Violence Disorders
Overview of Violence Disorders and Pediatric Abuse Lecturer: Miss Crowder
Course: Mental Health
Context: Final lecture discussing violence disorders and pediatric abuse/trauma
Definition and Nature of Violence
Violence is described as:
A social act involving a serious abuse of power.
Typically, a relatively stronger person controls or harms another individual, who is usually the least powerful.
Violence can originate from:
A family member
A stranger
An acquaintance
Human-made mass casualty incidents, such as terrorist attacks
Statistics on Victims:
Individuals with major mental illness are 2.5 times more likely to be victims of violence compared to those without mental illness.
Causes of Violence:
The most significant predictor of violence between strangers: Past history of violence and criminal activity.
Violence is most prevalent in family situations and is more frequently directed toward family and friends than strangers.
Types of Violence Behaviors
1. Child Abuse
Physical abuse examples: Shaking Baby Syndrome.
Risk Factors for Child Abuse:
Age under three.
Child is perceived as difficult (results from unwanted pregnancy, disabilities, or other vulnerabilities).
2. Domestic Violence
Examples of domestic violence include:
Striking or strangling a domestic partner.
Cycle of Violence:
Tension Building Phase:
Minor episodes of anger and verbal abuse by the abuser.
Victim feels tense and tries to appease the abuser.
Crisis/Battery Phase:
Major incident occurs, often violent.
Victim may cover injuries or seek help discreetly.
Honeymoon Phase:
Abuser shows remorse and claims to have changed.
Victim wants to believe these promises, hoping for improvement.
Risks:
Victims are at greatest risk when attempting to leave the relationship.
Pregnancy increases the likelihood of violence against a domestic partner.
3. Elder Abuse
Abuse towards older adults may include:
Pushing or causing falls.
The potential for violence is highest in families with previous violence.
Factors that increase risk:
Poor health, disruptive behavior, dependency on caregivers.
4. Sexual Violence
Definition:
Any situation where consent is not given or the individual is incapable of consenting.
Types of Sexual Violence:
Sexual assault (including pressured or forced sexual contact).
Incest, rape (viewed as a crime of violence involving aggression, anger, and power).
Most perpetrators are known to the victim.
Rape Trauma Syndrome:
Acute Phase:
Initial reactions: emotional outbursts (crying, anger) or appearing calm yet confused.
Somatic symptoms: bruising, soreness, headaches, sleep disturbances, GI symptoms, vaginal pain.
Long-term Reorganization Phase:
Symptoms persist, leading to flashbacks, anxiety, phobias.
Emotional and Economic Violence
Emotional Violence
Behavior that minimizes or humiliates an individual's feelings of self-worth through:
Repeated angry or belittling verbal comments.
Neglect
Failure to provide necessary care, which can encompass:
Physical, emotional, and educational needs.
Economic Violence:
Control of family resources to undermine the victim's independence.
Victim's Characteristics
Common traits include:
Low self-esteem and feelings of helplessness.
Guilt, shame, and acceptance of responsibility for abuse.
May deny severity of the situation or experience feelings of anger and terror.
Abuser's Characteristics
Common traits of abusers may include:
Use of threats and intimidation to control the victim.
Extreme disciplinarian beliefs in physical punishment.
History of substance abuse and prior exposure to family violence.
Assessment and Reporting
Collecting History
Conduct interviews regarding family abuse in a private setting:
Be direct but respectful; avoid using complex language.
Inform the client about referral processes to protection services if needed.
Physical Assessment for Infants
Signs of Shaken Baby Syndrome:
Respiratory distress, bulging fontanels, increased head circumference, bruising before six months is suspicious.
Physical signs for preschoolers/adolescents to assess:
Unusual bruising (e.g., abdomen, back, buttocks).
Assess for types of injuries:
Bruises with different stages of healing may indicate ongoing abuse.
Burns resembling glove/stocking patterns or small round burns may suggest forced immersion or cigarette burns.
Fractures with unusual patterns (e.g., spiral fractures) or head injuries (e.g., low consciousness).
Reporting and Documentation
Nurses have a legal responsibility to report suspected cases of child or elder abuse.
Proper documentation must include observations and details from interviews.
Interventions and Safety Plans
Domestic Violence Interventions
Safety Planning:
Develop a plan for escape when violence occurs.
Educate on recognizing triggers of violence.
Teaching Empowerment Skills:
Stabilizing family situations and maintaining violence-free environments.
Stress management techniques.
In Crisis Situations
Provide psychological first aid.
Ensure client is safe physically and psychologically.
Reduce stress-related symptoms.
Critical Incident Stress Debriefing:
Help clients express thoughts and emotions in a safe space.
Handling Aggressive Behavior
Stages of Anger:
Triggering Phase: Signs of restlessness, anxiety, irritability.
Escalation Phase: Increased agitation, potential loss of control (yelling, threatening).
Crisis Phase: Loss of control may lead to violent behaviors (e.g., throwing objects).
Recovery Phase: Client gains control; begin exploring alternative behaviors.
Post-Crisis Phase: Discuss behavior in a non-judgmental manner.
Professional Approaches and Documentation
Professional Conduct
Maintain a calm, non-authoritarian approach when intervening.
Provide space for the client to express feelings verbally.
Documentation Standards
Document incidents accurately and in detail.
Follow legal obligations regarding mandatory reporting for abuse cases.
Assess and address any staff injuries during incidents.