ABUSE AND VIOLENCE

Eligio, Ana Lourdes

Espera, Khrieza Mae
Estanislao, Kristine Anne
Fabroa, Pelumarea
N4-B

ABUSE
Abuse is a kind of behavior that one person engages in to unfairly control another
person.
VIOLENCE
Violence is the expression of physical or verbal force against self or other,
compelling action against one's will on pain of being hurt.

Elements of Abuse
The ABUSER
Generally male
Generally female
Grew up in an abusive family
Victims of beating/violence
Low-economic status
Immature
Domestic abuse
Child abuse
Fear of authority
Lack of skills to meet their own needs
Belief in harsh physical of discipline
Poor impulse control
Lack parenting / communication skills
Often use alcohol to cope with stress
The ABUSED

Demonstrates:

isolation

irrational jealousy

subtle presence of physical violence

discounting, minimizing, and trivializing

criticizing

withholding

Blaming
Helplessness

Low Self-esteem

A CRISIS

Precipitating event that sets the abusive person into action.

Example: Loss of job, divorce, illness, death of family member.

Types of Abuse

CHILD ABUSE

• Physical Abuse

• Child Neglect

• Emotional Abuse/Neglect

• Child Sexual Abuse

• Child Abduction

Types of Abuse

CHILD ABUSE

Maltreatment

Physical harm/death

Emotional harm

Sexual abuse

Neglect

Exploitation

Bullying

Child labor

Laws Against Child Abuse

SPECIAL PROTECTION OF CHILDREN AGAINST ABUSE, EXPLOITATION AND

DISCRIMINATION ACT (Republic Act No. 7610)
AN ACT PROHIBITING THE EMPLOYMENT OF CHILDREN BELOW 15 YEARS OF
AGE IN PUBLIC AND PRIVATE UNDERTAKINGS, AMENDING FOR THIS PURPOSE
SECTION 12, ARTICLE VIII OF R. A. 7610. (Republic Act No. 7658)

Types of abuse: Child Abuse

Potentially Abusive Parent

Denial of pregnancy

Depression during pregnancy

Fear of delivery

Lack of support from husband or family

Fear that the child would be a burden

Birth of unwanted child

Resentment toward the child by a jealous parent

Inability to tolerate child’s crying

Viewing child as being too demanding

Characteristics of an Abused Child

6 years and below

Physical/ mental handicap

Emotionally disturbed

Temperamental

Hyperactive

Adopted children

Classifications of Child Abuse

Physical Abuse

Bruises

Burns

Lacerations
Abrasions

Welts

Scars

Missing/loosened teeth

Musculoskeletal injuries

Munchausen Sndrome by Proxy

Parent/ caregiver systematically fabricates or deliberately causes illness or injury

in the child in order to gain attention for themselves.

Examples: Poisoning, apparent bleeding from variety of orifices, skin rashes and
pyrexia.

Shaken Baby Syndrome

A form of child abuse where an adult loses control and violently shakes a child
who has been crying incessantly.

Physical findings: bruisng from being grabbed firmly, major head injury or
nonfatal consequences such as blindness, cognitive imparment and c.palsy

Behavioral Indicators

include severe parental/caretaker problem such as alcoholism, drug abuse,

mental illness; crisis; geographic or social isolation of the family.

Physical Indicators

Weight loss – inadequate nutrition

Dental caries

Anemia, pneumonia

Child may look unkempt

Lack of adequate clothing

Behavioral Indicators

Failure to thrive

Learning difficulties
Poor attention span

Inability to concentrate

Autistic behavior

Drug/ alcohol use

Delinquency

Sexual misbehavior

Stuttering

Enuresis , encopresis

Hypochondriasis

Suicidal

Overeating

Environmental Indicators

Living in poverty

Presence of family problem

Lack of resources

Lack of positive parental attitudes

Lack of understanding of parents regarding childhood development

Display of lack of interest and attention

Occurs when one person uses words and body language to inappropriately
criticize and humiliate another person.

Often comes in the

form of constantly

criticizing, insulting,

belittling, intimidating,

making unreasonable
 demands or expressing disapproval of another person.

Emotional abuse often involves 'putdowns' and name-calling intended to make

the victim feel they are not worthy of love or respect, and that they do

not have ability or talent.

