ABUSE AND VIOLENCE

I CLINICAL PICTURE OF ABUSE AND VIOLENCE

Victims of abuse or violence certainly can have physical injuries needing medical
attention, but also experience psychological injuries
Reactions of clients:
o Agitated
o Upset
o Withdrawn
o Aloof
o Appearing numb or oblivious to surroundings
Often domestic violence remained undisclosed for months and years because of fear to
their abusers
Victims suppress their anger and resentment and do not tell anyone, particularly for
those cases of childhood sexual abuse
Survivors of abuse often suffer in silence and continue to feel guilt and shame, for the
following:
>Children:
-particularly come to believe that somehow they are at fault and did
somehow they are at fault and did something to deserve or provoke the
abuse
-more likely to miss school and less likely to attend college and continue
to have problems through adolescence into adulthood
>Adults
-they usually feel guilt or shame for trying to stop the abuse
-feel degraded
-humiliated
-dehumanized
-self esteem is low
-they view themselves as unlovable
-believe that they are unacceptable to others
-contaminated or ruined

Victims and survivors of abuse may have problems relating to others and these are:
o They find trusting others, especially figures to be difficult
o In relationships, their emotional reactions are likely to be erratic, intense and
perceived as unpredictable
Nurses should be particularly sensitive to abused clients need to feel safe, secure and in
control of his body.
They should take care to maintain the clients personal space, assess the clients anxiety
level and ask permission before touching them for any reason

II. CHARACTERISTICS OF VIOLENT FAMILIES
Family violence encompasses the following:
o Spouse battering
o Neglect and physical, emotional, or sexual abuse of children
o Elder abuse
o Marital rape
Research studies have identified some common characteristics of violent families
regardless of the type of abuse that exists.
a. Social Isolation members of these families keep to themselves and usually do not
invite others in their home
b. Abuse of Power and Control the abusive family member almost always holds a
position of power and control over the victim
- The abuser does not only exert physical power but also economic and social
control
- The abuser is often the only family member who makes decisions, spends
money, or spends outside the home with other people
- The abuser belittles and blames the victim, often by using threats and
emotional manipulation.
c. Alcohol and Other Drug Abuse
-it has been associated with family violence
-alcohol does not cause the person to be abusive; rather, an abusive person also
is likely to use alcohol or any other drugs.
-Fifty percent (90%) of men who batter their domestic partners have a history of
substance abuse; up to 50% of women who have been abused seek refuge in
alcohol
-alcohol is also cited as a factor in acquaintance or death rape
d. Intergenerational Transmission Process
-this shows that patterns of violence are perpetuated from one generation to the
next through role modeling and social learning
-women who grew up in violent homes are 50% more likely to expect or accept
violence in their own relationship

III. SPOUSE OR PARTNER ABUSE

It is the mistreatment or misuse of one person by another in the context of an intimate
relationship.
The abuse can be emotional or psychological, physical, sexual, or a combination
It is a behavior that may be the result of a number of different factors; studies show that
abusers are often motivated by feelings of powerlessness and insecurity
Spouse abuse inflates the ego and provides a false sense of control; it may be the result
of a misguided sense of love that results unhealthy possessiveness or jealousy

2 kinds of Spouse Abuse
a. PSYCHOLOGICAL ABUSE (EMOTIONAL ABUSE)
-includes name calling
-belittling
-screaming
-yelling
-destroying property
-making threats as well as subtler forms such as refusing to speak to or ignoring the
victim

b. PHYSICAL ABUSE
-ranges from shoving and pushing to severe battering
-choking and may involve broken limbs and ribs
-internal bleeding
-brain damage
-homicide
-assaults during sexual relations such as:
-biting nipples, pulling hair, slapping and hitting, and rape

90% to 95% of domestic violence victims are women, and estimates are that one in
three women in the United States has been beaten by a spouse at least once

CLINICAL PICTURE:
-an abusive husband often believes his wife belongs to him and becomes increasingly
violent and abusive if she shows any sign if independence, such as getting a job or threatening
to leave
-Dependency is the trait most commonly found in abused wives who stay with their
husbands
-Women often cite personal and financial dependency as reasons why they find leaving
an abusive relationship extremely difficult

