Violence against women

Any act or a series of acts committed By

any person against a woman who is his wife,
former wife, or a woman with whom he has
or has a sexual or dating relationship or
with whom he has a common child, which
result to physical, sexual, psychological harm
or suffering.

 Violence

against children

Any

act or series of act against a legitimate

or illegitimate child in or outside the home
which result to physical, sexual,
psychological harm or suffering.

Types of violence:

1. Physical violence refers

to acts that include

bodily or physical harm .
2. Sexual violence an act which is sexual in
nature, committed against a woman or her
child.

 3.

Psychological violence

Acts

4.

or omissions causing or likely to cause

mental or emotional suffering to the victim
such as, but not limited to, intimidation,
harassment, stalking, damage to property,
public ridicule or humiliation, repeated
verbal abuse and mental infidelity.
Economic abuse
- Refers to acts that make or attempt to
make a woman financially dependent.

 Battery

An

act of inflicting physical harm upon the

woman or her child resulting in physical
and psychological or emotional distress.
Battered Woman Syndrome
- Refers to a scientifically defined pattern
of psychological and behavioral symptoms
found in women living in battering
relationships as a result of cumulative abuse.

 An

estimated 2M victims per year suffer

from abuse by a male partner; severe,
deliberate and repeated demonstrable
physical violence. The number is even
higher when psychological abuse and
other violations of rights are considered.
Physical Abuse: S/S
1. pushing, shoving, hitting
2. Slapping, choking, pulling hair
3. Punching, kicking, grabbing
4. Using a weapon against her
5. Beating, throwing her down
6. Twisting arms, tripping, biting

 Emotional

abuse putting her down or

making her feel bad about herself; calling
her names; making her think shes crazy,
mind games
Economic abuse trying to keep her from
getting or keeping a job; making her ask for
money; not giving her a reasonable
allowance; taking her money
Sexual abuse making her do sexual things
against her will; physically attacking the
sexual parts of her body; treating her like a
sex object.

 Using

children making her feel guilty about the

children; using the children to give messages;
using visitation as a way to he harass her.
Threats making and/or carrying out threats to
do something to hurt her emotionally; threaten
to take the children; commit suicide, report her
to welfare.
Using male privilege treating her like a
servant; making all the big: decisions; acting
like the master of the castle
Intimidation putting her in fear by: using
looks, gestures, loud voice, smashing things,
destroying her property.
Isolation controlling what she does, show she
sees and talks to, where she goes.

Stage I. Tension building Phase creating tension , anger, fighting,.

Becoming more critical, irritable and
temperamental. The abuser punishes you
for your mistake (Involves minor battering
incidents.
Stage 2. Violent Episode partner is
physically, sexually, or verbally abusive.
Flies into a rage easily. Hitting, slapping
choking . Uses weapon. Serious violence
lasting from 2- 24 hrs is committed.
Stage 3. Honeymoon or aftermath stage
period of calm. Partner denies violence.
Makes excuses for behavior. Says sorry and
promises, becomes loving and promises not
to batter her again.

Reasons why women stay in an abusive

relationship:
1. For the children fear of losing custody
of the children
2. Financial reasons have no financial
sources, access to the resources, or job
skills.
3. Fear of retaliation: told that if she
leaves he will find her and kill her and
the children
4. Lack of support network: under
pressure from the family members to
stay in the marriage and try to work out
things .

5.

Religious reasons: may have religious

beliefs against divorce.

6. Hopefulness: she remembers food times

and love in relationship and has hope that
her partner will change her behavior and
they can have good times again.

1. Provision of temporary residence

2. Couples therapy/marriage counseling
3. Provision of assistance in the treatment of
injuries
4. Apply crisis intervention

 Health

care provider response to abuse:

Any health care provider like doctor,
nurse, clinician, BHW, therapist or
counselor who suspects abuse or has been
informed by the victims of violence is
expected to:
Properly document the victims physical,
emotional, or psychological injuries.
Properly record any of victims
suspicions, observations and
circumstances of the examination or
visit;

Automatically provide free medical

certificate concerning the assessment or
visit;
Safeguard the records of the victims and
make them available upon the victims
request; and
Provide immediate and adequate notice of
the victims rights and remedies provided
by law.

