Intimate Partner Abuse
Abuse put in the simplest terms is “the maltreatment of one person by another.” Evidence of maltreatment includes behaviors such as violence, intimidation, manipulation, humiliation, isolation, fear, coercion, threats, and blame to name a few. This maltreatment has been traced as far back to biblical times, and the devastating consequences have continued to accumulate in research. It is seen through all stages of life; childhood, adult, and elderly. It can manifests itself in any economic class or social group, abuse is not discriminative. (Townsend, 2017, p.694-97) Intimate partner abuse can be with or without physical violence. However, the CDC defines physical violence within a relationship as being, “accompanied by emotional or psychological abuse."
IPV–whether sexual, physical, or psychological–can lead to various psychological consequences for victims.” (CDC, 2018a) “What is intimate partner violence (IPV)? Many people mistakenly believe that IPV is only physical abuse and visible in the form of injuries. In fact, abuse can take many different forms. Intimate Partner Violence is a pattern of behavior that is designed to exert power and control over an intimate partner. The control is usually established using a number of different methods including: physical, verbal, financial, emotional, sexual, spiritual abuse or stalking behavior. This abuse usually takes place within what is commonly called the Cycle of Violence.”(Rise, 20118) This paper will focus on these psychological consequences while encompassing the etiology, social and environmental effects, nursing diagnosis, goals or outcomes, and interventions.
Etiology
There are several theories about why abuse occurs most of them point the finger at the need to gain control to compensate for something they lack emotionally and something learned. For the victim, we ask why do they stay or how does one become a victim? According to Essentials of Psychiatric Mental Health Nursing Book by Townsend, the profile of a victim describes them as being more women than men, having poor self esteem, commonly conform to the female sex role stereotype, and often blaming themselves for being abused. They are made to feel guilty, fearful, and shameful by the abuser which will result in anger most often. Some grow up in abusive family homes and leave the home to escape the abuse at a young age only to find themselves in an abusive relationship down the road. (Townsend, 2017, p.694-97)“The World Health Organization estimates that between 10% and 50% of women worldwide report having been assaulted physically or sexually by an intimate partner at some time in their lives, and when threats, financial and emotional abuse are included the prevalence rates are even higher. Abused women can suffer injury and long‐lasting physical and emotional health problems.” (Ramsay,2009)
As abuse continues the victim's perception of her own control over her life in the ability to have options outside the relationships, even more so if children are involved, greatly decreases. This refers to a “phenomenon” known as “learned helplessness” inhibiting one’s ability “to act on her own behalf”. (Townsend, 2017, p.698-9) As the victim is challenged by stress of the abuser who instills fear and self blame onto them will find themselves avoiding negative consequences for trying to leave.
Many factors play a role in keeping one in an abusive relationship as discussed above. Others are contributed to a lack of support, religious reasons, and even hopefulness. Hopeful in the memories of the good times and hope for change. This leads us into the cycle of abuse. There are phases an abuser will cycle through. The honeymoon phase gives fuel to the hope felt by the victim. The first phase usually is what Townsed calls “tension-building”. This is where tolerance for inconsequential annoyances declines. Anger at the slightest provocation erupts but is quick to apologize and minimize the episode. The victim becomes “more nurturing and compliant while trying to anticipate his every whim” to prevent escalation again. (Townsend, 2017, p.698-9)
During this phase, minor abuse occurs. The victim will generally accept the abuse toward her and blame herself for it. She tries to change herself, to be better, to do better in an effort to avoid the contention. She makes excuses for the behavior not only to herself but to others who might see it. While tension mounts an event will trigger the second phase known as “acute battering” where the most violence or emotional abuse occurs but is also the shortest. After the big event of abuse the cycle comes to phase three, “the honeymoon” again. This is where the abuser feels better from the abuse and is calm, loving, and respite. The abuser makes promises that the abuse will never happen again, reassures her of love and plays on her guilty feelings of wanting to be better. This is the idea that if the victim is better then abuse will not continue. (Townsend, 2017, p.698-9)
Medical Treatment
Crisis intervention for sexual assault. During this crisis period the focus is coping strategies for dealing with symptoms of the traumatic event. These symptoms include disorganization in the inability to make decisions, irrational fears, and mistrust. These are manifested in a range of observable behaviors like hysteria, anger and rage, to silence and withdrawal. Resources should be provided to help with the crisis like a safe house or shelter. These shelters provide needed information for support legally and emotionally. Then the victim can be provided options for what she may want to do with her life. Group support should be given as well to reduce the sense of isolation where she can connect with others and learn coping strategies.
Safe shelters are provided for in situations of physical abuse and provide the same sources of support legally and emotionally in counseling and therapy. One type of abused victim who seem to fall through the cracks of treatment are those with an abuser who is very covert. The victim keeps the abusers secrets and he is seen by their isolated community as normal or even a good guy. This can make leaving the relationship or seeking resources even more unavailable to the victim because she perceives there is no one who would believe her.
