Abuse & Neglect Survivors Flashcards
Is defined as the maltreatment of one person by another
Abuse
Can be either physical or emotional
Neglect
Also known as domestic violence; is physical abuse between domestic partners
May be known as spousal abuse, domestic or family violence, wife or husband ___, or IPV (intimate partner violence)
Battering
?
Are potentially traumatic events that can happen from ages 0-17; can have major impacts on one’s physical and mental health
- These experiences can be things like violence, abuse, or neglect; witnessing violence; having a family member attempt or die by suicide; having a family member w/a substance abuse problem or a mental health problem; or instability due to parental separation or household members being in jail or prison
Adverse Childhood Experiences (ACEs)
! Are linked to chronic health problems, mental illness, & substance abuse problems later in adulthood
! Can also negatively impact education, job opportunities, & earning potential
! ACEs can be prevented
What can nurses do to reduce the effects of ACEs?
→ Reducing stigma around seeking help for parenting; some of the challenges people face with parenting
→ Stigma around substance abuse & mental health issues
→ Promote a safe & stable, nurturing relationship between parents & children
! ACEs can be prevented
What can nurses do to reduce the effects of ACEs?
→ Reducing stigma around seeking help for parenting; some of the challenges people face with parenting
→ Stigma around substance abuse & mental health issues
→ Promote a safe & stable, nurturing relationship between parents & children
Predisposing factors to violent behaviors
Biological Theories
> Neurophysiological influences
> Biochemical influences
> Genetic influences
> Disorders of the brain
Psychosocial Theories
> Psychodynamic Theory
> Learning Theory
The ___ is responsible for impulse control & effective processing
Appears to be less well modulated in people w/aggression; responses to fear are reduced
amygdala
The limbic prefrontal cortex has a primary role in aggression
Areas of the brain known as the striatum play a critical role in selection & inhibition of effective cognitive & motor responses & have identified as dysfunctional in pts w/ aggression
Neurotransmitters have been implicated in aggression as well & include an increase in norepinephrine and dopamine & a decrease in serotonin
Biochemical influences
An increase in ___ release that’s been seen in cases of aggression as well as the relationship between testosterone & cortisol levels that are assoc w/aggression
dopamine
Genetic influences
Studies have found a potential role for the X-linked monoamine oxidase (a gene in the etiology of anti-social behaviors)
Disorders of the brain
Organic brain syndromes assoc w/various cerebral disorders have been implicated in the predisposition to aggressive & violent behaviors like brain tumors, particularly in the area of the limbic system & the temporal lobe
Trauma to the brain resulting in cerebral changes & dz’s such as encephalitis & temporal lobe epilepsy have also been implicated
____Theory
> Modeling behavior is more likely when the individual perceives the person as prestigious or influential. Individuals who were abused as children &/or who witnessed domestic violence as a child are more likely to manifest reactive aggression as adults
> Behaviors can also be modeled from influences from the media, like video games & movies
Learning
____ Theory
> These are some psychological theories that have been implicated in violent behavior & this is the idea that unmet needs for satisfaction and security results in poor self control
> Aggression & violence supply this individual w/a dose of power & prestige that inc their self-esteem
Psychodynamic
Predisposing Factors to violent behaviors
- Sociocultural theories
- Societal influences
⇢ Aggressive behavior is primarily a product of one’s culture in social structure
> Poverty, unemployment, family breakdown, exposure to violence, lack of social support and bullying are predisposing factors
Medications used to treat aggression
⇢ SSRI’s
⇢ Mood stabilizers
⇢ Anti-adrenergic agents
⇢ Antipsychotics
Anti-adrenergic agents
- Such as beta blockers; have been shown to reduce aggression in some individuals & this is done by dampening the excessive noradrenergic activity
___
- Includes both typical & atypical
- Have been helpful in the control of aggression & violence, particularly for individuals w/comorbid psychosis; this is a result of the dampening of dopamine
Antipsychotics
___
- Have been shown to reduce irritability & aggression & this is consistent w/the theory of reduced serotonin activity in aggression
Selective serotonin reuptake inhibitors (SSRI’s)
____
- These are important in reducing the overactivation of the limbic system
- Includes Tegretol, Dilantin, & Depakote
- Lithium has also been used effectively in violent pts
Mood stabilizers
IPV (Intimate Partner Violence)
IPV includes physical & sexual violence, stalking, & psychological aggression, which can include coercive tactics
- Can be by a current or former intimate partner
- One person believes that they’re entitled to control the other
This type of violence can occur between heterosexual or same-sex couples & does not require sexual intimacy
- Males can also be the target & females can be the victimizer
- IPV generally starts early and continues throughout the lifespan
- Power is gained in control through intimidation and fear
Victim
- Most often females
- Experience guilt, fear, shame, anger
- Isolated
- Low self-esteem
Victimizer
- Low self-esteem
- Jealous, possessive
- May have been abused
- May have been subject to extreme discipline
Cycling of battering
> Continues as a cycle & often has shorter phases in between phases 1 and 2
> The victim will stay out of fear; fear for her own life or for the lives of her children. The victim often suffers from low self-esteem & feels powerless; fears retaliation; fears losing custody of her children
> The victim may be physically or financially dependent on the abuser; may lack a support network; & there may be cultural or religious reasons
> Victim may also feel hopeless or lack awareness of the reality of the situation
> When a victim leaves an abusive relationship, she’s at a 75% greater risk of being killed by the partner & the abuse often does not stop once the person has left
