Exam 2 -- Trauma & Violence

How common is IPV in LGBTQ+ relationships compared to non-LGBTQ relationships?

IPV is least as common in LGBTQ relationships as in relationships of non-LGBTQ people

Which groups are at increased risk of experiencing IPV adn WHEN does this begin?

Bisexual and transgender individuals are at increased risks of experiencing IPV compared to cisgender, lesbian, gay, and straight people

For many LGBTQ+ individuals, IPV often begins in youth or young adulthood

How do LGBTQ students compare to straight students in being forced to have sex?

LGBT students report being forced to have sex more frequently than straight students

How do LGB individuals and transgender individuals compare to straight peers in dating violence rates?

LGB specifically, transgender individuals report higher rates of physical/sexual dating violence compared to their straight peers

Risk of IPV in LGBTQ+ Relationships — how do abusers use marginalization?

Abusers exploit existing social and economic vulnerabilities in LGBTQ+ individuals to gain control AND weaponize homophobia and transphobia (stigma, discrimination, lack of education) to maintain power and perpetuate abuse.

Physical Abuse in LGBTQ+ Relationships — key examples?

• Targeting a partner’s genitals or chest for violence

• Preventing healing from gender-affirming surgeries

• Denying access to hormones

• Forcing public affection in unsafe (anti-LGBTQ) areas

• Threats of suicide by the abusive partner

Emotional Abuse in LGBTQ+ Relationships — key examples?

• Blaming the abuse on a partner’s LGBTQ identity

• Denying that abuse can exist in LGBTQ communities

• Pressuring a partner to be “out“ or to be “closeted.”

• Defining abusive behaviours as a normal part of LGBTQ relationships

• Turning mutual friends against a partner

Sexual Abuse in LGBTQ+ Relationships — key examples?

• Using LGBTQ stereotypes to pressure specific sex acts

• Claiming women can’t rape or men can’t be raped

• Using gender roles to control sexual behaviour

• Using incorrect/gender-mismatched terms for a partner’s body

• Coercing sex in exchange for necessities (e.g., food, housing)

• Discouraging protection by claiming “LGBTQ sex is safer”

Financial Abuse in LGBTQ+ Relationships — key examples?

• Threatening to out a partner at work

• Identity theft (facilitated by same-gender assumptions)

• Forcing a partner to pay for gender-affirming hormones or surgeries

• Using gender roles to pressure a partner to pay more

Isolation in LGBTQ+ Relationships — key examples?

• Denying access to LGBTQ+ supports and events

• Creating scenes at LGBTQ events to discourage attendance

• Outing a partner to family, work, or religious groups

• Convincing a partner that they’ll be rejected for their identity

• Using discrimination to promote an “us vs. the world” mindset

• Using bi/trans/homophobia to isolate a partner

Identity/Cultural Abuse in LGBTQ+ Relationships — key examples?

• Saying a partner is “too much” or “not enough” of their LGBTQ identity

• Denying a partner’s gender identity or sexual orientation

• Intentionally using an incorrect name or pronouns

• Controlling how a partner expresses gender or sexuality

• Defining what it means to be LGBTQ for a partner

• Using slurs or reinforcing negative stereotypes

Consequences of IPV for LGBTQ+ Folks

• Substance Abuse 

• Depression, Anxiety or PTSD

• HIV+ Status

• Engagement in unprotected sex 

• Missing school work

Obstacles to Accessing Support (Shelters/Housing) for LGBTQ+ Survivors?

• Nearly half of LGBTQ survivors seeking shelter are denied; ~1/3 due to gender identity

• Bisexual & transgender women may face violence/discrimination in shelters

• Cisgender men & transgender individuals often struggle to find appropriate shelters

• Risk of abusive same-gender partner accessing the same shelter

• Limited availability of LGBTQ+-specific support agencies

Obstacles to Accessing Support (Legal System) for LGBTQ+ Survivors?

• Police/judicial systems may misinterpret LGBTQ IPV; over half report indifference or hostility

• Higher likelihood of dual arrests in same-gender IPV cases

• Judges more likely to issue mutual restraining orders

• Systemic biases: risk of police brutality, poor enforcement of protection orders, and ongoing homophobic, transphobic, and misogynistic attitudes

Obstacles to Accessing Support (Hospitals) for LGBTQ+ Survivors?

