1. DOMESTIC VIOLENCE: Profiles of the Abuser and Abused
Jessica L. Estes, DNP, APRN
Susan Matthews Ph.D., APRN, FAANP

2. VIOLENCE
Violence encompasses “physical, visual, verbal or sexual acts that are experienced by a woman or girl as threat, invasion, or assault and that have the effect of hurting her or degrading her and /or taking away her ability to control contact (intimate and otherwise) with another individual”

3. WHAT IS DOMESTIC VIOLENCE?
Domestic violence is defined in the law as certain criminal acts committed:
between persons of opposite sex who live together in the same household or who have lived together in the past; or
persons who have a child in common or are expecting a child (regardless of whether they have resided in the same household); or
persons related to one another in the following ways: spouse, child, grandparent, former spouse, brother, grandchild, parent, sister.

4. The criminal acts specifically defined in the law are:
Domestic Violence:
Criminal Acts
Assault
Criminal damage
Custodial interference
Endangerment
Imprisonment
Intimidation
Kid-napping
Trespass
The criminal acts specifically defined in the law are:
Disorderly conduct:
By fighting
Unreasonable noise
Abusive language
Reckless display or discharge of a deadly weapon or dangerous instrument.

5. TYPES OF VIOLENCE VERBAL SEXUAL PHYSICAL EXERCISING CONTROL F Pushing
Grabbing
Slapping
Kicking
Hitting with an object
Use of knife or gun
Acid throwing
Burning
Isolating her from family
and friends
Checking on her
Using the children
Economic control
Shouting
Making threats
Calling names
Humiliating remarks or gestures
Forcing intercourse
Making her do things against her will

6. DOMESTIC VIOLENCE Is pervasive and insidious.
Is carried out in private domain.
Is inflicted by an intimate partner or family member.
Continues over a period of time (chronic).
Limits avenues of escape for the victim.

7. Social tolerance of victimization
WHY IS VICTIMIZATION OF WOMEN SO COMMON ?
Dependent Status
Limited Mobility
Social tolerance of victimization
Physically Weaker

9. THE COST OF DOMESTIC VIOLENCE
In USA, nearly 5.3 million violent episodes each year
Cost: $8.3 billion a year for direct care, mental health services, lost days from work and household productivity.
Associated with increased health care utilization.
As common as breast cancer
More common that thyroid problems, HTN and colon cancer.
Source:
Source: CDC.gov.
Source: Forbes.com.

10. PREVALENCE/ INCIDENCE OF INTIMATE VIOLENCE IN WEST
In the USA, the leading cause of women going to the emergency wards in hospitals is the wound they get due to domestic violence.
The number of women wounded this way is more than the total number of women wounded in car accidents, mugging and rape cases.

11. PREVALENCE/ INCIDENCE OF INTIMATE VIOLENCE IN WEST
In Denmark, 25% of women state physical violence to be major cause of divorce.
In Austria, wife abuse was cited as a cause of breakdown in 59% of 1,500 divorced cases ( United Nations 1991).
In Romania, between march 93 and march 94, 28.55% of women in the hospital were there as a result of beating by their husbands or boyfriends. (The Domestic violence in Eastern Europe Project 1995)

12. PREVALENCE/ INCIDENCE OF INTIMATE VIOLENCE IN WEST
In Russia, a formal declaration by the government stated that in 1994, 15,000 women died as a result of their spouse’s violent behavior.
In Papua New guinea, it was shown that 56% of women in urban areas were victims of domestic violence.
In Canada, one in every 4 women are faced with sexual violence at one point in their lives and half of these women are exposed to sexual violence before the age of 16 .

13. SOME FACTS
It is estimated that about one third of children who are abused or exposed to violence as children become violent themselves in later life.
Boys are at increased risk to abuse an intimate partner in adult relationships if they were abused or witnessed abuse between parental figures.
The sons of the most violent parents had a rate of wife abuse 100 times higher than the sons of the nonviolent parents.

