Abuse & Neglect Survivors

Question 1

Is defined as the maltreatment of one person by another

Answer 1

Abuse

Question 2

Can be either physical or emotional

Answer 2

Neglect

Question 3

Also known as domestic violence; is physical abuse between domestic partners

May be known as spousal abuse, domestic or family violence, wife or husband ___, or IPV (intimate partner violence)

Answer 3

Battering

Question 4

?

Are potentially traumatic events that can happen from ages 0-17; can have major impacts on one’s physical and mental health

• These experiences can be things like violence, abuse, or neglect; witnessing violence; having a family member attempt or die by suicide; having a family member w/a substance abuse problem or a mental health problem; or instability due to parental separation or household members being in jail or prison

Answer 4

Adverse Childhood Experiences (ACEs)

! Are linked to chronic health problems, mental illness, & substance abuse problems later in adulthood

! Can also negatively impact education, job opportunities, & earning potential

Question 5

! ACEs can be prevented

Answer 5

What can nurses do to reduce the effects of ACEs?

→ Reducing stigma around seeking help for parenting; some of the challenges people face with parenting
→ Stigma around substance abuse & mental health issues
→ Promote a safe & stable, nurturing relationship between parents & children

Question 5

! ACEs can be prevented

Answer 5

What can nurses do to reduce the effects of ACEs?

→ Reducing stigma around seeking help for parenting; some of the challenges people face with parenting
→ Stigma around substance abuse & mental health issues
→ Promote a safe & stable, nurturing relationship between parents & children

Question 6

Predisposing factors to violent behaviors

Biological Theories
> Neurophysiological influences
> Biochemical influences
> Genetic influences
> Disorders of the brain

Answer 6

Psychosocial Theories
> Psychodynamic Theory
> Learning Theory

Question 7

The ___ is responsible for impulse control & effective processing

Appears to be less well modulated in people w/aggression; responses to fear are reduced

Answer 7

amygdala

Question 8

The limbic prefrontal cortex has a primary role in aggression

Answer 8

Areas of the brain known as the striatum play a critical role in selection & inhibition of effective cognitive & motor responses & have identified as dysfunctional in pts w/ aggression

Question 9

Neurotransmitters have been implicated in aggression as well & include an increase in norepinephrine and dopamine & a decrease in serotonin

Question 10

Biochemical influences

An increase in ___ release that’s been seen in cases of aggression as well as the relationship between testosterone & cortisol levels that are assoc w/aggression

Answer 10

dopamine

Question 11

Genetic influences

Studies have found a potential role for the X-linked monoamine oxidase (a gene in the etiology of anti-social behaviors)

Answer 11

Disorders of the brain

Organic brain syndromes assoc w/various cerebral disorders have been implicated in the predisposition to aggressive & violent behaviors like brain tumors, particularly in the area of the limbic system & the temporal lobe

Trauma to the brain resulting in cerebral changes & dz’s such as encephalitis & temporal lobe epilepsy have also been implicated

Question 12

____Theory

> Modeling behavior is more likely when the individual perceives the person as prestigious or influential. Individuals who were abused as children &/or who witnessed domestic violence as a child are more likely to manifest reactive aggression as adults

> Behaviors can also be modeled from influences from the media, like video games & movies

Answer 12

Learning

Question 13

____ Theory

> These are some psychological theories that have been implicated in violent behavior & this is the idea that unmet needs for satisfaction and security results in poor self control

> Aggression & violence supply this individual w/a dose of power & prestige that inc their self-esteem

Answer 13

Psychodynamic

Question 14

Predisposing Factors to violent behaviors

• Sociocultural theories
• Societal influences

Answer 14

⇢ Aggressive behavior is primarily a product of one’s culture in social structure

> Poverty, unemployment, family breakdown, exposure to violence, lack of social support and bullying are predisposing factors

Question 15

Medications used to treat aggression

⇢ SSRI’s
⇢ Mood stabilizers
⇢ Anti-adrenergic agents
⇢ Antipsychotics

Answer 15

Anti-adrenergic agents

• Such as beta blockers; have been shown to reduce aggression in some individuals & this is done by dampening the excessive noradrenergic activity

