Contemporary PsychiatricMental Health Nursing Third Edition CHAPTER 24

Contemporary Psychiatric-Mental Health Nursing Third Edition CHAPTER 24 Intrafamily Violence: Physical and Sexual Abuse Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

• Family violence encompasses spouse battering; neglect and physical, emotional, or sexual abuse of children; elder abuse; and marital rape. • In many cases, family members tolerate abusive and violent behavior from relatives they would never accept from strangers Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

Intimate partner violence • is the mistreatment or misuse of one person by another in the context of an emotionally intimate relationship. • The relationship may be spousal, between partners, boyfriend, girlfriend, or an estranged relationship. • The abuse can be emotional or psychological, physical, sexual, or a combination (which is common). Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

• Psychological abuse (emotional abuse) includes name-calling, belittling, screaming, yelling, destroying property, and making threats as well as subtler forms, such as refusing to speak to or ignoring the victim. • Physical abuse ranges from shoving and pushing to severe battering and choking and may involve broken limbs and ribs, internal bleeding, brain damage, and even homicide. Sexual abuse includes assaults during sexual relations such as biting nipples, pulling hair, slapping and hitting, and rape Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

The cycle of violence or abuse • is another reason often cited for why women have difficulty leaving abusive relationships. • A typical pattern exists: Usually, the initial episode of battering or violence is followed by a period of the abuser expressing regret, apologizing, and promising it will never happen again. He professes his love for his wife and may even engage in romantic behavior (e. g. , buying gifts and flowers). This period of contrition or remorse sometimes is called the honeymoon period. Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

• the tension-building phase begins; there may be arguments, stony silence, or complaints from the husband. • The tension ends in another violent episode after which the abuser once again feels regret and remorse and promises to change. Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

Rape • Is the perpetration of an act of sexual intercourse with a female against her will and without her consent, whether will is overcome by force, fear of force, drugs, or intoxicants. • It is also considered rape if the woman is incapable of exercising rational judgment because of mental deficiency or when she is younger than the age of consent Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

1. Rape may occur within a marriage and is often accompanied by extreme violence. The myth about male rape has been that it occurs only in situations where heterosexual contact is not possible, but today more male rape victims are reporting the crime. Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

2. Victims of rape are women. - Victims may be of any age, although one in five victims is a teen. - Half of rape victims know their abuser, and half of rapes occurring on college campuses are date rapes. - Alcohol abuse is frequently a contributing factor. Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

3. Children are at risk of intrafamily violence when they live with parents who were abused as children, have adult dysfunctional relationships, have poor self -esteem, are socially isolated, have unrealistic expectations of children’s abilities, or if there are children with special needs in the home. Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

male rapists have four categories • Sexual sadists who are aroused by the pain of their victims • Exploitive predators who impulsively use their victims as objects for gratification • Inadequate men who believe that no woman would voluntarily have sexual relations with them and who are obsessed with fantasies about sex • Men for whom rape is a displaced expression of anger and rage. Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

Rape • is a crime of violence generated by issues of power and control, rather than by sex drive • According to the intrapersonal theory, perpetrators who feel powerless and unsure of themselves abuse others to discharge their anger and frustration. • Intrapersonal theory categorizes five types of rape: anger, power, sadistic, gang, and date or acquaintance rapes Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

Most rapists/convicted sex offenders are young, do not suffer from major mental disorders, and report having been sexually and physically abused as children or adolescents. Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

§The social learning theory focuses more on the contribution of the media and culture in desensitizing individuals to the pain, fear, and humiliation of sexual aggression. §Gender bias theory considers rape as the result of deeply rooted socioeconomic traditions; men are viewed as dominant and women as subservient. According to this theory, men see women as wanting, needing, or deserving to be raped. As a result, men believe that women do not experience any physical or emotional harm by the rape Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

cause of domestic violence. • According to the neurobiologic theory, changes in genes and neurotransmitters are believed to contribute to violent behaviors. • The intrapersonal theory places emphasis on the personality of the abuser, family dynamics, and the inability of the individual to control impulsive expressions of anger - For instance, 80% of male abusers experienced domestic violence while growing up. Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

• Social learning theory contends that violence is a learned behavior, reinforced when violence is rewarded by a gain in power, and is a conscious choice made by the abuser. § Gender bias theory suggests that men have the right to keep women subordinate by any means possible. Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

Sexual abuse - involves a combination of family, personality, and cultural factors. - Intrapersonal theory suggests that perpetrators have low self-esteem; lack impulse control; are rigid, overcontrolling, dominant, and aggressive; and some were emotionally deprived as children. Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

-A number were sexually abused as children. -Families that are enmeshed, have chaotic boundaries, no assigned roles, and poor communication patterns are at higher risk for sexual abuse Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

-Childhood victims may become offenders when anger and hostility about the past are externalized and projected onto new victims. -According to family systems theory, intrafamily sexual abuse typically occurs in families that have difficulty with structure, cohesion, adaptability, and communication Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

Learning Outcome 2 Discuss the short-term and long-term effects on victims of intrafamily violence. Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

The four phases of response to rape 1 - The anticipatory phase begins when the victim realizes the situation is potentially dangerous. 2 - The impact phase includes the period of actual assault and its immediate aftermath. 3 - In the reconstitution phase, the victim has the outward appearance of adjustment but continues to be anxious, fearful, and have feelings of depression, guilt, shame, and vulnerability. 4 - In the resolution phase, the victim may still be angry, need to talk and seek support, but comes to terms with the event Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

Rape changes the victim’s life forever -Physical injuries resulting from rape, -Psychological impact. - Rape trauma syndrome: describes the victim’s response, although people may react in a variety of ways Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

