Victims of Domestic Violence and CoOccurring 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
  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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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

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False Assumptions

• Substance 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

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Cont 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.

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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

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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.

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• 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.

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Dont

• Label victims as co-dependents Alanon or Nar anon
  are not to victim
• .Dont ask a victim to detach, or focus on
  themselves,
• Dont expect or request a victim to stop enabling
• Dont 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.

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• 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 /
  STDs

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Examples of Co-occurring Disorders

• Substance Abuse Disorders
• Mood Disorders
• Sleep Disorders
• Anxiety Disorders
• Personality Disorders
• Somatoform Disorders

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Somatoform Disorders
Somatoform disorders are a group of disorders in
which people experience significant physical
symptoms for which there is no apparent organic
cause.
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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
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Associated Terms

• Malingering
• faking symptoms
• Primary Gain
• symptoms keep internal conflict repressed
• unconscious process
• Secondary Gain
• symptoms allow avoidance of responsibility

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Factitious Disorders

• deliberate faking to get medical attention
• Types
• Munchausen syndrome
• Munchausen by Proxy

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Types

• Body Dysmorphic Disorder
• Conversion Disorder
• Hypochondriasis
• Somatization Disorder
• Pain Disorder

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Body Dysmorphic Disorder

• Preoccupation with an imagined or exaggerated
  defect in physical appearance

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Conversion Disorder

• Unexplained symptoms affecting voluntary motor or
  sensory function
• suggests a neurological or other medical
  condition
• not intentionally faked
• significant distress or impairment occurs

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Conversion Disorder

• Course
• onset usually late childhood to early adulthood
• acute onset is usual
• recurrence is common

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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.
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Conversion Disorder

• Cultural differences
• more common in rural populations
• more common in lower SES
• higher reports in developing regions
• symptoms follow cultural definitions

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Conversion Disorder

• Gender related features
• in men, more often seen relating to work
  accidents
• women may later manifest full Somatization
  Disorder

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Conversion Disorder

• Prevalence
• 1 to 3 of treatment cases
• general population samples range from
• 11 to 300 in 100,000

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Hypochondriasis

• Preoccupation with a fear of having a serious
  disease
• misinterpretation of bodily symptoms

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Hypochondriasis

• Hypo below
• chondron cartilage below breastbone
• most common symptoms are in the abdoment
• may truly feel pain
• doctor shop

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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.
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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
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Hypochondriasis

• Onset usually in the 20 to 30s
• Course
• chronic
• Gender
• equal in men and women

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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
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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 Dont assume physical and
psychological problems accompany one another
moderate degrees quite common
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Somatization Disorder

• Old names
• hysteria
• Briquets syndrome
• polysymptomatic
• combination of pain, GI, sexual or
  pseudoneurological symptoms

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Somatization Disorder

• Onset
• begins before age 30 years
• Course
• chronic rarely remits completely

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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

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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

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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

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Pain Disorder

• New to DSM-IV
• pain is the predominant focus of attention
• psychological factors have an important role in
  the onset, severity, exacerbation or maintenance
  of the pain

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Pain Disorder

• Subtypes
• with psychological factors
• with both psychological factors and medical
  condition
• with medical condition

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Pain Disorder

• Course
• onset any age
• usually many years
• Prevalence
• common
• 10 to 15 of adults in the U.S. for back pain
  alone

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Etiology

• Anxiety is translated into functional symptoms
• symptoms decrease the awareness of anxiety

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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

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Anxiety Disorders

• PTSD
• Acute Stress Disorder
• General Anxiety Disorders
• Panic Disorders

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Personality Disorder

• Chronic pattern of maladaptive
• cognition
• emotion
• Behavior
• Examples you may see in Female Victims
• Borderline Personality disorder
• Histronic
• Avoidant
• Dependent

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Gender and Cultural Biases

• Female stereotypes
• over-diagnosis of histrionic, dependent and
  borderline
• Male stereotypes
• over-diagnosis of antisocial

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Many Victims are afraid to seek Treatment

• If they are self medicating Commonly Abused drugs
• Alcohol
• Benzodiazepines
• Barbiturates
• Amphetamine
• Marijuana
• Opioids
• Cocaine

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• 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.

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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.

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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

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Use your resources . Do you know your available
overlay services?

• See handout attached

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Thank you for all that you do !