CLINICAL PICTURE OF ABUSE AND VIOLENCE
Victims of abuse or violence certainly can have physical injuries needing medical attention, but they also experi-ence psychological injuries with a broad range of responses. Some clients are agitated and visibly upset; others are withdrawn and aloof, appearing numb or oblivious to their surroundings. Often, domestic violence remains undis-closed for months or even years because victims fear their abusers. Victims frequently suppress their anger and resentment and do not tell anyone. This is particularly true in cases of childhood sexual abuse.
Survivors of abuse often suffer in silence and con-tinue to feel guilt and shame. Children particularly come to believe that somehow they are at fault and did some-thing to deserve or provoke the abuse. They are more likely to miss school, are less likely to attend college, and continue to have problems through adolescence into adulthood. As adults, they usually feel guilt or shame for not trying to stop the abuse. Survivors feel degraded, humiliated, and dehumanized. Their self-esteem is extremely low, and they view themselves as unlovable. They believe they are unacceptable to others, contami-nated, or ruined. Depression, suicidal behavior, and marital and sexual difficulties are common (Child Wel-fare Information Gateway, 2008).
Victims and survivors of abuse may have problems relating to others. They find trusting others, especially authority figures, to be difficult. In relationships, their emotional reactions are likely to be erratic, intense, and perceived as unpredictable. Intimate relationships may trigger extreme emotional responses such as panic, anxi-ety, fear, and terror. Even when survivors of abuse desire closeness with another person, they may perceive actual closeness as intrusive and threatening.
Nurses should be particularly sensitive to the abused client’s need to feel safe, secure, and in control of his or her body. They should take care to maintain the client’s personal space, assess the client’s anxiety level, and ask permission before touching him or her for any reason. Because the nurse may not always be aware of a history of abuse when initially working with a client, he or she should apply these cautions to all clients in the mental health setting.