ABUSE AND VIOLENCE

What is abuse ?

 Abuse-is the wrongful use and

maltreatment of another
person
 -most abuse is perpetrated
by someone known to the
victim
Domestic Violence
Spouse abuse
Child abuse/ neglect
Elder abuse
 Characteristics of Violent Families
 Social isolation
-often abusers threaten victims if they reveal the secret
 Abuse of power & control
-The abuser exerts physical power, economic & social control
 Alcohol and other drug abuse
Alcohol does not cause the person to be abusive ; rather ; an
abusive person is also likely to use alcohol or other drugs.
 Intergenerational transmission
Pattern of violence are perpetuated from one generation to the
next gen.
 Spouse or Partner Abuse

 Itis the mistreatment or misuse of one

person by another in the context of an
intimate relationship.
Types
of
abuse
Emotional or Psychological

 Name calling
 Belittling
 Screaming
 Yelling
 destroying property
 making threats
 refusing to talk or ignoring the victim
 Physicalabuse: shoving,
pushing, severe battering,
choking

 Sexual abuse: assaults

during sexual relation:
biting nipples,
pulling hair, slapping,
hitting, rape.
Characteristics of
abuser
 Possessive-believes his wife is her
property
 Emotionally immature
 Needy
 Irrationally jealous
 Characteristics of the
Abused woman

 Dependent (personal & financial)

 Perceives self as unable to function without her husband

 Has low self-esteem
 Defines her success in her ability to make her marriage
work
 Fear their abuser
Family Characteristics Vulnerable to
Domestic Violence

o Alcohol abuse
-The perpetrator is more prone to uncontrolled violent outbursts.
o Cultural stereotypes
-socio-cultural beliefs may legitimize battering as it appears as an outward
manifestation of the “macho” image and is accepted by the family as part of
one’s role of being disciplinarian.
o Jekyll and Hyde Personality
-low self-esteem couples.
-Men respond by using violence and wife blames oneself as
deserving the violence due to one’s failure to meet the
husband’s expectations.
o Family at or below the poverty level
-is attributed to poor coping due to lack of financial
resources
- related stresses result to physical and psychological
releases.
Cycle of Abuse & Violence
initial episode of battering/ violence

period of expressing regret

apologizing, promising &

professes love/ romance
(period of contrition/remorse called
honeymoon period)

another period of violence

and remorse
 Assessment
 Stress/safety:
 What stress do you experience in your relationships?
 Do you feel safe in your relationships?
 Should I be concerned for your safety?
 Afraid/Abused:
 Are there situations in your relationships where you have felt afraid?
 Has your partner ever threatened or abused you or your children?
 Have you ever been physically hurt or threatened by your partner?
 Are you in a relationship like that now?
 Friends/family :
 Are your friends aware that you have been hurt?
 Do your parents/ siblings know this abuse?
 Do you think you can tell them, and would they be able to give you
support?
 Emergency plan:
 Do you have a safe place to go & the resources you need in an
emergency?
 If you are in danger now, would you help in locating a shelter?
 Would you like to talk to a social worker/counselor/me to develop an
emergency plan?
Treatment & Intervention

 Refer the victim for a psychotherapy, counseling, group

therapy, support & self-help.
 ABUSE

 Child abuse- is defined as the intentional injury of a child.

 It includes :
 physical abuse/injuries
 neglect or failure to prevent harm
 failure to provide adequate physical‚
emotional care or supervision
 Abandonment
 sexual assault
 intrusion, and
 overt torture or maiming
Types of Child Abuse
 1.Physical abuse- results from
unreasonably severe corporal punishment or
unjustifiable punishment.
 Sexual abuse- involves sexual acts
performed by an adult on a child younger
than 18 years old.
 Ex: incest, rape, sodomy, oral-genital
contact, acts of molestation, such as
rubbing, fondling or exposing the adult’s
genitals
 Exploitation, such as making, promoting,
selling pornography involving minors and
coercion of minors to participate in
obscene acts.
 3. Neglect or Child Abandonment

