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Domestic & Family Violence

Domestic (family) violence is a learned pattern of behaviors used by one person to control the other partner in the relationship. Control can be achieved by using physical, sexual or emotional abuse; threats and intimidation; economic control; social isolation; and the use of children or role privilege. The partners may be dating, married, separated, divorced or in a same sex relationship.

Family violence may also include:

  • child abuse and neglect
  • elder and vulnerable adult abuse
  • teen dating violence

Domestic violence takes many forms. It can be when someone:

  • puts you down, says mean things, yells, plays mind games
  • blames you for their behavior
  • threatens to leave you or take the children away from you
  • isolates you from your friends and family
  • doesn’t let you have a job, controls money and bank accounts, refuses to pay bills or buy food
  • takes away phone or car keys
  • treats you like a servant, makes all decisions, makes you ask permission
  • watches everything you do, is jealous, checks car mileage
  • hits, chokes, pushes, slaps, holds or ties you down
  • threatens to or does hurt you, the children or the pets
  • destroys your property
  • forces unwanted sex or sex acts
  • won’t let you sleep

Plan ahead for a quick and safer escape:

  • Pack extra clothes and personal supplies for you and your children.
  • Set aside an extra set of car keys, money and copies of important papers for you and the children: birth certificates, social security numbers, financial papers, federal tax returns, health documents and insurance policies.
  • Leave extra clothes, supplies and papers with someone you trust.
  • Try to leave the house every day at a set time (i.e. get mail, then walk the dog). When you are ready to leave, it won’t look suspicious.
  • Plan where you will go and how you will get there. Rehearse your plan.

Why should nurses and other health care providers be concerned about domestic violence? Why should our families, communities, schools, houses of worship or business be concerned? The answer, simply and sadly, is that domestic violence touches all of us, whether we are experiencing abuse personally in our homes, watching a beloved family member or friend struggle in abusive relationships, or we are caring for a patient who has been emotionally, physically or sexually assaulted by domestic violence.

Increasing visibility and awareness helps find a solution to the problem. Raising awareness bears a need to openly talk about these and similar health issues. Awareness in turn, moves us toward

Understanding the Abusive Relationship

Domestic violence in a relationship is about the abuser's use of power and control to get his/her way. The batterer has learned that conflicts are resolved with threats or force. When the partner does not behave in the desired way, the batterer uses power to punish the partner.

The relationship may not seem abusive at first. The abusive behaviors appear after the batterer feels that the partner is "hooked" in the relationship. The following behaviors are some of the ways that an abuser misuses power to control the partner:

  • physically abusing the partner, children or animals
  • threatening to harm the partner, the children, family animals
  • threatening to leave or take the children
  • destroying the partner's property
  • showing sudden mood changes (nice to explosive anger)
  • forcing unwanted sexual activity or using force during sex
  • yelling, using demeaning names and put downs, playing mind games
  • blaming the partner for causing the abusive behavior
  • controlling money and bank accounts - may not let the partner have a job
  • taking away the car keys or phone access Socially isolating the partner from family and friends Watching everything the partner does (checks car mi
  • treating partner like a servant - makes all the big decisions

Why do people stay in abusive relationships?

It takes the partner an average of seven times before successfully leaving the abusive relationship. Listed below are some of the key reasons why a partner stays in the relationship:

  • Fear. The risk of being murdered increases by 75% when the victim plans to leave the abuser. The person may fear losing their children or harming their immigration status.
  • No money. The person has no financial resources to be able to leave.
  • Psychological dependence. The abuser has destroyed the partner's confidence and self-esteem.
  • Lack of social support. The partner has been isolated and feels totally alone.
  • Religious and/or cultural beliefs. The person may be pushed to stay in the relationship and be encouraged to accept it.
  • The abuser promises to change. Many victims don't want to leave the relationship - they just want the abuse to stop.

Elder & Vulnerable Adult Abuse

Vulnerable adults are an at-risk population for abuse. Vulnerable adults are described as those over the age of 18 years, who are vulnerable due to their age, mental, emotional or physical abilities. Examples include those who are paralyzed, disabled, confused and who rely on others to provide their care.