• Abusive partner may pose as a “friend” in ER, compromising privacy and safety

• Hesitation to seek/report care due to fear of anti-LGBTQ+ stigma from past negative healthcare experiences

Affirmative Communication — what NOT to do?

• Don’t assume partner’s gender

• Don’t assume patient is “out”

• Don’t assume LGBTQ identity caused the abuse

• Don’t tell patients to leave their partner

• Don’t blame the patient or question what they did

• Don’t respond with doubt or disbelief

Affirmative Communication — key DO principles?

• Use gender-inclusive language until clarified

• Mirror patient’s terms for identity, partner, and anatomy

• Ask and respect pronouns

Affirmative Communication — clinical best practices?

• Collect sexual orientation & gender identity info for all patients

• Follow up appropriately during care

• Be aware of personal biases

• Create an LGBTQ+-affirming, inclusive environment

Minority Stress Model — what is it?

• Explains mental health inequalities in sexual minority populations

• Minority stress = stress from prejudice and stigma (not general stress)

• Includes social, psychological, and structural factors

Minority Stress Model — distal pressure

 external events, ranging from victimization at the interpersonal level to discrimination that is structural in origin

• Discrimination, rejection, laws/policies

• Microaggressions, victimization

• Acute & chronic stressors

• Positive experiences ruined by stigma

Minority Stress Model — proximal pressures

internal conflicts that minority group members experience in response to their exposure to external events.

• Internalized stigma, self-stigma

• Expectation of rejection

• Identity concealment

• Vigilance/anxiety about prejudice

• Negative feelings about identity

• Identity salience, rumination

Reading 1: Edwards & Sylaska — purpose & sample?

Purpose: Examine how minority stress relates to IPV perpetration (physical, sexual, psychological) in LGBTQ college youth

Sample: US youth in same sex relationships (aged 20), half men and majority lesbian or gay; mority caucasian

Reading 1: Edwards & Sylaska (2023) — key findings?

Physical IPV most common (then psychological, then sexual)

• 50% reported no IPV involvement

• All forms of perpetration and victimization are interrelated

• IPV is often mutual/bidirectional (victimization predicts perpetration)

Edwards & Sylaska (2023) — minority stress links

1. Internalized homonegativity

2. Identity concealment

3. Sexual orientation victimization

4. External sexual orientation stigma

• Internalized homonegativity → related positively with physical & sexual IPV among same sex partners but unrelated to psychological perceptions

• Identity concealment → related to psychological perpetrations but unrelated to physical and sexual IPV

• Orientation-related victimization → related to psychological IPV but unrelated to physical and sexual perpetrations

• External stigma → not related to same-sex persecutions or violence.

Edwards & Sylaska (2023) — Conclusions & limitations

• very big issue among LGBTQ college youth, ~30% reported IPV perpetration

• Minority stress contributes to IPV → need identity support & social support

limitations

• Sampling & selection bias (openly LGBTQ, in relationships)

• College-only sample → limited generalizability

• Cross-sectional → no causality established

What is elder abuse?

Any action or lack of action by someone in a position of trust that harms the health or well-being of an older person, causing physical, emotional or mental harm

• including the damage and loss of assets and property

• Often perpetrated by a person of trust (often a family member) as a form of systematic control

Categories of Elder Abuse — Domestic

Abuse usually occurs in the older adult’s home or in the home of the caregiver (oftena close friend, paid companion)

Categories of Elder Abuse — Institutional Abuse

Abuse that takes place in a residential home, foster home, or assisted living facility

• The abuser has a financial or contractual obligation to care for the older adult

Category of Elder Abuse — Self Neglect

The behaviour of an older adult that threatens their own health or safety

• Self-neglect is present when an older adult refuses or fails to provide themselves with adequate food, water, clothing, shelter, medication, personal hygiene, and safety precautions.

Types of Elder Abuse — Physical Abuse

Any physical act, such as hitting, pushing, beating, or restraints

• has become more seen in elder abuse, such as restraining to room

Types of Elder Abuse — Emotional Verbal Abuse

Humilitating, threatening, or controlling behaviours that harm older adults emotional well-being

Types of Elder Abuse — Sexual Abuse

Any non-consensual sexual contact of any kind with an older adult

• Specifically with elders, any sexual activity is considered sexual abuse

Types of Elder Abuse — Neglect

The dismissal of the older adult is often seen in long-term care homes, retirement homes, and palliative care.

