Abuse
Abuse, Neglect and Family Violence
Introduction: Abuse and violence in the family refer to physically and emotionally harmful behaviors that occur between family and household members. It includes child abuse, child neglect, intimate partners abuse and violence, marital rape, and elder abuse. It could be a learned behavior that can be unlearned through therapy. Perpetrators try to isolate the family to keep it secret and avoid sanctions. They usually have some power and control over the other members of the family. They may rationalize the violence with their drug use. The use of cocaine, PCP, amphetamine etc may increase violent behavior.
Forms of Abuse: Physical abuse includes hitting, punching, shoving, stabbing, shooting, kicking, and withholding medication, wheelchair, food, and fluids. Sexual abuse includes coercion, marital rape, and withholding sex. Psychological abuse includes threat, harassment, and blackmail. Emotional abuse includes name-calling, insults, and ridicule. Economic abuse includes total control over finance, running up bills, forbidding school or work.
Myths and Reality About Violence: Family violence occurs at all levels of society. Separation or divorce may not end violence. Abuser does not need to be provoked. Some survivors wrongly tend to blame self. Treat the violence but also the alcohol, drug, stress, and mental health problems if any. Violence occurs between gays and lesbians too. Abused women are discouraged from disclosure by threats, fear, denial and disbelief expressed by ‘confidants’.
Models of Intervention: The Paternalistic model assumes that the clinician has more knowledge than the patient; that the survivor is responsible for ending the violence; that the clinician should give advice and sympathy; and see the patient as a victim. Whereas, the Empowerment model, which is better, assumes that the clinician should mutually share knowledge with the patient, plan strategies with the patient, respect patient’s competence, experience and strengths, and see the patient as survivor.
Response of Survivors to Violence: Physical signs include injuries at multiple sites in various stages of healing (head, neck, face, throat, sexual organs), headache, insomnia, and stress. Behavioral sign is that the individual does not leave the abuser or leaves and returns before making a final break. Psychological signs include delayed reaction, depression, lowered self esteem, attributions e.g. self-blame, impaired school or work performance and conduct, poor concentration and poor problem solving.
Why Individual Does Not Leave the Abuser? Abused individuals do not leave the abuser for any of many reasons, which include fear of being stalked and killed (which is a realistic fear), strong emotional attachment to the abuser, determination to end the abuse, sanctions present in the couple’s culture, fear of stigma, lack of resources to live away from the abuser, and consideration of what will happen to her children if she leaves. She may leave and return, thinking, “Maybe he will change”.
Child Abuse & Neglect: In every state, child abuse and neglect are must be reported. Types of abuse include child sexual abuse, child physical abuse, child emotional abuse, and child neglect. Child that witnesses family violence may also suffer abuse.
Child Sexual Abuse: This is the involvement of children in sexual activities that they do not fully comprehend and to which they do not or cannot freely give consent. This violates child’s trust in the adult that is supposed to protect him/her. Threat to the child, pet, and others keeps the child quiet. It results in confusion, shame, and helplessness. Its effect may last a lifetime and affect mental health. It may be guarded as a family secret.
Observable Signs of Sexual Abuse: The observable signs of child sexual abuse include physical aggression, excessive masturbation, social withdrawal, low self esteem, impaired school performance, sleep disturbance, STD’s, bleeding, soreness, itching, UTI, pregnancy, bruises, swelling, redness, fracture, burns, and unkempt appearance.
School Violence: School violence is usually due to child drug use, child’s access to guns, antisocial and impulsive behaviors, family dysfunction, community unresponsiveness, interpersonal disputes, and bullying and harassment by peers.
Child Abduction: Most abduction is done by a parent. 70% are by fathers, 25% by their mothers. Parents that are likely to abduct include those that have threatened or attempted it in the past, suspect abuse by the other parent, may be paranoid, may intend to use it as revenge, punishment, trophy, or one that strongly believes that child be raised in his or her home country.
