Psychiatric Mental Health Nursing by Videbeck

(Nancy Kaufman) #1
partners who are not married, same-sex partners, and
wives who abuse their husbands.
An abusive husband often believes his wife be-
longs to him (like property) and becomes increasingly
violent and abusive if she shows any sign of inde-
pendence such as getting a job or threatening to leave.
Typically the abuser has strong feelings of inade-
quacy and low self-esteem as well as poor problem-
solving and social skills. He is emotionally immature,
needy, irrationally jealous, and possessive. He may
even be jealous of his wife’s attention to their own
children or beat both his children and wife. By bully-
ing and physically punishing the family, the abuser
often experiences a sense of power and control, a feel-
ing that eludes him outside the home. Therefore the
violent behavior often is rewarding and boosts his
self-esteem.
Dependency is the trait most commonly found in
abused wives who stay with their husbands. Women
often cite personal and financial dependency as rea-
sons why they find leaving an abusive relationship
extremely difficult. Regardless of the victim’s talents
or abilities, she perceives herself as unable to func-
tion without her husband. She too often suffers from
low self-esteem and defines her success as a person
by her ability to remain loyal to her marriage and
“make it work.” Some women internalize the criti-
cism they receive and mistakenly believe they are to
blame. Women also fear their abuser will kill them if
they try to leave (Barnett, 2001). This fear is realistic,
given that national statistics show 65% of women
murdered by spouses or boyfriends were attempting
to leave or had left the relationship (ABA Commission
on Domestic Violence, 2002).

Cycle of Abuse and Violence
The cycle of violenceor abuse is another reason
often cited for why women have difficulty leaving an
abusive relationship. A typical pattern exists. Usually
the initial episode of battering or violence is followed
by a period of the abuser expressing regret, apologiz-
ing, and promising it will never happen again. He pro-
fesses his love for his wife and may even engage in
romantic behavior (e.g., buying gifts and flowers).
This period of contrition or remorse sometimes is
called the honeymoon period.The woman naturally
wants to believe her husband and hopes the violence
was an isolated incident. After this honeymoon period,
the tension-building phase begins; there may be argu-
ments, stony silence, or complaints from the husband.
The tension ends in another violent episode after
which the abuser once again feels regret and remorse
and promises to change. This cycle continually repeats
itself. Each time, the victim keeps hoping the violence
will stop.

212 Unit 3 CURRENTSOCIAL ANDEMOTIONALCONCERNS


SPOUSE OR PARTNER ABUSE


Spouse or partner abuseis the mistreatment or
misuse of one person by another in the context of an
intimate relationship. The abuse can be emotional
or psychological, physical, sexual, or a combination
(which is common). Emotional or psychological
abuseincludes name-calling, belittling, screaming,
yelling, destroying property, and making threats as
well as subtler forms such as refusing to speak to or
ignoring the victim. Physical abuseranges from
shoving and pushing to severe battering and chok-
ing and may involving broken limbs and ribs, in-
ternal bleeding, brain damage, even homicide. Sex-
ual abuse includes assaults during sexual relations
such as biting nipples, pulling hair, slapping and hit-
ting, as well as rape (discussed later).
Ninety to ninety-five percent of domestic violence
victims are women, and estimates are that one in
three women in the United States has been beaten by
a spouse at least once (ABA Commission on Domestic
Violence, 2002). Each year as many as 4 million women
in the United States experience a serious assault by a
partner. Eight percent of U.S. homicides involve one
spouse killing another, and three of every 10 female
homicide victims are murdered by their spouse, ex-
spouse, boyfriend, or ex-boyfriend.
An estimated 15% to 25% of women experience
violence while pregnant, according to a CDC survey.
Battering during pregnancy leads to adverse out-
comes, such as miscarriage and stillbirth, as well
as further physical and psychological problems for
the woman (Mattson & Rodriguez, 1999; Scobie &
McGuire, 1999).
According to the ABA Commission on Domestic
Violence (2002), domestic violence occurs in same-sex
relationships with the same statistical frequency as in
heterosexual relationships and affects 50,000 lesbian
women and 500,000 gay men each year. Although
same-sex battering mirrors heterosexual battering
in prevalence, its victims receive fewer protections.
Seven states define domestic violence in a way that ex-
cludes same-sex victims. Twenty-one other states have
sodomy laws that designate sodomy (anal inter-
course) as a crime; thus, same-sex victims must first
confess to the crime of sodomy to prove a domestic re-
lationship between partners. The same-sex batterer
has an additional weapon to use against the victim:
the threat of revealing the partner’s homosexuality to
friends, family, employers, or the community.


Clinical Picture


Because abuse often is perpetrated by a husband
against a wife, that example is used in this section.
These same patterns are consistent, however, between

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