 Child

abuse is any behaviour directed

toward a child by a parent, guardian, care
giver, other family member, or other
adult, that endangers or impairs a childs
physical or emotional health and
development. (WHO)

 Child Abuse

(as defined RA 7610, Anti- Child

Abuse Law)
Maltreatment

of a person below 18 yrs of

age or those above 18-yrs old but unable to
protect themselves from abuse due to
physical or mental ability.
Forms of Abuse :
1. Psychological and physical abuse, neglect
cruelty and emotional maltreatment.

Physical Abuse includes any physical injury as a

result of punching, beating, kicking, biting,
burning, shaking, throwing, stabbing, choking,
hitting, burning, or otherwise harming a child.
S/S of physical Abuse:
1. Has unexplained burns, bites, bruises , broken
bones, or black eyes.
2. Has fading bruises or other marks noticeable
after an absence from sch.
3. Seems frightened of the parents and protests
or cries when it is time to go home.
4. Shrinks at he approach of adult
5. Reports injury by a parent or another adult
caregiver

Physical abuse may be suspected when he

parent or other adult caregiver:
1. Offers conflicting, unconvincing , or no
explanation for the childs injury.
2. Describes the child as evil or in some
other very negative way.
3. Uses harsh physical discipline with the
child.
4. Has a hx of abuse as a child.

 Emotional

abuse - involves a pattern of

behavior on the part of the parent or
caretaker that results in serious impairment
of the childs social, emotional or
intellectual functioning.
Example of emotional injury:
Belittling

or rejecting the child, ignoring

the child, blaming the child for things
over which he/she has no control,
isolating the child from normal social
experiences, and using harsh and
inconsistent discipline.

 Behavioral
1.

2.
3.
4.
5.

indicators of emotional injury:

Shows extremes in behavior, such as
overly compliant or demanding behavior,
extreme passivity, or aggression.
Is either inappropriately adult of
inappropriately infantile
Is delayed in physical or emotional
devlpmt.
Has attempted suicide.
Reports lack of attachment to the
parent.

 Emotional

abuse ma be suspected when the

parent / or adult caregiver:
1. Constantly blames, belittles, or berates the
child
2. Is unconcerned about the child and refuses
to consider offers of help for the childs
problems.
3. Overtly rejects the child

Physical neglect includes refusal f or

delay in seeking health care,
abandonment, expulsion from the home
or refusal to allow a runaway to return
home, and inadequate supervision
Emotional neglect refers to a chronic
failure by the parent or caretaker to
provide the child with the hope, love, and
support necessary for the devlpmt of a
sound, healthy personality.

 Is

frequently absent from school

Begs or steals food for money
Lacks needed medical or dental care
Is consistently dirty and has severe body odor
Lacks sufficient clothing
Abuses alcohol or other drugs
State that there is no one at home to provide
care.

 2.

Deeds or words which debase , degrade or

demean the dignity of the child.
3. Unreasonable deprivation of the childs
basic needs for survival such as food and
shelter,
4. Failure to immediately give medical
treatment to an injured child resulting to
impairment of his/her growth and development
or permanent incapacity or death.

Complaints of unlawful acts committed

against children may be filed by any of
the ff:
Offended party
Parents or guardians
Relatives within third degree of consanguinity
Social worker or a representative of a licensed
child caring institution
Officer of the Dept of Social Welfare and
Development

 Barangay

Chairman
At least three responsible citizens where the
incident occurred.
Characteristics of Abusive Parents:
a. Usually from violent families
b. Were also abuse by their parents
c. Have inadequate parenting skills
d. Socially isolated because they do not trust
anyone.

 e.

Emotionally immature
f. Have negative attitude towards the
management of the abused.

A Absence of trauma but with serious

injuries (fracture, burns, lacerations)
B Bruised, red, swollen, teared genitalia
(vagina and anal)
U Unusual injuries for age and
development (Femoral fx in a 2 month
old)
S Switching and inconsistencies in
childs history.
E Evidence of old injuries.
D Delay in seeking treatment for severe

injury.

Rape
Is

a physical violence in which the act of

intercourse takes place
A crime involving lack of consent, threat
of force and sexual penetration.
Sexual Assault
Refers to forcible sexual acts performed
without the victims consent and are
against his or will.

