1. Essentials of Cultural Competence in Pharmacy Practice: Chapter 15 Notes Chapter Author: Dr. Brenda Hall The Culture of Domestic Violence

2. 1. Understand what contributes to the continuation of domestic violence. 2. Know common characteristics of abusers. 3. Understand the typical cycle of abuse. 4. Know how to talk with potential victims of abuse. Learning Objectives

3. Overview of Domestic Violence American Psychological Association defines domestic violence (DV) or intimate partner violence (IPV) as a “pattern of abusive behaviors including a wide range of physical, sexual, and psychological mistreatment used by one person in an intimate relationship with another to gain power unfairly or maintain that person’s misuse of power, control and authority.”

4. Prevalence of Domestic Violence Not limited to a specific part of the world, a particular culture or economic status. Occurs in families from all racial, ethnic, educational, and religious backgrounds, and in inner city, suburban, and rural communities. 10-59% of women around the world each year experience violence in their relationships with male partners or husbands. In the U.S., DV is cited as the most common cause of serious injury among women.

5. Prevalence of DV (continued) Approximately 1.5 million women are physically assaulted or raped by an intimate partner annually. For male victims, the estimate is 834,732 annually. Many victims experience multiple acts of violence, so there may be as many as 4.8 million physical assaults and rapes of women each year in the U.S. Approximately 2.9 million intimate partner physical assaults are committed against men. If one considers all types of domestic abuse, the statistics are consistently high. In any given year, 1 in 9 women experiences violence; 1 in 4 women will suffer DV at some stage of their life.

6. Cultural Considerations Individuals from different racial and ethnic groups may view and respond differently to IPV. For instance, compared to white women, African-American women are more likely to leave their abusive partners; yet, they are also more likely to return to the relationship. Black women are also more likely to fight back. Several studies conducted in the U.S. indicate that all racial minorities experience more intimate partner violence than their white counterparts. While it may be assumed that these cultures are more accepting or prone to aggressive acts, the literature suggests otherwise. Minorities’ economic and marginalized status puts them at a much greater risk for intimate partner abuse.

7. Cultural Considerations of DV Socially and economically disadvantaged men and women are more vulnerable to experience violence as a consequence of difficult life experiences. Abused ethnic minority women, particularly blacks and Hispanics, seek help at lower rates than white abused women. Low acculturation is cited as the most significant cultural barrier to utilization of services and resources.

8. Abuse Women who are part of an ethnic minority who consider leaving a violent relationship may hesitate due to fear of supporting existing negative stereotypes and stigmatization. They may try hard to avoid attention that could be perceived as a sign of weakness or disloyalty to their ethnic group. In a qualitative study, Russian immigrants who were brought to the U. S. to marry American citizens described how their abuse was linked to coercion. These women relocated to the U.S. not speaking the language, not having a support group or any financial resources, and not aware of their rights.

9. Cycle of Violence Cycle of abuse. Scenarios such as this one demonstrate typical dynamics within the culture of domestic violence. Domestic violence is systematic. The negative behavior is rarely exhibited at the beginning of the relationship, yet over time hurtful behaviors escalate, becoming more frequent and severe. Abusers believe they are entitled to control the other person and rationalize that violence is acceptable if it is necessary in order to gain and maintain control. Typically the abuser establishes power with intimidation and fear or threat of physical harm. Intimate partner violence occurs in a cycle of three repeating phases.

10. Characteristics of Abusers Batterers: Often grandiose, overidentifying with traditional and cultural sex-role stereotypes Exaggerated sense of worth and power and feel entitled to what they want when they want it Many have grown up in violent homes Generally self-absorbed and can identify their own needs, wants and desires, but not those of their partner or children. Often low on assertiveness skills and difficulty expressing their needs, wants and desires. Generally avoid or deny personal responsibility and consequences for their feelings and actions. May appear strong and independent but are usually emotionally dependent on their partner.

11. Health Effects Workforce—A major public health issue that results in $5.8 billion spent yearly. Physical—Physical and sexual assaults lead to injuries such as broke bones, bruises, sprains, cuts, concussions, bleeding, and internal injuries. Prolonged exposure to domestic violence results in long-term medical conditions. Mental—High rates of depression, anxiety, and trauma are common experiences. Pregnancy—In the U.S. IPV rates for pregnant women vary between 1% and 20%.

12. Considerations Communication Care Encouragement

13. Reflection Questions 1. If you suspect a patient is in an abusive relationship, what will you do? 2. How can you prepare yourself, as well as the others with whom you work, to identify abuse? 3. How have your own biases about victims of domestic abuse changed after reading this chapter?