Behavioral Indicators

Low self-concept

Failure to thrive

Learning difficulties

Poor attention span

Inability to concentrate

Autistic behavior

Drug/ alcohol use

Delinquency

Sexual misbehavior

Stuttering

Enuresis , encopresis

Hypochondriasis

Suicidal

Environmental Indicators

Living in poverty

Presence of family problem

Lack of resources

Rejection or immature behavior’s of parents

Dicriminatory treatment towards children

Display of lack of interest and attention

Drug/ alcohol abuse

Child Sexual Abuse

Serious Effects

Emotional distress

Behavioral problems

STD’s

Unwanted pregnancy

Drug/ alcohol abuse

Sexual deviance

Diff. in establishing intimate relationships

Children at risk:

3 y/o and below

Suffers from developmental delay

With single parent

Parents or caretakers were sexually abused themselves

Parents or caretakers are mentally ill

Substance abusive

Classification of Child Sexual Abuse

Physical Indicators

Itching, pain, bruises or bleeding in the external genitalia, vagina or anal area

Edema of the cervix

Torn, stained or bloody undergarments

Stretched hymen at a very young age

Presence of semen or STD’s

Pregnancy in an older child

Bladder infections

Behavioral Indicators

Fear of being touched

Difficulty walking or sitting.

Reluctance to participate in recreational / physical activites

Preoccupation with sexual organs of self and others

Sexual promiscuity

Change in sleeping patterns

Drug/ alcohol abuse

Delinquency

 Effects of Childhood Sexual Abuse on the Child

 End result is distrubed growth and development and denial of what is

happening to protect the whole family or the community.

 The child wishes for love, not sex, but eventually feels guilty, exploited,
betrayed, angry, ‘dirty’, helpless and responsible.

 Denial, repression, suppression, rationalization, and dissociation are

mechanisms used by young victims to cope up.

 Repression normally lasts until victims are in their 30s or 30s and are
having trouble with close relationships and parenting.

 Effects of Childhood Sexual Abuse on the Adolescent

 Shows dysfunctional coping such as impulsive acting out, violence

towards others,self destructive behaviors, suicide attempts, substance
abuse, early pregnancy and early marriage.

 Adolescents may have fantasies of revenge and wish for perpetrator’s

death.

 Victims may not be even aware of the reason for their rage, shame, guilt
and confusion and may not realize it is related to their abuse.

Recovery from Childhood Sexual Abuse

The memories, and emotions are strong, painful and confusing.

Counseling take 2 years or more.

Psychotherapeutic Management

Empathy, active support, compassion, warmth and being nonjudgmental is needed.

Victims need to feel safe about confidentiality.

It is usually helpful for survivors to be reminded periodically that they are not
responsible for the sexual abuse, are not to be blamed and that the way they coped up
with it in the past was the best they could do at that time.

Establish a trusting and supportive environment.

Reinforce that recovery is possible, even if it is difficult.

Adult Survivors of Childhood Sexual Abuse

Nature of the Problem

The crimes of childhood sexual abuse and incest are especially destructive for two
major reasons: the crimes are not onetime occurrences and the perpetrators are usually
known and trusted persons.

Sexual abuse and incest include voyeurism and exhibitionism, which can lead to
intercourse and mutilation, but always involve a younger victim who is not capable of
giving consent to older individual.

 The victim is urged to maintain the “secret” because of various threats.

For young victims, there is usually an emotional reaction of fear and confusion,
and some physical pain but not a moral or ethical concept of “wrong”.

At times, the child may even have the physical experience of sensual pleasure,
but emotional pleasure and concept of sexual love are absent.

CHILD ABDUCTION

Abduction by a Family member usually parents – 82%

Non-family or aquaintance abduction –18%

DOMESTIC or INTIMATE PARTNER VIOLENCE

Examples:
Repeated battering and injury

Psychological abuse

Sexual assault

Progressive social isolation

Stalking

Deprivation

Intimidation

Groups at Risk

Women who are emotionally involved with the batterer.

Children (Silent victims)

Elderly

Men

Same – sex couples

- women living with female partners experiences domestic violence than

women living with men.

-Men living with male partners experience domestic violence than men who live
with women.

