Survivors of Violence and Trauma

Elements of Abuse
The Abuser

The Abused
The Crisis

Effects of Abuse and Violence on the Victim

Result:

Loss of trust Loss of sense of control Denial, fear, anger, powerlessness, guilt, sense of failure, depression Due to victims loss of trust and others responses

Emotional reactions to crime:

Disrupted family relationships:

Recovery from Violence and Trauma

Impact

Recoil
Reorganization

Impact
Lasts minutes to days

Common responses: shock, denial, disbelief,

confusion, fear, horror, hysteria, shame, helplessness, disturbed sleeping and eating patterns Delayed reactions possible At times: dissociative symptoms, intrusive memories, severe anxiety

Recoil
Weeks to months

Struggle to adapt
Periods of acting normal At a later time: desire to talk about details,

feelings about trauma Need for support and temporary dependence Gradual awareness of full impact

Reorganization
Months to years

Gradual decrease in emotions of anxiety,

fear, anger Review of: what happened, why, blaming, justifying Progress towards regaining control and self protection Unless resolution occurs, remaining symptoms qualify as PTSD

Nurse-Patient Relationship
Impact stage: crisis intervention Need for physical safety, emotional security Give simple directions: avoid accusations Provide phone #s for crisis intervention Recoil stage: support groups and short-term

counseling

Validation of victim and rights as a victim Referrals

Reorganization stage: long-term counseling if needed Refer for tx and counseling for Axis I D/O

Domestic Violence (DV)

Stats: (U.S. Department of Health and Human Services, Bureau of
Investigation, 2003).

4 mil. women and 800,000 men are abused annually Assault from a partner; women to men: 7:1 20% of ER visits by women are DV related 75% of women victims suffer additional injuries within a year 1:3 teenagers report having experienced violence in a dating relationship DV among lesbian partners is 50%-60% , compared to 30% among heterosexual partners

Forms of Domestic Violence

Intimidation

Threats
Sexual abuse Isolation Emotional abuse Use of children Male privilege Economic abuse

Dynamics of Domestic Violence

Tension-Building

Acute Battering Phase

Loving Phase

Barriers to Leaving a Violent Relationship

Lack of Resources

Lack of Institutional Responses

Traditional Ideology

Rape Trauma Syndrome

Sleep disturbances, nightmares

Anorexia, amotivation
Fears, anxiety, phobias, suspicion Relationship disruptions Self-blame, guilt, shame Lowered self-esteem Somatic symptoms

Psychotherapeutic Management following Rape

Stay with patient

Provide empathy, support, safety

Provide medical care, information Give rationales for care Protect rights Shame may interfere with reaching out for

support Referrals: crisis intervention, support group, counseling

Other Interventions
Couple, family counseling

Support groups
Medication Milieu management Refer to outpatient resources

Adult Manifestations of Childhood Sexual Abuse

Memory disturbances Anxiety Relationship issues Addiction Body symptoms Other issues

Detachment Control Self-punishment Anger Sexual identity

Special Population
Child Abuse Physical Abuse Child Neglect Emotional Abuse Child Sexual Abuse Elder Abuse Physical Abuse Emotional Abuse Abandonment, neglect Financial Exploitation Sexual Abuse

Workplace Violence
Stats:
Injuries).
(Bureau of Labor Statisticss Census of Fatal Occupational

In 2000: 674 workplace homicides (11% of the total

number of fatal work injuries in the U.S.) 13% of all homicides occur in an office or factory 9,000 health care providers are attacked on the job daily

Workplace Violence (cont)

Verbal abuse Intimidation, ridicule, aggressive posturing, rude gestures, threats, ostracism, offensive notes, emails Sexual harassment Belittling jokes, sexual advances, pornography, sexual assault Stalking Obsessional pursuit/intimidation Assault and battery Rape and murder

Web Links
www.journals.wiley.com/0096-140X

www.helping.apa.org/warningsigns
www.alaska.net/~avv www.cdc.gov

www.osha.gov
www.nimh.nih.gov/publicat/violenceresfact.com www.afro.who.int/press/2002/pr2002091602.html http://www.ncvc.org/resources/statistics/workplaceviolence

City of Chicago Domestic Violence Hotline:

877-863-6338

Nursing Care Plan

Case Study:

The Victim of Domestic Violence

Please refer to handout