Chapter 12 Abuse & Violence

Question 1

Abuse

Answer 1

Wrongful use & maltreatment of another

Perpetrator typically someone the victim knows

Victims across life span: spouses, partners, children, elderly parents

Types of injuries
- Physical
- Psychological

Effect on survivors
- Some clients are agitated & visibly upset
- Others are w/drawn & aloof (appear numb to their surroundings)
- Most suffer in silence due to fear of their abusers

Question 2

Family Violence

Answer 2

Spouse battering; neglect and physical, emotional, or sexual abuse of children; elder abuse; marital rape

Question 3

Characteristics of Violent Families

Answer 3

Social isolation: Members of family are not allowed to interact w/ those outside
- Could be due to shame
- Perpetrator will threaten violence

Abuse of power & control
- Usually the breadwinner

Alcohol & other drug abuse
- Alcohol takes away any & all inhibitions

Intergenerational transmission process

Question 4

Social Isolation

Answer 4

Members of these families keep to themselves and usually do not invite others into the home or tell anyone what is happening
- Abusers threaten victims w/ even greater harm if they reveal the secret.
- May tell children that a parent, sibling, or pet will die if anyone outside the family learns of the abuse.

Children then keep the secret out of fear, which prevents others from “interfering with private family business.”

Question 5

Abuse of Power & Control

Answer 5

The family member who is abusive almost always holds a position of power and control over the victim (child, spouse, or older adult parent).
- Abuser exerts not only physical power but also economic and social control.

Often the only family member who makes decisions, spends money, or spends time outside the home with other people.

Belittles and blames the victim, often using threats and emotional manipulation.

If the abuser perceives any indication, real or imagined, of victim independence or disobedience, violence usually escalates.

In the United States, female homicide victims are most likely to have been killed by a current or former romantic partner than by a stranger
- Homicide is more likely when the relationship is ending, such as in separation or divorce

Question 6

Alcohol & Other Drug Use

Answer 6

Substance abuse, especially alcoholism, has been associated with family violence
- This finding does not imply a cause-and-effect relationship.
- Alcohol does NOT cause the person to be abusive; rather, a person who is abusive is also likely to use alcohol or other drug

Most victims of intimate violence report that alcohol was involved in the violent incident.
- Women whose partners abused alcohol were more likely than other women to be assaulted by their partners.

Although alcohol may not cause the abuse, many researchers believe that alcohol may diminish inhibitions and make violent behavior more intense or frequent

Alcohol is also cited as a factor in acquaintance rape or date rape.
- Often, both victims and offenders reported drinking alcohol at the time of the assault.
- In addition, use of the illegal drug flunitrazepam (Rohypnol) or other “date rape drugs” to subdue potential victims is on the rise

Question 7

Intergenerational Transmission Process

Answer 7

Explains that patterns of violence are perpetuated from one generation to the next through role modeling and social learning
- Suggests that family violence is a learned pattern of behavior

Ex) Children who witness violence between their parents learn that violence is a way to resolve conflict and is an integral part of a close relationship

Statistics show that 1/3 of men who are abusive are likely to have come from violent homes where they witnessed abuse or were abused themselves
- Women who grew up in violent homes are much more likely to expect or accept violence in their own relationships.

Not all persons exposed to family violence, however, become abusive or violent as adults.
- This single factor does not explain the perpetuation of violent behavior.

Question 8

Cultural Considerations

Answer 8

Domestic violence spanning families of all ages and from all ethnic, racial, religious, socioeconomic, national, and sexual orientation backgrounds

Battered immigrant women at particular risk
- Face legal, social, and economic problems different from the U.S. citizens

Question 9

Intimate Partner Violence

Answer 9

Mistreatment or misuse of 1 person by another in context of emotionally intimate relationship

Relationship may be spousal, between partners, boyfriend, girlfriend, or an estranged relationship

Abuse may consist of physical, psychological, sexual or a combination (MOST COMMON)

Question 10

Psychological Abuse

Answer 10

AKA Emotional Abuse

Includes:
- Name-calling
- Belittling
- Screaming, yelling
- Destroying property, and making threats as well as subtler forms, such as refusing to speak to or ignoring the victim.

Question 11

Physical Abuse

Answer 11

Ranges from shoving and pushing to severe battering and choking and may involve broken limbs and ribs, internal bleeding, brain damage, and even homicide

Nearly 1 in 5 women and 1 in 7 men report having experienced severe physical violence from an intimate partner in their lifetimes in the United State

Question 12

Sexual Abuse

Answer 12

Includes assaults during sexual relations such as biting nipples, pulling hair, slapping and hitting, and rape

About 1 in 5 women and 1 in 12 men have experienced sexual violence by an intimate partner

Question 13

Rape

Answer 13

A crime of violence, domination, and humiliation of the victim expressed through sexual means

Question 14

Date Rape

Answer 14

AKA Acquaintance Rape

Sexual assault that may occur on a 1st date, on a ride home from a party or when the two people have known each other for some time

Question 15

Pregnant Women & Abuse

Answer 15

Pregnant women experience an increase in violence during pregnancy

Battering during pregnancy leads to adverse outcomes, such as miscarriage and stillbirth, as well as further physical and psychological problems for the woman.