14. SOME FACTS
Girls are at increased risk to be abused by an intimate male in adulthood, if they witnessed abuse between parental figures in childhood.
Early physical abuse is a strong predictive factor of criminal behavior in adulthood.
40-75% of children exposed to marital violence are estimated to be victims of physical child abuse also.

15. SOME FACTS
Alcohol use is frequently associated with violence between intimate partners. 
It is estimated that in 45% of cases of intimate partner violence, men had been drinking, and in about 20% of cases, women had been drinking.

16. STUDY BY MEDICAL STUDENTS AKU (CLASS OF 1996)
In a sample of 176 males
27% practiced physical abuse.
76% recognized it as mistreatment.
46% felt men have a right to hit women.
68% practiced isolation.
44% did not see it as abuse.

18. EFFECTS OF DOMESTIC VIOLENCE
Anxiety
Chronic depression
Chronic pain
Death
Dehydration
Dissociative states
Drug and alcohol dependence
Eating disorders
Emotional "over-reactions" to stimuli
General emotional numbing
Health problems
Malnutrition

19. EFFECTS OF DOMESTIC VIOLENCE
Panic attacks
Poor adherence to medical recommendations
Repeated self-injury
Self neglect
Sexual dysfunction
Sleep disorders
Somatization disorders
Strained family relationships
Suicide attempts
Inability to adequately respond to the needs of their children

20. In a 1999 study from Johns Hopkins, it was reported that abused women are at higher risk of miscarriages, stillbirths, and infant deaths, and are more likely to give birth to low birth weight children, a risk factor for neonatal and infant deaths. 
Children of abused women were more likely to be malnourished and were more likely to have had a recent untreated case of diarrhea and less likely to have been immunized against childhood diseases.

21. Cycle of Domestic Violence

22. Early Signs POSSESSION AND JEALOUSY/ ACCUSATIONS OF AFFAIRS:
HE’S TOO GOOD TO BE TRUE:
Individuals who engage in domestic violence are often perfectionists and demand that those around them also be perfect.
They lash out at others when mistakes occur or when things are not just exactly as they want them to be.
This sets up their own justification for violent actions toward their partner.
POSSESSION AND JEALOUSY/ ACCUSATIONS OF AFFAIRS:
This sort of accusation occurs with a partner who is controlling and demands accountability for every moment of the day.
This often stems from internal feelings of insecurity and poor self-esteem on the part of the partner.
Accuses partner of flirting/having sexual relationships with others; monitors partner’s clothing/make-up.

23. Early Signs COVERED-UP INJURIES:
Victims of abuse often cover up injuries out of embarrassment and shame that they are involved in an abusive relationship.
AVOIDING CONFLICT:
Tendency to avoid conflict.
Although this characteristic could stem initially from experiences with domestic violence, avoidance behaviors can spill over into other relationships, including friends and coworkers.

24. Early Signs CHANGES IN PERSONALITY:
One primary indicator of domestic violence is marked changes in a person's personality and demeanor.
This can include avoiding conflict.
Lowering of self-esteem and withdrawing into herself.
As the relationship becomes more abusive, a woman may go from being outgoing and full of confidence to being careful about what she says and does, so that she does not trigger an outburst from her partner.
These changes in personality can appear in other areas of her life, until this becomes a dominating feature of her personality.

25. Breaking the Myths about Domestic Violence

26. Domestic Violence is not a Private Family Matter
To many people continue to believe that domestic violence is a private matter between a couple, rather than a criminal offense that merits a strong and swift response.

27. Domestic Violence is not caused by Anger, Alcohol or Drugs
If the abuser is truly unable to control his anger, why doesn’t he lash out at every person who makes him mad?
Why is his family the only target of his violence?
The abuser knows that society will accept the excuse that alcohol or drugs lower his inhibitions and “allow” him to be violent.
Though substance abuse may exacerbate or trigger the abuse, it is still a choice that the man makes

28. Domestic Violence is NOT caused by the Victim’s Behavior
There is no provocation that justifies an abuser’s action. Using violence is a choice.

