ABUSE AND VIOLENCE

(Psychiatric Nursing)

I. Definition of terms:

A. ABUSE
 Wrongful use and maltreatment of another person.
 Willful infliction of physical injury or mentally anguish and
deprivation by provider or essential services, may in value omission
or commission.

B. VIOLENCE
 Physical force exerted for purpose of violating or damaging.
 Unjust exercise of power often resulting in physical injury.

C. OFFENDER OR PERPETRATOR
 Person who inflicts violence or abuse in another person.

D. VICTIM
 Person who is scapegoat, target, recipient of abuse or violence.

II. TYPES

A. PHYSICAL
1. poking, beating, hitting, shooting, cutting, burning, scolding, raping.
2. with holding personal care, neglecting basic needs for:
• Food, water, warmth, cleanliness
• Health care including preventive care
• Social contact
• Education and supervision for children

B. PSYCHOLOGICAL
1. verbal assault and threats of physical harm, usually to intimidate &
manipulate.
2. sarcasm, humiliation, devaluing, criticism
3. disturbed, inconsistent communication patterns including withdrawal
and silence
emotional deprivation and withholding of affection.
4. exposure to parental alcoholism, drug use and prostitution.
C. MATERIAL
1. Theft of money or property.
2. Misuse of money or property.

D. SOCIAL
1. violation of personal right ( families, friends, social activities )
2. isolation of victim.

E. SEXUAL
1. pressured or force sexual activity ( by person or with an object )
 Sexually stimulating talk or actions
 Inappropriate touches or intercourse ( acts of molestation: rubbing,
fondling, exposure of genitals, oral-genital-anal acts )
 Rape
2. Incest: sexual behavior between blood & relatives
3. Exploitation: promoting or selling pornography, usually involving
coercion of minors to participate in obscene acts.

III. CAUSATIVE THEORIES

A. No single cause, multiple factors interact in any situation of family

violence or abuse.
B. Neubiologic theory
1. Humans possess natural instinct for fighting
2. Limbic-system and neurotransmitter irregularities precipitate
violence.
( serotonin exhibits inhibitory control over aggression, losing temper,
explore range )
Limbic system -- emotional aspect of the brain.

C. FAMILY THEORY
1. family system theory
 violence is the outward manifestation of tension produced
in an undifferentiated family system intergenerational
process through role modeling and social learning.
 Structural family theory - violence occurs in a
dysfunctional families with problems.
 D. BEHAVIORAL THEORY
 Violence is lessened and becomes reinforced by the
environment.

E. PSYCHODYNAMIC THEORY
 Family violence linked to personal histories and conflicts

F. SOCIAL LEARNING THEORY

IV. FAMILY VIOLENCE

 Encompasses physical, emotional and sexual abuse and
neglect of client / children, spouse, battering, marital rape
and elder abuse.

A. SPOUSE OR PARTNER
 Mistreatment or misuse of one person or another in the context
of an intimate relationship.

1. General characteristics of an Abuser and Victim

Characteristics Abuser Victim
A. Behavioral  Former victim of  Lack of
abuse relationship with
 Socially isolated family / friends
 History of drug  Financially
or alcohol dependent on
 Poor impulse abuser
control  Socially isolated
 Fear of abuser yet
attempts to
 Involves in crisis conceal it from
situation others
 Efforts to please
abuse / prevent
from getting
angry
B. Affective  Extremely  Depressed /
jealous and anxious
possessive  Feelings of guilt
  Feels superior or self blame
and in control  Helplessness /
using violence fear of reciprocal

C. Cognitive  Perfectionist  low self-esteem

standards for
family members  worthlessness
 rigid obsessive  tendency to
regarding excuse abuses
retaining control behavior
 Inflexible with  hope that abuse
poor problems will stop
skills  view spouse as
 narcissistic male dominant

2. Other characteristics
a. Spouse abuse may also refer to battered husband
b. It is largely ignored because of men’s embarrassment in reporting
abusive
incidents.
c. The battered man is very cautious of his power or he may be ill,
feeble, old
passive on the woman and self- blaming.
d. men stay in violent marriages due to emotional and economic
dependence or
custody of children.

3. Cycles of abuse and violence

2
Violent behavior
1 3
Tension building Period of
remorse or
Contrition

a. Tension building
 complaints
 silent treatment
  argument
 blaming
 accusation
 verbal attacks
b. Violent behavior
 abuser relieve tension
 victim escalates tension
 physical injury and abuse

c. period of remorse and contrition “honeymoon period “

 asking of forgiveness of abuser
 promising “ sorry it will not happen again “

4. Treatment and Intervention

a. restraining order
b. referrals to appropriate health care professionals
c. ask for SAFE questions
S - Stress / Safety
A - Afraid / Abused
F - Friends / Family
E - Emergency Plan

5. DO’s AND DON’T’s

DO’s DON’T’s
1. Disclose client’s 1. Ensure and maintain client’s
information without confidentiality / privacy
his/her consent 2. Listen, affirm and say “ I am
2. Preach, moralize or imply sorry you have been hurt”
doubt about the client’ 3. express “ I am concerned for
3. Minimize the impact your safety”
about the violence 4. Tell the victims “ You have the
4. express outrage with the right to be safe and respected”
perpetrator 5. Say “ The abuse is not your
5. Imply the client is fault”
responsible for the abuse 6. Recommend couples
6. Recommend couple counseling support group
counseling 7. \identify community resources
7. Direct the client to leave and encourage to develop
the relationship safety plan
 8. Take charge 7 do 8. Offer to help contact, a shelter,
everything for the client police or other resources.
B. Child Abuse and Maltreatment
 Intentional injury of a child.

