Statistics on IPV, Child, and Elder Abuse

Intimate Partner Violence (IPV) Statistics

• CDC 2018 reported that 1 in 5 women experienced attempted or completed rape, 1 in 6 women were stalked, and 1 in 4 women experienced contact sexual or physical violence, stalking, or intimate partner violence.
• 1 in 14 men were forced to sexually penetrate another person, 1 in 17 men were stalked, and 1 in 10 men experienced contact sexual or physical violence, stalking, or intimate partner violence.
• Most incidents of IPV occur before the age of 25 for both men and women.

Child Abuse Statistics

• According to the U.S. Department of Health and Human Services (DHHS) in 2021, 61% of children experienced neglect, 10.3% experienced physical abuse, and 7.2% experienced sexual abuse.
• In 2019, 1840 children died due to abuse or neglect.
• Many abusers experienced abuse as children.
• Federal law mandated reporting of child abuse in 1968.

Elder Abuse Statistics

• According to the CDC in 2020, 1 in 10 elders living with family are victims of physical/sexual abuse, neglect, abandonment, and/or financial exploitation.
• Neglect is the most common form of elder abuse.
• Less than 1 in 24 cases of institutional abuse is reported.

Predisposing Factors: Biological Theories

• Neurophysiological
  • People with smaller amygdala volumes (responsible for fear and sensory processing) are more likely to react impulsively.
  • A smaller volume of gray matter on the left side and a larger volume on the right side of the limbic prefrontal cortex, along with reduced connections between the amygdala and prefrontal cortex, may correlate with aggressive behaviors.
  • Striatum dysfunction (involving motivation and reward) is linked to aggression.
• Biochemical
  • Low striatal serotonin levels are associated with violence.
  • Elevated plasma concentrations of serotonin in cerebrospinal fluid (CSF) may also be implicated in violence.
  • GABA and glutamate modulate serotonin-related violence.
  • Increased dopamine release is connected to aggression.
  • The complex interaction of testosterone and cortisol levels with serotonin can influence aggression.
  • Reactive aggression is an impulsive response to threats or provocation and is more common in those with a history of abuse.
  • Proactive aggression is planned aggression to achieve goals, initiated rather than provoked, and more common in psychopathy.
• Genetic
  • At least 40 genes are associated with aggression.
  • Trauma can alter genetic expression.
  • ADHD and depression share common DNA variants.
  • Possible X-chromosome linked mutations of the MAO-A gene (breaks down neurotransmitters)
  • Variations in the serotonin transporter gene may be linked to aggression.
• Brain Structure/Function
  • Organic brain syndromes (various cerebral disorders and traumatic brain injuries) are linked to aggression.
  • Tumors in the limbic system and temporal lobe can influence aggression.
  • Brain trauma can cause cerebral changes and impact behaviors.
  • Disease processes like epilepsy, particularly temporal lobe epilepsy, encephalitis, medications that impact brain function can influence aggression.

Predisposing Factors: Psychological Theories

• Psychodynamic Theory
  • Unmet needs for satisfaction and security during childhood can create a weak ego and superego, leading to underdeveloped emotional regulation and increased aggression.
  • Aggression can be used to boost self-image and create a sense of power and control.
• Learning Theory
  • Children may imitate role models who are perceived as prestigious, powerful, or influential, especially when the behavior is reinforced.
  • Individuals who experienced abuse or witnessed domestic violence in childhood are more likely to experience reactive aggression as adults.
  • Individuals with a biological predisposition to aggressive behaviors may be more susceptible to negative role modeling.

Predisposing Factors: Sociocultural Factors

• Aggressive behavior is seen as a product of culture and social structure.
• American society accepts some forms of aggression as means to solve problems (war, physical discipline, law enforcement).
• Societal factors like relative deprivation, marginalization, poverty, unemployment, lack of resources, emotional stress, family breakdown, and exposure to violence in the family and community contribute to aggression.

The Cycle of Battering

• Phase 1: Tension-Building Phase
  • Abuser exhibits increasing irritability, anger, and verbal aggression as tolerance for frustration decreases.
  • Minor battering incidents occur during this phase, often rationalized by victims who may assume guilt.
  • Fear of the partner leaving leads to increased jealousy and possessiveness and escalated threats and violence.
• Phase 2: Acute Battering Incident
  • The abuse escalates to violence, often physical or sexual.
  • This phase may escalate into a violent outburst.
  • The abuser may minimize or deny the abuse.
• Phase 3: Honeymoon Phase
  • The abuser may apologize, show remorse, and promise to change behaviors.
  • The victim may feel hope that the behavior won't repeat.
  • This phase reinforces a sense of hope and prevents the victim from seeking external support.

Child Neglect

• Signs in Children
  • Frequent absenteeism from school.
  • Begging or stealing food or money.
  • Lack of medical, dental, or other basic care needs.
  • Consistently dirty or lacking appropriate clothing for the weather.
  • Alcohol or drug abuse, especially among children.
  • Reporting no one at home to provide care.
• Signs in Parents/Caregivers
  • Indifference towards the child's well-being.
  • Irrational or bizarre behavior.
  • Apathy or depression.
  • Substance abuse (alcohol or drugs).

