Domestic Violence

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Domestic Violence

• A Public Health Epidemic
• A Primary Health Issue

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Chapter One

• Understanding Domestic Violence
• Adapted from Improving the Health care to
  Domestic Violence

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Objectives

• To establish that domestic violence is a health
  care issue facing patients, families and
  practitioners of all levels.
• To correct misinformation about domestic violence
  that may block effective responses from health
  care workers

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Responding

• In order to respond to domestic violence
  effectively health care providers need to have
  an understanding of
• the dynamics of domestic violence
• the causes
• the perpetrators
• the victims
• its impact on health of victims and their
  children

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I. Definition

• Relationship violence is an escalating
• pattern of abuse where one partner in
• an intimate relationship controls the
• other through force, intimidation or
• threats of violence.

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Abuse comes in many forms...

• Physical Kicking, punching, shoving, slapping,
  pushing, choking, burning and any other acts
  which may harm a body.

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Abuse comes in many forms...

• Sexual Calling of vulgar names, criticizing
  body parts or sensuality, forced or pressured
  sexual acts, including rape.

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Abuse comes in many forms...

• Psychological
• Threats of violence or harm
• Destructive acts against pets, property.

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Abuse comes in many forms...

• Psychological
• Emotional/ Verbal Assaults against your
  self-esteem. You are so stupid, no one else
  would want you. Name-calling, threats,
  put-downs. stupid, fat, whore etc.

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Abuse comes in many forms...

• Psychological
• Isolation
• Use of Children

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Abuse comes in many forms...

• Economic Controlling money and resources, using
  financial contribution as power, making all
  financial decisions.

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Abuse comes in many forms

• The use of physical and sexual force give power
  to the psychological abusive acts

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Abuse comes in many forms

• Mutual Battering
• Rare- motivation of the victim
• is self defense

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• Physical violence typically starts when the
  couple has become more seriously involved
• engaged
• living together
• going steady
• after marriage
• pregnancy
• after birth of a child

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II. Why does this happen?

• Abusive relationships are based on the mistaken
  belief that one person has the right to control
  another.
• The relationship is based on the exercise of
  power to gain and maintain control.

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Causes of Domestic Violence

• Domestic Violence is
• ...a learned behavior. Batterers learn from
  observations of other people, including family,
  friends and society
• Violent and coercive tactics are used because
  they often work and the batterer too often is not
  held responsible

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II. Causes of Domestic Violence

• Domestic Violence is a gender specific behavior

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Demographics

• Relationship violence occurs in every race,
  religion, ethnic group and social class.
• Relationship violence occurs in both heterosexual
  and homosexual relationships.
• Relationship Violence occurs male to female(95)
  and female to male (5)

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Cultures With Higher Incidence

• Patriarchal
• Patrilineal
• Womens work is undervalued
• Genders roles are very polarized
• Arranged marriages

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In Indian Country...

• In Indian Country domestic violence also varies
  in prevalence with tribe to tribe.
• As with other Communities incidence and severity
  varies from family to family

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Domestic Violence Vs Illness Based Violence

• Illness
• Organic brain disease
• Target is whoever is present
• Changes in speech, gait,
• May be psychosis
• Progression with disease

• Domestic Violence
• Learned
• Target intimate partner
• Coercive

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Domestic Violence and Substance Abuse

• Domestic Violence Is not Caused by Alcohol or
  other drugs

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Dispelling Myths

• Domestic Violence is not caused by anger
• Domestic Violence is not caused by Stress
• Domestic Violence is not causes by the victims
  behavior or the relationship

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Causes of Domestic Violence

• Domestic Violence is not loosing control
• It is taking control

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III. victims

• Who are the victims?

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III. Who are the victims?

• Victims of domestic violence are often the
  patients we see in our hospitals and clinics
  every day

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III. Who are the victims?

• Victims can be found in all communities
• Victims come from all races, religions, sexual
  orientations, education levels, physical
  abilities and social groups.
• Can be male or female
• Can be adolescent to elderly

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III. Who are the victims?

