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Perinatal Implications Of Domestic Violence, Substance Abuse And Depression
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Perinatal Implications Of Domestic Violence, Substance Abuse And Depression Perinatal Implications Of Domestic Violence, Substance Abuse And Depression Document Transcript

  • 4/29/2010 THE PERINATAL IMPLICATIONS OF SUBSTANCE ABUSE, DEPRESSION AND VIOLENCE A Workshop Presented by José A. Rivera, J.D. Rivera, Sierra & Company, Inc. jrivera@riverasierra.com FACES OF VIOLENCE 1
  • 4/29/2010 QUESTION In our agency, our work be a lot easier if the clients would only… QUESTION Women stay in abusive relationships because… 2
  • 4/29/2010 Mirror, Mirror On the wall, Who s Who’s most unbiased Of them all? LOOK IN THE MIRROR  Even good people have biases  Even good staff have issues  Even good counselors need to understand boundaries  Even good listeners are under pressure to judge or superimpose one’s values or one s upbringing on another 3
  • 4/29/2010 OTHERING  Consider the following pronouns: 5 demonstratives: the, this, that, these, those 2 personal pronouns each with four forms: thou, thee, thy, thine; they, them, their, theirs  The TH sound is used by speaker to differentiate the speaker from the person spoken about so a third party will know and understand that the speaker is different from the person spoken about. Domestic Violence 2 1 4 Substance 3 Depression Abuse What does this mean? 4
  • 4/29/2010 THE ADVOCACY/SELF ADVOCACY RELATIONSHIP Time P e r c Self-Advocacy e n t a g e / A Advocacy m o u n t © 2005 Rivera, Sierra & Co., Inc. ADVOCACY/SELF ADVOCACY  When a client comes to us, they are often in need of 90% advocacy and bring with them about 10% self-advocacy.  The goal of case management is to reverse this over time so that, in the end, a client is a 90% that end self advocate and relies upon systems for 10% advocacy. 5
  • 4/29/2010 A VICTIM  Can be found within any level of education  Can be found within any level of job satisfaction  Can be poor as well as extremely rich  Can be physically beautiful as well as not  Can be childless, childbearing, pregnant  Can be preconceptional or interconceptional  Can be straight, gay/lesbian, transgender THE VICTIMS “When people meet me, and find out that I ve been in an abusive I’ve relationship, they just can’t believe it.” “Looking at me, with all the things I’ve done in my life.. They think, how could I have been in Stacy a relationship like that?” First American woman to summit Mount Everest 6
  • 4/29/2010 THE VICTIMS “Either dinner wasn’t exactly what he wanted, the house wasn t wanted wasn’t immaculate, I didn’t look presentable enough… any excuse at all, really… and it was always my fault.” “ It was very debilitating, I ended up walking on eggshells. I began questioning my own competence to do anything.” Psychosocial Definition of Domestic Violence The use of physical, sexual, economic, and/or s p ys c , s , c c, d/ psychological/emotional abuse by one person in an intimate or social relationship in order to establish and maintain power and control over the other person. This power and control becomes a pattern of behavior not just for the abuser but also for the abused as well. 7
  • 4/29/2010 Example A: Abuser Uses Abuse to Hurt Example B: Abuser Uses Abuse to Get Power & Control DOMESTIC VIOLENCE = BEHAVIOR  Because it is learned  Because it evolves over time  Because it becomes engrained and second nature  Because it becomes natural  And then it becomes nature 8
  • 4/29/2010 The Mind of the Abuser The New Cycle of Domestic Violence New Abuse Setup Self-Directed Guilt Rationalization Planning Fantasy False Normality Isolation The Buzz 9
  • 4/29/2010 THE MIND OF THE ABUSER  Excuse Making  Fragmentation  Blaming  Minimizing  Redefining  Anger  Success Fantasies  Power Plays  Lying  Playing Victim  Assuming  Drama and Excitement  Above the Rules  Closed Channel  Making Fools of Others  Ownership  Self-glorification Addiction “A chronic progressive relapsing disorder A progressive, characterized by compulsive use of one or more substances that results in physical, psychological, or social harm to the individual and continued use of the substance or substances despite this harm.” Schnoll, 1986 10