• Includes failing to provide care, food, and hygiene, and not considering them as equal members of society

Types of Elder Abuse — Financial Abuse

Exploitation of an older adult's financial resources, including theft, fraud, extortion, and misuse of a power of attorney

• This becomes important as they tend to have more resources than their younger counterparts

• Becomes a problem with financial exploitation due to limited knowledge of technology 

Signs of Elder Abuse

These can be hard to dictate as most signs are associated with diseases and medications

• bruising, burns, cuts, lack of hygiene, proper drinking water and appropriate clothing

• Sucken eyes, lack of medical aids, dismissive attitudes, character changes that are unexplained, insufficient care or unpaid bills are inadequate financial resources

75% of seniors who reported experiencing violent victimization in 2019 were

physically assaulted

• A serious growing problem, and its extent is unknown due to a lack of reporting 

• Many older generations have a hard time accepting abuse and speaking about it

• Physical abuse is the most commonly reported form of elder abuse

Current Police data on Elder Abuse

•  The highest group of elders experiencing violence is aged 65-74

• Among any other age group, seniors account for the largest proportion of abuse

• 2/3 of elders experiencing abuse were victimized by an intimate partner, family member, or caregiver

In class elder abuse

Ageism— the idea that there is not as valuabe to society

• The severity of abuse against seniors is getting worse, and report calls are increasing

Strategies to Prevent Elder Abuse

1. The role of education

• Abuse is preventable through increased public education

• Awareness is higher for nursing abuse, but most abuse occurs at home

• Need education on older adults and risk factors for abuse

• Limitation: issue often frames individual rather than systemic —> reduces broader action and support

Strategies to Prevent Elder Abuse — Respite Care?

• Reduces caregiver stress (major risk factor for abuse)

• Provides caregivers time away from responsibility

• Even a few hours/week of relief is important

• Especially crucial for high-needs elders (e.g., dementia, disability)

Strategies to Prevent Elder Abuse — Social Contact & Support?

• Strong social networks reduce caregiver stress and tension

• Families can share support and informal respite

• Support benefits both the elder and the caregiver

• Larger social circles increase detection of abuse

Strategies to Prevent Elder Abuse — Counselling?

• Helps address harmful behaviours and coping patterns

• Improves stress management and family dynamics

• Can prevent abuse even if not yet confirmed

• Reduces risk of future mistreatment

What is dementia?

a family of disorders that affect cognitive and behavioural function, with Alzheimer’s disease (AD) being the most common and prevalent form

• Dementia presents varying symptoms, but AD is the most common, as it affects memory loss

• Can express a lack of emotion (resulting in caregiver frustration, criticism, and hostility); highly correlated with abuse

• Behavioural symptoms can include agitation, repetition, and communication breakdown or difficulties; they can trigger abuse
  

Elder abuse is more prevalent among persons living with dementia. Why is this?

cognitive impairments, communication difficulties & behavioural symptoms → frustration/abuse

Identifying & Addressing Dementia-Related Abuse — key challenges & solutions?

• Dementia may prevent older adults from reporting abuse

• Lack of standardized screening tools in dementia care settings

• Solution: routine screening in long-term care, retirement homes, and home care

• Stigma around caregiver stress and “duty” can normalize abusive behaviours

Factors leading to dementia-related abuse:

• Caregiver Stress & Burnout

• Dementia-Related Behaviours

• Psychological distress in caregivers

• Lack of trainingss

• Stigma and normalization of abuse

Barriers: Caregiver Stress & Burnout

High levels of expressed emotion (frustration, hostility, criticism) correlate with abusive behaviour

Barriers: Dementia related behaviours

Repetitive speech, aggression, and agitation are triggers for abuse

Barriers: Psychological Distress in Caregivers

Caregivers experiencing anxiety, depression, or lack of support are at higher risk of becoming abusive

Barriers: Lack of Training

Many caregivers are unprepared to handle behavioural symptoms, leading to frustration and mistreatment, correlating to abusive behaviour.