It is a malicious/ignorant withholding of physical, emotional, or educational

necessities for the child’s well-being.
Ex: Refusal to seek care/delaying it
 Abandonment
 Inadequate supervision
 Reckless disregard for the child’s safety
 Punitive, exploitative treatment
 Giving the child permission to be truant
 Failing to enroll child in school
4. Psychological (emotional) abuse
 Verbal assaults such as blaming, screaming, name-calling, using
sarcasm
 Constant family discord characterized by fighting, yelling, chaos
 Emotional deprivation
or withholding of
affection, nurturing, and
normal experiences that
engender acceptance,
love, security and self-worth.
 Behavioral Clues of Possibly
Abused Child:
 Sudden change in eating, sleeping, or bowel habits
 Secondary enuresis
 Separation anxiety
 Refusal to go to someone’s house
 Avoidance of a particular person
 Personality changes: withdrawal, hyperactivity,
aggressiveness
 Excessive masturbation or sexually explicit acts
 Facts about Patterns of
Child Abuse
 Parentswho abuse their children are likely to
have been abused as children
 Young children who are viewed as “different” are
sometimes abused
 Times of crises often trigger child abuse, such as
loss of job, death of loved ones, separation
 Long-Term Effects Associated
w/ Child Sexual Abuse
Assessment
Warning signs of child abused
 Serious injury, such as fractures,
burns or lacerations w/ no reported hx of trauma
 Delay in seeking tx
 Child or parent gives a hx inconsistent w/ severity of injury
 Inconsistencies or changes in the child’s hx during the evaluation
by either the child or adult
 Unusual injuries for the
child’s age & level of
development
 UTI, bruised, red, swollen
genitalia, tears or bruising of rectum/vagina
 Evidence of unreported
past injuries or ,multiple
bruises that parent or
caregiver cannot explain adequately.
Treatment &Interventions
 Goal: To ensure child’s safety & well-being
-Remove the child from his home.
-psychotherapy
-Play therapy to communicate her feelings
-Family therapy
-Parents may require psychiatric or substance abuse treatment
 Elder Abuse
Is the maltreatment of older adults by family members or caretakers
 Physical abused
 Sexual abused
 Psychological abused or emotional abused
Manifested by:
-helplessness
-hesitance to talk openly
-anger or agitation
-withdrawn behavior/or depressed
 Neglect
-Dirt, fecal or urine smell
-Rashes, sores
-Has untreated medical condition,
malnourished, dehydrated
-Has inadequate clothing
 Self-neglect

-Inability to manage ADLs

-Wandering, isolation

- Financial exploitation
- Denial of adequate medical tx
- Multiple, chronic mental and physical health
problems
 Rape & Sexual Assault
 Rape is a crime of violence & humiliation of the victim
expressed through sexual means.
 It is the perpetration of an act of sexual intercourse w/ a
female against her will & without her consent, whether her
will is overcome by force, fear of force, drugs or
intoxicants.
 If the victim is also incapable of exercising rational
judgment because of mental deficiency or when she is
below the age of consent
 Assessment
 The physical exam should be done before a woman has washed
herself, brushed her teeth, douched, changed her clothes, or had
anything to drink.
Treatment & Intervention
 Provide emotional support
 Assist the doctor who is assessing physical evidence
 Do not rush the woman through any interview or procedures
 Prophylactic tx for STDs are offered-gonorrhea, HIV
 Prophylaxis-ethinylestradiol & norgestrel (Ovral)
can be offered to prevent pregnancy
 Psychotherapy, group therapy to restore sense of
control, relieve feelings of hopelessness,
dependency, regaining trust, improve daily
functioning, finding adequate social support,
dealings w/ feelings of guilt, shame & anger
 Legal Issues
 Universal declaration of human rights (UN)
 The Philippine Constitutional Mandates of Women’s rights
gender equality, family & domestic violence and violence
against women
-Sec. 5, Art II- The state has the obligation to protect
life, liberty of citizens regardless of gender.
 Revised family code of the Phil. (1998).
- Act. 5 grants legal separation on repeated violence caused
by a spouse.
 R.A 7877- Known as “anti-sexual harassment act of 1995”.
An act of sexual harassment is unlawful
 Senate bill No.95 & house Bill no. 6265. Known as the
“Anti-rape law”
Agencies helping Abused Children in the Country
 “Bantay Bata 163” – a social welfare program of the ABS-
CBN Foundation
 Rescues and rehabilitate & provide shelter to sick and abused
children
 DSWD
Psychiatric Disorders r/t
Abuse & Violence
 Posttraumatic Stress Disorder (PTSD)- is a disturbing pattern of behavior
demonstrated by some who has experienced a traumatic event (a natural
disaster, combat or an assault)
3 cluster of symptoms:
- Reliving the event
- Avoiding reminders of the event
- Being on guard or hyper
arousal such as insomnia or
hyperervigilance, irritability
or anger out burst
 The person persistently re-experience the trauma through:
 Memories
 Dreams
 flashback
 reactions to external cues
about the event.

