Your SlideShare is downloading. ×
Domestic Violence And Substance Abuse
Domestic Violence And Substance Abuse
Domestic Violence And Substance Abuse
Domestic Violence And Substance Abuse
Domestic Violence And Substance Abuse
Domestic Violence And Substance Abuse
Domestic Violence And Substance Abuse
Domestic Violence And Substance Abuse
Domestic Violence And Substance Abuse
Domestic Violence And Substance Abuse
Domestic Violence And Substance Abuse
Domestic Violence And Substance Abuse
Domestic Violence And Substance Abuse
Domestic Violence And Substance Abuse
Domestic Violence And Substance Abuse
Domestic Violence And Substance Abuse
Domestic Violence And Substance Abuse
Domestic Violence And Substance Abuse
Domestic Violence And Substance Abuse
Domestic Violence And Substance Abuse
Domestic Violence And Substance Abuse
Domestic Violence And Substance Abuse
Domestic Violence And Substance Abuse
Domestic Violence And Substance Abuse
Domestic Violence And Substance Abuse
Domestic Violence And Substance Abuse
Domestic Violence And Substance Abuse
Domestic Violence And Substance Abuse
Domestic Violence And Substance Abuse
Domestic Violence And Substance Abuse
Domestic Violence And Substance Abuse
Domestic Violence And Substance Abuse
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Domestic Violence And Substance Abuse

1,991

Published on

1 Comment
3 Likes
Statistics
Notes
  • Congratulations on your presentation very interesting ! Great work...!!! ! ! Thank you for sharing. I allowed myself to add it to 'GREAT CAUSES and JUST CAUSES' Slideshare group . Feel free to join us. Thank you in advance for your participation and sharing your 'favorites'. .. With friendship from France. Bernard