Barriers: Stigma and normaliztion of abuse

Some abusive behaviours, especially verbal abuse and neglect, may be seen as "understandable" due to the challenges of dementia care

What is dementia-related stigma?

A complex phenomenon that involves negative stereotypes, prejudice, and discrimination toward persons living with dementia as well as their caregivers.

dementia-related stigma — public stigma

negative societal attitudes toward speople living with dementia

dementia-related stigma — self stigma

Persons living with dementia internalize these stereotypes, impacting self-esteem & autonomy

• May contribute to experiencing abuse, as people are likely to accept it as they are receiving care

Dementia Related Sigma — Caregiver Stigma

Stigma extends to family members & caregivers, influencing emotional wellbeing & behaviours

Consequences of Dementia-Related Stigma

Stereotype: Persons living with dementia are childlike and incapable of decision-making

Stereotype: Dementia makes people aggressive, unmanageable or a burden

Stereotype: Persons living with dementia have no quality of life and are “already gone.”

1. leads to infantilization, where caregivers treat older adults as children, taking away autonomy (increasing the risk of psychological abuse)

2. Caregivers become frustrated and resentful, increasing the likelihood of verbal and physical abuse (‘too difficult’)

3. Justified neglect or substandardized care leads to dehumanization (increasing risk of physical or emotional abuse)

Consequences of Dementia-Related Stigma — healthcare & system impacts?

• Under-diagnosis and under-treatment by professionals

• Lack of caregiver supports → increased stress and burnout

• Low societal prioritization of dementia care → higher neglect/abuse risk

• Older adults may not be believed when reporting abuse

Consequences of Dementia-Related Stigma — caregiver & social impacts?

• Caregivers feel judged, blamed, and ashamed

• Reluctance to seek help → increased frustration

• Social isolation (caregiver + elder) → emotional distress

• Higher expressed emotion → increased verbal/physical abuse risk

• Fear of being seen as a “bad caregiver” prevents support-seeking

Why is dementia related abuse often overlooked?

• Persons living with dementia may not be able to report abuse

• Signs of abuse may be mistaken for dementia symptoms (bruising from rough handling vs falls)

• A caregiver may justify abuse as necessary to manage difficult behaviours 

Purpose of the Storey Reading on Elder Abuse

• Identifies perpetrator and victim risk factors for elder abuse

• Aims to inform professional practice

• Provides foundation for developing an evidence-based risk assessment tool

Conclusion and Limitations of Storey Reading (elder abuse)

Conclusion

• Risk factors are too broad and cannot be causally related in cases

• Perpetrator and victim vulnerabilities are interconnected

• Parents of abusive children have been added to the vulnerability

Limitations

• Not all risk factors are captured

• Elder abuse is underreported, leading to findings based only on reported cases

Sibling Violence

Consists of physical, emotional, psychological, sexual and economic abuse by one sibling to another

• Includes a power imbalance, making it difficult to protect themselves

Is sibling violence seen as a form of abuse ?

Sibling violence is not recognized as a form of abuse even by the child being harmed

• Often considered normal sibling rivalry

3 ways we can identify sibling violence?

1. Perceptions— how well the interaction is understood

2. Intent— is the intent to cause harm?

3. Severity— duration and intensity of the behaviour

4 forms of sibling violence and explain: (PSEE)

• Physical: Occurs when one sibling intentionally causes physical harm and pain to a sister/brother.

• Sexual: Behaviour between siblings that is not age-appropriate, not transitory and not motivated by developmentally appropriate curiosity 

• Emotional: Any act that diminished a sibling’s sense of identity, dignity, and worth

• Economic: One sibling exerts control or manipulation over another sibling financially.

What are our current rates and findings on sibling violence?

• 1/3 have experiences victimation of sibling violence

• It is underreported so we do not have good numerical data

What groups experience sibling violence? and what is it the most prevalence form of?

• Sibling sexual assault may be the most prevalent form of intra-familial sexual abuse

• Sibling violence is more common among White children than Black or Hispanic

Brother-brother pairs are the most likely to experience ____

What gender group is most common with sexual abuse?

physical sibling victimization

older brother younger sister pairs

Who is likely targeted by sibling violence?