Child Abuse Assessment and Intervention: Explore and be aware of your own attitude to abuse survivors so as not to be judgmental. Do a thorough history & physical assessment. Use private, quiet uninterrupted environment. Honestly state the purpose of the interview. Inform victim of the pending physical assessment. Use a calm and supportive approach
If possible, interview child separately first before joint interview with parent or guardian. Pay attention to child’s affect (look) and behavior, mother’s understanding of the problem, discrepancies in their stories, and parent’s emotional responses. Document your assessment fully. Report suspected abuse to CPS. Coordinate services such as further assessment, psychological testing, individual psychotherapy, family psychotherapy, and group psychotherapy.
Intimate Partner Violence (IPV): IPV is a pattern of coercive and assaultive behavior between intimate and dating partners. Abuse of female partners is the more prevalent IPV. Female violence is more often in self-defense. Many IPV end in homicide or homicide-suicide. Leaving or an attempt to leave by the victim increases homicide risk. There is a higher homicide risk with handgun, history of suicidal ideation or attempt, battering during pregnancy, sexual abuse, substance use, extreme jealousy, and controlling behavior (“if I can’t have you, no one can”). Few women kill their abusers if there is no intervention. Assessment of IPV should be part of mental health assessment. Ask partners about history of conflicts, “pushing and shoving”, and quality of relationship. Observe for hesitation, looking away, and unease. Be supportive, let victim know she is not alone. Describe and map the extent of injuries. Assess for attribution e.g. self-blame. Assess for depression, PTSD, and anxiety. If patient is the abuser, assess potential for further violence. Consult legal advisor for “Duty to Warn”. Courts have made it mandatory abusers (happens to be mostly men) to be treated. Treatment includes confronting the violence, affirming that responsibility lies with the abuser, behavior therapy, anger control, attitude change to women, couple counseling, and cognitive behavior therapy (CBT). Empower the woman, using laws, community resources, support groups, and safe shelters. Mutually set goals with the victim. Mutually consider and choose from options. Help mobilize natural, social and professional supports.
Rape and Sexual Assault: This affects men, women and children, especially women and children. Sexual assault is a forced act of sexual contact without consent. It is usually done to humiliate, defile or dominate the victim. Rape is a felony, yet majority is unreported. Survivors of marital rape do not seek care because of embarrassment and humiliation. Careful assessment and questioning is needed. In caring for the victim, listen, be nonjudgmental, and provide emotional support. Document your observation and assessment fully. Help collect evidence if patient chooses to litigate. In the acute stage, assess for fear, disorganization, shock, and restlessness. In the second stage, assess for flashbacks, phobias to places and people, and sexual difficulties. Encourage the victim to discuss feelings. Explore options e.g. changing phone number. Explore available community services and support groups. Refer for physical treatment and psychotherapy. Plan for a follow-up phone contact in a few days.
Elder Abuse: There are about 5 million abused elderly persons in the US annually. Spouse abuse overlaps with elder abuse
The abused does not report for fear of being abandoned to a nursing home or being isolated. Signs include bruises on arms, wrists, ankles, face lacerations, vaginal lacerations, fractures, malnutrition, poor hygiene, dehydration, flinching and shrinking away in the presence of abuser. Help and care include reporting a suspected abuse to the Adult Protective Services (APS), counseling, psychotherapy, substance abuse and treatment of the abuser, if necessary.
(Dr. Samson Omotosho, PhD, APRN/PMHN)
Verbal Abuse, Emotional Abuse – Overt and Covert
Our society is filled with verbal and emotional abuse, from radio and TV commentators and presidential candidates, to parents, educators, employers and managers. As Patricia Evans states in “The Verbally Abusive Relationship”, the old adage, “Sticks and stones can break my bones but words will never hurt me,” is not at all true. Just as physical abuse is wounding the to body, verbal abuse is deeply wounding to the soul.
If you grew up in a verbally and/or emotionally abusive family, you might not realize when you are being abusive and when you are being abused.
