensitive to the needs of the client, safety, security and in control of his/her own body.
*Nurses should take care to maintain the clients anxiety lvl, and always ask permission before touching her/him for any
reason, & this should be applied in all setting in a mental health setting.
II. TYPES OF ABUSE
1. Physical

Pushing, hitting, throwing or any action that would result to physical injury

2. Psychological

Verbal degrading

3. Sexual

Wife, child, friend, family member, stranger

4. Neglect

Medical or needs especially in children and elderly

Common abused persons: Wives, children, elderly, rarely husbands

III. CHARACTERISTICS OF VIOLENT FAMILIES

Family violence

Encompasses spouse battering, neglect, physical, emotional, or sexual abuse in children,

elderly abuse and marital rape.

*In many cases, family tolerate abusive and violent behavior form relatives
*The home w/c is suppose to be the place where love and safety is observe and practice becomes the most dangerous place for
survivors of abuse and violence.
1. Social isolation

They keep to themselves and usually they dont invite others in to the home or tell whats
happening in the family.

2. Abuse power of control

The abusive family member always hold position in a power, and control over a victim,
including social and economic control

3. Alcohol and other drug abuse

Substance abuse, especially alcoholism has been associated w/ family violence but
alcohol doesnt cause the person to be violent, but it is the abuser that is likely to use
alcohol or drugs.

4. Integrational transmission process

Shows that the patterns of violence are perpetuated form one generation to another
through the role modeling and social learning

IV. PREDISPOSING FACTORS THAT CONTRIBUTE TO THE PATTERNS OF ABUSE

1. BIOLOGIC THEORIES
A. Neurophysiological influences

Alteration in the limbic system of the brain may have an influence on aggressive
behavior in some individuals

B. Biochemical influences

Various neurotransmitters ex. Epinephrine, norepinephrine, dopamine, serotonin,

acetylcholine; may play a role in the facilitation and inhibition in aggressive impulses

C. Genetic influences

Some studies have implicated heredity as a component in the predisposition to

aggressive behavior but evidences are still inconclusive

D. Brain d/os

Various d/o of the brain including tumors, trauma, and certain diseases have been
implicated to aggressive behavior

2. PSYCHOLOGICAL THEORIES
A.They hypothesized that aggression and violence are the overt expressions of powerlessness and low self esteem, when childs
needs for satisfaction during childhood were unmet.
B. LEARNING THEORY- postulates that aggressive and violent behavior are learned from influential role models. Individuals who
were abused as children or whose parents disciplined w/ physical punishments are more likely to behave in violent manner as adults.
3. SOCIOCULTURAL THEORIES
A. Societal influences

Believe that aggressive behavior is primarily a product of ones culture and social
structure
-Societal influences may contribute to violence when individuals come to realize that
their needs and desire cant be met through conventional means, and they resort to
delinquent behaviors in an effort to obtain and desired needs

V. SPOUSE OR PARTNER ABUSE

Is the mistreatment or misuse of one person by another in the context of an intimate

relationship
Abuse can be physical, psychological, sexual, or combination.

Namecalling, bellitling, screaming, yelling,

destroying property, making threats,
refusing to speak, or ignoring the
victims/survivor

Psychological abuse includes:

Pushing to choking

Physcial abuse ranges from _ and may result to physical injuries that need medical
treatment or homecide.

Battering during pregnancy may result to miscarriage or stillbirths.

-Domestic violence may also occur in same sex relationship w/ same statistical frequency in heterosexual relationship.

2 Abuse and Violence (escalante-saac)

A. CLINICAL PICTURE
1. Abusive husband

Often believes his wife belongs to him(like property) and becomes increasingly violent
and abusive if she shows any signs of independence such as getting a job or threatening
to leave.
He is emotionally immature, needy, irrational, jealous and possessive
He may even be jealous of his wifes attention to their own children or may beat
both his children and wife

Inadequacy and low self esteem

The abuser has strong feeling s of _, as well as poor problem solving and social
skills.

