NCM 116 – Care of Clients with Maladaptive SEM 02
Patterns of Behavior, Acute and Chronic FINALS
Lecturer: Dr. Cefer S. Sales, RN, MD, MHM, CHA
UNIT 3 – CHAPTER 12: ABUSE AND VIOLENCE
INTRODUCTION ALCOHOL AND OTHER DRUG ABUSE
• Abuse is the wrongful use and maltreatment of • Substance abuse, especially alcoholism, has been
another person. associated with family violence.
• Statistics show that most abuse is perpetrated by • Alcohol does not cause the person to be abusive;
someone the victim knows. rather, an abusive person is also likely to use alcohol
or other drugs.
CLINICAL PICTURE OF ABUSE AND VIOLENCE • Alcohol is also cited as a factor in acquaintance rape
• Victims of abuse or violence can certainly have or date rape.
physical injuries and psychological injuries with a • In addition, use of the illegal drug flunitrazepam
broad range of responses. (Rohypnol) or other “date rape drugs” to subdue
• Children particularly come to believe that somehow, potential victims is on the rise.
they are at fault and did something to deserve or
provoke the abuse. INTERGENERATIONAL
• As adults, they usually feel guilt or shame for not TRANSMISSION PROCESS
trying to stop the abuse. Survivors feel degraded, • The intergenerational transmission process shows
humiliated, and dehumanized. that patterns of violence are perpetuated from one
o Their self-esteem is extremely low, and they view generation to the next through role modeling and
themselves as unlovable. They believe they are social learning.
unacceptable to others, contaminated, or ruined. • This suggests that family violence is a learned pattern
o Depression, suicidal behavior, and marital and of behavior.
sexual difficulties are common. • For example, children who witness violence between
• Victims and survivors of abuse may find trusting their parents learn that violence is a way to resolve
others, especially authority figures, to be difficult. conflict and is an integral part of a close relationship.
• Intimate relationships may trigger extreme emotional
responses such as panic, anxiety, fear, and terror. INTIMATE PARTNER VIOLENCE (IPV)
• Nurses should be particularly sensitive to the abused • Intimate partner violence is the mistreatment or
client’s need to feel safe, secure, and in control of his misuse of one person by another in the context of an
or her body. emotionally intimate relationship.
o They should take care to maintain the client’s • The relationship may be spousal, between partners,
personal space, assess the client’s anxiety level, boyfriend, girlfriend, or an estranged relationship.
and ask permission before touching him or her for • The abuse can be emotional or psychological,
any reason. physical, sexual, or a combination (which is common).
• Battering during pregnancy leads to adverse
CHARACTERISTICS OF VIOLENT FAMILIES outcomes, such as miscarriage and stillbirth, as well
• Family violence encompasses spouse battering; as further physical and psychological problems for the
neglect and physical, emotional, or sexual abuse of woman.
children; elder abuse; and marital rape. o The increase in violence often results from the
• In violent families, the home, which is normally a safe partner’s jealousy, possessiveness, insecurity,
haven of love and protection, may be the most and lessened physical and emotional availability
dangerous place for victims. of the pregnant woman.
• Domestic violence occurs in same-sex relationships
SOCIAL ISOLATION with the same statistical frequency as in heterosexual
• Members of these families keep to themselves and relationships.
usually do not invite others into the home or tell o Although same-sex battering mirrors
anyone what is happening. heterosexual battering in prevalence, its victims
• Often, abusers threaten victims that a parent, sibling, receive fewer protections.
or pet will die if anyone outside the family learns of the o The same-sex batterer has an additional weapon
abuse. to use against the victim: the threat of revealing
• Children then keep the secret out of fear, which the partner’s homosexuality to friends, family,
prevents others from “interfering with private family employers, or the community.
business."
CLINICAL PICTURE
ABUSE OF POWER AND CONTROL • Because abuse is often perpetrated by a husband
• The abusive family member almost always holds a against a wife, these same patterns are consistent
position of power and control over the victim (child, also between partners who are not married, between
spouse, or elderly parent). same-sex partners, and with wives who abuse their
• The abuser exerts not only physical power but also husbands.
economic and social control. • Typically, the abuser believes that his/her victim
• He or she is often the only family member who makes belongs to him or her.
decisions, spends money, or spends time outside the • The abuser has strong feelings of inadequacy and low
self-esteem as well as poor problem-solving and
, • 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.
• Therefore, the violent behavior is often rewarding and
boosts his self-esteem.
• Dependency is the trait most commonly found in
abused wives who stay with their husbands.
• Women also fear their abusers will kill them if they try
to leave.
CYCLE OF ABUSE AND VIOLENCE
TREATMENT AND INTERVENTION
• Because most abused women do not seek direct help
for the problem, nurses must help identify abused
women in various settings.
• A woman can obtain a restraining order (protection
order) from her county of residence that legally
prohibits the abuser from approaching or contacting
her. Nevertheless, a restraining order provides only
limited protection.
o The abuser may decide to violate the order and
severely injure or kill the woman before police can
intervene.