Factors that influence a victim’s response 1. age, developmental state, victimization history, resources, and the rape itself. 2. During the rape and during initial treatment, victims may use depersonalization or dissociation. Anxiety, agitation, and nonpurposeful behaviors may develop into shock, disbelief, and fear Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

Long-term consequences of Rape trauma • Posttrauma depression has a short-term effect, and usually lasts up to 3 months. • Major depressive disorder that will require medical intervention. • The reactions of some victims may interfere with daily functioning and include flashbacks, violent dreams, preoccupation with thoughts of danger, social withdrawal, phobic avoidance, and longterm sexual dysfunction. Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

Other consequences • Intense feelings of shame, guilt, and secrecy keep them isolated, which leads to alienation from peers. • Other feelings include powerlessness, self-defeat, and self-destruction. • Some victims use denial to cope with the trauma, others may act out sexually or run away from home. • When sexual abuse is severe or sadistic, victims may develop dissociative identity disorder. Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

• Intrafamily violence includes sibling abuse, child abuse and neglect, shaken baby syndrome, homicide of a child or parent, partner abuse, abuse of elders and pregnant women, and emotional abuse Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

Treating victims of violence -The first part of treatment is to ensure the client’s safety and well-being. - Attending to medical needs always takes priority. -Given the high risk for psychological problems, it is recommended that a comprehensive assessment be performed. - Assessments should include physical, behavioral, affective, cognitive, and sociocultural components Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

Interventions 1 - Assuring safety; 2 - developing rapport between the medical professional and the victim; 3 - identifying the victim’s strengths, abilities, coping skills and support systems; and suggesting therapy. 4 - Building a sense of trust and rapport with a victim of violence is crucial. 5 - Talking about the trauma and expressing feelings can be very painful. Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

Intervention -Many clients will need ongoing support, community services, and long-term individual and group counseling -Identifying effective coping skills, strengths, and abilities, and evaluating new coping strategies will assist the client to progress from the state of victim to one of survivor. - Managing the individual’s case holistically versus focusing on any one specific issue will bring better results. - Therapy is usually supportive and focuses on restoring the victim’s lost sense of control Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

Community-based interventions 1. identifying risk factors 2. implementing crisis interventions Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

Continue …. . inter • Multidisciplinary approach: Medical, social, and legal professionals must coordinate to intervene effectively. • Psychoeducation training can assist the client to improve in the areas of communication, conflict resolution, anger management, and parenting skills. • It is important to empower the victim to regain control. • Treating the abuser should also be a component. Abusers need to learn that violence is always a choice. Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

The important of spiritual recovery for persons who have been victims of violence 1 - Survivors are frequently consumed with spiritual questions and struggle with questions of a God who either overlooked or did not see their pain. 2 - Survivors who become angry with God and hold God responsible may become fearful and feel guilty for hating someone so powerful Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

Continue… 1. Healing is a long process and survivors need to experience human contact. 2. Spirituality includes a sense of connectedness and allows the survivor to develop trusting relationships. 3. When a survivor can self-forgive, more complete healing is possible. 4. If clients desire, religious counselors who understand the emotional issues involved can assist them in working through their struggles. Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

Child abuse Is defined as: The intentional injury of a child. It can include physical abuse or injuries, neglect or failure to prevent harm, failure to provide adequate physical or emotional care or supervision, abandonment, sexual assault or intrusion, and overt torture or maiming Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

Elder abuse - is the maltreatment of older adults by family members or caregivers. - It may include physical and sexual abuse, psychological abuse, neglect, selfneglect, financial exploitation, and denial of adequate medical treatment. - Estimates are that people over age 65 are injured, exploited, abused, or neglected by their caregivers and that only 1 in 14 elder maltreatment cases are reported Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

Question The nurse is working with a group of perpetrators of family abuse who are attending a counseling session mandated by the court. The focus of therapy should be on: Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

Question 1. Teaching them appropriate ways to deal with anger. 2. Ensuring that they don’t place themselves in situations in which they may be provoked by others. 3. Requesting that they bring their families to the session to identify family areas that need improvement. 4. Instructing them to identify situations that trigger angry outbursts. Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

Rationale Answer #1 is correct. Effective anger management is part of developing a healthier way to deal with stress and frustration and avoid resorting to abusive behavior. Applying level Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

Question The nurse is working with a college student who has been abused by a popular, wellknown football player on the school’s team. Which statement by the nurse to the mental health team indicates a judgmental attitude toward the student’s experience? Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

Question 1. “Rape is an issue of power and control. ” 2. “She probably realized he wasn’t interested in a long-term relationship, so she called it rape. ” 3. “When alcohol is involved, a lot of bad things can happen. ” 4. “Parents should meet their children’s dates before they go out. ” Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

Rationale Answer #2 is correct. By believing the student is claiming rape to get back at her boyfriend, the nurse automatically assumes that all women pursue men with resources and status. Creating level Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

Question The nurse herself was a victim of domestic violence in the past. Which statement by the nurse indicates that the nurse should not work with a victim of abuse? Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

Question 1. “I will make sure her husband is punished for what he did to her. ” 2. “I really feel bad for my client and angry toward her husband. ” 3. “I feel bad that she allowed things to get this bad for her. ” 4. “I will make sure my client understands her rights and knows where to go for help. ” Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff

Rationale Answer #1 is correct. Vowing to pursue punishment of the husband shows that the nurse is overinvolved in the client’s situation and that the nurse’s primary focus is to “punish” the abuser, whereas the focus should be on attending to the client’s needs and providing her with tools and resources to protect herself. Applying level Contemporary Psychiatric-Mental Health Nursing , Third Edition Carol Ren Kneisl • Eileen Trigoboff