Behind verbal and emotional abuse is always about a desire to control the other person – to have power over the other’s feelings and actions.
Verbal abuse includes:
Being Irritable, impatient, and argumentative
Blaming anger, unpredictable anger, hostility, explosiveness, jealousy
Blaming the other for the abuser’s behavior
Demanding, ordering
Being critical and judgmental
Verbal abuse is also emotionally abusive, but emotional abuse may not look verbally abusive. Often emotional abuse is more subtle and covert than overt verbal abuse.
Emotional abuse includes:
Lack of empathy
Withholding and withdrawing
Defining another with seeming kindness: “Honey, You’re just a bad driver”
Discounting another’s feelings and opinions
Being nice to others but not to a partner
Being competitive
Acting like the victim
Quick come-backs or joking put-downs
It is vitally important for people at the other end of verbal or emotional abuse to understand that you DO NOT CAUSE AN ABUSER TO BE ABUSIVE, and that there is no excuse or justification for any form of abuse.
Once you understand that you do not cause abusers to be abusive, perhaps you can also understand that there is nothing you can do to have control over getting an abuser to see or understand what he or she is doing, or how hurtful it is to you, or to understand your point of view. There is no way of having a rational discussion because, when someone is deeply attached to having power and control over another, they don’t WANT to understand or work it out.
Abuse comes from feeling very powerless, from not being able to handle fear, loneliness, heartache, and helplessness over others. Abusers want to have control over getting others to do what they want so they don’t have to feel their painful feelings. Trying to talk things out is often the last thing they want to do. They just want to win – to have their way. However, there are things you can do to not be a victim of verbally abusive behavior. (Physical abuse is another matter. It is imperative to find a way to leave a relationship that is physically dangerous to you or your children.)
Patricia Evans, in the above-mentioned book, states that what abusers really want is connection. Because they are so disconnected from themselves – from their own feelings and from a spiritual source of comfort and guidance – they are desperate to connect with another person. But for them connection is more like ownership, rather than authentic connection based on mutuality and caring. When you engage with an abuser through explaining, defending, trying to understand, or complying, you are giving the abuser what he or she wants – some level of connection. It’s important to recognize that, while you are never causing an abuser to abuse, you might be feeding the abuse with your response.
If you are in a relationship with a verbal/emotional abuser and you are not ready to leave the relationship, you might want to try NOT connecting at ALL with the abuser when there is any level of abuse. By completely disengaging from any abusive interaction, or at the most saying an incredulous, “What?” (which Evans recommends in “Controlling People”) and then disengaging by singing a “happy song” (a simple song that you sing in your mind to stop thinking about the interaction), you might have a chance of stopping the cycle of abuse.
The challenge in taking this action in your own behalf is to learn to disengage both physically and energetically – which is why singing your happy song is so important. Singing moves you out of your programmed reactive left-brain wounded self and into your spiritually-connected right-brain, energetically stopping your engagement in the interaction.
While disengaging in this way doesn’t guarantee that your relationship will heal, it may be the only possibility you have other than leaving. Perhaps it worth a try!
Author: Margaret Paul, Ph.d.
Top 10 Signs of an Abusive Man
Abusive men are often survivors of abuse themselves. Signs of an abusive man can range from emotional, verbal, physical, or sexual abuse. Frequently an emotionally abusive man is also a verbally abusive man or a combination of all abuse types. A sign of an abusive man can usually be found after a few dates if you pay attention, ask a lot of questions and do some investigating into his past.
Abusive relationships are characterized by control games, violence, jealousy and withholding sex and emotional contact. An emotionally abusive man is harder to pin-point and a skilled, abusive man can easily make you think you aren’t good enough or that everything is your fault. It is just as difficult to recover from emotional abuse as it is from physical abuse. Emotional abuse causes low self-esteem and depression. An abusive man may tell you he loves you or that he will change, so you won’t leave. However, the more times you take him back, the more control he will gain. Empty promises become the norm. Make sure you pay attention to his actions and not merely his words. As the old saying goes, “actions speak louder than words.” Abusive relationships are never abusive in the beginning. If they were, women would dump the abusive men immediately in search of a good man.