• Stalking, or repeated and persistent attempts to
impose unwanted communication or contact on
another person, is a crime of intimidation in which
• The cycle of violence or abuse is another reason perpetrators harass and terrorize their victims through
often cited for why women have difficulty leaving behavior that causes fear or substantial emotional
abusive relationships. distress.
• A typical pattern exists; usually, the initial episode of o In addition to abusive partner stalking when the
battering or violence is followed by a period of the end of the relationship is not accepted, other
abuser expressing regret, apologizing, and promising stalkers are “would-be lovers,” pursuing
it will never happen again. relationships that have never even existed,
o This period of contrition or remorse is sometimes doctors stalked by patients, or famous people
called the honeymoon period. stalked by “fans.”
o Initially, the honeymoon period may last weeks or o Cyberstalking can be monitoring, following, or
even months, causing the woman to believe that intruding into another’s social media, using a
the relationship has improved and her husband’s false identity to get back into the person’s life, or
behavior has changed. tracking his or her location with a cell phone.
• Over time, however, the violent episodes are more • Battered women’s shelters can provide temporary
frequent, the period of remorse disappears housing and food for abused women and their
altogether, and the level of violence and severity of children when they decide to leave the abusive
injuries worsen. relationship.
• Eventually, the violence is routine—several times a • Individual psychotherapy or counseling, group
week or even daily. therapy, or support and self-help groups can help
abused women deal with their trauma and begin to
ASSESSMENT build new, healthier relationships.
• Because most abused women do not seek direct help
for the problem, nurses must help identify abused CHILD ABUSE
women in various settings. • Child abuse or maltreatment generally is defined as
o Some victims may be seeking treatment for other the intentional injury of a child.
medical conditions not directly related to the • It can include physical abuse or injuries, neglect or
abuse or for pregnancy. failure to prevent harm, failure to provide adequate
physical or emotional care or supervision,
abandonment, sexual assault or intrusion, and overt
torture or maiming.
TYPES OF CHILD ABUSE
1. Physical Abuse
→ This often results from unreasonably severe
corporal punishment or unjustifiable punishment
such as hitting an infant for crying or soiling his or
her diapers.
→ Intentional, deliberate assaults on children
include burning, biting, cutting, poking, twisting
limbs, or scalding with hot water.
→ The victim often has evidence of old injuries (e.g.,
scars, untreated fractures, or multiple bruises of
• It is essential to ask everyone whether they are safe various ages) that the history given by parents or
at home or in their relationship. Thus, nurses must be caregivers does not explain adequately.
Patterns of Behavior, Acute and Chronic FINALS
Lecturer: Dr. Cefer S. Sales, RN, MD, MHM, CHA
UNIT 3 – CHAPTER 12: ABUSE AND VIOLENCE
INTRODUCTION ALCOHOL AND OTHER DRUG ABUSE
• Abuse is the wrongful use and maltreatment of • Substance abuse, especially alcoholism, has been
another person. associated with family violence.
• Statistics show that most abuse is perpetrated by • Alcohol does not cause the person to be abusive;
someone the victim knows. rather, an abusive person is also likely to use alcohol
or other drugs.
CLINICAL PICTURE OF ABUSE AND VIOLENCE • Alcohol is also cited as a factor in acquaintance rape
• Victims of abuse or violence can certainly have or date rape.
physical injuries and psychological injuries with a • In addition, use of the illegal drug flunitrazepam
broad range of responses. (Rohypnol) or other “date rape drugs” to subdue
• Children particularly come to believe that somehow, potential victims is on the rise.
they are at fault and did something to deserve or
provoke the abuse. INTERGENERATIONAL
• As adults, they usually feel guilt or shame for not TRANSMISSION PROCESS
trying to stop the abuse. Survivors feel degraded, • The intergenerational transmission process shows
humiliated, and dehumanized. that patterns of violence are perpetuated from one
o Their self-esteem is extremely low, and they view generation to the next through role modeling and
themselves as unlovable. They believe they are social learning.
unacceptable to others, contaminated, or ruined. • This suggests that family violence is a learned pattern
o Depression, suicidal behavior, and marital and of behavior.
sexual difficulties are common. • For example, children who witness violence between
• Victims and survivors of abuse may find trusting their parents learn that violence is a way to resolve
others, especially authority figures, to be difficult. conflict and is an integral part of a close relationship.
• Intimate relationships may trigger extreme emotional
responses such as panic, anxiety, fear, and terror. INTIMATE PARTNER VIOLENCE (IPV)
• Nurses should be particularly sensitive to the abused • Intimate partner violence is the mistreatment or
client’s need to feel safe, secure, and in control of his misuse of one person by another in the context of an
or her body. emotionally intimate relationship.
o They should take care to maintain the client’s • The relationship may be spousal, between partners,
personal space, assess the client’s anxiety level, boyfriend, girlfriend, or an estranged relationship.
and ask permission before touching him or her for • The abuse can be emotional or psychological,
any reason. physical, sexual, or a combination (which is common).