Question 16

___

• Includes both typical & atypical
• Have been helpful in the control of aggression & violence, particularly for individuals w/comorbid psychosis; this is a result of the dampening of dopamine

Answer 16

Antipsychotics

Question 17

___

• Have been shown to reduce irritability & aggression & this is consistent w/the theory of reduced serotonin activity in aggression

Answer 17

Selective serotonin reuptake inhibitors (SSRI’s)

Question 18

____

• These are important in reducing the overactivation of the limbic system
• Includes Tegretol, Dilantin, & Depakote
• Lithium has also been used effectively in violent pts

Answer 18

Mood stabilizers

Question 19

IPV (Intimate Partner Violence)

IPV includes physical & sexual violence, stalking, & psychological aggression, which can include coercive tactics

• Can be by a current or former intimate partner
• One person believes that they’re entitled to control the other

Answer 19

This type of violence can occur between heterosexual or same-sex couples & does not require sexual intimacy

• Males can also be the target & females can be the victimizer
• IPV generally starts early and continues throughout the lifespan
• Power is gained in control through intimidation and fear

Question 20

Victim

• Most often females
• Experience guilt, fear, shame, anger
• Isolated
• Low self-esteem

Answer 20

Victimizer

• Low self-esteem
• Jealous, possessive
• May have been abused
• May have been subject to extreme discipline

Question 21

Cycling of battering

> Continues as a cycle & often has shorter phases in between phases 1 and 2

> The victim will stay out of fear; fear for her own life or for the lives of her children. The victim often suffers from low self-esteem & feels powerless; fears retaliation; fears losing custody of her children

> The victim may be physically or financially dependent on the abuser; may lack a support network; & there may be cultural or religious reasons

Answer 21

> Victim may also feel hopeless or lack awareness of the reality of the situation

> When a victim leaves an abusive relationship, she’s at a 75% greater risk of being killed by the partner & the abuse often does not stop once the person has left

> The decision to leave must be theirs to make; they need empowerment in their decisions & to be provided w/resources, support, & referrals

Question 22

? phase

> Is the most violent & shortest phase
Violence is justified by the abuser
Victim may try to find a safe place to hide; help is sought if the injury was severe or if the woman fears for her life, for her children’s lives

Answer 22

Phase 2 Acute battering

Question 23

? phase

> Minor battering incidents may occur
Abuser is angry w/little provocation & the victim believes it’s her fault

Answer 23

Phase 1 Tension-building

Question 24

? phase > The abuser is calm, loving, promises to stop, apologizes, shows romantic gestures, & the victim wants to believe that this is true & stays in the relationship

Answer 24

Phase 3 Honeymoon

Question 25

Child abuse Signs of physical abuse [child] > burns, bites, bruises, broken bones, or black eyes > fading bruises or other marks > frightened of the parents (or other adults) > reports injury > abuses animals

Answer 25

Signs of physical suspect [caregiver] ! lack of believable explanation ! negative view of child ! uses harsh discipline ! h/o abuse as child ! h/o animal abuse

Question 26

Risk factors for child abuse include children under 4, special needs that may increase caregiver burden [disabilities, mental health issues, & chronic physical illness]

Answer 26

Risk factors for perpetrators – > parents’ lack of understanding of children’s neglect; child development & parenting skills > a parental history of child abuse or neglect; substance abuse &/or mental health issues (i.e., depression) > parental characteristics such as a young age; a low education; single parenthood; a large number of dependent children & low income > nonbiological or transient caregivers in the home (i.e., the mother’s male partner) > parental thoughts & emotion that tend to support or justify maltreatment behaviors

Question 27

Family risk factors - > social isolation; family disorganization, dissolution, & violence (including IPV); parenting stress; poor parenting-child relationship, & negative interaction

Answer 27

Community risk factors – > community violence; concentrated neighborhood disadvantage (e.g., high poverty & residential instability); high unemployment rates; high density of alcohol outlets; poor social connection

