Violence and Co-Occurring Disorders Victims who are impacted by Domestic Violence and who may suffer from illness such as mental health and substance abuse often are not taken seriously. Many of our victims have faced many obstacles accessing services due to their co- occurring disorders.
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Victims of Domestic Violence and Co-Occurring Disorders Victims who are impacted by Domestic Violence and who may suffer from illness such as mental health.
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Victims of Domestic Violence and Co-Occurring Disorders
Victims who are impacted by Domestic Violence and who may suffer from illness
such as mental health and substance abuse often are not taken seriously.
Many of our victims have faced many obstacles accessing services due to their
co-occurring disorders.
Some Facts about Domestic Violence
A women is beaten every 15 seconds (bureau of Justice) Domestic Violence is the leading cause of injury to
woman between the ages of 15-44. 22-25% of woman who seek medical assistance at the emergency room are there due to Domestic Violence Woman who leave their batterer are at 75% greater risk
of being killed. 50% of all homeless woman and children are on the
streets due to domestic violence There are three times more animal shelters than victim
shelters for woman and children
False AssumptionsSubstance Abuse does not cause domestic Violence.. Research done by (Straus
& Gelles 1990)
Domestic Violence professionals often fail to identify substance abuse
problems. Substance abuse professionals may minimize or excuse the
abusive behavior. Substance abuse is high among domestic violence offenders 54% are heavy poly substance users 46% are dependant or abusing 26% dependent on opiates. Cocaine, inhalants or marijuana
( Institute for teaching and Research for woman 1993) Alcohol and drug misuse causes the battering • Substance abuse treatment alone will solve the problem • Victims are co-dependent and contribute to continuation of abuse • Addicted victims must get sober before addressing the victim issues
Con’t False assumptions
Indicates that batterers who were heavy drinkers displayed a higher rate of perpetration and injury was more serious. The false belief that substance abuse treatment will resolve Batterering has characteristics similar to addictive behavior (false) Addiction models are inappropriate to apply to perpetrators Abstinence From anger with domestic violence , is as inappropriate as abstinence from food for eating disorders. Batterers do not have a loss of control over their battering behavior as experience with addicts over their using behavior.
Re-victimization Do not use the co-dependency model when working w/ Victims or
batterers Preoccupation w/ partner Being over focused Making others needs a priority Being unable to define ones own needs Denial Enabling behaviors Unable to set limits and boundaries Being reactive rather than proactive Putting self down – low self esteem Suffering somatic illness Defining mood based on other peoples moods Working a better program will not stop the violence
Definitions of Co-occurring Disorders
Disorders that commonly coincide with a certain condition. An example is bulimia as a co-occurring disorder of borderline personality disorder.
A person who has both an alcohol or drug problem and an emotional/psychiatric problem is said to have a co-occurring disorder. To recovery fully, the person needs treatment for both problems.
Researchers have discovered that a large percentage of those who have alcohol or drug problems also have at least one personality disorder or mental illness.
People with a mental illness are three to six times more likely to abuse substances than people without a mental illness. However, some mental illnesses occur more frequently than others. The most common are:
depressive disorders, such as depression and bipolar disorder;
anxiety disorders, including generalized anxiety disorder, panic disorder, obsessive-compulsive disorder and other phobias; and
other psychiatric disorders, such as
Schizophrenia and personality disorders.
Don’t Label victims as co-dependents Alanon or Nar anon are
not to victim .Don’t ask a victim to detach, or focus on themselves, Don’t expect or request a victim to stop enabling Don’t ask a victim to set boundaries, These strategies will more than likely escalate the abuse Avoid shame base questions or remarks Victims of substance abusing partners need information
and resources to make informed choices and set realistic
expectations about benefits of and source of help.
Chemically dependent victims are less likely to be taken seriously by others They are more likely to be blamed by others Intoxicated woman are often not admitted into emergency shelters Substance abuse treatment often does not provide childcare Impairment of cognitive and motor functioning may also interfere with safety strategies Unwilling or unable victims are then cut off from safety related services Substance abuse may increase the risk for HIV / STD’s
Somatoform disorders are a group of disorders in which people experience significant physical symptoms for which there is no apparent organic cause.
Somatoform Disorders
Somatoform and Pain Disorders: Subjective experience of many physical symptoms, with no organic causes
Psychosomatic Disorders: Actual physical illness present and psychological factors seem to be contributing to the illness
Factitious Disorder: Deliberate faking of physical illness to gain medical attention
Associated Terms
Malingering faking symptoms
Primary Gain symptoms keep internal conflict repressed unconscious process
Secondary Gain symptoms allow avoidance of responsibility
Factitious Disorders
deliberate faking to get medical attentionTypes:
Munchausen syndrome Munchausen by Proxy
Types
Body Dysmorphic DisorderConversion DisorderHypochondriasisSomatization DisorderPain Disorder
Body Dysmorphic Disorder
Preoccupation with an imagined or exaggerated defect in physical appearance
Conversion Disorder
Unexplained symptoms affecting voluntary motor or sensory function
suggests a neurological or other medical condition
not intentionally fakedsignificant distress or impairment occurs
Conversion Disorder
Course onset usually late childhood to early adulthood acute onset is usual recurrence is common
Conversion Disorder
Etiology: Often can occur after trauma or stress, perhaps because the individual cannot face memories or emotions associated with the trauma
Issues to Consider: It is rarely diagnosed in the general population. Children can also have conversion symptoms.
