Introduction

Abuse and violence in the family refers to physically and emotionally harmful behaviors that occur between family and household members. It includes child abuse, child neglect, intimate partner abuse and violence, spousal rape, and elder abuse. It could be a learned behavior that can be unlearned through therapy. The perpetrators try to isolate the family to keep it secret and avoid penalties. They usually have some power and control over the other members of the family. They may rationalize violence with their drug use. The use of cocaine, PCP, amphetamines, etc. May increase violent behavior.

forms of abuse

Physical abuse includes hitting, punching, shoving, stabbing, shooting, kicking, and withholding medication, wheelchairs, food, and liquids. Sexual abuse includes coercion, marital rape, and denial of sexual relations. Psychological abuse includes threats, harassment, and blackmail. Emotional abuse includes name calling, name calling, and teasing. Economic abuse includes total control over finances, increased bills, a ban on studying or working.

reality about violence

Family violence occurs at all levels of society. Separation or divorce may not end the violence. The abuse does not need to be provoked. Some survivors mistakenly tend to blame themselves. Treat violence, but also alcohol, drugs, stress and mental health problems, if any. Violence also occurs between gays and lesbians. Abused women are discouraged from disclosing their situation through threats, fear, denial and disbelief expressed by ‘confidants’.

Intervention Models

The Paternalistic model assumes that the clinician has more knowledge than the patient; that the survivor is responsible for ending the violence; that the clinician should give advice and sympathy; and see the patient as a victim. While the empowerment model, which is better, assumes that the clinician should mutually share knowledge with the patient, strategize with the patient, respect the patient’s competence, experience, and strengths, and view the patient as a survivor.

Survivor Response to Violence

Physical signs of abuse include injuries to multiple sites in various stages of healing (head, neck, face, throat, sexual organs), headache, insomnia, and stress. Behavioral sign is that the individual does not leave the abuser or leaves and returns before making a final break. Psychological signs include delayed reactions, depression, low self-esteem, attributions, eg self-blame, impaired school or work performance and conduct, poor concentration, and poor problem solving.

Why doesn’t the individual leave the abuser?

Abused people do not leave the abuser for a variety of reasons, including fear of being stalked and killed (which is a realistic fear), strong emotional attachment to the abuser, determination to end the abuse, sanctions present in the abuse culture, the partner, fear of stigma, the lack of resources to live away from the abuser and the consideration of what will happen to her children if she leaves. She can leave and come back, thinking: “Maybe he will change.”

Child abuse and neglect

In all states, child abuse and neglect must be reported. Types of abuse include child sexual abuse, child physical abuse, child emotional abuse, and child neglect. The child who witnesses family violence may also experience abuse.

child sexual abuse

This is the involvement of children in sexual activities that they do not fully understand and to which they do not or cannot freely consent. This violates the child’s trust in the adult who is supposed to protect him. Threat to the child, pet, and others keeps the child quiet. It results in confusion, shame and helplessness. Its effect can last a lifetime and affect mental health. It can be kept as a family secret.

Observable signs of sexual abuse

Observable signs of child sexual abuse include physical assault, excessive masturbation, social withdrawal, low self-esteem, poor school performance, sleep disturbances, STDs, bleeding, pain, itching, UTIs, pregnancy, bruising, swelling, redness, fracture, burns, and empty appearance.

school violence

School violence is typically due to drug use by children, children’s access to weapons, antisocial and impulsive behaviors, family dysfunction, lack of community response, interpersonal disputes and bullying, and bullying by peers.

Child abduction

Most abductions are carried out by one of the parents. 70% are from fathers, 25% from their mothers. Parents likely to abduct include those who have threatened or attempted to kidnap in the past, suspect abuse by the other parent, may be paranoid, may be intent on using it as revenge, punishment, trophy, or one who strongly believes the child should be raised. in their country of origin.

Child Abuse Assessment and Intervention

Explore and be aware of your own attitude toward survivors of abuse so you don’t judge them. Take a complete history and physical evaluation. Use a private, quiet and uninterrupted environment. State honestly the purpose of the interview. Inform the victim of the pending physical evaluation. Use a calm and supportive approach. If possible, interview the child separately first before the joint interview with the parent or guardian. Pay attention to the child’s affect (appearance) and behavior, the mother’s understanding of the problem, discrepancies in her stories, and the parents’ emotional responses. Document your evaluation fully. Report suspected abuse to CPS. Coordinate services such as further evaluation, psychological testing, individual psychotherapy, family psychotherapy, and group psychotherapy.

Intimate Partner Violence (IPV)

IPV is a pattern of coercive and aggressive behavior between intimate partners and intimate partners. Abuse by female partners is the most frequent IPV. Female violence is more often in self-defense. Many IPVs end in homicide or homicide-suicide. The victim’s exit or attempted exit increases the risk of homicide. There is an increased risk of homicide with a firearm, a history of suicidal ideation or attempt, beatings during pregnancy, sexual abuse, substance use, extreme jealousy, and controlling behavior (“if I can’t have you, no one can”). Few women kill their abusers without intervention. The IPV assessment should be part of the mental health assessment. Ask the partners about the history of conflicts, “pushing and shoving” and the quality of the relationship. Watch for hesitation, looking away, and restlessness. Be supportive, let the victim know that she is not alone. Describe and map the extent of lesions. Evaluate attribution, for example, self-blame. Evaluated for depression, PTSD and anxiety. If the patient is the abuser, assess the possibility of further violence. Consult legal counsel for “Duty to Warn”. The courts have made it mandatory for abusers (the majority of whom are men) to receive treatment. Treatment includes confronting the violence, affirming that the abuser is responsible, behavioral therapy, anger management, attitude change toward women, couples counseling, and cognitive behavioral therapy (CBT). Empower women, using laws, community resources, support groups and safe shelters. Set goals mutually with the victim. Mutually consider and choose among the options. Help mobilizes natural, social and professional supports.

Rape and Sexual Assault

This affects men, women and children, especially women and children. Sexual assault is a forced act of sexual contact without consent. It is usually done to humiliate, desecrate or dominate the victim. Rape is a serious crime, but most go unreported. Marital rape survivors do not seek care out of shame and humiliation. Careful evaluation and questioning is needed. When caring for the victim, listen, be non-judgmental, and provide emotional support. Document your observation and evaluation fully. Help collect evidence if the patient decides to litigate. In the acute stage, assess for fear, disorganization, shock, and restlessness. In the second stage, assess for flashbacks, phobias of places and people, and sexual difficulties. Encourage the victim to talk about her feelings. Explore the options, for example, change the phone number. Explore available community services and support groups. Refer for physical treatment and psychotherapy. Plan a follow-up phone contact in a few days.

elder abuse

There are about 5 million abused seniors in the US annually. Spousal abuse overlaps with elder abuse. The abused person does not report for fear of being abandoned in a nursing home or being isolated. Signs include bruises on the arms, wrists, ankles, facial lacerations, vaginal lacerations, fractures, malnutrition, poor hygiene, dehydration, shuddering, and cringing in the presence of the abuser. Help and care includes reporting suspected abuse to Adult Protective Services (APS), counseling, psychotherapy, substance abuse, and abuser treatment, if needed.

Reference: Stuart, GW & Laraia, MT (2005). Principles and Practice of Psychiatric Nursing (8th ed.). St. Louis, MO: Elsevier Mosby.