The increase in violence often results from:
- The partner’s jealousy
- Possessiveness
- Insecurity
- Lessened physical and emotional availability of the pregnant woman

Question 16

Domestic Violence & Same-Sex Relationships

Answer 16

Although same-sex battering mirrors heterosexual battering in prevalence, its victims receive fewer protections.

7 states define domestic violence in a way that excludes same-sex victims.

12 states have sodomy laws that designate sodomy as a crime, even though such laws were invalidated by the Supreme Court in 2003.

The same-sex batterer has an additional weapon to use against the victim: the threat of revealing the partner’s homosexuality to friends, family, employers, or the community

Question 17

Sodomy

Answer 17

Anal intercourse

Question 18

Clinical Picture of Abuse

Answer 18

A husband who is abusive often believes his wife belongs to him (like property) and becomes increasingly violent and abusive if she shows any sign of independence, such as getting a job or threatening to leave.

Typically, the abuser has strong feelings of inadequacy and low self-esteem as well as poor problem-solving and social skills.
- Emotionally immature, needy, irrationally jealous, and possessive
- May even be jealous of his wife’s attention to their own children or may beat both his children and his wife

By bullying and physically punishing the family, the abuser often experiences a sense of power and control, a feeling that eludes him outside the home.
- The violent behavior is often rewarding and boosts his self-esteem

Question 19

Victim Dependence on Abuser

Answer 19

Dependency is the trait most commonly found in wives who are abused who stay with their husbands.

Women often cite personal and financial dependency as reasons why they find leaving an abusive relationship extremely difficult.
- She perceives herself as unable to function without her husband
- Often suffers from low self-esteem and defines her success as a person by her ability to remain loyal to her marriage and “make it work.”

Some women internalize the criticism they receive and mistakenly believe they are to blame.

Women also fear their abusers will kill them if they try to leave
- This fear is realistic, given that national statistics show that women have a much greater chance of being murdered when leaving an abusive relationship than if they stay

Question 20

Cycle of Violence & Abuse

Answer 20

A typical pattern in domestic battering: violence; honeymoon or remorseful period; tension building; and, finally, violence
- This pattern continually repeats itself throughout the relationship w/ victim hoping the violence will stop

Question 21

Assessment of Intimate Partner Violence

Answer 21

Most women who are abused do not seek direct help for the problem
- Nurses must help identify such women in various settings

May encounter women who have been abused in emergency departments, clinics, or pediatricians’ offices.

Some victims may be seeking treatment for other medical conditions not directly related to the abuse or for pregnancy.

Identifying women who are abused and who need assistance is a TOP priority of the Department of Health and Human Services.

The generalist nurse is not expected to deal with this complicated problem alone.
- They can, however, make referrals and contact appropriate health care professionals experienced in working with women are abused.
- Above all, the nurse can offer caring and support throughout the victim’s visit.

Question 22

Questions to Ask About Safety

Answer 22

Do you feel safe in your relationships?

Are you concerned for your safety?

Are family or friends concerned for your safety?

Are your children (if any) safe?

Do you ever feel threatened?

If you felt threatened or unsafe, is there someone you can call? Night or day?

Do you have a safe place to go if you need to?

Do you have a plan if your situation suddenly becomes unsafe?

Question 23

Dos of Working w/ Victims of Partner Abuse

Answer 23

Do believe the victim.

Do ensure and maintain the client’s confidentiality.

Do listen, affirm, and say, “I am sorry you have been hurt.”

Do express, “I’m concerned for your safety.”

Do tell the victim, “You have a right to be safe and respected.”

Do say, “The abuse is not your fault.”

Do recommend a support group or individual counseling.

Do identify community resources, and encourage the client to develop a safety plan.

Do offer to help the client contact a shelter, the police, or other resources.

Do accept and respect the victim’s decision.

Do encourage development of a safety plan

Question 24

Dont’s of Working w/ Victims of Partner Abuse

Answer 24

Don’t tell the victim what to do.

Don’t express disgust, disbelief, or anger.

Don’t disclose client communications without the client’s consent.

Don’t preach, moralize, or imply that you doubt the client.

Don’t minimize the impact of violence.

Don’t express outrage with the perpetrator.

Don’t imply that the client is responsible for the abuse.

Don’t recommend couples’ counseling.

Don’t direct the client to leave the relationship.

Don’t take charge and do everything for the client

Question 25

Restraining Order

Answer 25

A legal order of protection obtained to prohibit contact between a victim and a perpetrator of abuse

However, a restraining order provides only limited protection
- The abuser may decide to violate the order and severely injure or kill the woman before police can intervene

Some states have enacted laws removing firearms from persons identified on a protection order, sometimes called extreme risk protection order with red flag
- However, informing the person of the firearm ban or collecting the firearm is an ambiguous process in some states.

Question 26

Stalking

Answer 26

Repeated and persistent attempts to impose unwanted communication or contact on another person

In addition to abusive partner stalking when the end of the relationship is not accepted, other stalkers are “would-be lovers,” pursuing relationships that have never even existed, doctors stalked by patients, or famous people stalked by “fans.”

Among college students, 17% reported being the victim of a stalker

Cyberstalking can be monitoring, following, or intruding into another’s social media; using a false identity to get back into the person’s life; or tracking their location with a cell phone.
-These have all become more common in recent years, and it has become more difficult to detect the stalker