    http://www.slideshare.net/group/great-causes-and-just-causes
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
No Downloads
Views
Total Views
1,991
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
86
Comments
1
Likes
3
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Domestic Violence Pascale Gehy-Andre PA-C
  • 2. Objectives
    • To sensitize you to the issue of domestic violence
    • To help you understand the dynamics, the barriers to identification
    • To recognize the physical and behavioral symptoms
    • To give you guidance on how to inquire about it
    • To provide recommendations on how to manage it
  • 3. Domestic Violence
    • Define as any intentional, controlling behavior consisting of physical, sexual, or psychological assaults in the context of an intimate relationship
    • Studies demonstrate most couples reported violence at some point in their history
  • 4. The Silent Epidemic
    • SILENT: Because it is both hidden and largely unrecognized despite its magnitude, the recent media attention and coverage.
    • EPIDEMIC: Because the dimensions of the problems are truly staggering.
  • 5. EPIDEMIOLOGY
    • Popular misconception sees domestic violence as a phenomenon only of the poor and uneducated women.
    • The silent epidemic crosses boundaries of age, gender, ethnicity, socioeconomic status, and sexual orientation.
    • Women between 19 and 29 are most likely to be abused.
    • Violence also occurs in dating couples, with 20% adolescents reporting being physically or sexually abused.
  • 6. EPIDEMIOLOGY
    • It is estimated that 10% of professional and working women are victims of battering mates.
    • Intimate partner violence occurs with similar frequency in lesbian and gay relationships.
    • Elderly and women with disabilities are also at higher risk for abuse in the hand of the caretakers.
    • Approximately 3.3 million children a year are exposed to violence by a family member against their mother. Such children are 1,500 times more likely to be abused or become abusers.
  • 7. Epidemiology
    • It is estimated 4-8 million women are subject to battering each year.
    • Men reports of physical abuse by female partners are below national statistics as compared to females and injuries inflicted by women on men, are not considered a significant public health or medical problem.
  • 8. Epidemiology
    • Economic costs of treating domestic violence are enormous. (more than $2 billion)
    • Annually: ¼ of all ER visits.
            • 21,000 hospitalizations
            • 40,000 clinic visits
            • 175,000 disability days
    • According to the National Coalition on Domestic Violence, domestic violence accounts for more injuries to women than all other causes combined and around 2,000 women die as a result of it.
  • 9. Epidemiology
    • Homicide is the #1 killer of pregnant and post partum (1) women.
    • Most alarming is that about 955 of cases presented in health care settings were not identified as such.
    • JAMA March 2001 editorial argued that all health care professionals must do a better job in all settings to recognize and provide appropriate treatment to victims of domestic or intimate partner violence.
  • 10. BATTERER PROFILE
      • What kind of men is a batterer?
      • He objectifies women (sexual objects, property)
      • Charming, pleasant, “nice guy”.
      • May come from a chaotic abusive family
      • Have feeling of powerlessness.
      • “JEKYLL AND HYDE”!!!
  • 11. THE BATTERING CYCLE
    • Relationships involving domestic violence progress through cycles.
    • 1- The TENSION BUILDING PHASE
    • 2- The VIOLENT PHASE
    • 3- The HONEYMOON PHASE
  • 12. TENSION BUILDING PHASE
    • Batterer will accuse the significant other of various wrong doings, and in repeated criticisms tell her she can do nothing right.
    • He will start controlling her behaviors by restricting her basic rights, ( not letting her drive or leave the house without him) or even ordering her into isolation.
  • 13. VIOLENT PHASE
    • Starts when the batterer uses any real or imagined objectionable act or behavior as a reason to launch into explosive violence.
    • In early phase violence can take the form of breaking or throwing objects, or harming, killing pets.
    • Escalates and is directed more and more against partner.
    • Frequently abuser will be under the influence of alcohol or drugs.
  • 14. Honeymoon phase
    • Once the abuser has released his tension, the honeymoon phase follows.
    • The batterer becomes remorseful, apologizes, and may make various excuses for his behavior.
    • He may insist that he really loves his partner, and cannot do without her.
    • He will blame it on the substance abuse.
    • He will promise (often with real tears) that he will NEVER do it again.
  • 15. OBSTACLES TO LEAVING AN ABUSIVE RELATIONSHIP
    • FEAR AND TERROR OF THE ABUSER
    • LOW SELF ESTEEM
    • LACK OF MONEY
    • LACK OF SHELTER OR HOUSING
    • BATTERER’S PROMISES TO CHANGE
    • ISOLATION
    • LACK OF FAMILY OR SOCIAL SUPPORT
    • LACK OF ACCESS TO LEGAL COUNSEL
    • HISTORY OF PRIOR INEFFECTIVE LEGAL INTERVENTION
    • DENIAL AND MINIMIZATION BY VICTIM AND OUTSIDERS
    • SHAME , EMBARRASSMENT, SELF BLAME, AND GUILT
    • RELIGIOUS BELIEFS
    • WANTING TO KEEP FAMILY TOGETHER
    • PROTECTING THE CHILDREN ( BY TAKING THE ABUSE TO SHIELD THEIR CHILDREN)
    • FEAR OF BEING CONSIDERED UNBELIEVABLE OR CRAZY.
  • 16. ASSESSMENT
    • THERE ARE SEVERAL KEYS TO CORRECTLY ASSESS DOMESTIC VIOLENCE .
    • 1- WILLINGNESS TO OVERCOME VARIOUS BARRIERS.
    • 2- PAYING ATTENTION TO RED FLAGS OR INCONSISTENCIES BETWEEN THE PHYSICAL EVIDENCE AND THE EXPLANATIONS GIVEN BY THE PATIENT OR THE PARTNER
    • 3- Have protocols for handling domestic violence cases in place in your health care setting.
  • 17. HISTORY
    • Diagnosis usually made through history.
    • A thorough history is the cornerstone of the diagnosis of domestic violence