  • 4/29/2010 CHARACTERISTICS OF ADDICTION  A Brain Disease  Chronic  Progressive  Ignores Adverse Circumstances  Relapse  Treatable  Reversible 11
  • 4/29/2010 ADDICTED CLIENT CHARACTERISTICS  50% + History of intergenerational TANF  50% + have abuse/violence histories  50% + have criminal justice issues  50% + have CPS issues  50% + resisted employment efforts  50% + lack HS diploma or GED  50% + had teenage pregnancy The Layers of Trauma Alcohol and Substance Abuse MH Issues PTSD, OCD, BPD LD/CD Trauma 12
  • 4/29/2010 WOMEN AND TRAUMA “The core experiences of psychological trauma are disempowerment and disconnection from others. others Recovery, then, is based upon the empowerment of the survivor and the creation of new connections. Recovery can take place only within the context of relationships; it cannot occur in isolation (p. 133).” Herman, Trauma and Recovery (1992) THE POWER OF RECOVERY 4 3 1 0 2 © 2005 Rivera, Sierra & Co., Inc. 13
  • 4/29/2010 DOMAINS/TYPES OF DOMESTIC VIOLENCE  Physical  Sexual  Economic  Psychological/Emotional 14
  • 4/29/2010 PHYSICAL VIOLENCE  Scratches, bites, grabs or spits at a current or former intimate partner.  Shakes, shoves, pushes, restrains or throws her.  Twists, l T i t slaps, punches, strangles or b h t l burns th victim. the i ti  Throws objects at her.  Physically restrains her from movement.  Puts her in fear of possible assault or battery  Subjects her to reckless driving.  Locks her in or out of the house.  Refuses to help when she’s sick, injured or pregnant, or withholds medication or treatment.  Withholds food as punishment.  Abuses her at mealtime, which disrupts eating patterns and can result in malnutrition.  Abuses her at night, which disrupts sleeping patterns and can result in sleep deprivation.  Attacks her with weapons or kills her. SEXUAL VIOLENCE  Is jealously angry and assumes she will have sex with anyone.  Withholds sex and affection as punishment.  Calls her sexual names names.  Pressures her to have sex when she doesn’t want to.  Insists that his partner dress in a more sexual way than she wants.  Coerces sex by manipulation or threats.  Physically forces sex or is sexually violent.  Coerces her into sexual acts that she is uncomfortable with, such as sex with a third party, physically painful sex, sexual activity she finds offensive or verbal degradation during sex.  Inflicts i j i that I fli t injuries th t are sex-specific. ifi  Denies the victim contraception or protection against sexually transmitted diseases.  Deliberately infects her with a STD in order to make her less desirable to others. 15
  • 4/29/2010 ECONOMIC VIOLENCE  Controls all the money.  Doesn’t let her work outside the home or sabotages her attempts to work or go to school.  Refuses to work and makes her support the family.  Ruins her credit rating rating.  Uses household money to buy gifts as apology for violence instead of paying bills. PSYCHOLOGICAL VIOLENCE  Verbally attacks and humiliates his partner in private or public.  Attacks her vulnerabilities, such as her language abilities, educational level, level skills as a parent, religious and cultural beliefs or physical parent appearance.  Plays mind games, such as when he denies requests he has made previously or when he undercuts her sense of reality.  Forces her to do degrading things.  Ignores her feelings.  Withholds approval or affection as punishment.  Regularly threatens to leave or tells his partner to leave.  Harasses her about affairs he imagines her to be having having.  Stalks her.  Always claims to be right.  Is unfaithful after committing to monogamy.  Controls her schedule, actions, cell phone, etc.  PAVLOV 16
  • 4/29/2010 IMPACT OF VIOLENCE What is the Domino Theory? 17
