Survivors of Violence and Trauma

1.6 million individuals were seen in emergency departments for physical injuries caused by assaults in 2005 (Simon et al., 2008).

Not all crimes involve physical violence, injury, and threat to life; however, all crimes involve emotional violation and trauma. Victims lose a sense of the ability to control their own lives, as well as losing trust in others.

1. 2. 3.

4.
5. 6.

7.

Typical Reactions: Denial Fear Anxiety Anger Powerlessness Depression

Emotional Reactions: 1. Sense of failure 2. Feeling of guilt 3. Fantasies of revenge 4. Wish for legal retribution

Types of Crime:
1.
2. 3. 4. 5.

Verbal abuse Sexual harassment Stalking Assault & Battery Rape and Murder

1. 2. 3. 4. 5.

R.A. 9262 Anti-Violence Against Women and Their Children Act of 2004 R.A. 9208 Anti-Trafficking in Persons Act of 2003 R.A. 8353 Anti-Rape Law of 1997 R.A. 7192 Women in Development and Nation Building Act R.A. 7610 Special Protection of Children Against Child Abuse, Exploitation and Discrimination Act

6. R.A. 7877 Anti-Sexual Harassment Act of 1995 7. R.A. 8505 Rape Victim Assistance and Protection Act of 1998 8. Revised Family Code of the Philippines (Article 68 and 72) 9. Penal Code (Articles 262, 263, 265, 266, 246, 248, 249, and 247)

Types of Crimes: I. Verbal abuse

Abuse is defined as:

Characteristics of Abusers
1. Abused himself/herself People, especially children-tend to imitate what they see. Violence, aggression and abuse are learned behaviors.

2.

Low self-esteem/need for power

Characteristics of Abusers
3. Parents with unwanted children o Parents who for some reason dont want a family o Mothers who are victims of rape or who have no spouse o Parents who are drug or alcohol users

Verbal Abuse Intimidation High pitch or tone of voice Rude gestures Threatening language Offensive notes Humiliation

II. Sexual Harassment is an unwelcomed sexual advance or conduct on the job that creates an intimidating, hostile, or offensive working environment, repeated offensive or belittling jokes to pornography or outright sexual assault.

III. Stalking is a crime that can occur anywhere but often follows victims to their workplace.

Forensic psychologists who have studied stalkers generally divide them into four general categories. Each stalker is different and may show signs from different categories. 1. Simple Obsessional 2. Love Obsessional 3. Erotomania 4. False victimization syndrome

Thought to be the most common, in this kind of stalking, the stalker generally has a previous relationship with his victim. The relationship could be marriage, a romance, a friendship, a date, a co-worker, an employee, etc. Remember "Fatal Attraction"? Glen Close played a simple obsessional stalker. In "Sleeping With The Enemy", Julia Roberts was married to a simple obsessional stalker. They can be dangerous - don't let the word "simple" fool you!

These stalkers, being the most common, are also the most well studied. a. They are known to be generally immature b. socially incompetent and unable to maintain relationships

c. d. e. f. g.

Jealous Insecure Paranoid feel helpless and powerless have very low self esteem.

Love obsessional stalkers tend to be persistent in their pursuit of their victims. These stalkers fantasize about the victim being a romantic partner, and when that fantasy clashes with reality, the stalker often tries harder and harder to get noticed. Increasingly drastic means may ensue. Negative or positive attention may not matter, as long as their victim notices and in noticing, becomes a part of the stalker's life.

This kind of stalker suffers from a severe lack of self esteem. He feels very inferior to the victim whom he admires greatly, although he will rarely admit this to be true. These stalkers, believing themselves to be inferior to, or wronged or rejected by the ones they admire most, begin harassing and following the victims, spreading tales, keeping tabs, and in many instances plotting revenge. Very frequently these are same-sex stalkers.

1.

2.

Systematic education of all employees about verbal abuse, sexual harassment, and other forms of violence, along with ways to prevent and deal with them; Development of corporate policies and procedures related to workplace violence and reporting procedures.

3.

4.

Definition of roles of supervisors, employee, health staff, and security personnel; and Provision for treatment and counseling for employee victims.

I.

Psychopharmacology Anxiolytic decrease anxiety and facilitate sleep

II.

Milieu Management
Different agencies (NGOs) for counseling
UNICEF DSWD PMHA Gabriela

III.

N-PR Trust Empathy Emotional support An ear

1. Initial disorganization (Impact) The initial reaction to a single-event trauma usually lasts from a few minutes to a few days. They need simple directions on what to do, where to go, and what to avoid. Avoid accusations (blaming), intimidations, unnecessary intrusion, and invasion of privacy.

Common Responses: a. Shock b. Denial c. Disbelief d. Confusion (+) Paralyzing fear Hysteria, horror Anger

2.

A struggle to adapt (recoil) It takes a weeks or months. There are times that the victim looks and acts normal & able to carry out daily routines. Trying to unmask the emotional stress but later in this phase, there is a desire to talk about all the details and feelings about the trauma (What happened?). Fantasies of revenge

3. Reconstruction (reorganization) It takes a months or years to accomplish. Although the trauma is not forgotten, the anxiety, fear, and anger diminish, and victims reconstruct their lives. This phase starts to review and organized what happened and why (why me?)-blaming oneself or others or both.

Why did I act the way I did then and since then? justifying ones own actions at the time Regaining a sense of control and selfprotection If Reorganization is not effective, PTSD.

