How To Fix A Bad Relationship With Your Mother-In-Law Family Violence and Abuse – Helping Victims and Survivors

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Family Violence and Abuse – Helping Victims and Survivors

Introduction

Domestic abuse and violence refers to physically and emotionally harmful behaviors that occur between family and household members. This includes child abuse, child neglect, intimate partner abuse and violence, marital rape and elder abuse. This may be a learned behavior that can be unlearned through therapy. The perpetrators try to isolate the family to keep it secret and avoid sanctions. They usually have some authority and control over other family members. They may rationalize violence with drug use. The use of cocaine, PCP, amphetamine, etc. may increase aggressive behavior.

Forms of abuse

Physical abuse includes hitting, punching, pushing, stabbing, shooting, kicking, and withholding medication, a wheelchair, food, and liquids. Sexual violence includes coercion, marital rape and withholding of sex. Psychological abuse includes threats, harassment and blackmail. Emotional abuse includes insults, insults, and ridicule. Economic abuse includes total control over finances, racking up bills, being banned from school or work.

Reality about violence

Domestic violence occurs at all levels of society. Separation or divorce may not end the abuse. The bully must not be provoked. Some survivors mistakenly tend to blame themselves. Treat the abuse, but also alcohol, drug, stress and mental health issues, if any. There is also violence between gays and lesbians. Abused women are discouraged from disclosure by threats, fear, denial and disbelief expressed by “confidants”.

Models of intervention

The paternalistic model assumes that the clinician has more knowledge than the patient; that the survivor is responsible for ending the abuse; that the clinician should provide advice and sympathy; and view the patient as a victim. Whereas the empowerment model, which is better, suggests that the clinician should mutually share knowledge with the patient, plan strategies with the patient, respect the patient’s competence, experience, and strengths, and view the patient as survived.

Response of survivors of abuse

Physical signs of abuse include multiple site injuries in various stages of healing (head, neck, face, throat, genitals), headaches, insomnia, and stress. The behavioral sign is that the individual does not leave the abuser or leaves and returns before breaking up permanently. Psychological signs include delayed reaction, depression, low self-esteem, attributions such as self-blame, impaired performance and behavior at school or work, poor concentration, and poor problem solving.

Why does the individual not leave the abuser?

Abused persons do not leave the abuser for a variety of reasons, which include fear of being hunted down and killed (which is a realistic fear), strong emotional attachment to the abuser, determination to end the abuse, sanctions present in the couple’s culture, fear of stigma, lack of of resources for living away from the abuser and considering what would happen to her children if she left. She might leave and come back thinking, “Maybe he’ll change.”

Child abuse and neglect

Child abuse and neglect must be reported in every state. Types of abuse include child sexual abuse, child physical abuse, child emotional abuse, and child neglect. A child who witnesses domestic violence may also be abused.

Sexual abuse of children

It 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 breaks the child’s trust in the adult who is supposed to protect him. Threatening the child, pet, and others keeps the child quiet. This leads to confusion, shame and helplessness. Its effect can last a lifetime and affect mental health. It can be kept as a family secret.

Visible signs of sexual abuse

Observed signs of child sexual abuse include physical aggression, excessive masturbation, social withdrawal, low self-esteem, poor school performance, sleep disturbances, sexually transmitted diseases, bleeding, soreness, itching, UTI, pregnancy, bruising, swelling, redness, fracture , burns, and a sloppy appearance.

School violence

School violence is usually caused by child drug use, child access to weapons, antisocial and impulsive behavior, family dysfunction, lack of community responsiveness, interpersonal disputes, and peer bullying and harassment.

Kidnapping a child

Most abductions are done by a parent. 70% are from fathers, 25% from mothers. Parents who are likely to abduct include those who have threatened or attempted to do so in the past, suspect abuse by the other parent, may be paranoid, may intend to use it as revenge, punishment, trophy or such, who strongly believe that the child will be raised in his or her home country.

Child abuse assessment and intervention

Examine and become aware of your own attitudes toward victims of abuse so that you are not judgmental. Take a thorough history and physical assessment. Use a private, quiet environment without interruption. Honestly state the purpose of the interview. Inform the victim of the upcoming physical evaluation. Use a calm and supportive approach. If possible, interview the child separately first before jointly interviewing a parent or guardian. Note the child’s affect (gaze) and behavior, the mother’s understanding of the problem, inconsistencies in their stories, and the parents’ emotional responses. Document your assessment fully. Report suspected abuse to CPS. Coordinate services such as additional assessment, psychological testing, individual psychotherapy, family psychotherapy, and group psychotherapy.

Intimate partner violence (IPV)

IPV is a pattern of coercive and violent behavior between intimate partners and dating partners. Intimate partner abuse is the more common form of IPV. Female violence is more common in self-defense. Many IPVs end in murder or murder-suicide. Leaving or attempting to leave the victim increases the risk of murder. There is a higher risk of homicide with a gun, history of suicidal ideation or attempt, battering 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 if there is no intervention. Assessment of IPV should be part of the mental health assessment. Ask partners about their history of conflict, pushing and shoving, and relationship quality. Watch for hesitation, looking away, and restlessness. Be supportive, let the victim know they are not alone. Describe and map the extent of injuries. Rate for attribution, e.g. self-blame. Assess for depression, PTSD, and anxiety. If the patient is the abuser, assess the potential for further abuse. Consult legal counsel about the Duty to Warn. Courts mandated that abusers (who happen to be mostly men) receive treatment. Treatment includes confronting the abuse, affirming that the abuser is responsible, behavioral therapy, anger management, changing attitudes toward women, couples counseling, and cognitive behavioral therapy (CBT). Empower women using laws, community resources, support groups and safe havens. Mutual goal-setting with the victim. Mutually consider and choose from the options. Help mobilize natural, social and professional support.

Rape and sexual assault

It affects men, women and children, especially women and children. Sexual assault is a violent act of non-consensual sexual contact. It is usually done to humiliate, defile or dominate the victim. Rape is a felony, but most go unreported. Survivors of marital rape do not seek care because of embarrassment and humiliation. Careful evaluation and debriefing is required. When caring for the victim, listen, be non-judgmental and provide emotional support. Fully document your observation and evaluation. Help gather evidence if the patient decides to file a lawsuit. In the acute stage, assess for fear, disorganization, shock, and restlessness. In the second stage, assess memories, phobias of places and people, and sexual difficulties. Encourage the victim to discuss their feelings. Explore options, e.g. change phone number. Explore available community services and support groups. Refer to physical therapy and psychotherapy. Schedule a follow-up phone call in a few days.

Elder abuse

About 5 million elderly people are abused in the US each year. Spousal abuse overlaps with elder abuse. The abused does not report for fear of being abandoned in a nursing home or isolated. Signs include bruises on hands, wrists, ankles, facial lacerations, vaginal lacerations, fractures, malnutrition, poor hygiene, dehydration, trembling and withdrawal in the presence of the abuser. Help and care includes reporting suspected abuse to the Adult Protective Services (APS), counseling, psychotherapy, substance abuse, and treatment for the abuser if needed.

Reference: Stuart, GW & Laraia, MT (2005). Principles and practice of psychiatric nursing (8th ed.). St. Louis, MO: Elsevier Mosby.

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