> The decision to leave must be theirs to make; they need empowerment in their decisions & to be provided w/resources, support, & referrals
? phase
> Is the most violent & shortest phase
Violence is justified by the abuser
Victim may try to find a safe place to hide; help is sought if the injury was severe or if the woman fears for her life, for her children’s lives
Phase 2 Acute battering
? phase
> Minor battering incidents may occur
Abuser is angry w/little provocation & the victim believes it’s her fault
Phase 1 Tension-building
? phase
> The abuser is calm, loving, promises to stop, apologizes, shows romantic gestures, & the victim wants to believe that this is true & stays in the relationship
Phase 3 Honeymoon
Child abuse
Signs of physical abuse [child]
> burns, bites, bruises, broken bones, or black eyes
fading bruises or other marks
frightened of the parents (or other adults)
reports injury
abuses animals
Signs of physical suspect [caregiver]
! lack of believable explanation
! negative view of child
! uses harsh discipline
! h/o abuse as child
! h/o animal abuse
Risk factors for child abuse include children under 4, special needs that may increase caregiver burden [disabilities, mental health issues, & chronic physical illness]
Risk factors for perpetrators –
> parents’ lack of understanding of children’s neglect; child development & parenting skills
> a parental history of child abuse or neglect; substance abuse &/or mental health issues (i.e., depression)
> parental characteristics such as a young age; a low education; single parenthood; a large number of dependent children & low income
> nonbiological or transient caregivers in the home (i.e., the mother’s male partner)
> parental thoughts & emotion that tend to support or justify maltreatment behaviors
Family risk factors -
> social isolation; family disorganization, dissolution, & violence (including IPV); parenting stress; poor parenting-child relationship, & negative interaction
Community risk factors –
> community violence; concentrated neighborhood disadvantage (e.g., high poverty & residential instability); high unemployment rates; high density of alcohol outlets; poor social connection
Child abuse
Signs of emotional abuse [child]
- extremes in behavior
- not behaving age appropriate
- physical or emotional delays
- suicide attempt
- lack of parental attachment
Signs of suspect [caregiver]
! blames, belittles, berates child
! unconcerned
! rejects child
Child neglect (can be physical or emotional)
Signs of emotional neglect [child]
- freq school absence
- begging/stealing
- lack of medical care
- unkempt, not dressed for weather
- alcohol/drug use
- reports of no caregiver @ home
Signs of suspect [caregiver]
- indifferent to child
- apathetic, depressed
- irrational/bizarre behavior
- alcohol or drug use
Sexual abuse (can incl sexual exploitation; perpetrators are in most cases known to the victim)
Signs of sexual abuse [child]
> has difficulty walking/sitting
suddenly refuses to change for gym or to participate in physical activities
reports nightmares or bedwetting
experiences a sudden change in appetite
bizarre, sophisticated, or unusual sexual behavior
becomes pregnant or contracts an STD
runs away
reports sexual abuse
attaches quickly to strangers
Signs of suspect [caregiver]
! unduly protective of the child or severely limits the child’s contact w/other children, esp of the opposite sex
! secretive & isolated
! jealous or controlling w/family members
Incest
Incestuous relationship
- father is domineering, impulsive
- mother is passive, aware or suspicious, may alternate between caring or competing
- begins @ 8-10
- child - confused, love/hate relationship
- Typically, this involves an impaired sexual relationship between the parents
- About 1/3 of children who are abused or neglected in childhood become perpetrators of the same kind of abuse as parents
- Revelations of incest as a child are often revealed after death of the perpetrator
Adult survivor of incest
- lacks trust
- low self-esteem, poor self-identity
- absence of sexual pleasure
Sexual Violence
> Sexual aggression is an act of aggression, not passion, & is an act of power & dominance
> Sexual violence includes any act of sexual coercion, including penetration, unwanted sexual contact & noncontact & unwanted sexual experiences
> Rape includes a surprise attack, statutory rape, date rape, marital rape, & can happen at any age
Victim
- highest risk 34 or younger, lower income, living in rural area
Victimizer
- sexual sadists
- exploitative predators
- men who fantasize of sex they believe cannot be achieved w/o the use of force
- are displacing anger & rage
Victim Responses (feelings of powerlessness & intimidation)
- expressed response pattern
> the survivor expresses feelings of fear, anger, & anxiety, often through behavior such as crying, sobbing, restlessness, & tension - controlled response pattern
- compounded rape reaction
> the survivor can develop substance abuse, depression, & suicide - silent rape reaction
> the survivor tells no one, suppresses the anxiety until a future time when forced to face a sexual crisis. This reactivates the trauma
?
- feelings are masked; the survivor is calm, composed, & subdued
- in the days & weeks > the attack, the victim often experiences physical manifestations, & these include contusions & abrasions, headache, fatigue, sleep pattern disturbances, stomach pains, N/V, vaginal discharge & itching, burning upon urination, rectal bleeding & pain
- emotional manifestations include rage, humiliation, embarrassment, desire for revenge, & self-blame; fear of physical violence & death can also occur
controlled response pattern
Nursing diagnoses for the survivors of abuse
→ Rape-trauma syndrome
→ Powerlessness
→ Risk for delayed development
Nursing Interventions
→ Tending to physical injuries
→ Staying w/the client to provide security
→ Assisting the client to recognize options
→ Promoting trust
→ Reporting suspected child abuse or neglect
Treatment modalities
> Crisis intervention
Safe house or shelter
Family therapy
- In crisis intervention, the goal is to help survivors return to their previous lifestyle as quickly as possible. The client should be involved in the intervention from the beginning
> This promotes a sense of competency, control, & decision-making b/c an overwhelming sense of powerlessness accompanies the rape experience - Active involvement by the survivor is both a validation of personal worth & the beginning of the recovery process