According to the American Psychological Association Force on Violence and Family, over 4 million American women experience a serious assault by a partner each year! Who can forget when heavy-weight champ Mike Tyson was convicted of raping Desiree Washington and sentenced to six years in prison. Tyson served three years before being released on parole. Thereafter, he married Robin Givens but they divorced on Valentine’s Day only a year later because Givens claimed Tyson abused her. Abusive behavior touches all ranges of society.
We have broken down the top 10 signs of an abusive man. If your partner exhibits one or more of these signs, it may be time to reevaluate your relationship and seek help or get out.
1. Jealousy & Possessiveness – Becomes jealous over your family, friends, co-workers. Tries to isolate you. Views his woman and children as his property instead of as unique individuals. Accuses you of cheating or flirting with other men without cause. Always asks where you’ve been and with whom in an accusatory manner.
2. Control – He is overly demanding of your time and must be the center of your attention. He controls finances, the car, and the activities you partake in. Becomes angry if woman begins showing signs of independence or strength.
3. Superiority – He is always right, has to win or be in charge. He always justifies his actions so he can be “right” by blaming you or others. A verbally abusive man will talk down to you or call you names in order to make himself feel better. The goal of an abusive man is to make you feel weak so they can feel powerful. Abusers are frequently insecure and this power makes them feel better about themselves.
4. Manipulates – Tells you you’re crazy or stupid so the blame is turned on you. Tries to make you think that it’s your fault he is abusive. Says he can’t help being abusive so you feel sorry for him and you keep trying to “help” him. Tells others you are unstable.
5. Mood Swings – His mood switches from aggressive and abusive to apologetic and loving after the abuse has occurred.
6. Actions don’t match words – He breaks promises, says he loves you and then abuses you.
7. Punishes you – An emotionally abusive man may withhold sex, emotional intimacy, or plays the “silent game” as punishment when he doesn’t get his way. He verbally abuses you by frequently criticizing you.
8. Unwilling to seek help – An abusive man doesn’t think there is anything wrong with him so why should he seek help? Does not acknowledge his faults or blames it on his childhood or outside circumstances.
9. Disrespects women – Shows no respect towards his mother, sisters, or any women in his life. Thinks women are stupid and worthless.
10. Has a history of abusing women and/or animals or was abused himself – Batterers repeat their patterns and seek out women who are submissive and can be controlled. Abusive behavior can be a generational dysfunction and abused men have a great chance of becoming abusers. Men who abuse animals are much more likely to abuse women also.
If you continue to stay in an abusive relationship because you think he will change and start treating you well, think again. An abusive man does not change without long-term therapy. Group counseling sessions are particularly helpful in helping abusive men recognize their abusive patterns. Type A personality types seem to be more prone to abusive behavior due to their aggressive nature. Drugs and alcohol can create or further escalate an abusive relationship. Alcoholics Anonymous and Narcotics Anonymous are excellent programs for an addict. The abuser’s partner should also seek help for their codependent behavior at Codependents Anonymous.
Author: Stephany Alexander
If the abusive man is not willing to seek help, then you must take action by protecting yourself and any children involved by leaving. By staying in an abusive relationship you are condoning it. If you are scared you won’t be able to survive because of finances, pick up the phone book and start calling shelters. Try calling family, friends and associates and ask them if they can help or know of ways to help. Once you leave, the abuser may cry and beg for forgiveness but don’t go back until you have spoken to his counselor and he has completed long-term therapy successfully. Be prepared for the abuse to increase after you leave because the abuser has lost control. The Bureau of Justice Statistics states that on the average, more than three women are murdered by their husbands or boyfriends every day so please be careful. If you partner is not willing to seek help for his abusive behavior, your only option is to leave.