29. The abuser is not always the Male Partner
In many cultures, there is a definite hierarchy within the extended family. The oldest members may have the most authority and expect the newest members to serve them. The abuser may be a mother-in-law who expects the daughter-in-law to be a servant. The batterer may be a father-in-law who expected the daughter-in-law to bring a higher dowry. In many cultures, the way a person behaves is a reflection of the entire family’s reputation. Female family members may be punished if their behavior is seen to break the rules and “dishonor” the family. The batterer could also be a sibling, a child, or anyone else in the family. Domestic Violence also occurs in same sex relationships.

30. Why Does He Batter?
He’s learned that it gets him the results he wants.
It makes him feel like a “man” when he can dominate and control another person.
He’s found that no one will hold him responsible for his violence.

31. Why does She Stay?

32. Economic Barriers Economic dependence on husband
Low paying job with no benefits or job security
She may not be eligible for public assistance
May not have work authorization, thus employer may not risk hiring her
Relatives in her home country may need financial assistance
Fear that reporting the abuse may lead to his being deported, leaving her without support

33. Cultural Barriers Community may ostracize her if she leaves partner
Loss of mutual friends and her social standing in the community
Protection of spouse’s standing in community
In same-sex relationships, fear that she may be “outed.”
Her culture may find it acceptable for a husband to beat his wife and for her to endure it.

34. Cultural Barriers
Lack of safety measures in home country to protect victim from the batterer or batterer’s family.
Cultural norms concerning a woman’s place, her role and family expectations
Responsibility to siblings. Her divorce may scare off her siblings’ potential suitors

35. Legal Barriers
Fear of being blamed for “endangering” the children and as a result, children being removed from victim’s custody
Fear that once the violence is reported, she may have no control whatsoever about what ultimately is done by the various systems.
May have distrust of the legal system that originated from her own experience in her country of origin
Difficulty understanding the U.S. legal system

36. Legal Barriers
Belief that the judiciary does not function independently from the government
Expectations that people with money, U.S. citizenship or ties with the government will prevail in courts
Belief that undocumented immigrants will be denied access to legal services or will not be treated fairly

37. Language Barriers
Limited access to shelter, police and court services because of lack of bilingual professionals who can provide services
May not feel welcome or comfortable seeking or using services
The assumption that because she speaks English, she is able to navigate the U.S. system

38. Additional reasons she may stay
Fear that for her safety, because it’s most dangerous when she leaves.
She has seen so much violence in her life, she thinks it’s normal.
Denial that the man she married is capable of hurting her or her children.
She wants him to change.
She believes that there is no real punishment that will make him stop and keep her safe.

39. Additional reasons she may stay
She doesn’t know what kind of help is available
Belief that the children need a father, even if he’s abusive
Social stigma of revealing to outsiders that there is violence
She loves him

40. IT’ S HARD TO STOP BECAUSE IT’S HARD TO REPORT!!

41. Domestic Abuse in Pregnancy
High incidence of miscarriage.
Higher incidence of still birth.
Premature labour more likely.
Increased incidence of smoking / alcohol / drug misuse.

42. Domestic Abuse & Child Abuse
33-70% of children from families where domestic abuse occurs experience child abuse, usually by the same violent man.
40% of child abuse cases are associated with violence to the mother.
Children who witness domestic violence are at increased risk of maladaptation.

43. Effects of Domestic Abuse on Children
School problems
Truancy
Poor performance
Social problems
Shame & embarrassment about family.
Tendency to get into “serious” relationships early to escape from home.
Depression.
Suicide.
Alcohol/drug problems.
Confusion about gender roles.
Physical injuries.
Physically intervening to protect mother.