2. Abused wives
Dependency
Personal and financial dependency

Is the most trait that could describe an abused wife

are reasons why theres difficulty leaving the abusive husband

Abused wives

She perceives herself as unable to function w/out her husband eventhough shes
talented and capable to do something productive

Abused wives

She too often suffers low self esteem and remain loyal to her marriage and make
it work
-They fear their abuser will kill them if theyre goin to leave

B. CYCLE OF ABUSE AND VIOLENCE

1. Initially there is the battering or violence
2. Followed by a period of the abuser expressing regret, apologizing, and promising it will never happen again
-He professes his love for his wife and may even engage in a romantic behavior(like buying gifts/flowers). This is called the period of
contrition or called honeymoon period.
-This may last for wks./mos, causing the woman to believe that the relationship has improved.
-Woman wants to believe her husband and thinking that the violence was an isolated incident.
3. After the honeymoon period, the tension-phase begins, where there may be arguments, stony silence, or complaints from
the husband.
-The tension ends in another violent episode, after w/c the abuser feels regret and remorse and promises to change.
-The cycle continually repeats itself. The abused keeps on hoping that the violence will stop,
-Overtime, the violence may become a routine, several times a wk or becomes daily.
C. ASSESSMENT
1. Signs of physical abuses:
*Bruises over various areas of the body, bite marks, burns, scars, lacerations, bleeding, bald spots
*In children, signs of regressive behavior like: enuresis, thumbsucking, extreme anxiety and mistrust of others
2. Signs of neglect of a child:
*Soiled clothing that doesnt fit and maybe inappropriate for the weather
*Poor hygiene
*Always hungry w/ signs of malnourish
*Tired and weak
*Unattended medical probs
*Isolation, unsatisfactory peer relationship
*Poor school performance and absenteeism
*Cigarette marks or may have stocking or glove distribution, indicating scalding skull fracture
Warning signs of abused/neglected children:
*Signs of serious injuries such as skull fractures, burns, lacerations
*Delay in seeking medical attention for significant injuury
*Inconsistent information regarding cause of injury from parent
*Inconsistent or changes in childs history
*Unusual injuries for the childs age
*High incidence of UTI, bruised, swollen genitals, lacerations in rectum/vagina
*Evidence of old injuries/scars
3. SIGNS OF SEXUAL ABUSE:
*Frequent UTI
*Difficulty or pain in walking
*Rashes or itching in the genital area
*Seductive behavior: Compulsive masturbation, precocious sex play, excessive anxiety adn mistrust of others, sexually abusing
another child
4. Signs of sexual abuse of an adult
*Contussion and abrasions in various part of the body
*Headache, fatigue, sleep disturbance
*Stomachaches, N/V
*Unusual vaginal discharge, itching, burning upon urination, rectal bleeding and pain
* Humiliation, embarassment, desire for revenge, self-blame
*Overwhelming sign of helplessness, rage
D. TREATMENT AND INTERVENTIONS:
1. If abused file a complaint against the abuser, there would be investigations that would be made by authorities like the police, a
social worker
2. Abuse wife can request for restraining order from the court, but restraining orders proviede only limited protection
-Before restraining order have ended, the abused may have been killed already.
3. Battered women can be housed in shelters who can temporarily provide security, and foods if she decided to leave the abusive
husband.
4. Individual psychotherapy or counseling or group therapy or support and self-help grp can help abused women deal w/ their trauma
and begin to build new, healthier relationships.
Battering may also result in PTSD.
E. TREATMENT FOR CHILD ABUSE/NEGLECT:
1. Ensure childs safety and well-being, removing the child from the home
2. There should be trust that would build up between the therapist and the child to help deal w/ trauma of abuse.
3. Long treatment for the child usually involves a psychiatrist, social worker, and psychologist.
4. The child may ask to do play therapy where he/she can act situations regarding his/ her traumatic experience through a doll or
puppets
5. Family therapy is indicated if returning the child to the family is feasible, and the social worker will be the one to decide.
VI. Elder abuse

Maltreatment of older adults by family members or caregivers. Most are 75 y.o.

