VIOLENCE and ABUSE Violence means the use of force or physical compulsion to abuse or damage, the term abuse

is much broader and includes physical or mental maltreatment and neglect that result in emotional, physical,or sexual injury. In the case of children, the disabled, or elderly, abuse can result from direct actions or omissions by those responsible for the individuals care. ETIOLOGY Psychoanalytical theory suggests that unmet needs for satisfaction and security result in an underdeveloped ego and a poor self-concept in the individuals involved in violent episodes. Aggression and violence supply the offender with a sense of power and prestige that boosts the self-image and provides a significance or purpose to the individuals life that is lacking. Aggression and violence are the overt expressions of powerlessness and low selfesteem. CHARACTERISTICS OF VIOLENT FAMILIES 1. SOCIAL ISOLATION-members of the family keep to themselves and usually do not invite others into the home or tell them what is happening 2. ABUSE OF POWER AND CONTROL-the abusive family member almost always holds a position of power and control over the victim 3. ALCOHOL AND DRUG ABUSE-alcohol does not cause the person to be abusive; rather an abusive person is likely to use alcohol or other drugs 4. INTERGENERATIONAL TRANSMISSION PROCESS-shows that patterns of violence are perpetuated from one generation to the next through role-modelling and social learning. Family violence is learned pattern of behavior CYCLE OF BATTERING Tension-building acute battering honeymoon tension-building 1. Tension-building phase: the batterers tolerance to the victims behavior is decreasing. There is an increase in arguments, complaints, and stony silence from the batterer. Minor battering incidents may occur in this phase 2. Acute battering incident This phase ends the tension-building phase and is the shortest yet most violent phase. This often begins with the batterer justifying his own actions by teaching the victim a lesson. In the end of the incident, the batterer cannot understand what happened since rage had taken over his behavior. During this phase, the victim feels that his only option is to find a safe place to hide from the batterer.

The beating is severe and help is sought if injury is severe or the victim fears for her life or the life of her children. 3. Honeymoon phase In contrast to the previous phases, the batterer becomes increasingly loving, attentive, kind, and seemingly patient. He begs for forgiveness and swears that the battering would never occur again. The batterer is afraid that the victim will leave so he charms his way in order to prevent this and uses the victims guilt feelings against her. The victim then relieves her dreams of ideal love and chooses to believe in the batterers promises. Initially, the honeymoon phase (period of remorse) lasts for weeks or even months. However, over time, this phase becomes shorter and shorter until it disappears altogether, and the level and severity of violence worsens. CHILD ABUSE This is termed generally as the intentional injury to a child. This includes physical or emotional injury, physical or emotional neglect, and sexual abuse inflicted on the child by the caregiver or significant other. ELDER ABUSE This is denied as the maltreatment of older adults by family members, significant others, or caregivers. It may cover physical or sexual abuse, psychological or emotional abuse, neglect, selfneglect, financial abuse , and denial of suffice medical treatment. Most elders who are abuse victims are 75 years old and older. SPOUSE OR PARTNER ABUSE Is the mistreatment or misuse of one person by another in the context of an intimate relationship. The abuse can be emotional or psychological, physical, sexual or a combination ( which is common SEXUAL ASSAULT Rape is an act of aggression and not of passion. It is defined as the expression of power and dominance through sexual violence. This is common in men than women, although men may also be rape victims. Date rape is when the rapist is known to the victim (may be an acquaintance or a person that the victim dates). Marital rape is the term used when there is a sexual abuse directed to a spouse, which is against the persons will. DOMESTIC VIOLENCE Domestic violence includes not only family members but persons not related by blood and affinity, who live in the same domicile or constitute a household

RA 9262 act defining VAW, their children, and penalties RA 7610 Special Protection of Children Against Child Abuse, Exploitation and Discrimination In the Philippines, recent estimates: 1 in 10 to 6 in 10 women are assaulted at home Family violence consists of several (combination) forms of abuses: physical, verbal, economic, emotional, and sexual Almost all victims (98%) women with an average age of 23 y/o Violence Against Women (VAW) any act of gender based violence that results in or is likely to result in physical, sexual, or psychological harm or suffering to women, including threats of such act, coercion, or arbitrary deprivatioin of liberty , whether occurring in public or private life. (Declaration against VAW, 1992) Victims experience violence repeatedly at varying periods of time, in the hands of the same or different household members. Father is the most frequent abuser. The most common perpetrators are male spouses or partners (> of abuses) The cycle will go on unless: the man takes responsibility for the behavior and genuinely changes; or the women leaves the violent situation and/or takes legal steps to halt the violence and abuse INTERVIEWING ABUSE VICTIMS APPROACH SENSITIVE QUESTIONING ASK RELEVANT QUESTIONS AND AVOID ASKING WHY QUESTIONS 3. SOFTEN THE EFFECT OF SENSITIVE QUESTIONS BY STATING THE REASONS FOR ASKING SUCH QUESTIONS 4. BE CAREFUL IN USING WORDS SUCH AS ALLEGED RAPE WITHIN THE SURVIVORS HEARING 5. SHOULD BE DONE IN PRIVATE ROOM WITH ONLY APPROPRIATE PERSONNEL PRESENT (IF DOCTOR IS DOING THE INTERVIEWTHE NURSE MUST BE PRESENT) 6. PHYSICAL EXAMINATION AND EVIDENCE COLLECTION a. Give brief concrete explanation of what is going to happen b. Determine what the survivor wants c. Do not ask to undress or climb up to the stirrups before the procedure d. Provide privacy and be gentle throughout the examination e. If the doctor does the examination, the nurse must be present 1. 2. RED FLAGS OF CHILD ABUSE UNEXPLAINED BRUISES AND WETS ON ANY PARTS BRUISES ON DIFFERENT STAGES INJURIES REFLECTING SHAPE OF ARTICLES USED UNEXPLAINED BURNS ROPE BURNS ON ARMS, LEGS AND NECK INJURIES INCONSISTENT WITH INFORMATION

IMMERSION BURNS WITH DISTINCT BOUNDARY LINE UNEXPAINED LACERATION, ABRASIONS OR FRACTURES CHILD ABUSE Clinging excessively or unresponsive to parent or adult Has tendency to be fearful of physical contact Inconsistent history and injury Lack of reaction to frightening events During care, uncooperative Accepts pain (less or no crying) Becomes aggressive (acting out behaviour) Unusually affectionate and outgoing Superficial relationships Extreme behaviour WHAT TO DO CALL THE APPROPRIATE AUTHORITIES IF THERE IS SUSPICION OR SIGNS OF CHILD ABUSE PRESENT THE CHILDS SAFETY IS OF UTMOST IMPORTANCE