Characteristics of Parents/Caregivers Who Abuse

• Often victims of childhood abuse.
• Active substance use.
• Experiencing a stressful life situation.
• Lack of support systems and social isolation.
• Lack of adaptive coping skills, easily angered, difficulty trusting others.
• They tend to have unrealistic expectations of their children and exaggerate any mild differences as "abnormal".

Childhood Sexual Abuse

• Signs in Children
  • Difficulty walking or sitting.
  • Reluctance to participate in physical activities.
  • Nightmares, bedwetting (nocturnal enuresis).
  • Sudden changes in appetite.
  • Unusual sexual knowledge or behavior.
  • Pregnancy or sexually transmitted infections under the age of 14.
  • Running away from home.
  • Reporting sexual abuse by a parent or adult.
  • Quickly attaching to strangers or new adults.
• Signs in Parents/Caregivers
  • Unduly protective of the child, limiting contact with other children, especially those of the opposite sex.
  • Secrecy and social isolation.
  • Disrespect for boundaries, ignoring "no" from others.
  • Giving children gifts without reason or occasion.
  • Jealousy and controlling behavior toward family members.
• Sexual Exploitation of a Child
  • Inducing or coercing a child to engage in sexually explicit conduct for the purpose of promotion.
• Incestuous Relationships
  • Most research is on father-daughter incest, often starting between 8-10 years old.
  • The oldest daughter is often the target of the incestuous abuse.
  • If one child reports abuse, suspect all children in the household.
  • Long-term impact on adults: Lack of trust, low self-esteem, poor identity development, alterations in sexual activity, and increased inflammatory markers in the body.

Sexual Violence

• Forms of sexual violence: Sexual coercion, penetration, unwanted sexual experiences, non-contact sexual experiences, rape.
• Includes: sexual assault, acquaintance rape, marital rape, and statutory rape.
• Rape is an expression of power and dominance through sexual violence.

Psychological Responses to Sexual Violence

• Expressed Response Pattern: expressing fear, anger, anxiety through crying, sobbing, restlessness, and tension.
• Controlled Response Pattern: masking or hiding feelings with a calm or subdued affect.
• Feelings of guilt are common.
• In the days and weeks after the assault:
  • Physical signs: Contusions, abrasions, headaches, fatigue, sleep disturbances, stomach pain, nausea, vomiting, vaginal discharge, rectal bleeding or pain, burning upon urination.
  • Emotional and psychological signs: Rage, humiliation, embarrassment, desire for revenge, self-blame, fear of violence and death.
• At risk for PTSD symptoms
• Long-term effects: Restlessness, intrusive thoughts, nightmares, phobias.

Other Psychological Responses to Sexual Violence

• Compound Rape Reaction: Rape trauma syndrome symptoms along with additional issues like depression, suicidal ideation, substance use, and psychotic behaviors.
• Silent Rape Reaction: The victim tells no one about the assault, suppressing anxiety. The unresolved trauma may emerge later during another sexual crisis in their life.

Nursing Care for Victims of Sexual Violence

• Nursing Diagnoses
  • Rape Trauma Syndrome related to sexual assault.
  • Powerlessness related to the cycle of battering.
  • Risk for delayed development related to abusive family situations.
• Outcomes
  • For victims of sexual assault: Reduced panic anxiety, increased trust in the primary nurse, immediate care for injuries, and initiation of grief behaviors.
  • For victims of physical battering: Immediate care for injuries, verbalization of feeling safe, discussing life situation with the nurse, and identifying resources for assistance.
  • For abused children: Immediate care for injuries, demonstration of trust through play therapy, and reduction in regressive behaviors.
• Interventions
  • Communicate safety, empathy, and support.
  • Explain assessments and procedures.
  • Maintain a caring and non-judgmental attitude.
  • Provide privacy for all interventions.
  • Encourage the victim to disclose details of the assault.
  • Document information clearly and accurately using phrases like "patient/client reports" instead of "patient alleges".

Evaluation Questions for Victims of Abuse

• For victims of sexual and physical violence: Reassurance of safety, decreased panic anxiety, appropriate care for injuries, support for emotional needs, establishment of trust with someone they can confide in, identification and notification of support systems, presentation of options for immediate circumstances, ability to manage activities of daily living, healing of physical wounds, progression through the stages of grief, absence of sleep disturbances, psychosomatic symptoms, regressive behaviors, and psychosexual disturbances, absence of problems in interpersonal relationships.
• For victims of physical violence: Consideration of alternatives for change in their life situation, decision making regarding available choices, and satisfaction with their decision.
• For victims of sexual violence: Progression through the stages of grief and absence of sleep disturbances, psychosomatic symptoms, regressive behaviors, and psychosexual disturbances.
• For victims of a compound rape reaction: Progress toward resolving depression, suicidal thoughts, substance use, and psychotic behaviors.
• For victims of a silent rape reaction: Successful disclosure of the assault.
• For abused children: Progress toward reducing regressive behaviors and increased trust in the primary nurse.