IV. CYCLE OF ABUSE AND VIOLENCE

The cycle of violence and abuse is another reason often cited for why women have
difficulty leaving abusive relationships
Typical pattern exists:
-usually, the initial episode of battering or violence is followed by a period of the abuser
expressing regret;
-apologizing, and promising it will never happen again.
-professes his love for his wife and may even engage in romantic behavior; this period of
contrition is called honeymoon period
-the woman naturally wants to believe her husband and hopes the violence was as
isolated incident.
-after this honeymoon period, the tension-building phase begins; there may be
arguments, stony silence, or complaints from husband
-the tension ends in another violent episode after which the abuser once again feels
regret and remorse and promises to change.
-initially, the honeymoon period may last weeks or even months causing the woman to
believe the relationship has improved.
-over time, however, the violent episodes are more frequent, the period of remorse
disappears altogether, and the level of injury worsens
ASSESSMENT

Identifying abused women who need assistance is a top priority of the Department of
Health and Human Services
Many hospitals, clinics, and doctors offices ask women about safety issues as part of
health histories or intake interviews

V. CHILD/ELDERLY ABUSE

Child abuse or maltreatment generally is defined as the intentional injury of a child.
Can cause physical abuse or injuries, neglect or failure to prevent harm, failure to
provide adequate physical or emotional care or supervision, abandonment, sexual
assault or intrusion, and overt torture or maiming

TYPES OF CHILD ABUSE

A. PHYSICAL ABUSE
-results from unreasonably severe corporal punishment or unjustifiable punishment
such as:
-hitting an infant for crying or soiling his or her diapers
-burning
-biting
-cutting
-poking
-twisting limbs
-scalding with hot water
-the victim often has evidenced of old injuries (e.g., scars, untreated fractures, multiple
bruises of various ages

B. SEXUAL ABUSE
-involves sexual acts performed by an adult on a child younger than 18 years of age,
examples are:
-incest
-rape
-Sodomy-performed directly by the person or with an object
-oral genital contact
-acts of molestations such as: rubbing, fondling or exposing the adults genitals
-a second type of sexual abuse involves:
-exploitation, such as making, promoting, or selling pornography involving minor,
and coercion of minors to participate in obscene acts

C. NEGLECT
-malicious or ignorant withholding of physical, emotional, or educational necessities
-it is the most prevalent type of maltreatment and includes refusal to seek health care,
examples are:
-abandonment
-inadequate supervision
-reckless disregard for the childs safety
-punitive
-exploitive
-abusive emotional treatment
-spousal abuse in the childs presence
-failing to enroll the child in school

D. PSYCHOLOGICAL ABUSE
-includes verbal assaults such as:
-blaming
-screaming
-name-calling and using sarcasm
-fighting
-yelling
-low self esteem
-sleep disorders
-withholding of affection

WARNING SIGNS OF ABUSES/NEGLECTED CHILDREN

a. Serious injuries such as fractures, burns, or lacerations, with no reported history of
trauma
b. Delay in seeking treatment for a significant injury
c. Child or parent gives a history inconsistent with severity of injury, such as baby with
contrecoup injuries to the brain that the parents claim happened when the infant
rolled off the sofa
d. Inconsistencies of changes in the childs history during the evaluation by either the
child or the adult
e. Unusual injuries for the childs age and level of development, such as a fractured
femur on a 2 month old or a dislocated shoulder in a 2 year old
f. High incidence of urinary tract infections; bruised, red or swollen genitalia; tears of
bruising of rectum or vagina
g. Evidence of old injuries not reported such as scars, fractures, not treated ; multiple
bruises that parent/caregiver cannot explain adequately

TREATMENT AND INTERVENTION

a. Ensure the childs safety and well-being; involves removing the child from the home
b. Thorough psychiatric evaluation is indicated
c. Long tern treatment for the child usually involves professionals from psychiatrist,
social worker, and psychologist
d. The very young child may communicate best to play therapy

VI. ELDER ABUSE

Maltreatment of older adults by family members, or caregivers
Includes physical and sexual abuse, psychological abuse, neglect, self-neglect, financial
exploitation, and denial of medical treatment

POSSIBLE INDICATIONS OF ELDERLY ABUSE

A. PHYSICAL ABUSE INDICATORS
-frequent unexplained injuries accompanied by a habit of seeking medical-assistance
from various locations
-reluctance to seek medical treatment for injuries or denial of their existence
-disorientation or grogginess indicating misuse of medications
-fear or edginess in the presence of family member or caregiver

B. PSYCHOLOGICAL OR EMOTIONAL ABUSE INDICATORS
-helplessness
-hesitance to talk openly
-anger or agitation
-withdrawal or depression

C. FINANCIAL ABUSE INDICATORS
-unusual or inappropriate activity in bank accounts
-signatures on checks that differ from the elders
-recent changes in will or power of attorney when elder is not capable of making those
decisions
-missing valuable belongings that are not jus misplaced
-lack of television, clothes, or personal items that are easily affordable
-unusual concern by the caregiver over the expense of the elders treatment when it is
not the caregivers money being spent