Question 28

Child abuse Signs of emotional abuse [child] - extremes in behavior - not behaving age appropriate - physical or emotional delays - suicide attempt - lack of parental attachment

Answer 28

Signs of suspect [caregiver] ! blames, belittles, berates child ! unconcerned ! rejects child

Question 29

Child neglect (can be physical or emotional) Signs of emotional neglect [child] - freq school absence - begging/stealing - lack of medical care - unkempt, not dressed for weather - alcohol/drug use - reports of no caregiver @ home

Answer 29

Signs of suspect [caregiver] - indifferent to child - apathetic, depressed - irrational/bizarre behavior - alcohol or drug use

Question 30

Sexual abuse (can incl sexual exploitation; perpetrators are in most cases known to the victim) Signs of sexual abuse [child] > has difficulty walking/sitting > suddenly refuses to change for gym or to participate in physical activities > reports nightmares or bedwetting > experiences a sudden change in appetite > bizarre, sophisticated, or unusual sexual behavior > becomes pregnant or contracts an STD > runs away > reports sexual abuse > attaches quickly to strangers

Answer 30

Signs of suspect [caregiver] ! unduly protective of the child or severely limits the child's contact w/other children, esp of the opposite sex ! secretive & isolated ! jealous or controlling w/family members

Question 31

Incest Incestuous relationship - father is domineering, impulsive - mother is passive, aware or suspicious, may alternate between caring or competing - begins @ 8-10 - child - confused, love/hate relationship * Typically, this involves an impaired sexual relationship between the parents * About 1/3 of children who are abused or neglected in childhood become perpetrators of the same kind of abuse as parents * Revelations of incest as a child are often revealed after death of the perpetrator

Answer 31

Adult survivor of incest - lacks trust - low self-esteem, poor self-identity - absence of sexual pleasure

Question 32

Sexual Violence > Sexual aggression is an act of aggression, not passion, & is an act of power & dominance > Sexual violence includes any act of sexual coercion, including penetration, unwanted sexual contact & noncontact & unwanted sexual experiences

Answer 32

> Rape includes a surprise attack, statutory rape, date rape, marital rape, & can happen at any age

Question 33

Victim - highest risk 34 or younger, lower income, living in rural area

Answer 33

Victimizer - sexual sadists - exploitative predators - men who fantasize of sex they believe cannot be achieved w/o the use of force - are displacing anger & rage

Question 34

Victim Responses (feelings of powerlessness & intimidation) - expressed response pattern > the survivor expresses feelings of fear, anger, & anxiety, often through behavior such as crying, sobbing, restlessness, & tension - controlled response pattern

Answer 34

- compounded rape reaction > the survivor can develop substance abuse, depression, & suicide - silent rape reaction > the survivor tells no one, suppresses the anxiety until a future time when forced to face a sexual crisis. This reactivates the trauma

Question 35

? - feelings are masked; the survivor is calm, composed, & subdued - in the days & weeks > the attack, the victim often experiences physical manifestations, & these include contusions & abrasions, headache, fatigue, sleep pattern disturbances, stomach pains, N/V, vaginal discharge & itching, burning upon urination, rectal bleeding & pain - emotional manifestations include rage, humiliation, embarrassment, desire for revenge, & self-blame; fear of physical violence & death can also occur

Answer 35

controlled response pattern

Question 36

Nursing diagnoses for the survivors of abuse → Rape-trauma syndrome → Powerlessness → Risk for delayed development

Answer 36

Nursing Interventions → Tending to physical injuries → Staying w/the client to provide security → Assisting the client to recognize options → Promoting trust → Reporting suspected child abuse or neglect

Question 37

Treatment modalities > Crisis intervention > Safe house or shelter > Family therapy

Answer 37

- In crisis intervention, the goal is to help survivors return to their previous lifestyle as quickly as possible. The client should be involved in the intervention from the beginning > This promotes a sense of competency, control, & decision-making b/c an overwhelming sense of powerlessness accompanies the rape experience - Active involvement by the survivor is both a validation of personal worth & the beginning of the recovery process