These individuals can be neglected, abused or exploited financially.

Physical or sexual abuse involves inflicting physical discomfort, pain or injury. It includes behaviors such as slapping, hitting, beating, burning, sexual assault and rough handling. Warning signs are suspicious bruising or other injuries or caregivers refusing visitors.

Psychological or emotional abuse diminishes the identity, dignity and self-worth of the vulnerable adult. Some examples are: name calling, insulting, threatening, ignoring, isolating, excluding from meaningful events and deprivation of rights. Warning signs include the person being emotionally upset, withdrawn or unresponsive.

Neglect is the failure of a caregiver to meet the needs of a vulnerable adult who is unable to meet those needs alone. It can include such behaviors as denial of food, water and medical treatment. Warning signs include dehydration, weight loss, unattended health problems.

Financial exploitation involves the misuse of money or property. Examples include stealing money or possessions, forging a signature, misusing a power of attorney, and tricking an older adult into selling their property.

The U. S. Senate has estimated the number of victims at 5 million/year. However, only 4 percent of older adults living in private homes reported experiencing abuse or neglect. Victims often do not report due to embarrassment, fear of rejection by loved ones or having to leave their home.

Factors that contribute to abuse:

  • The abusive caregiver often has mental health problems and is more likely to have a substance abuse problem.
  • Caregiver stress related to long-term care of vulnerable adults sometimes leads to abuse.
  • Children from homes with family violence may be "getting back at" a parent.
  • Older adults who live with someone are more likely to be abused than those who live alone. Older adults who live with grown offspring or other caregivers are more likely to be abused than those who live with a spouse.
  • Males are more likely to physically abuse. Women are more likely to neglect and financially abuse.
  • To prevent re-occurrence in serious cases, changing the living arrangements is usually more effective than giving care giving assistance to the abuser.

Child Abuse & Neglect

The mistreatment of children can be in the form of neglect or abuse, harmful things being done to them. Not meeting a child's basic physical, medical, educational, and emotional needs is neglect. Actual abuse may be physical, sexual, or emotional. Each year, more than 896,000 children are neglected or abused and 1400 die in the U S.

Child neglect and abuse often occurs with other forms of family violence, such as spousal abuse. Child neglect and abuse can lead to long-lasting problems, such as mental health problems and substance abuse. Abuse often creates a cycle, with adults who were abused as children being more likely to abuse their own children

Doctors and nurses are required by law to promptly report cases of suspected child neglect or abuse to a local Child Protective Services agency. Depending on the circumstances, the local law enforcement agency may also be notified. All reported cases of child abuse are investigated by representatives of the local Child Protective Services agency, who determine the facts and make recommendations.

Physical Neglect: Physically neglected children may appear undernourished, tired, or dirty or may lack appropriate clothing. Their development may be slow.

Physical Abuse: Children who have been abused for a long time are often fearful and irritable. They often sleep poorly. They may be depressed and anxious. They are more likely to act in violent, criminal, or suicidal ways. Bruises, burns, welts, or scrapes are common signs of physical abuse. Severe injuries to the mouth, eyes, brain, or other internal organs may be present but not visible - for example, infants who have been shaken violently may have no visible signs of injury and may appear to be sleeping deeply. There may be signs of old injuries, such as broken bones, which have healed.

Emotional Abuse: In general, children who are emotionally abused tend to be insecure and anxious and have low self-esteem. Infants who are emotionally neglected may appear unemotional or uninterested in their surroundings. They may lack social skills or be slow to develop speech and language skills. Children who are terrorized may appear fearful and withdrawn. They may be distrustful, unassertive, and extremely anxious to please adults. They may inappropriately reach out to strangers

Sexual Abuse: Changes in behavior, often abrupt, are common. Children may become aggressive, withdrawn or develop phobias/sleep disorders. They may behave in sexually inappropriate ways for their age. Sexual abuse may also result in bruises, tears, or bleeding in areas around the genitals, rectum, or mouth. Injuries in the genital and rectal areas may make walking and sitting difficult. Girls may have a vaginal discharge or a sexually transmitted disease