March 2005 27 elementary schoolchildren died and another 100 were hospitalized after eating a snack caramelized cassava, during morning recess in the Southern Philippines. February 2006 wowowee stampede at Philsport Arena in Pasig City claimed 74 lives of Filipino people. August 2010 - Typhoon Ondoy, hundreds of thousands of people Typhoon Pepeng

 Such

overwhelming life experiences can lead to what we call PostTraumatic Stress Disorder.

It is an anxiety disorder that can develop after exposure to one or more traumatic events that threatened or caused great physical or emotional harm.

1.

Re-experiencing

2.

Avoidance

3.

Arousal

I.

Re-experiencing 1. Recurrent & disturbing collections of the traumatic event, including thoughts, images, or repetitive play in young children. 2. Recurrent distressing dreams of the event; or generally frightening dreams in young children. 3. Acting or feeling as if the event were recurring (flashbacks); or re-enactment in play in young children.

4. 5.

Intense psychological distress at exposure to reminders. Psychological reactivity on exposure to reminders

II.

Avoidance
1. Efforts to avoid thoughts, feelings or conversations associated with the event. 2. Efforts to avoid activities, places, or people that arouse recollections of the event. 3. Inability to recall an important aspect of the event. 4. Markedly diminished interest or participation in significant activities.

5. Feeling of detachment or estrangement from others. 6. Restricted range of affect (unable to have loving feelings). 7. Sense of foreshortened future.

III.

Arousal
Difficulty falling or staying asleep. Irritability or outbursts of anger. Difficulty concentrating Hypervigilance Exaggerated startle response

1. 2. 3. 4. 5.

There are no tests that can be done to make the diagnosis of PTSD. The diagnosis is made based on a certain set of symptoms that persist after a history of extreme trauma. It is important to seek professional help immediately. Counseling & crisis intervention

What works?
1. Provide children and adolescents with opportunities to share or discuss their feelings and concerns.

2.

Encourage children and adolescents to resume normal roles and routines or develop new routine.

3.

Maintain social connections. Encourage children and teens to stay healthy and fit by eating well and getting regular exercise and proper sleep.

4.

5.

Reduce or minimize childrens and adolescents exposure to upsetting images.

6.

Encourage children and adolescents to use positive strategies for coping with stressors that ensue.

What doesnt work?

2.

Pressuring children to talk.

Sexual assault and rape refer to any forced sexual contact without consent. Sexual harassment involves physical or verbal sexual innuendo, may take place in many situations but typically occurs on a job by someone in authority.

 Effects:

The

rape victim experiences a severe violation. Victims usually live but wish they had died. RTS rape trauma syndrome

 Sleep

disturbances, nightmares Denial, guilt, self blame Loss of control Fears, anxiety, phobias Low self-esteem, feeling of worthlessness Humiliation, embarrassment Changes in relationships with family & friends Feelings of being contaminated

 Powerlessness,

helplessness Inability to make decisions Sexual dysfunction Loss of appetite Low mood Substance abuse Physical trauma initially, then physical symptoms may persist

1. Regain a sense of control & retreat to a safe place

2. Take a thorough shower

3. Destroy any damaged belongings

Philippines scenario

should know the needs and rights of rape survivors: 1. Crisis intervention: information, counseling and referrals. 2. Help with basic needs: housing, transportation, child care, safety.

They

3.

4. 5.

Medical information and care: information about pregnancy prevention, testing for STD, 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 tests.

6.

Protection rights: to refuse collection of evidence, to determine who will and will not be present during examinations, to get copies of all medical and legal reports, and to apply for reimbursement through victims compensation.

7.

8.

Fairness , information, and protection of legal rights during investigations, hearings, and trial, including not being asked about prior sexual experiences with anyone other than the suspect or defendant. Reasonable protection against further harm: escorts to court, restraining order, additional patrols, even relocation if needed

1.

2.

NPR Crisis intervention: counseling Assessment if reorganization is not effective Psychopharmacology Diazepam/Clonazepam Fluoxetine HCl

3.

Milieu Management Referral can be made to a rape support group or center.

Type of Abuse:

Sexual

Signs/Symptoms:
Violent or nonviolent sexual contact or activity that is not wanted by the receiver. Foreplay, touching, kissing, and mutual masturbation, as well as oral sex and intercourse. Frequent bladder or vaginal infections Bloody underwear

Nursing Interventions:
Preserve evidence. (sexual abuse) Provide safety. Be nonjudgmental. Show empathy. Be advocate for patient. Maintain calm milieu. Know own thoughts and feelings regarding abuse & abuser. Know agency policies. Assist with contacting outside agencies (lawyer)

Type of Abuse: Signs/Symptoms:

Physical

Any actions that cause physical harm to another Hitting Burning Withholding food, water, and other basic needs Other activities that go beyond accidental contact Request to stop ignored or mocked by the perpetrator

Signs/Symptoms: continuation
Activity repeating itself in future situations Frequent visits to emergency department (for all forms of abuse) Excessive bruising or bruising on unusual areas of body. Withdrawal from friends and social groups.
Nursing interventions is same with the sexual except for no. 1 (evidence).

Review: Sir Dayrit coverage: psychopharma, schizophrenia & depression. Maam Pearl: more on long quiz, few in behavioral, somatic & chap 41.

GOOD LUCK & thanks for sharing your experience with the client (RLE)!