 Three

essential elements to define

an Act of Rape:

1.

2.
3.

Vaginal penetration however slight

Use of force intimidation threat or
duress
Lack of consent of the victim

 As

defined in RA 8353, Anti-Rape Law, 1997 is

committed when a person how sexual
intercourse with a woman under the ff
conditions:
Through

force, threat or intimidation

When the victim is deprived of reasons or is
unconscious
Through fraudulent machinations or grave
abuse of authority
When the victim is under 12 yrs old or is
demented; and
By inserting an instrument or object into the
anal or genital orifice of another person.

 Rape

is an act of violence or aggression;

a crime against person.
Rape can occur between married persons
and persons of he same sex.
In date rape and acquaintance rape, the
rapist is known to the victim. It may
occur on the first date or after the victim
and the rapist have known each other for
months.
Most rapes are pre-mediated and planned
and the victims are pre-selected.

 About

50% or rape cases are committed

by strangers and another 50% by people
who are known to the victim.
Rape may occur at any age. Reported
cases involved an infant less than 1 yr
old and elderly clients who are as old as
92.
The initial assessment of a rape victim
can significantly affect the psychological
impact of the assault on the victim.

 The

initial information that shld be elicited

from the rape victim is her perception of
what occurred.
The significant others of the rape victim
may require time and professional
assistance for resolution of crisis.
The victim s support from his/her spouse
or significant others and the effectiveness
of his/her coping mechanisms will
decrease the severity of the trauma
brought about by the rape.

 Power

rape is done by the rapist to

compensate for his feelings of inadequacy
and incompetence concerning his masculine
identity; woman is placed in a helpless,
controlled situation where she cannot resist
or refuse.
Anger rape the rapists motives are
retaliation and revenge against a
transgression by a significant female in his
life; uses sexual assault as a means of
expressing and discharging feelings of intense
anger, frustration and contempt.

 Sadistic

rape involves the eroticization

of aggression; finds pleasure in the
premeditation and ritualistic acts of
violence, which usually involves bondage
and torture.
Date Rape rape by an acquaintance
following consent to shared company but
not to sexual activity.

1.

2.

3.

4.

Blitz rape occurs when the woman has

neither previous knowledge of, nor
threat of vulnerability from the rapist.
Confidence rape- involves some
interaction between the assailant and
victim before the rape occurs.
Accessory-to-sex describes sexual acts
with an indvl which is unable to consent
to sex.
Sex-stress situation refers to events
arising after initial consent to sex is
given and then withdrawn.

 Is

the process of adaptation that includes:

Freeing oneself from the fear of a lifethreatening situation
Redefining ones feeling of vulnerability
and helplessness
Regaining control and equilibrium in
ones life.

Immediate or acute phase

(Disorganization)
Victim displays two types of emotions
a.
Controlled outwardly, marked calm,
and composed affect
b. Expressed feelings of anger, fear,
humiliation and anxiety; guilt about
surviving
General soreness of the body, muscle
tension
Disturbances in eating and sleeping
pattern

1.

2.

Feeling of fear of physical injury

Second-guessing phenomenon of selfrecrimination; self-blame
Lasts from few days to a few weeks.
Long-term process (reorganization)
The indvl is able only to resume minimal level
of functioning
Regains a feeling of physical well-being and
safety.
Generally relies on family for support
Some victims may change residence in the
hope that they stop worrying about being
raped again.

Dreams and nightmares are experienced,

either of rape or violence and murder
Development of phobia but works through
resolving them.
May exhibit pseudoadjusment.
Assimilation the event into ones sense of
self.
Marital rape occurs when there is forced
sexual activities between husband and
wife.

 Occurs

when the person experiencing the

sexual assault does not deal with the
feelings or reactions to the experience.

 ASSESSMENT

focus

on the victims physical and

emotional state
concerns for physical safety
Anxiety about significant others
Coping skills
Preservation and protection of medicolegal evidence
Availability off people supportive to the
victim

 ASSESSMENT

(cont)
Perception of the event:
Behavioral self-blame- attribution is
made to a controllable, modifiable
source, represents an adaptive
response.
Characterological Self-Blame
attribution is made to ones character, a
relatively non-modifiable source ;
maladaptive response . Associated with
depression and helplessness.