• autism spectrum disorder, physical disabilities, & overweight children

• Ability, sexual identity and social class are all correlated to sibling victimization

• LGBQ children

• Families with college-educated parents and families experiencing financial stress

• Children who are caregivers for their siblings face abusive behaviour

factors associated with sibling violence

• exposure to different forms of violence

• acceptance of abuse (ie. parents who condone violence)

• unhealthy family relationships

• age of children (younger sibling pairs engage in more violence)

• sex of children

Warning signs of sibling violence (may inteact with toher signs)

1. Change in behaviour

2. Physical signs

3. Nature of sibling relationship

4. Overly sexualized behaviours

Sibling Violence among children and adolescence

• Internalizing and externalizing problems

• Trauma reactions (such as sleep disturbances)

• Social isolation/poor social interactions

• Disruptions/compromises in optimal development & Delinquency

Sibling vioence with adults

• Psychological difficulties

• Substance and alcohol use

• Repeated negative patterns and roles

• Sexual promiscuity or avoidance

• Negative impacts on relational ties among siblings (behaviours spill over into other relationships)

Elliot et al. — purpose & methods?

Purpose: This article explores characteristics of sibling violence identified in this study, impacts of the violence on siblings, parents, and families, and responses to sibling violence in Australia.

Methods to Elliot et al.

Combined focus groups and in-depth interviews with a range of experts, family violence and youth service providers, legal practitioners, general practitioners and health service providers, and an online, open, anonymous survey

• that sought to capture the voices of those who have experienced or carried out adolescent family violence (AFV)

Elliot et al. (2019) —results

• presenting in gendered roles, in gendered ways, with those affected mostly identifying as women, and those carrying out the violence mostly referred to only as brothers

Results in Reading: Experiences of violence in adolescence

• Direct and indirect effects of sibling violence

• Sisters targeted by brothers through sexual violence; verbal abuse focuses on bodies and weight

• Shame and stigma around experiences of sibling violence

Results – Recursive & Intergenerational Violence

• Young people carrying out the violence might also have experienced violence themselves

• A delicate balance between trying to best address the needs of the adolescent using violence and ensuring the safety and well-being of siblings in the home

Results – Impact

• Ongoing and serious impacts of violence, including the ability to work, maintain adequate mental health and sustain intimate and familial relationships

• Breakdown of family relationships

• Frustration or blame towards mothers who they saw as failing to keep them safe

• Mothers face a dilemma of ensuring the safety of the affected sibling(s) & child using the violence

Results – Responding to Sibling Violence

• Currently no systemic response to the needs of young people and their families

• Lack of capacity, funding, and time, alongside the difficulty of working with both the adolescent carrying out the violence and the affected sibling(s)

Results – Adults as Gatekeepers to Accessing Help

• Not believed by the adults in their lives, or violence dismissed as “normal sibling behaviour.”

• Unable to access assistance without the help of parents or other adults, which often curtailed their options for safety from the violence and seeking assistance

• Specialized police training is essential to ensure effective frontline responses to adolescents who use violence and to protect siblings affected by violence

Results – Child Protection & Removal of Children from The Home

• Mothers described situations in which Child Protection had removed either the violent adolescent or the affected sibling(s) from the family home in an attempt to keep sibling(s) safe

• Many participants noted the inadequacy of the response of removing children from the home on its own, stressing that it fails to address the complexities of adolescent family violence

• Taking them away is all that happens in this phase

Reading 1: Elliot et al., 2019 — Limitations

• Did not consider sibling violence across the life course

• Unable to directly address the experiences of those who have used sibling violence

• Lack of generalizability

Child to Parent Violence

• Pattern of violent/aggressive behaviours by children or youth toward parents/caregivers

• Used to exert control, gain needs/wants, or respond to parental violence/harsh discipline

• Learned behaviour over time

• Limited research in this area

Children and youth are more likely to engage in CPV if they have had

• Exposure to violence or maltreatment

• Psychological distress

• Previous involvement with criminal justice

• Difficulty with social/school functioning (i.e. emotional dysregulation)

Child-Parent Violence Research

1. The field of CPV is rapidly growing, but with a predominance of quantitative studies (i. Live experiences are lacking).

2. There is no agreed-upon universal definition.

3. Children with disabilities who identify as trans or non- binary, or who are adopted or fostered, are almost completely absent from the existing research.

