Chapter 12:

Abuse and Violence

Clinical Picture of Abuse and Violence

v Abuse: wrongful use and maltreatment of another

o Perpetrator typically someone the person knows
v Victims across life span: spouses, partners, children,
elderly parents
v Types of injuries
o Physical
o Psychological
v Effect on survivors

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Characteristics of Violent Families
v Family violence: spouse battering; neglect and physical,
emotional, or sexual abuse of children; elder abuse;
marital rape
v Common characteristics
o Social isolation
o Abuse of power and control
o Alcohol and other drug abuse
o Intergenerational transmission process

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Cultural Considerations

v Domestic violence spanning families of all ages and from

all ethnic, racial, religious, socioeconomic, and sexual
orientation backgrounds
v Battered immigrant women at particular risk
o Face legal, social, and economic problems different
from the U.S. citizens

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Intimate Partner Violence #1

v Mistreatment or misuse of one person by another in

context of emotionally intimate relationship
v Psychological abuse (emotional abuse) can be overt or
subtle.
v Physical abuse: shoving, pushing, battering, choking
v Sexual: assaults during sexual relations, rape
v Rates higher among women
v Increased rates during pregnancy
v Domestic violence occurs in same-sex relationships with
same statistical frequency.
o Victims have fewer protections.

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Intimate Partner Violence #2

v Clinical picture
o Abuse often perpetrated by husband against wife
o Abuser’s view of wife as belonging to him; strong
feelings of inadequacy, low self-esteem; poor
problem-solving and social skills
o Increasing violence, abuse with any signs of
independence
o Dependency trait most commonly found in abused
women who stay with their husbands

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Intimate Partner Violence #3

v Cycle of abuse and violence

o Violent episode → honeymoon period → tension-
building phase → violent episode

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Intimate Partner Violence #4

v Assessment
o Victims do not commonly seek direct help for abuse.
§ Some may be seeking treatment for other
conditions.
v Ask all clients if they feel safe
v Ask questions about safety (see Box 12.2)

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1. Question #1

Is the following statement true or false?

v The honeymoon period of violence often occurs before
the first episode of violence.

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1. Answer to Question #1

False
v Rationale: The honeymoon period occurs after an episode
of violence; this is the period in which the abuser
expresses regret and then apologizes and promises it will
never happen again.

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Intimate Partner Violence #5
v Treatment and interventions
o Laws related to domestic violence; arrest
o Restraining order/protection order
o Recognition of stalking
o Shelters
o Individual psychotherapy/counseling, group therapy,
support and self-help groups
o Treatment for PTSD

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Child Abuse #1

v Intentional injury of a child

o Physical abuse or injuries
o Neglect or failure to prevent harm
o Failure to provide adequate physical or emotional
care or supervision
o Abandonment
o Sexual assault or intrusion
o Overt torture or maiming

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Child Abuse #2

v Clinical picture of parents

o Minimal parenting knowledge and skills
o Emotionally immature, needy, incapable of meeting
own needs
o Frequently view children as property
o Cycle of family violence: adults raising children in
same way they were raised
§ Adults who were victims of abuse frequently abuse
their own children.

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Child Abuse #3

v Detection and accurate identification are the first steps

(see Box 12.3).
v Report suspected child abuse
o Nurse does not have to decide for certainty if abuse
occurred.
v Treatment and intervention
o Child’s safety and well-being is a priority.
o Psychiatric evaluation
o Therapy may be indicated over significant period.
o Approach depends on the age of a child.
o Social services involvement
o Family therapy/requirements for parents
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Elder Abuse #1

v Maltreatment of older adults

o Physical, sexual, psychological abuse
o Neglect of self-neglect
o Financial exploitation
o Denial of adequate medical treatment
v Estimated 10% of population over age 65 abused by
caregivers.
v 60% to 65% of victims are women.

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Elder Abuse #2

v People who abuse elders almost always in caretaker role

or elders depend on them in some way.
v Most cases when one older spouse is taking care of
another
v Bullying between residents in senior living facilities
v Elders often reluctant to report abuse
o Want to protect family members
o Fear losing support
v Clinical picture: variable depending on the type of abuse

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Elder Abuse #3

v Assessment (possible indicators, see Box 12.4)

v Treatment and intervention
o Caregiver stress relief
o Additional resources
o Possible removal of elder or caregiver

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2. Question #2

Is the following statement true or false?

v Adults who were abused as children are more likely to
abuse their own children.

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2. Answer to Question #2

True
v Rationale: The tendency for adults to raise children in the
same way they were raised perpetrates the cycle of
family violence. Adults who were victims of abuse as
children frequently abuse their own children.

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Rape and Sexual Assault #1

v Perpetration of act of sexual intercourse with person

against his or her will and without consent
o Will overcome by force, fear of force, drugs,
intoxicants
v Crime of violence and humiliation of victim expressed
through sexual means
v Also rape if victim cannot exercise rational judgment
v Only slight penetration necessary

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Rape and Sexual Assault #2

v Committed by strangers (~28% of rapes),

acquaintances, married people, people of same sex
v Date rape (acquaintance rape)
v Highly underreported crime
v Most commonly occurs in victim’s neighborhood, often
inside or near home

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Rape and Sexual Assault #3
v Most rapes are premeditated.
v Male rape is significantly underacknowledged and
underreported.

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Rape and Sexual Assault #4

v Dynamics of rape
o Generally accepted that rape is not sexual crime
§ Exertion of power, control, infliction of pain or
punishment.
o Feminist theory: women historically objects for
aggression.
o Primary motivation of victim is to stay alive.
o Severe physical and psychological trauma
o Treatment has improved, but many still believe a
woman provokes rape with behavior.
o Common myths (see Box 12.5)

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Rape and Sexual Assault #5

v Assessment
o Physical examination to preserve evidence
o Description of what happened
o Rape kits, rape protocols
v Treatment and intervention
o Immediate support
o Education (see Box 12.6)
o Give control back to victim
o Prophylactic treatment for STIs, pregnancy
o Counseling
o Supportive therapy

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Community Violence

v School violence (homicides, suicides, theft, violent

crimes)
v Bullying
o Ostracism
v Hazing
v Effects on children, young adults
v Violence on a larger scale (e.g., terrorism)
o PTSD and depression

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3. Question #3

v Which of the following statements about rape is most

accurate?
A. It is a highly reported crime.
B. Most rapes are premeditated.
C. Rape requires ejaculation.
D. Provocative dress invites rape.

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3. Answer to Question #3

B. Most rapes are premeditated.

v Rationale: Most rapes are premeditated.
o Rape, an underreported crime, requires only slight
penetration of the vulva. Full erection or ejaculation
is not necessary. Provocative dress leading to rape is
a myth.

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Self-Awareness Issues
v Be aware of own beliefs.
v Contain feelings of horror or revulsion, focus on client’s
needs.
o Validate the client’s feelings.
v Ask all women about abuse.
v Help client focus on the present.

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