*Physical

A. TYPES OF ELDER ABUSE

3 Abuse and Violence (escalante-saac)

*Sexual
*Psychological
*Neglect/self-neglect
*Final exploitation
*Denial of medical treatment
B. WHEN DOES ELDER ABUSE MOST LIKELY TO HAPPEN
*When elder has chronic mental and physical health probs
*When is dependent on others for food, medical care, and various ADLS
*When one older spouse is taking care of another
C. REASONS WHY ABUSED ELDERS ARE RELUCTANT TO REPORT OF THEIR CONDITION:
1. The abusive is a family member whom the elder wishes to protection
2. Elders often fear of losing their support or afraid to be moved to an institution
*May have bruises or fractures
*Lack eyeglasses or hearing aids
* Maybe Restrained in bed
*May be denied of foods, water, or meds
*Looks untidy, w/ poor hygiene and may
have sores on the skin and other parts of
the body

D. CLINICAL PICTURE OF ELDER ABUSED

E. ASSESSMENT
*The nurse suspect if injuries are have been hidden or untreated or are incompatible w/ the info provided
*Possible indications of self neglect: inability to manage money, inability to perform activity of daily living, and changes in intellectual
function like confusion, disorientation, inappropriate responses
*The nurse may detect possible indicators of abuse from a caregiver if caregiver complaint about difficulty in caring for the elder
client (Feeding, incontinence, excessive cost of meds)
F. TREATMENT AND INTERVENTIONS:
1. Relieve the caregiver from stress by providing additional resources/ looking for another caregiver who could rotate in caring for the
elder client.
2. The caregiver should be given access to the clients financial resources
VII. RAPE AND SEXUAL ASSAULT
A. Rape

Crime of violence and humiliation of the victim expressed through sexual means
-It is the perpetration of an act of sexual intercourse w/ female against her will and w/o
her consent
-Also considered as rape if the woman is incapable of exercising rational judgment
because of mental deficiency or younger than the age of consent
-The crime of rape raquires only a slight penetration of the outer vulva, full erection and
ejaculation isnt necessary

B. BASED ON RESEARCH, MALE RAPIST IS CATEGORIZED INTO:

1. Sexual sadist who are aroused by te pain of their victims
2. Exploitive predators who impulsively use their victims as objects of gratification
3. Inadequate men who believe that no woman would voluntary have sexual relations w/ them who are obsessed w/ fantasies about
sexually
4. Men for whom rape is a displaced expression of anger or rage
C. POSSIBLE EFFECTS OF RAPE TO THE
SURVIVOR

1. The physical and psychological trauma that rape victims suffer is severe
2. Related med probs can include: acute injury, STS, Pregnancy

Family abuse

Any physical injury on 1 family member

Physical abuse

Infliction of pain/bodily harm to person

Sexual abuse

Any form of sexual contact/exposure w/out consent

Emotional abuse

Infliction of mental anguish ex. Threatening, humiliating, penalizing, belittling person

Subtle hostility

*Hatred to an individual
*Persistently ignoring an individual
*Consistently belittling and criticizing an individual
*Threatening individual of bad comment

Physical neglect

Failure to provide need/ protect individual for harm

Emotional neglect

Failure to attend to basic emotional needs

Educational neglect

Failure to provide child w/ experiencing including education for intellectual growth and
dvpt

Medical neglect

Failure to provide basic medical, dental/ psychiatric care of individual

Economical abuse

W/holding of financial support/illegal exploitation of hands w/ ones personal care

Family violence

Intentional intimidation abuse/ neglect of children, adult, elderly by family member,

intimate partner.

Intimate partner abuse/ spousal abuseDomestic violence

Female 6x affected more than men

Penetrators

Initiates violence