  • 4/29/2010 MEDICAL IMPACT OF PHYSICAL VIOLENCE ON PREGNANCY  Insufficient weight gain  Delayed prenatal care  Vaginal/Cervical/Kidney  Miscarriage infections  Low birth weight  Vaginal bleeding  Ruptured membranes  Abdominal trauma  Separation of the placenta  Hemorrhage  Uterine infection  Increase of chronic illness  Fetal bruising, fractures, and blood  Complications during labor clots  Irritable Bowel Syndrome Source: American Medical Association TRAUMA AND PREGNANCY “Maternal anxiety disorders have been linked with low birth weight and irritable neonatal behaviors as well as a doubled risk of hyperactivity.” “Women with PTSD during pregnancy were at higher i k for t i hi h risk f ectopic pregnancy, spontaneous t abortion, and hyperemesis (nausea) than were those who did not have PTSD.” 18
  • 4/29/2010 TRAUMA AND PREGNANCY “Pregnant women who had experienced childhood sexual abuse, domestic violence or rape as an adult, exposure to a violent crime, or another interpersonal trauma exhibited a lower quality of attachment to their unborn q y children.” TRAUMA AND PREGNANCY “In addition, infants of mothers who were depressed during pregnancy show changes in neurobehavioral functioning and are more withdrawn, irritable, and inconsolable than infants of asymptomatic women.” 19
  • 4/29/2010 TRAUMA AND PREGNANCY “Asthmatic women are at risk for idiopathic preterm labor, preeclampsia, hypertension, chorioamnionitis, and cesarean delivery, and their infants are at risk for preterm birth and low birth weight.” TRAUMA AND PREGNANCY “Women with eating disorder symptoms during pregnancy are at higher risk for cesarean section and have more difficulty maintaining breast-feeding than women without eating disorder symptoms.” 20
  • 4/29/2010 Signs and Symptoms of DV SIGNS AND SYMPTOMS OF DV Behavioral cues  Changes in appointment pattern — This may reflect the abuser’s desire to hide physical indicators of abuse (scratches bruises, welts) and control (scratches, bruises the victim’s access to information and possible support. Cancellation of two or more appointments by a male partner is indicative of possible domestic violence.  Overprotective partner — The partner frequently or always accompanies the patient, seems controlling and always speaks for her.  Threatening partner — Batterers may glare at their partners, use threatening words or gestures, restrict their partner’s movements, or use other tactics designed to maintain power and control over victims and anyone offering assistance. ff i i t  Multiple visits for vague somatic complaints — Battered women use medical services eight times the rate of non-battered women, yet are identified and referred to domestic violence programs only 4-6% of the time.  Late entry or sporadic utilization of prenatal care. 21
  • 4/29/2010 SIGNS AND SYMPTOMS OF DV Physical cues  Poor management of asthma, diabetes, or other chronic conditions  Chronic pain  Headache  Pelvic or abdominal pain  Dyspareunia D i  Irritable Bowel Syndrome  Somatization Disorder  Frequent vaginal or urinary tract infections SIGNS AND SYMPTOMS OF DV Psychosocial cues  Chronic substance misuse/ alcohol or other drug addiction. While not a cause of addiction domestic violence may be a co occurring addiction, co-occurring problem.  Stress-related symptoms such as fatigue, anxiety, headache, difficulty concentrating, appetite disturbances, palpitations, dizziness, paresthesia (pins and needles), and dyspnea (shortness of breath).  Post traumatic stress disorder (PTSD) symptoms including hypervigilance, exaggerated startle response, feeling detachment from others, sense of shortened future, difficulty sleeping and irritability or outbursts of anger. (For many battered women there is nothing ‘post’ about their stress. Providers are encouraged to screen all women presenting with PTSD symptoms for both past and current abuse histories).  Eating disorders  Depression  Suicide attempts 22
  • 4/29/2010 THANK YOU AND REMEMBER Honor Recovery Honor People in Recovery And in doing that Honor Yourself 23