1. Two (2) types of a Child Abuse and it’s Physical & Behavioral
Indicators

TYPES PHYSICAL INDICATORS BEHAVIORAL

INDICATORS
1. Physical Abuse 1.Unexplained bruise  wary of adult
-- results of severe • on face, lips, & mouth, torso, contact
unreasonable & back buttocks, thighs  apprehensive
unjustifiable • In various stage of healing: when other
corporal --Red to blue – 24 hours children cry
punishment or --Purple to dark blue – 4 day  Behavioral
intentional assault --Green to yellow green – extreme
5 – 7 days Aggressions
--Yellow to brown – 7-10day or withdrawal
--Disappearance 1-3 weeks  Frightened of
• Clustered forming regular parents
patterns reflecting shape of  Afraid to go
article used inflict (cord/belt) home
• Regularly appear after absence,  Reports injury
weekend or vacation by parents
2. Unexplained burns
• Cigarette burns on soles, palm,
back buttock
• Immersion burns; ( sack- like,
glove like, doughnut shaped on
buttock or genetalia)
• Pattern3ed like electric burner,
iron etc..
• Rape burn on arms, legs, neck or
torso
3. Unexplained Fractures:
• To skull, nose, facial structure on
various stage of healing
• Multiple or spiral fractures

4. Unexplained laceration or abrasion

• To mouth, lips, gums, eyes,
external genetalia
2. Physical Neglect • Consistent • Begging, stealing
--- malicious or hunger, poor food
ignorant withholding of hygiene, • Extended stays
physical, emotional or inappropriate of school( early
educational necessities dress arrivals & late
for child’s well being • Consistent lack departures)
of supervision in • Frequent
dangerous unexplained
activities for absences from
long periods of school or work
time • Constant fatigue,
• Unattended restlessness or
physical medical falling asleep in
problems or class
needs • Non-participants
• abandonment on activities
• Alcohol / drug
abuse
• Delinquency
( theft)
• States there is no
caretaker
3. Sexual Abuse • Difficulties in
-- Involves sexual acts walking
performed by an adult
on child younger 18
years old
4. Emotional • Speech disorders • Habit disorders
maltreatment • in physical ( sucking, ,
-- Involves verbal development rocking
assault & emotional • Failure to thrive • Conduct
deprivation after disorders
accompanied by ( anti social )
physical or sexual • Developmental
abuse. lap(mental/emoti
 onal)
• Attempted
suicide

Republic Act 7610

 Anti-child abuse law
 Report to DSWD, brgy, officials, police within 48 hours

2. Parents who abuse their children

3. Treatment and Intervention

C. Elder Abuse

Physical Psychological Financial Neglect Indicators Warning

Abuse or emotional abuse Indicators of self- indicators
Indicators abuse indicators neglect from
indicators caregiver
- Frequent - Helplessnes - Unusual or - Dirt, fecal -Inability -Elder is not
unexplained -hesitance to inappropriate or urine to manage given
injuries talk openly activity in smell personal opportunity
- Reluctance - Anger or bank - rashes, finances to speak for
to seek agitation accounts sores or -Inability self
medical - Withdrawal - signature lice on the to manage - Attitude of
treatment or depression on checks elder activities indifferences
Disorientatio that differ - elder has -Wanderin -Blaming the
n or from the untreated g elder of his
grogginess elderly medical -Failure to illness
indicating - recent conditione keep Conflicting
misuse of changes in d needed accounts of
medications will - -Confusio elder’s
- Fear or - Missing Inadequate n, memory abilities,
edginess in valuable clothing loss problems &
the presence belongings - Lack of so forth
of family - lack of toilet -Previous
member amenities facilities history of
- unusual abuse or
 concern by problems
the caregiver with alcohol
or drugs

RAPE

R.A. 8353
 Insertion of penis into the mouth, vagina, anus of a victim
considered as an act of hostility, anger and violence.

ELEMENT:
 Use of threat or force
 Lack of consent from victim
 Actual penetration to vagina

STATUTORY RAPE
 Minor female, older male
 Date rape --- acquaintance rape
 Male rape --- between two persons, G to G etc..
 Sodomy --- fellatio and anal sex

4 Categories of male rapist

1. sexual sadist
2. exploitative predators
3. inadequate men
4. men who considers rape as a displaced expression of anger and large
displacement of anger

R - rape
T - trauma
S - syndrome

Phases of RTS
1. Acute
 Shock, disbelief & numbness
2. Denial
 Refuses to talk about the event
3. Heightened anxiety
 Fear, tension, nightmares,
 Rape victims vulnerable to PTSD
4. Reorganization
 Normalizes, go on ADL, open