Learning Objectives
By the end of this section, you will be able to:
- Discuss the definition of psychologic abuse and the role of the nurse
- Identify clinical manifestations of IPV
- Describe programs to assist women who have been victimized
Safety is a basic human need and always receives priority in patient care. Nurses typically use Maslow’s Hierarchy of Needs (Figure 9.4) to prioritize urgent patient needs, with the bottom two rows of the pyramid receiving top priority. Safety is intertwined with basic physiologic needs.
Psychologic abuse violates a person’s feelings of safety and self-worth, inhibiting their basic human needs. Because their basic human needs are not met, the overall health of the victim declines. Abuse eventually affects a woman’s reproductive and mental health. Violence also destroys relationships and decreases the victim’s confidence. Nurses can lobby organizations and lawmakers to help stop violence against women.
Psychologic Abuse
The type of abuse that can include harassment; verbal abuse such as name calling, degradation, and blaming; threats; stalking; and isolation with the intent to attack the person’s self-esteem and self-worth, making the person reliant on their abuser is psychologic abuse (National Network to End Domestic Violence, 2021). Abusers often isolate their partner from family members and friends. They may deprive them of essentials, such as food, money, transportation, and access to health care (National Network to End Domestic Violence, 2021). The abuser thrives on control and manipulation. The abuser can be a coworker, boss, family member, intimate partner, or acquaintance. Name-calling, insults, belittling or threats can lead to long-term psychologic harm to the person (National Network to End Domestic Violence, 2021). Signs of psychologic abuse may include being withdrawn or isolated, emotional reactions that are not consistent with the situation, or other behavior outside the norm for that person (Washington State Department of Social and Health Services, n.d.).
The nurse who suspects a patient is experiencing psychologic abuse should take steps similar to those for suspected physical abuse. The patient should be given resources and referrals. The nurse should also educate the patient that psychologic abuse is as significant a health concern as physical abuse.
Clinical Manifestations of Psychologic Abuse
Psychologic abuse leads to outward manifestations of the abuse, such as mental health problems, cognitive issues, reproductive issues, and relationship problems. Many times, abusers will threaten to hurt themselves if the person decides to end the relationship (National Network to End Domestic Violence, 2021). Victims of psychologic abuse become fearful of ending their relationship or disagreeing with the abuser. Victims can isolate, become depressed, or feel anxious around the abuser (National Network to End Domestic Violence, 2021). These manifestations of violence and abuse may be the red flags needed for nurses, health-care providers, and family members to recognize that abuse is occurring.
Effects of Violence on Mental Health
Psychologic abuse can lead to depression, anxiety, and suicidal ideation. People can feel confusion, shame, and guilt over being in the relationship (National Network to End Domestic Violence, 2021). The victim feels there is no way out of the horrible situation except death. Suicidal ideation can be a response to mental health conditions, life events, substance use problems, and violence. People at risk of suicide may be more likely to engage in risky behaviors due to their underlying mental health crisis. Nurses may recognize their patient is depressed, using drugs, and feels hopeless. These could be signs of abuse leading to thoughts of suicide. It is important to provide support and a safety plan for people who are at risk for suicide. Referrals to mental health providers are essential for these patients.
Effects of Violence on Cognition
Survivors of violence experience immediate consequences, but they also suffer long-term consequences. Violence can affect short-term memory, cognitive control, and emotion regulation by altering brain organization and communication between brain regions (Mattheiss et al., 2022). This leads to lower grades in school, poor performance at work, and financial issues. Survivors of violence may have difficulty in making decisions. In children, violence can impact the development of their mental functions and can increase the risk of developing personality disorders during adolescence (Zucchelli & Giuseppe, 2019).
Effects of IPV on Reproductive Health
Women who experience violence undergo stress. Stress induces the release of cortisol, which then causes inflammation. Recent research has shown a correlation between chronic stress and a dysregulation of endocrine-inflammatory-epigenetic changes, which may lead to the development and progression of endometriosis (Hutchinson et al., 2023). Infertility has been linked to IPV (Stellar et al., 2016). IPV has also been associated with unintended pregnancies, abortions, miscarriages, and STIs.
Cultural Context
Infertility and IPV in Iran
Iran’s infertility rate is 24.9 percent, and its IPV frequency varies between 14 percent and 61 percent (Alijani et al., 2022). Alijani et al.’s 2022 study focused on women being treated at an infertility clinic at a university medical center. They were interviewed for IPV using a questionnaire-screening. According to this study, 88.9 percent of the infertile women reported physical violence, and 85.8 percent reported psychologic violence.
Effects of Violence on Families
People who experience IPV can struggle to be good parents due to their low self-esteem and lack of confidence. They often lack support because of the isolation that some perpetrators cause; therefore, when children are sick or mothers need help with small children, they have very few people to ask for help. Preschool children who observe domestic violence may experience nightmares, developmental delays, and loss of memory functioning (U.S. Department of Veterans Affairs, 2021). Children may have difficulty expressing their emotions, show signs of PTSD, and have a difficult time making friends (U.S. Department of Veterans Affairs, 2021). Adolescents may be forced into the role of adult and become the caretaker of younger children. They may feel ashamed or embarrassed about their family; possibly act out and make poor choices; explore sex, drugs, or alcohol; and shut down emotionally (U.S. Department of Veterans Affairs, 2021). Nurses should consider resources for the whole family when discussing IPV with patients.
Centers for Disease Control and Prevention Interventions on Behalf of Women
The CDC has developed violence prevention programs to address IPV. Their site also includes facts about IPV, risks and protective factors, prevention strategies, discussions of different types of IPV, and specific programs for dating and teen violence (CDC, 2021a). The CDC’s prevention strategies include teaching safe and healthy relationship skills, engaging influential adults and peers, disrupting the developmental pathways toward partner violence, creating protective environments, strengthening economic supports for families, and supporting survivors to increase safety and lessen harm. The CDC (2021a) also developed the National Intimate Partner and Sexual Violence Survey (NISVS) to collect the most current and comprehensive data on IPV, sexual violence, and stalking in the United States. These data are collected to help create violence prevention strategies.
Violence Prevention Timeline
The CDC has developed a timeline devoted to mapping the progression of violence as a public health problem. The timeline begins in 1979 with the U.S. Surgeon General’s Report, Healthy People, which identified violence as one of 15 priority areas for improvement for the nation (CDC, 2022a). The CDC established the Division of Injury Epidemiology and Control to study injuries and violence in 1986. In 1994, Congress passed the Violence Against Women Act that aided in preventing IPV and provided grants for rape prevention and education (CDC, 2022a).
In 2000, the WHO also created a Department of Injuries and Violence Prevention. The timeline then presented the release of evidence showing the effects of IPV on public health and the programs that were developed in response to this research. The timeline continues to this day as the CDC continues to find ways to battle violence against women.
National Intimate Partner and Sexual Violence Survey
In 1998, a joint project between the National Institute of Justice and the CDC was created to discover more about IPV and sexual violence in the United States. The National Intimate Partner and Sexual Violence Survey was launched. The investigators used telephone surveys to learn more information about violence against women. The results showed the prevalence and incidence of rape, physical assault, and stalking; the rate of injury among those incidences; and injured victims’ use of health-care services (U.S. Department of Justice, 1998). The survey found that women from underrepresented groups had higher incidences of IPV and rape, that rape is more common for women under the age of 18, and that stalking is a significant social problem (U.S. Department of Justice, 1998). The survey provided data so that programs would be aimed at improving the negative data results.