 PLANNING

medical attention
Provision of physical safety
Long range planning: continued contact
with the victim. Supportive counseling,
helping victim reorganize life.
INTERVENTION
A. Emergency care

a. emergency medical treatment

b. preparing the victim for medical
events
c. prevention of pregnancy and
venereal disease
d. psychological support
e. Correct collection and preservation
of legal evidence.

Intervention (Cont)
B. Implement action to reduce trauma
a. Minimize questioning; encourage
ventilation about the assault but do not
force the victim
b. Observe caution in words used in
communicating with the patient
c. Provide privacy; build rapport and trust
d. Avoid why questions
e. Explain the reasons why some questions
are asked.

C. Use desentization tech. to treat phobia

D. Exploring physical safety concerns
E. Apply crisis intervention
F. Anticipating guidance for significant others
G. Making follow-up plans ( med. appointments,
supportive counseling)
H. Promoting reorganization
I. Feelings and attitudes of the nurse to
enhance the therapeutic potential, nurses
must recognize and face their own fears and
stereotypical views of rape and sexual assault.
EVALUATION
Monitor the progress of victims coping and the
effectiveness of the interventions provided.

1.

2.
3.

4.

5.

Crisis Intervention: information,

counseling, and referrals
Help with basic needs: housing condition,
transportation, child care safety
Medical information and care:
information about pregnancy prevention,
follow-up care, and counseling.
Advocacy for whatever choices are made
about reporting or prosecuting
Protection of rights : to privacy,
confidentiality, gentleness, sensitivity
and explanations of procedures and etcs.

 6.

Protection of rights: to refuse

collection of evidence, to determine who
will and will not be present during the
examinations, to get copies of all medical
and legal reports, and to apply for
reimbursement through victims
compensation
7. Fairness, information and protection
of legal rights: during investigations,
hearings and trial, including nit being
asked about prior sexual experiences with
anyone besides the suspect or defendant.

8. Reasonable protection against further

harm: escorts to court, restraining order,
additional patrols even relocation if
necessary.

 Is

char by long standing sexual

urges, fantasies or behaviors that
are directed toward nonhuman
objects, or infliction of pain or
humiliation to self, partner,
children, or other nonconsenting
individuals.

 The

behavior could be near normal

but may progress to destructive.
The extremely one-sided acts
involve aggression and victimization
The condition may be related to
unresolved oedipal complex.
Most paraphiliacs are men and
fantasies often begin in late
childhood and adolescence,
continuing throughout life adult.

 Paraphiliacs

are often called

perverts by society and their unusual
sex practices may have legal abnd
social consequences.
Most paraphiliacs do not seek
treatment on their own initiative;
often they are forced to by court
order or by a significant person.

 Exhibitionism

recurrent desire to
publicly show the genitals.
Fetishism Inanimate objects which
are intimately associated with the
human body (eg: shoes,underwear,
socks)
Transvestic Fetishism sexual
arousal from wearing the apparel of
the opposite sex.

 Pedophilia-

recurrent desire for sex

with a child 13 yrs old and below.
Sexual masochism recurrent and
intense sexual desire to experience
pain.
Sexual sadism - recurrent and intense
sexual desire to inflict pain.
Voyeurism/scophophilia- recurrent
preoccupation with seeing others nude.
Frotteurism rubbing the genitals
against the body parts of a fully
clothed woman.

 Zoophilia

sexual relation with

animals
Coprophilia- desire to defecate on
the patner or to be defecated on by
ht epartner
Coprophagia desire to eat feces.
Urophilia desire to urinate on the
partner or to be urinated on by the
partner.
Klismaphilia sexual stimulation
with the use of enema

 Hypoxyphilia

-desire to experience
hypoxia during orgasm
Necrophilia - sexual gratification from
cadavers.
Partialism sexual activity is only
concentrated on only one part of the
body.
Telephone scatologia sexually
provocative and obscene phone calling
made to another person.
Computer scatologia sexually explicit
messages are sent through computer.

 The

pedophilias choice of sex

object is primarily based on sexual
attraction to children.
Pedophilia is most common type of
paraphilia.
More than 50% of paraphilias have
their onset at age 18.
Fetishism almost exclusively occurs
in men.
Treatment involves self-help grps
and psychotherapy.