The ABUSER / PERPETRATOR

Usually male w/ low self-estem, insecurities and fears.

They experience extreme jealousy.

Did not developed positive ways to communicate feelings and needs.

They use force and violence to solve problems.

Denial is the most common def. mechanism.

The ABUSED

Either male or female

Abused women exhibit a patterned of learned helplessness, low self-esteem and
shame.

They may hold religious or cultural beliefs about the trad. Gender roles of men
and women.

Forms of Domestic Violence

Dynamics of Domestic Violence

 Effects of Partner Abuse

 Learned helplessness

 Three of the necessary

conditions for learned

helplessness are

certainly present in

partner abuse:

 The victim’s behavior

is not related to the cause of beatings.

 The victims has no control over preventing or stopping the

beatings

 The victim sees little hope of escaping because of the

threats of increased harm.

Barriers to Leaving a Violent Relationship

Why Women Stay as Long as They Do

Situational Factors

Economic dependence

Fear of greater physical danger to themselves and children

Fear of emotional damage to children for having no father

Fear of losing custody of children

Lack of job skills

Lack of alternative housing

Fear of involvement in court processes

Emotional Factors

Poor self-image

Fear of loneliness

Personal embarrassment and protecting image of husband and family

Guilt about failure of marriage and relationship

Fear that partner is not able to survive alone

Belief that partner will change

Belief that partner is sick and needs help

Lack of emotional support

Cultural Factors

Knowing batterers are not held accountable for their violent actions

Believing the abuse is her fault

Being raised to be passive and submissive

Developing survival skills instead of escape skills

Recognizing that the legal system is a male-dominated system

PLUS: She still loves him

ADULT SEXUAL ABUSE

Effects of Childhood Sexual Abuse on the Adult

There is repression of memories followed by breakthrough of unwanted, intrusive

memories.

The inability to handle the memories of abuse and painful emotions, especially anger,
often induces thought of suicide.

Self-harm or mutilation is a common way of dealing with the emotional pain.

Victims describe several patterns of their mutilation:

When emotions build up, they go numb and have to inflict pain to make sure they can
still feel.

When they are feeling unreal, they draw blood to make sure they are alive.

They cause physical pain so they do not have to focus on emotional pain.

They punish themselves when they are feeling guilty, ashamed or fearful.

The mutilation relieves the anger/rage.

Rape

Nature of the problem

Rape is considered forcible penetration of the victim’s body by perpetrator’s genitals

without consent.

Sodomy - term for male rape

Any other form of forced sexual contact (from touch to mutilation) is considered sexual
assault.

Motives for Rape

Subclassifications of Rape

Effects of rape and sexual assault

Rape victim experiences a severe

violation and all possible

emotions

of impact stage.

Powerlessness, loss of control,

fear, shame, guilt, humiliation,

rage and feeling of being

contaminated or “dirty” may be

overwhelming.
A typical reaction of the victim

is the wish to regain a sense of control and retreat to safe place, take a thorough
shower and destroy any damaged belongings.

 Rape Trauma Symptoms

 Sleep disturbances

 Nightmares

 Loss of appetite

 Fears, anxiety, phobias,

suspicion

 Decrease in activities

and motivation

 Disruptions in relationships with partners, family, friends

 Self-blame, guilt, shame

 Lowered self-esteem, feeling of worthlessness

Psychotherapeutic Management

Rape victim needs continual empathy, support and opportunity to process the events
and intense feelings that result.

Having one nurse stay with the victim through examinations and interrogations can be
reassuring.

Short-term counseling and rape support group

Benzodiazepines to reduce anxiety may be used on temporary basis.

Recovery from Rape and Sexual Assault

Rape victims need assistance, information, and support.

Fear and mistrust are major issues and may be directed toward persons resembling the
perpetrator or to everyone around them.

If the rape occurred in their own residence, they may move or at least make safety
related changes to prevent recurrence.
Elder Abuse

Types and Examples of Elder Abuse

Violence

Classification of Workplace Violence Incidents

Cycle of Violence

Another accepted view of why women endure abuse was originally described by Walker
(1979). The cycle of violence document several principles:

Abuse is not constant, nor it is random.

There is an imbalance of power in the relationship.

Abuse occurs in a cycle and has three phases that vary in time and intensity.

