Understanding Abuse and Violence

• Abuse is the wrongful use and maltreatment of another person, typically by someone the victim knows
• Victims of abuse can include partners, children, or older adults/parents

Clinical Picture of Abuse and Violence

• Physical and psychological injuries are common in abuse victims
• Abuse victims may exhibit agitation or withdrawal
• Victims often internalize blame for the abuse
• Low self-esteem and feelings of being unlovable are common, which can lead to missing school
• Abuse can lead to depression and suicidal behaviors

Characteristics of Violent Families

• Family violence can manifest as child abuse, elder abuse, or marital rape
• Common characteristics of violent families include social isolation, abuse of power and control (physical, economic, social)
• Alcohol and drug abuse, as well as intergenerational transmission of violence, are also indicators

Intimate Partner Violence

• Involves mistreatment or misuse of one person by another within an emotionally intimate relationship
• Women experience higher rates of intimate partner violence at 1 in 5, versus men who experience it at 1 in 12
• Rates of intimate partner violence increase during pregnancy
• Occurs in same-sex relationships with similar statistical frequency, but victims may have fewer protections
• Abusers view their partners as possessions
• Abusers become increasingly violent when their partner shows signs of independence
• Abusers tend to have feelings of inadequacy and low self-esteem
• Abusers gain a boost in self-esteem through abuse

Dynamics of Abuse and Violence

• Cycle: violent episode, honeymoon period, tension-building phase, then another violent episode
• Victims don't often seek direct help for abuse, but may seek treatment for other conditions

Questions to Assess Safety

• Are you concerned about your safety?
• Do you feel safe in your relationship?
• Do you ever feel threatened?
• Are your children safe?
• Are family and friends concerned for your safety?
• If you feel threatened or unsafe, is there someone you can call?
• Do you have a safe place to go?
• Do you have a plan if your situation suddenly becomes unsafe?

Treatment and Interventions for Abuse and Violence

• Laws related to domestic violence and arrest
• Restraining orders/protection orders can provide legal protection
• Shelters can provide safe housing
• Psychotherapy/counseling, both individual and group therapy can address abuse
• Treatment for posttraumatic stress disorder (PTSD) with cognitive behavioral therapy

Child Abuse

• Intentional injury of a child, including: Physical abuse or injuries, Neglect (physical, emotional, educational necessities), Psychological abuse, Abandonment, Sexual assault or intrusion, and Overt torture or maiming
• Most reported cases involve father-daughter incest; mother-son incest is much less frequent
• Parents who abuse their child may show: minimal parenting knowledge and skills, emotional immaturity, neediness, incapacity to meet their own needs, frequently children are seen as properties, intergenerational transmission
• Look out for: Serious injuries without history of trauma (fractures or burns) that the parents cannot explain, Inconsistency in story of child and parent, Unusual injuries for the child's age (ex. 2 month old with fracture of femur), and Different stages of healing of injuries
• Nurses do not have to decide if abuse has occurred, reporting suspected child abuse with accurate documentation
• Child's safety and well-being is a priority, involve removing patient from home
• Psychiatric evaluation, and Therapy may be indicated over a long time

Elder Abuse

• Maltreatment of older adults, including: Physical, sexual, psychological abuse, Neglect or self-neglect, Financial exploitation, and Denial of adequate medical treatment
• Abuse is likely when an older adult has multiple conditions
• Abuser – caregiver (usually family member) mostly spouse
• Older adults are reluctant to report to protect family members, and because they fear losing support
• Look out for: Frequent, unexplained injuries, Malnourishment, Unusual activity in bank accounts, Poor personal hygiene, Failure to keep on medical appointments, and Inability to manage ADL
• Provide caregiver stress releif, additional reasources, and possible removal of older adult or caregiver

Rape and Sexual Assault

• It is the perpetration of the act of sexual intercourse with person against their will and without consent
• Will overcome by force, fear of force, drugs, intoxicants
• Only slight penetration is necessary for rape
• rape is committed by acquaintances, married people, people of same sex, or strangers
• it is most commonly done by met people
• Rape is a highly underreported crime
• Most commonly occurs in victim's neighborhood, often inside or near home
• Most rapes are premeditated
• Male rape is significantly underacknowledged and underreported

Dynamics of Rape

• Women were historically objects of aggression
• Primary motivation of victim is to stay alive
• Severe physical and psychological trauma

Assessment for Rape

• Physical examination to preserve evidence is needed
• Description of what happened need to be gathered
• Look out for Rape kits, and rape protocols
• the treatment and intervention should involve: Immediate support, Gice control back to victim, prophylactic treatment for sexually transmitted diseases, pregnancy, Counseling, and Supportive therapy

Community Violence

• Includes School violence (homicides, shootings), and Bullying with Ostracism, and Hazing
• Effects children, and young adults
• Violence on a larger scale (e.g., terrorism), PTSD and depression

Explanation of abuse as wrongful maltreatment by a known person, impacting partners, children, or older adults. Abuse victims commonly suffer physical and psychological injuries, withdraw, and internalize blame. Violent families often exhibit social isolation, power abuse, substance abuse, and intergenerational violence.