• Battering during pregnancy leads to adverse
CHARACTERISTICS OF VIOLENT FAMILIES outcomes, such as miscarriage and stillbirth, as well
• Family violence encompasses spouse battering; as further physical and psychological problems for the
neglect and physical, emotional, or sexual abuse of woman.
children; elder abuse; and marital rape. o The increase in violence often results from the
• In violent families, the home, which is normally a safe partner’s jealousy, possessiveness, insecurity,
haven of love and protection, may be the most and lessened physical and emotional availability
dangerous place for victims. of the pregnant woman.
• Domestic violence occurs in same-sex relationships
SOCIAL ISOLATION with the same statistical frequency as in heterosexual
• Members of these families keep to themselves and relationships.
usually do not invite others into the home or tell o Although same-sex battering mirrors
anyone what is happening. heterosexual battering in prevalence, its victims
• Often, abusers threaten victims that a parent, sibling, receive fewer protections.
or pet will die if anyone outside the family learns of the o The same-sex batterer has an additional weapon
abuse. to use against the victim: the threat of revealing
• Children then keep the secret out of fear, which the partner’s homosexuality to friends, family,
prevents others from “interfering with private family employers, or the community.
business."
CLINICAL PICTURE
ABUSE OF POWER AND CONTROL • Because abuse is often perpetrated by a husband
• The abusive family member almost always holds a against a wife, these same patterns are consistent
position of power and control over the victim (child, also between partners who are not married, between
spouse, or elderly parent). same-sex partners, and with wives who abuse their
• The abuser exerts not only physical power but also husbands.
economic and social control. • Typically, the abuser believes that his/her victim
• He or she is often the only family member who makes belongs to him or her.
decisions, spends money, or spends time outside the • The abuser has strong feelings of inadequacy and low
self-esteem as well as poor problem-solving and
, • 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.
• Therefore, the violent behavior is often rewarding and
boosts his self-esteem.
• Dependency is the trait most commonly found in
abused wives who stay with their husbands.
• Women also fear their abusers will kill them if they try
to leave.
CYCLE OF ABUSE AND VIOLENCE
TREATMENT AND INTERVENTION
• Because most abused women do not seek direct help
for the problem, nurses must help identify abused
women in various settings.
• A woman can obtain a restraining order (protection
order) from her county of residence that legally
prohibits the abuser from approaching or contacting
her. Nevertheless, a restraining order provides only
limited protection.
o The abuser may decide to violate the order and
severely injure or kill the woman before police can
intervene.
• Stalking, or repeated and persistent attempts to
impose unwanted communication or contact on
another person, is a crime of intimidation in which
• The cycle of violence or abuse is another reason perpetrators harass and terrorize their victims through
often cited for why women have difficulty leaving behavior that causes fear or substantial emotional
abusive relationships. distress.
• A typical pattern exists; usually, the initial episode of o In addition to abusive partner stalking when the
battering or violence is followed by a period of the end of the relationship is not accepted, other
abuser expressing regret, apologizing, and promising stalkers are “would-be lovers,” pursuing
it will never happen again. relationships that have never even existed,
o This period of contrition or remorse is sometimes doctors stalked by patients, or famous people
called the honeymoon period. stalked by “fans.”
o Initially, the honeymoon period may last weeks or o Cyberstalking can be monitoring, following, or
even months, causing the woman to believe that intruding into another’s social media, using a
the relationship has improved and her husband’s false identity to get back into the person’s life, or
behavior has changed. tracking his or her location with a cell phone.
• Over time, however, the violent episodes are more • Battered women’s shelters can provide temporary
frequent, the period of remorse disappears housing and food for abused women and their
altogether, and the level of violence and severity of children when they decide to leave the abusive
injuries worsen. relationship.
• Eventually, the violence is routine—several times a • Individual psychotherapy or counseling, group
week or even daily. therapy, or support and self-help groups can help
abused women deal with their trauma and begin to
ASSESSMENT build new, healthier relationships.
• Because most abused women do not seek direct help
for the problem, nurses must help identify abused CHILD ABUSE
women in various settings. • Child abuse or maltreatment generally is defined as
o Some victims may be seeking treatment for other the intentional injury of a child.
medical conditions not directly related to the • It can include physical abuse or injuries, neglect or
abuse or for pregnancy. failure to prevent harm, failure to provide adequate
physical or emotional care or supervision,
abandonment, sexual assault or intrusion, and overt
torture or maiming.
TYPES OF CHILD ABUSE
1. Physical Abuse
→ This often results from unreasonably severe
corporal punishment or unjustifiable punishment
such as hitting an infant for crying or soiling his or
her diapers.
→ Intentional, deliberate assaults on children
include burning, biting, cutting, poking, twisting
limbs, or scalding with hot water.
→ The victim often has evidence of old injuries (e.g.,
scars, untreated fractures, or multiple bruises of
• It is essential to ask everyone whether they are safe various ages) that the history given by parents or
at home or in their relationship. Thus, nurses must be caregivers does not explain adequately.