4. There is very limited research focusing on protective factors or on help-seeking.

CPV in Canada — Study 1

• Overall low frequency of verbal & physical CPV

• Higher violence toward mothers than toward fathers

• Boys are more verbally violent toward fathers than girls

• Strongly linked to exposure to violence/maltreatment

• Predictors (mother-directed):

  • Psychological aggression, spanking, and physical abuse

  • Witnessing parental violence

  • Positive discipline strategies

• Witnessing IPV → 5.8× higher odds of violence toward mothers

• Experiencing abuse → 4.9× higher odds

• Father-directed predictors: being White, parental verbal violence, positive discipline

CPV in Canada (Study 2) — prevalence & predictors?

• Physical aggression: 12.3% (boys), 9.5% (girls) toward fathers

• Over half reported verbal aggression

• No major gender differences in overall CPV prevalence

Predictors (father-directed):

• Paternal education

• Parent–child involvement

• Adolescent substance use

• Harsh father-to-child verbal punishment

CPV in Canada (Study 3) — key findings & recommended approach?

• Aggression often begins by age 10

• Serious impacts: family breakdown, financial loss, severe injuries

Approach:

• Child-rights lens: support/protect + ensure child is heard

• Trauma-informed, relational, and empathetic services

• Avoid stigma; respect all parties

• Whole-systems approach balancing all family members’ needs

CPV in Canada — overall conclusions?

• CPV is linked to trauma, intergenerational violence, and disciplinary practices

• Prevention/intervention should focus on:

  • Positive parent–child relationships

  • Trauma-informed approaches

  • Supportive, consistent parenting strategies

Rates of CPV in Canada

• Rates of youth charged with violent offences where the victim was a parent have declined. 

• Know the trends of the graph as well as the places

• Highest was Ontario, and the prairies, and the lowest was the territories

Contreras (2016): Purpose

Examine how exposure to violence (home, school, community, TV) relates to social-cognitive factors in youth who assault parents

Contreras et al. — key findings

• CPV youth had highest violence exposure at home (strongest predictor)

• Non-CPV offenders had more community violence exposure

• Home violence (witnessing/victimization) → linked to perceived maternal criticism/rejection

• Victimization at home → more negative social perceptions

Contreras et al. (2016) — conclusions & limitations?

Conclusions:

• CPV linked to unique pattern: home violence + hostile perception (especially toward mothers)

• Need specialized intervention programs for CPV youth

Limitations:

• Cross-sectional (no causality)

• Small sample, limited generalizability

• Self-report data

• Only includes reported cases (many unreported)

Challenges in Family Research

• Not all individuals who experience family violence feel comfortable participating in research

• Risk of retraumatization is compounded in certain contexts

• Leads to a lack of literature on the experiences of violence of certain groups of the population and an underrepresentation of diverse voices

• Since experiences of violence are often entrenched in systems of stigmatization, researchers often face the challenge of exploring experiences while not further perpetuating this stigma

• Stigmatized experiences pose challenges to research since nuances are often kept hidden by participants

Arts-Informed Research — what is it?

• Method used in complex research contexts

• Emphasizes empathy, support, and creating a safe space for participants

• Combines reflection with artistic representation

• Focuses on understanding lived experiences beyond traditional methods

Arts-Informed Research — key benefits & features?

• Enables co-production of knowledge through:

  • Understanding social context

  • Capturing emotions and embodied experiences

• Moves from recounting events → interpreting experiences

• Helps overcome research barriers

• Promotes storytelling and reduces power imbalance (poly-vocality)

Arts-Based Storytelling — role in family violence?

• Empowers survivors by allowing them to share their experiences

• Provides emotional (affective) and cognitive benefits

• Builds empathy and understanding in others

• Offers an accessible, safe way to express and externalize trauma

• Supports trust-building and the development of coping strategies

• Useful in social service and therapeutic contexts

Arts Based Approaches in Practice

• Pre/post study (~8 weeks) using participant-chosen art

• Looked at effects on mental health (depression, anxiety, stress)

• And coping (resilience, self-esteem, self-agency)

• Sample: Canadian mothers with IPV history

Before artwork creation

• Significant positive correlation between mothers’ self-esteem and self-agency

• Significant negative correlations between mothers’ self-esteem and stress, self-agency and stress, and depression and income