44. Effects of Domestic Abuse on Children
Advanced maturity
Sense of responsibility
Feelings of guilt or shame
Aggression or anger to mother
Bed wetting
Nightmares
Sleep disturbance
Eating problems
Self-harm
Low self esteem

45. If the Children Don’t See IT?
Domestic abuse can include actual physical abuse or threats to harm the children as part of the man’s control strategy.
During 90% of abuse incidences, children are in the same or adjacent room.
Living with domestic abuse and the impact on mothers causes distress, confusion and disruption to children.
There is an overlap between sexual abuse of children and domestic abuse of partner (control).

46. Related Issues Stays in shelters/refuges often means:
Risk to health and safety
Disrupted education
Sometimes sharing bathrooms/kitchens with male offenders and drug users.

47. Related Issues
When mother and child are being abused by the same man, child protection work is often ineffective for protecting both child and mother.

48. Related Issues
Men are almost routinely granted contact orders for their children, whether or not they are violent.
Thus Children Act contact orders undermine other child protection work as they create the circumstances for a violent man to continue to abuse his partner and child(ren).

49. Domestic Abuse and Child Death
Domestic abuse is prominent in many cases of child death since 1974,(Maria Colwell, Sukina Hammond, Toni Dales, Kimberley Carlisle, Victoria Climbie etc).
Significance often not understood or acknowledged by professionals.
Only since the 1990’s that debate has occurred on the relationship between DA and child abuse. ……Why?

50. Characteristics of the Abuser (most commonly male)
Abusers minimize the impact and effect of their abuse. They make it less than it is which makes us feel that we are over reacting.
Abusers blame their partner for their abuse. They may blame alcohol, drugs, their parents, their job anything but themselves to justify their behavior.
Abusers tend to associate with other abusive men. They invite support for their abuse from other people.

51. Beliefs of Abusers Anger causes violence! Women are manipulative!
If I don't control her, she'll control me!
Smashing things isn't abusive, it's venting!
Sometimes there's no alternative to violence!
Women are just as abusive as men!
Women want to be dominated by men!
Somebody has to be in charge!
Jealousy is natural to men!
Violence is a breakdown in communications!
Men can't change if women won't!

52. Kentucky Law: Domestic Violence and Mandatory Reporting
Requires mandatory reporting of spouse abuse, child abuse, and abuse of those adults unable to protect themselves (elderly or disabled).
Any person having reason to believe a married person of any age has been abused or neglected by their spouse must report it to the Cabinet for Health and Family Services.

53. Kentucky Law: Domestic Violence and Mandatory Reporting
Once a report has been made:
The Cabinet, is required to notify the appropriate law enforcement agency.
Disclosure of spouse abuse will result in notification to law enforcement and may result in an investigation, arrest and prosecution of the abuser.

54. Kentucky Law: Domestic Violence and Mandatory Reporting
Any person who has reason to believe a child has been neglected or abused must report this to the Cabinet, the state or local police, or the local prosecutor’s office.

55. Kentucky Law: Domestic Violence and Mandatory Reporting
Over the past few years there has been an increasing number of cases of elder abuse and abuse of individuals who have disabilities. KRS 209, was enacted to protect such vulnerable adults. Many of these victims fall within the Kentucky domestic violence laws.

56. Kentucky Law: Domestic Violence and Mandatory Reporting
There is no law requiring reporting of intimate partner abuse if the partners are not married.
It is currently the procedure of the cabinet to accept any such reports and offer services to victims without regard to marital status.
Reports being forwarded to law enforcement may vary from county to county.
Source: Kentucky Domestic Violence Association.

57. RECOMMENDATIONS
Screen for a history of domestic violence during medical visits
Improve the status of woman within society
Change perceptions regarding victims
Change perceptions regarding accepted reasons for abusing
Educate our children
Easy access to law without fear of losing children or being blamed
Work to remove the stigma related to violence
Support the victim

58. THANK YOU