Why do people abuse? Why do abused stay? What to look for and what to ask?
In screening for intimate/partner violence, consider stage of abuse
- Precontemplation- may not understand or see the abusive situation
- Contemplation- the pt has considered that there may be an issues, something is not healthy but they are not ready to leave
- Determination- the pt has recognized and are ready to attempt
- Activation- the patient is taking steps to address the domestic violence
It is important that leaving the situation can be dangerous however, emphasize that stay is definitely dangerous.
Remember it is all different people and all different types of environments and relationships, including the workplace and people of all ages
*Senior citizens included! *
-My professor told our class a story of how she once took care of an elderly lady in her physicians office, for years she had been her care provider. She never once asked the lady if she was abused or concerned for her safety. She just didn’t look like the type to be abused. One day my professor noticed that the elderly ladies husband had passed (noticing the obituary section of the paper) not long after the elderly lady had come into the office for a visit. During the visit she provided her condolenses for her patients husbands passing. The elderly lady looked at her and said she was not sorry he had passed away.
When my professor inquired further, she found out that her marriage was full of abuse. The elderly lady confessed to her that on her wedding night, her husband took her to the bedroom and opened the nightstand drawer. He pulled out a loaded gun and told her not to make him ever have to use it on her.
All types including homosexual relationships/family/friends
Power and Control- The Abuser
Intentional Abuser- they have a strong need to have power and control over their partner
Abusers are not out of control, they have a need to control others
Anger management is not accurate for abusers, that assumes that violence comes from anger and that is not always the case. It is a need to control
A person can show signs of being abusive- how do we help notice that and get them help for being an abuser?
Physical abuse typically 75% males,emotional abuse about equal, verbal abuse, sexual abuse, spiritual abuse- using one’s religion or spiritual belief over them, financial abuse
Abuse is often co-occurring to better abuse and manipulate and control their partners
Screen Men for History of abuse!
⅓ of women physically and sexually abused
Most women forced sex experience are under the age of 15
Ask about childhood sexual abuse, be sure to ask males
1/10 women have been raped by a partner
Abused pregnant women are 3x more likely to be murdered or severely abused by the abuser
Danger assessment form for patients can be used to help assess abuse risk
3 women a day are murdered by their male partner
Divorced and separated women are most at risk of murder by the significant other
About half of survivors did not even know and they were completely surprised by the attack of attempted murder, the signs are often not noticeable
Every 9 seconds a teenage female is abused by a relationship partner in the US
Men historically have applied for approx 30 % of protection orders in domestic violence
Over 1 million women are stalked by a partner & 300,000 men
Rape happens in men as it does in women
30% of domestic deaths are men (in violence)
Isolation- the abuser will tend to separate them from family,friends, outside activities, ‘ not being supportive of activities that the other person likes to do’ simple as don’t join the basketball team we won’t have time together , saying i love you so much I want to be with you tonight instead of going to do item x or see family member x or work x
Rushing- appears romantic, tactic for power and control- being in love early on
Identity- telling them what to wear, how to dress, political thoughts, altering thinking, altering appearing, changing likes
Degrading- name calling, bitch, whore, slut, stupid, fat, ugly, slow, retarded, idiot, worthless,POS, waste, it can be in public or the total opposite, often it is in private so there are not witnesses
They will play Mr. Perfect in pubic
They use information and insecurities to manipulate and control, they charm others in public so the victim will not be believed when they finally try to get help
Technology- constantly tracking and possessiveness, texting emailing, where are you, what are you doing, why aren’t you here
Accusatory- jealousy accusing the person of flirting or cheating or doing things that are inappropriate
Threatening behaviors- tones of voice, yelling, or can bring out weapons
The use of weapons significantly increases the death rate from the partner killing them
Sexual coercion- will use alcohol or drugs to make their partner vulnerable to get the person to participate, actively mess up birth control methods,
My professor actually had a man pull out an IUD on his partner during sex and did not tell her and she was not aware
Crazy accusations /making- the abuser will deny their behavior, say that you are making it up, or they will minimize their abuse, or they turn the tables and accuse their partner – if you would have done what I said, I would not have had to do that
Manipulation Desperation- They say that their partner is the only person in the world that likes me or wants me, and or they will threaten suicide if the other leaves