• Victims may or may not have been previously abused

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III. Who are the victims?

• Some behaviors of victims seen in health
  care setting can be better understood in light of
  the control the perpetrator has gained over her
  through isolation

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III. victims

• Why do they Stay?

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Why do they stay?

• Many victims do leave. This must be carefully
  thought out
• There are often numerous barriers to leaving an
  abusive relationship some of these follow

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Why do they stay?

• Fear - threats of suicide, homicide, threats to
  family or children

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Myth

• Victims of Domestic violence Stay with their
  batterer because they like the abuse.

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Why do they stay?

• Immobilization by psychological and physical
  trauma
• Illness and dependence on the perpetrator for
  health care

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Why do they stay?

• Children- He is the father of my children, I
  thought my children needed a father
• Illness creating dependence on the batterer for
  health care

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Why do they stay?

• Isolation- social, family, geographical

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Why do they stay?

• Optimism- I thought it would get better if he
  stopped drinking, He said he would never do it
  again
• Belief that the batterer needs her for survival

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Why do they stay?

• Religious/ Cultural beliefs/marriage vows- till
  death do us part
• Insufficient Funding and resources nation wide

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Why do they stay?

• Lack of real alternatives for employment and
  financial assistance
• Lack of affordable legal assistance
• Lack of affordable housing

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Why do they stay?

• Oppression
• Victim Blaming

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III. Victims

• Survival Strategies

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Survival Strategies

• Survival Strategies used by Victims of Domestic
  Violence often leave them labeled as crazy ,
  codependent or with inappropriate behavior

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Survival Strategies

• Agreeing with denial or minimization in public
• Accepting promises

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IV. Who are the perpetrators?

• Batterers come from all races, religions, sexual
  orientations, education levels, and social
  groups.
• Can be male or female
• Can be adolescent to elderly

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Who are the perpetrators?

• The one commonality is the tactics used to gram
  power and control l in the relationship

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IV. Who are the perpetrators?

• Batterers are our patients

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Who are the perpetrators?

• Regardless of how we feel about perpetrators
  they still may have good qualities
• The reality is that seemingly nice normal people
  can batter and may be very dangerous

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Control Through HealthCare

• Perpetrators may enlist others to aid them in
  control of their victim. These tactics may be
  used to coerce the victim to stop talking with
  the health care provider, to reunite them, or to
  drop objections to joint custody

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V. Children are the silent
victims !

• Domestic Violence always effects the children!

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Trauma and Terrorization of children

• Intentional injures
• Unintentional injures
• Children witnessing abuse
• Using children to control the victim

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B. Effects on Children

• Infancy
• Crucial development of emotional attachments
• Forming attachments provides a foundation for
  healthy development

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B. Effects on Children

• Children age 2-5 years
• Primary task of role development
• Primary task of cognitive development

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B. Effects on Children

• Teenage years
• Primary task is autonomy

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C. Health Effects on Children

• Physical injuries
• Abuse and Neglect
• Alcohol and Drug abuse
• Psychosomatic complaints
• stomachache, headache
• Sleeping disorders
• Eating disorders
• Suicidal attempts/Suicide

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D. Mental Health Effects on Children

• Aggressive , acting out
• Destructive rages
• Detachment,
• Avoidance,
• Depression, mood disorders
• Post Traumatic Stress Disorder

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E. Behavioral Effects on Children

• Over compliance
• Clinginess,
• withdrawal
• Emotional neediness
• Restlessness
• Finger biting
• Stuttering
• shaking

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Domestic Violence and Children
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F. Children and Domestic Violence

• Victims of abuse use numerous methods to protect
  their children form the perpetrator off
  violence.

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Add It All Up...

• Physical and sexual violence against women is a
  public health problem that has reached epidemic
  proportions.
• American Medical Association
• 
  Diagnostic and Treatment Guidelines
• on
  Domestic Violence, 1992

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Conclusion ...

• As health care providers we play an important
  role in the coordinated community response to
  domestic violence. Understanding Domestic
  violence is Key to our addressing, identifying
  and intervening