Conversion Disorder
Cultural differences more common in rural populations more common in lower SES higher reports in developing regions symptoms follow cultural definitions
Conversion Disorder
Gender related features in men, more often seen relating to work
accidents women may later manifest full Somatization
Disorder
Conversion Disorder
Prevalence 1% to 3% of treatment cases general population samples range from
• 11 to 300 in 100,000
Hypochondriasis
Preoccupation with a fear of having a serious disease
misinterpretation of bodily symptoms
Hypochondriasis
Hypo = belowchondron = cartilage below breastbonemost common symptoms are in the
abdomentmay truly feel paindoctor shop
Hypochondriasis Disorder
Symptoms: Chronic worry that one has a serious medical disease despite evidence that one does not; frequent consultations with physicians over this worry.
Hypochondriasis Disorder
Etiology: A family history of depression or anxiety is common. These people may suffer from chronic distress and cope with this distress by exaggerating physical symptoms
Issues to Consider: Most studies of hypochondriasis have grouped this disorder with people with somatization disorder
Hypochondriasis
Onset usually in the 20 to 30sCourse
chronic
Gender equal in men and women
Somatization & Pain Disorders
Symptoms: involves a long history of multiple
physical complaints for which people have sought treatment but for which there is no apparent organic cause.
Pain disorder involves only the experience of chronic, unexplainable pain
Somatization & Pain Disorders
Etiology: run in families, but it is not clear whether this is due to genetics or modeling. Different theories claim different origins for this disorder
Issues to Consider: Don’t assume physical and psychological problems accompany one another; moderate degrees quite common
Somatization Disorder
Old names hysteria Briquet’s syndrome
polysymptomaticcombination of pain, GI, sexual or
pseudoneurological symptoms
Somatization Disorder
Onset begins before age 30 years
Course chronic rarely remits completely
Somatization Disorder
Cultural differences type and frequency different for cultures
Africa and South Asia common: burning feet and hands worms in the head
India dhat syndrome = concern about semen loss
Somatization Disorder
Gender Differences U.S. rarely occurs in men Greece and Puerto Rican men have higher
frequency
Prevalence 0.2% to 2% for women less than 0.2% for men
Somatization Disorder
Family Trends found in 10% to 20% of female first-degree
biological relatives sons have a higher risk of antisocial personality
disorder and substance-related disorders
Pain Disorder
New to DSM-IVpain is the predominant focus of attentionpsychological factors have an important
role in the onset, severity, exacerbation or maintenance of the pain
Pain Disorder
Subtypes with psychological factors with both psychological factors and medical
condition with medical condition
Pain Disorder
Course onset any age usually many years
Prevalence common 10% to 15% of adults in the U.S. for back pain
alone
Etiology
Anxiety is translated into functional symptoms
symptoms decrease the awareness of anxiety
What are Anxiety Disorders
Anxiety is a normal reaction to stressBut when anxiety becomes excessive it can become a disabling disorder and impact cognitive functioning
Personality DisorderChronic pattern of maladaptive
cognition emotion Behavior
Examples you may see in Female Victim’s Borderline Personality disorder Histronic Avoidant Dependent
Gender and Cultural Biases
Female stereotypes over-diagnosis of histrionic, dependent and
borderline
Male stereotypes over-diagnosis of antisocial
Many Victims are afraid to seek Treatment
If they are self medicating Commonly Abused drugs Alcohol Benzodiazepines Barbiturates Amphetamine Marijuana Opioids Cocaine
Women can become addicted quickly to certain drugs, such as crack cocaine. therefore, by the time they seek help, their addiction may be difficult to treat.
Women who use drugs often suffer from other serious health problems, sexually transmitted diseases, and mental health problems, such as depression.
Many women who use drugs have had troubled lives. Studies have found that at least 70 percent of women drug users have been sexually abused by the age of 16.
Most of these women had at least one parent who abused alcohol or drugs.
Often, women who use drugs have low self-esteem, little self-confidence, and feel powerless. They often feel lonely and are isolated from support networks.
Women from certain cultural backgrounds or who have difficulty with the English language may not know how to find help for their addiction.
Mood Disorders
Mood disorders are very common, about 20% of the population has a mood disorder.
Depression is a common feature of mental illness. A person with a history of any serious psychiatric disorder has a high chance of developing major depression.
Personality and Mood Disorders
Victims are more easily demoralized by depression and is slower to recovery from, they can be very self-critical and / or irritable, impulsive and hypersensitive.
They may show signs of panic
and anxiety Please do not overlook
the signs
Use your resources . Do you know your available overlay services? See handout attached