    • Presentation often subtle
    • Detection requires high index of suspicion
    • Clues that prompt to further inquiry
  • 18. SIGNS AND SYMPTOMS OF DOMESTIC VIOLENCE
    • PHYSICAL SYMPTOMS
    • SOMATIC STRESS SYMPTOMS
    • BEHAVIORAL CUES
    • VERBAL
  • 19. PHYSICAL SYMPTOMS
    • ACUTE TRAUMATIC INJURY
    • HEADACHES OR HEARING DIFFICULTY FROM HEAD TRAUMA
    • JOINT PAINS FROM TWISTING INJURIES
    • ABDOMINAL OR BREAST PAIN FOLLOWING BLOW TO THE TORSO.
    • DYSPAREUNIA OR RECURRENT UROGENITAL INFECTIONS FROM SEXUAL ASSAULT .
    • RECURRENT SINUS INFECTIONS OR DENTAL PROBLEM, DISLOCATED JAW OR CERVICAL SPINE
    • BRUISES OR PAIN IN THE NECK OR THROAT FROM STRANGULATION, ALSO LOOK FOR BULGING EYES.
    • BRUISES OR BROKEN BONES AT VARIOUS LEVEL OF HEALING.
    • IBS OR CHRONIC ABDOMINAL PAIN
    • RECURRENT SEXUALLY TRANSMITTED INFECTIONS
  • 20. SOMATIC STRESS SYMPTOMS
    • CHRONIC HEADACHES
    • CHRONIC ABDOMINAL, PELVIC, OR CHEST PAINS
    • CHRONIC JOINT AND BACK PAIN
    • MYALGIA AND CHRONIC FATIGUE
    • SLEEPING OR EATING DISTURBANCES
    • HEARTBURN, IBS
    • EXACERBATION OF CHRONIC DISEASES LIKE DM, ASTHMA, CAD
    • SIGNS OF POST TRAUMATIC STRESS DISORDER: ANXIETY, HYPER VIGILANCE, JUMPINESS
    • DEPRESSION, DIFFICULTY CONCENTRATING, FEELING NUMB, SUICIDE ATTEMPTS OR GESTURES.
    • CONVERSION DISORDERS: TEMPORARY BLINDNESS
  • 21. BEHAVIORAL CLUES
    • NERVOUS OR INAPPROPRIATE LAUGTHER OR SMILING (TINGED WITH FEAR)
    • CRYING, SIGHING, OR HYPERVENTILATING.
    • ANXIOUS, JUMPY, FURTIVE LOOKS AT THE EXAMINATION ROOM DOOR.
    • DEFENSIVENESS, ANGER
    • EYES AVERTED OR DOWNCAST, FEARFUL OF EYE CONTACT
    • PARTNER: OVERLY ATTENTIVE OR DEFENSIVE: DOES NOT WANT TO LEAVE HER ALONE .
  • 22. VERBAL
    • MINIMIZES SERIOUSNESS OF INJURIES
    • GIVES EXPLANATIONS OF INJURIES INCONSISTENT WITH ACTUAL INJURY
    • TALKS ABOUT “A FRIEND” WHO HAS BEEN ABUSED
    • REFERS TO PARTNER’S ANGER OR TEMPER
    • REFERS TO PARTNER AS BEING VERY JEALOUS
    • SAYS SHE WILL HAVE TO CHECK WITH PARTNER ABOUT ANY TREATMENT SUGGESTIONS
    • IF PARTNER IS PRESENT, PATIENT WILL DEFER TO HIM TO ANSWER
    • QUESTIONS, OR LOOK AT HIM BEFORE ANSWERING QUESTIONS.
  • 23. Homosexuals
    • Similar prevalence of domestic violence exist in gay and lesbian relationships with the same physical and emotional consequences
    • Often primary care providers should be aware of homophobia
    • Gay and lesbian patients have difficulty disclosing abusive relationships
  • 24. Screening for domestic violence
    • Health care providers often feel awkward about broaching the subject of domestic violence with their patients.
    • Questions about domestic violence should be a routine part of the history and physical examination for all female patients.
    • Show support and be nonjudgmental in your interaction with your patient.
    • If answer is vague or evasive, more direct questions must be asked to determine if abuse is taking place.
  • 25. SCREENING QUESTIONNAIRE
    • Five simple screening questions known by the acronym PEACE can be made part of any intake Questionnaire.
    • 1- Have you ever been in a relationship in which you have been Physically hurt by a partner or someone you love?
    • 2- Have you ever felt you are “walking on Eggshells ” to avoid conflicts with a partner or someone you love?
    • 3- Have you ever been sexually Abused, threatened or forced to have sex, or participate in sexual practices when you did not want to?
    • 4- Has your partner or someone you love tried to Control where you go, what you do, who you talk to or who your friends are?
    • 5- Have you ever been Emotionally abused or threatened by a partner or someone you love?
  • 26. TREATMENT
    • TREAT
    • DOCUMENT
    • EDUCATE
    • DON’T RESCUE!!!
  • 27. Treatment
    • First task is to treat the patient’s medical condition.
    • Document your findings. Consult expert .
    • When extent of abuse becomes apparent, your emotions of outrage, sympathy and caring may be aroused. You may be tempted to rescue the victim.
    • IT IS NOT Your function to get her to leave the batterer, SHE NEEDS to reach that decision herself .
  • 28. GIVING ASSURANCES
    • Create a supportive environment .
    • Assure the patient confidentiality and privacy.
    • Point out to her that she is a survivor.
    • Commend her for taking the first step toward improving her life and that of her children.
    • Emphasize that no one has the right to hurt others.
    • Provide her with information about the resources available for battered women and their children.
  • 29. What to Avoid
    • Do not insist that the battered woman terminate the relationship
    • Remember, due to the barriers discussed above, it will usually take multiple attempts at leaving the domestic violence situation before a survivor succeeds in resisting the batterer’s pressure to return.
  • 30. SAFETY PLANNING
    • Before the end of the first visit, you need to review the patient situation with her.
    • Your primary aim is not to get her to take action but simply to focus on safety for herself.
    • First and foremost is her immediate safety if she returns home. Most murder/suicide in abusive relationships happen at this juncture. HENCE SAFETY PLANNING IS CRITICAL.
  • 31. Conclusion
    • Treating patients who are in domestic violence situations is a necessary part of health care.
    • Given the high number of incidents related to domestic violence that go unrecognized in the health care system, it is imperative that health care providers become part of the solution rather than part of the problem.
    • Create increased awareness not only among health care providers, but all support personnel.
  • 32. Conclusion
    • It is a team effort to work with the victims as you treat their injuries, supportively listen to their stories, and educate them on the options available to them. This is how you collectively build a bridge out of their isolation.

×