 numbing of general responsiveness

 Dissociative disorders
 A disruption in the usually integrated functions of
consciousness, memory, identity or environmental
perception.
Dissociation- is a subconscious defense mechanism
that helps a person protect his/ her emotional self
from recognizing the whole effects of some
horrific/ traumatic event by allowing the mind to
forget or remove itself from the painful situation
or memory.
 This can occur both during and after the
event
 Prevalent among with histories of
childhood physical & sexual abuse
I've built walls,
A fortress deep and mighty,
That none may penetrate.
I have no need of friendship;
Friendship causes pain.
Its laughter and its loving I disdain.
I am a rock,
I am an island.I Am A Rock

Simon & Garfunkel

Types of Dissociative disorders
 Dissociativeamnesia- cannot remember
important personal information usually of a
traumatic or stressful nature

 Dissociative fugue- has episodes of suddenly

leaving the home, place of work w/o any
explanation, traveling to another city, unable to
remember his/her past or identity, and he/she
may assume a new identity.
 Dissociative identity disorder (multiple personality
disorder)-

display two or more distinct identities or

personality states that recurrently take control of
his/her behavior accompanied by the inability to
recall important personal information.
 Depersonalization disorder-

has a persistent or recurrent feeling of being

detached from his/her mental processes or
body accompanied by intact reality testing (not
psychotic or out of touch w/ reality).
Treatment & Interventions
 Group or individual therapy
 Cognitive-behavioral therapy- to deal w/ the thoughts & subsequent feelings
& behavior of trauma & abused
 Reassociation for Dissociative disorders- (putting the consciousness back
together)
 Anti-anxiety, antidepressant drugs
 Paroxetine (Paxil) & Sertraline (Zoloft) treats PTSD
 Nursing Process:
Assessment
 Health hx: has experienced trauma & abused
 General appearance & motor behavior:
 hyper alert & easily startled,
 uncomfortable when a N is too close physically
 may require greater distance/personal space than most people
 Anxious & agitated
 Mood & affect:
 wide range of emotions from passivity to anger, frightened/scared, or
agitated & hostile
 Cry, scream, hide or run away
 If dissociating, may speak in different tone or appear numb w/ a vacant stare,
may report intense rage or anger or feeling dead inside & unable to identify
any feelings or emotions.
 Thought process & content:

 Reports reliving the trauma through nightmares/flashbacks

 Intrusive persistent thoughts interfere w/ his/her ADLs
 hallucinations or buzzing voices in their heads
 report fantasies
 May have self-destructive thoughts & impulses (suicidal ideation)
 Sensorium & intellectual Processes
-Oriented to reality, except if has experiencing flashbacks & dissociative
episodes

 Judgment & Insight

-the ability to make decisions or solve problems may be impaired
 Self-concept:
 low self-esteem, believe to be bad that they deserve/provoke the abuse
 may think they are going crazy & are out of control
 See themselves as helpless, hopeless & worthless
 Physiologic:
 Difficulty sleeping because
of nightmares or anxiety
 over eating or anorexia,
 may use drugs/alcohol to
induce sleep
 Roles & Relationships

-Has problems w/ relationships

-Inability to socialize w/ family or friends
-Avoid social/family or events
Nursing Dx
 Risk for self-mutilation
 Ineffective coping
 Post-trauma response
 Chronic low self-esteem
 Powerlessness
 Disturbed sleep pattern
 Sexual dysfunction
 Rape-trauma syndrome
 Spiritual distress
 Social isolation
Outcome Identification
 Expected outcome:
The client will be:
-physically safe
-distinguish between ideas of self-harm & taking action on those ideas
-Demonstrate healthy, effective ways of dealing with stress
-express emotions nondestructively
-establish a social support system in the community
Interventions

 Promote client’s safety

 Help cope with stress & emotions
 Grounding techniques-use w/ dissociations of flashbacks; reminds client that
he/she is an adult & is safe.
• Validate client’s feelings to increase contact w/ reality (focusing on the
present)
• help him/her focus on what he/she is experiencing through the senses.
• Deep breathing
• Relaxation
• focus on sensory information in the env’t.
 engage in positive distractions until the feelings subside (exercise, listening to
music, talking to others, engaging to a hobby or activity
 Promote client’s self-esteem
- View the client as a survivor than as a
victim
 Establish social support
- Family, friends
- Recreational activities to divert
attentions