Safe shelters are provided for in situations of physical abuse and provide the same sources of support legally and emotionally in counseling and therapy. One type of abused victim who seem to fall through the cracks of treatment are those with an abuser who is very covert. The victim keeps the abusers secrets and he is seen by their isolated community as normal or even a good guy. This can make leaving the relationship or seeking resources even more unavailable to the victim because she perceives there is no one who would believe her.
Effect on Patient, Family, and Community
The patient who has experienced abuse can manifest many psychological issues. Some of these issues include post traumatic stress syndrome where “repeated trauma produces changes in the neurochemistry of the brain that affect memory formation. Instead of memories being formed in the normal way, which allows them to be modified by later experiences and integrated into the person's ongoing life, traumatic memories are stored as chaotic fragments of emotion and sensation that are sealed off from ordinary consciousness. These traumatic memories may then erupt from time to time in the form of flashbacks” (EMD,2018).
Mistrust and depression often persist as well, “They often misinterpret other people's behavior and refuse to trust them. Emotional distortions include such patterns as being unable to handle strong feelings, or being unusually tolerant of behavior from others that most people would protest.” (EMD, 2018)
This personal psychological and cognitive effects bleed into the fabric of the victims family and community relationships. As an adult, “abuse survivors are at risk of repeating childhood patterns through forming relationships with abusive spouses, employers, or professionals. Even though a survivor may consciously want to avoid re-abuse, the individual is often unconsciously attracted to people who remind him or her of the family of origin. Abused adults are also likely to fail to complete their education, or they accept employment that is significantly below their actual level of ability.” (EMD,2018)
This personal psychological and cognitive effects bleed into the fabric of the victims family and community relationships. As an adult, “abuse survivors are at risk of repeating childhood patterns through forming relationships with abusive spouses, employers, or professionals. Even though a survivor may consciously want to avoid re-abuse, the individual is often unconsciously attracted to people who remind him or her of the family of origin. Abused adults are also likely to fail to complete their education, or they accept employment that is significantly below their actual level of ability.” (EMD,2018)
Psychosocial Nsg Dx
Nursing diagnosis for abuse are; Powerlessness related to the cycle of abuse as evidenced by many factors like bruises or lacerations in various stages of healing, verbalizations of abuse, fear for safety of self and/or children, verbalizations of no options to leave the relationship. (Ackley, 2017, p.625) Another important and common nursing diagnosis would be trauma related to sexual assault, repeated betrayal, and verbal abuse to name a few. This is evidenced by verbalizations of attack, observable bruises or lacerations in various stages of healing, and severe manifestations of anxiety. (Ackley, 2017, p.616,820)
Patient Goals/Outcomes
Patient goals for these nursing diagnosis would address the ability to overcome the extreme anxiety, trauma, fear, mistrust, and powerlessness exhibited. There are three main goals for a victim of abuse that focus on long term are:
1. Patient will demonstrate healthy grief resolution, starting the process of physical and psychological healing at which a length of time will be determined by the individuals progress.
2. Patient will demonstrate control over her life situation by deciding about what she is to do regarding living with the cycle of abuse in a timely manner.
3. Patient will exhibit behaviors that are age appropriate for community interactions and family disciplining every day. (Twonsend, 2017, p.706-7)
Nurse Interventions
1. Nursing intervention for the victim of abuse is to provide shelter and promote reassurance of his or her safety.
2. Tending to physical injuries if needed while promoting trust and staying with the patient as needed.
3. Assisting the client to recognize options for recovery and life changes needed. (Ackley, 2017, p.137)
References:
Ackley, B. J., Ladwig, G. B., Makic, M. B. F. (2017). Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care. St. Louis, Mo. :Mosby Elsevier,
Centers for Disease Control and Prevention (CDC). (2018a) Intimate Partner Violence: Consequences. Retrieved Nov.27, 2018 from:
https://www.cdc.gov/violenceprevention/intimatepartnerviolence/consequences.html
Encyclopedia of Mental Disorders (EMD).(2018) Abuse. Retrieved Nov.14, 2018 from:
http://www.minddisorders.com/A-Br/Abuse.html
Ramsay J, Carter Y, Davidson L, Dunne D, Eldridge S, Hegarty K, Rivas C, Taft A, Warburton A, Feder G. Advocacy interventions to reduce or eliminate violence and promote the physical and psychosocial well‐being of women who experience intimate partner abuse. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD005043. DOI: 10.1002/14651858.CD005043.pub2.
Richard E. Hayman, Amy M. Smith Slep, Heather M. Foran. (2015) Enhanced Definitions of Intimate Partner Violence for DSM-5 and ICD-11 May Promote Improved Screening and Treatment. Reviewed on Nov. 14th 2018 from: file:///C:/Users/owner/Downloads/Enhanced_Definitions_of_Intimate_Partner%20(2).pdf
RISE. (2018). Intimate Partner Violence Survivors. Retrieved from https://www.riseslo.org/intimate_partner_violence_survivors.php
RISE is a non-profit 501(c)(3) organization© 2018 RISE, All Rights Reserved.
Townsend, M. C. (2017). Essentials of psychiatric mental health nursing: Concepts of care in evidence-based practice. Philadelphia: F.A. Davis