The last stage (“honeymoon”) is the one that convinces the woman that she should stay
in the relationship.

Psychotherapeutic Management

Interview the victim privately and with sensitivity, empathy and compassion.

Be nonjudgmental, objective and nonthreatening.

Ask directly if abuse is occurring.

Referrals may be needed for job counselling or training, legal assistance, financial aid
and permanent housing.

Effects of Crime

Not all crimes involve physical violence, injury and threat to life, however, all crimes
involve emotional violation and trauma.

There is loss of trust, not only in the criminal, but to some degree in all other persons.

Victims lose a sense of ability to control their own lives and themselves (autonomy
issues).

Typical reactions are denial, fear, anger, powerlessness and depression.

 Sense of failure and guilt are common.

  The relationships of victims to family and friends can be disturbed, in part
due to loss of trust, but also because of the response of others.

Other Forms of Abuse

Torture and Ritual Abuse

Nature of the Problem

Effect of torture, whether perpetrated by individuals, relatives, gangs, cults or military-

political organizations, is more severe because it involves multiple crimes against each
victim.

It is used to create fear, humiliation, and submission in individuals, communities and

socities.

Torture and ritual abuse tactics

Torture involves physical, psychological, pharmacological, mind control or sexual tactics

aimed at damaging the victim’s identity, personality, emotional stability, spirit and
physical integrity.

Can involve using hot irons, electric shock, submersion, suffocation, large doses of
drugs, beatings, physical restraint, gang rape, sexual and physical mutilation, starvation,
being tied or hung in the air and threats with weapons.

Effects of Torture and Ritual Abuse

Injuries to teeth, head, genitals, as well as bone fratcures, dislocations, scars, burns,
pain and chronic headaches.

Loss of trust and self-esteem; identity and personality changes; terror and insecurity;
and damaged social and family relationships.

Recovery from Trauma

Recovery from Trauma

Stages of Recovery

Impact

Initial reaction to trauma usually lasts from a few minutes to a few days.

Common responses are shock, denial, disbelief, and confusion.

There may be paralyzing fear, hysteria, a sense of helplessness and vulnerability,
physiological responses and disturbed sleeping and eating.

Recoil

Victim begins the struggle to adapt.

Immediate danger is over, but a great deal of emotional stress remains.

Later in the phase, there is a desire to talk about the details of and feelings about the
trauma.

Victims often feel the need for support and to be temporarily dependent.

Fantasies of revenge are natural on this stage.

Reorganization

May take months or years to accomplish.

The trauma is not forgotten, but anxiety, fear and anger diminish and victims reconstruct
their lives.

Grief over losses resolves slowly.

The goal of recovery is to move from victim status to survivor status by integrating the
memories of the crime or trauma and moving on in life with restored functioning, a
reasonable sense of safety and security and self-esteem.

Recovery from Torture and Ritual Abuse

Major goals for recovery:

Processing and integrating the memories of the experiences, often from the least to
most bizarre experiences

Expressing and dealing with intense emotions, especially anger

Developing or re-establishing healthy relationships with family, friends and community.

 Abuse and Violence

 APPLICATION TO NURSING PROCESS

 Assessment

 Background: trauma or abuse

 General Appearance and motor behavior

 Assessment

 Mood and Affect

 Assessment

 Thought Process and Content

 Sensorium and Intellectual process

 Assessment

 Judgment and Insight

 Self-Concept

 Assessment

 Roles and Relationships

 Physiologic considerations

 Difficulty sleeping

 Lack of appetite

 Diagnosis

 Risk for self-mutilation

 Ineffective coping

 Post-traumatic response

 Chronic low self-esteem

 Powerlessness

 Disturbed sleep pattern

 Sexual dysfunction

 Rape-Trauma syndrome

 Spiritual distress
  Social isolation

 Planning-Objectives

Ensure client:

 Is physically safe

 Can distinguish between ideas of self-harm and taking actions of those ideas

 Will demonstrate healthy, effective ways of dealing with stress

 Will express emotions nondestructively

 Will establish a social support system in the community

 Intervention

 Promote client safety

 Intervention

 Helping the client cope with stress and emotion

 Intervention

 Helping promote self-esteem

 Intervention

 Establishing Social Support