11 ABUSE ANDVIOLENCE 211
and usually do not invite others into the home or tell
them what is happening. Often abusers threaten
victims with even greater harm if they reveal the se-
cret. They may tell children that a parent, sibling, or
pet will die if anyone outside the family learns of the
abuse. So children keep the secret out of fear, which
prevents others from “interfering with private family
business.”
Abuse of Power and Control
The abusive family member almost always holds a
position of power and control over the victim (child,
spouse, or elderly parent). The abuser not only exerts
physical power but also economic and social control.
The abuser is often the only family member who makes
decisions, spends money, or spends time outside the
home with other people. The abuser belittles and
blames the victim, often by using threats and emo-
tional manipulation. If the abuser perceives any in-
dication, real or imagined, of victim independence
or disobedience, violence usually escalates (Ameri-
can Bar Association [ABA] Commission on Domes-
tic Violence, 2002).
Alcohol and Other Drug Abuse
Substance abuse, especially alcoholism, has been as-
sociated with family violence. This finding does not
imply a cause-and-effect relationship. Alcohol does not
cause the person to be abusive; rather, an abusive per-
son also is likely to use alcohol or other drugs. Fifty to
ninety percent of men who batter their domestic part-
ners have a history of substance abuse; up to 50% of
women who have been abused seek refuge in alcohol
(ABA Commission on Domestic Violence, 2002). Al-
though alcohol may not cause the abuse, many re-
searchers believe that alcohol may diminish inhi-
bitions and make violent behavior more intense or
frequent (Gerlock, 2001).
Alcohol is also cited as a factor in acquaintance or
date rape. The Division of Violence Prevention of the
Centers for Disease Control and Prevention (CDC) re-
ports that findings have linked heavy alcohol or drug
use with sexual assault. In addition, use of the illegal
drug flunitrazepam (Rohypnol) to subdue potential
victims of date rape is on the rise in the United States
(van der Kolk, 2000).Intergenerational
Transmission Process
Intergenerational transmission processmeans
that patterns of violence are perpetuated from one gen-
eration to the next through role modeling and social
learning (van der Kolk, 2000). Intergenerational trans-
mission suggests that family violence is a learned pat-
tern of behavior. For example, children who witness
violence between their parents learn that violence is a
way to resolve conflict as well as an integral part of
a close relationship. Statistics show that one third
of abusive men are likely to have come from violent
homes where they witnessed wife-beating or were
abused themselves. Women who grew up in violent
homes are 50% more likely to expect or accept violence
in their own relationships (Barnett, 2001). Not all per-
sons exposed to family violence, however, become abu-
sive or violent as adults. Therefore this single factor
does not explain the perpetuation of violent behavior.CULTURAL CONSIDERATIONS
The ABA Commission on Domestic Violence (2002)
has stated that domestic violence affects families of
all ethnic, racial, age, national origin, sexual orienta-
tion, religious, and socioeconomic backgrounds. This
commission, however, addressed a specific population
particularly at risk: immigrant women. Battered im-
migrant women face legal, social, and economic prob-
lems different from U.S. citizens who are battered
and people of other cultural, racial, and ethnic origins
who are not battered:- The battered woman may come from a
culture that accepts domestic violence. - She may believe she has less access to legal
and social services than do U.S. citizens. - If she is not a citizen, she may be forced to
leave the United States if she seeks legal
sanctions against her husband or attempts to
leave him. - She is isolated by cultural dynamics that do
not permit her to leave her husband;
economically she may be unable to gather
the resources to leave, work, or go to school. - Language barriers may interfere with her
ability to call 911, learn about her rights or
legal options, and obtain shelter, financial
assistance, or food.
It may be necessary for the nurse to obtain the
assistance of an interpreter whom the woman will
trust, make referrals to legal services, and assist the
woman to contact the Department of Immigration
to deal with these additional concerns.
Box 11-1
➤ CHARACTERISTICS OFVIOLENTFAMILIES
Social isolation
Abuse of power and control
Alcohol and other drug abuse
Intergenerational transmission process