D. NEGLEC T INDICATORS
-dirt, fecal or urine smell, or other health hazards in the elders living environment
-rashes, sores, or lice on the elder
-elder has an untreated medical condition or is malnourished or dehydrated not related
to a known illness
-inadequate clothing

E. INDICATORS OF SELF NEGLECT
-inability to manage personal finances, such as hoarding, squandering, or giving away
money while not paying bills
-inability to manage activities of daily living, such as personal care, shopping or
housework
-wandering, refusing needed medical attention, isolation, substance use
-failure to keep needed medical appointments
-confusion, memory loss, responsiveness
-lack of toilet facilities, living quarters infested with animals or vermin

F. WARNING INDICATORS FROM CAREGIVER
-elder is not give n opportunity to speak for self, to have visitors, or to see anyone
without the presence of the caregiver
-attitudes of indifference or anger toward the elder
-blaming the elder for his or her illness or limitations
-defensiveness
-conflicting accounts of elders abilities, problems and so forth
-previous history of abuse or problems with alcohol or drugs

MANIFESTATIONS OF ELDERLY ABUSE

a. Injuries such as cuts
b. Lacerations
c. Puncture wounds
d. Bruises
e. Welts
f. Burns
g. Scalding
h. Acid
i. Caustic burns
j. Friction burns of the wrists or ankles caused from being restrained by ropes, clothings,
or chains



TREATMENT AND INTERVENTION

a. Assess for signs of abuse and neglect
b. Reports cases of abuse
c. Assess for dysfunctional family systems
d. Promote family functioning and initiate contact with resources

VII. RAPE
is a crime of violence and humiliation of the victim expressed through sexual means
perpetration of an act of sexual intercourse with a female against he will and without
her consent
woman who is raped also may be physically beaten or injured
rape can occur between stranger, acquaintances, married persons, and persons of the
same sex
DATE RAPE- may occur on the first date
Highest incidence is in girls and women 16 24 years of age
Male rape is significantly underreported crime

DYNAMICS OF RAPES

Recent research has categorized male rapists into four categories:

-sexual sadists who are aroused by the pain of their victims
-exploitive predators who impulsively use their victims as objects for gratification
-inadequate men who believe that no woman would voluntarily have sexual relations
with them and who are obsessed with fantasies about sex
-men for whom rape is a displaced expression of anger and rage

COMMON MYTHS ABOUT RAPE

A. When a woman submits to rape, she really wants it to happen
B. Women who dress provocatively are asking for trouble
C. Some women like rough sex but later call it rape
D. Once a man is aroused by a woman, he cannot stop his actions
E. Walking alone at night is an invitation for rape
F. Rape cannot happen between persons who are married
G. Rape is exciting for some women
H. Most sexual assaults involve a black man raping a white woman
I. Most rapists are poor
J. No person can be sexually assaulted against her will
K. Sexual assault is provoked by the victim. Victim ask for it by their actions, behaviors, or
by the way they dress
L. Only bad girls get sexually assaulted
M. Most rapes are reported by women who change their minds afterwards or who want
to get even with a man.
N. Women have rape fantasies and secretly desire rape. If you are going to be raped, you
might as well relax and enjoy it
O. Rapists are crazy, deranged, abnormal perverts. They are lonely men without female
relationships.

TREATMENT AND INTERVENTION

a. must receive immediate support and can express fear and rage to family
members
b. education about rape and the needs of victims is an ongoing requirement for
health care professionals
c. rape treatment centers are most helpful to the victims
d. the nurse should allow the woman to proceed at her own pace and not rush her
through any interview or examination procedures
e. giving much control back to the patient
f. rape crisis centers, womens advocacy groups, and other local resources often
provide a counselor

WARNING SIGNS OF RELATIONSHIP VIOLENCE

a. emotionally abuses you (insults, makes belittling comments, act sulky or angry
when you initiate an idea or activity)
b. tells you with whom you may be friends or how you should dress, or tries to
control other elements of your life
c. talks negatively about women in general
d. gets jealous for no reason
e. drinks heavily, uses drugs, or tries to get you drunk
f. acts in an intimidating way by invading your personal space such as standing too
close or touching you when you dont want him to
g. cannot handle sexual or emotional frustration without becoming angry
h. does not view you as an equal; sees himself as smarter or socially superior
i. guards his masculinity by acting tough
j. is angry or threatening to the point that you have changed your life or yourself
so you wont anger him