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EMOTIONAL DISTRESS AS ADDITIONAL SUFFERING IN ABUSED … · (Fouché & Schurink, cited in De Vos, 2011:316; Whittaker, 2009:34) •Two non-governmental organisations (NGOs) and one

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Page 4: EMOTIONAL DISTRESS AS ADDITIONAL SUFFERING IN ABUSED … · (Fouché & Schurink, cited in De Vos, 2011:316; Whittaker, 2009:34) •Two non-governmental organisations (NGOs) and one

• Several researchers view domestic violence as a leading cause of female injury in almost every country.

• It is claimed that fatal injuries as a result of domestic violence are more common than from muggings, car accidents and death resulting from cancer combined.

(Artz, 1999:2; Damon, 2003:94; Dwyer, Smokowski, Bricout and Wodarski (1995:185) Flinck, Paavilainen & Asredt-Kurki, 2005:383; Gelles, 1999:168; Vincent & Jouriles, 2002:7)

Page 5: EMOTIONAL DISTRESS AS ADDITIONAL SUFFERING IN ABUSED … · (Fouché & Schurink, cited in De Vos, 2011:316; Whittaker, 2009:34) •Two non-governmental organisations (NGOs) and one

• Violence against women mostly occur in the home, which is supposed to be a safe shelter for women and children.

• It is no cause for wonder that some researchers claim that the home can be one of society’s most dangerous places when violence occurs in intimate relationships.

(Danis and Lee, 2003:237, Stephens and McDonald, 2002:81; Sullivan and Hagen, 2005:346)

Page 6: EMOTIONAL DISTRESS AS ADDITIONAL SUFFERING IN ABUSED … · (Fouché & Schurink, cited in De Vos, 2011:316; Whittaker, 2009:34) •Two non-governmental organisations (NGOs) and one

EMOTIONAL DISTRESS

• Intimate partner abuse is increasingly viewed as a prevalent social problem and a source of emotional distress.

• Some authors claim that up to 50% of women worldwide have been abused by their intimate male partners.

• Although women can be violent towards men and abuse also occurs in same-sex relationships, more than 90% of domestic abuse is committed by men against women.

(Buchbinder and Goldblatt, 2011; Carlson, McNutt, Choy and Rose, 2002:720; Parenzee and Smythe, 2003: 33; Prinsloo, 2007:36; Women in Action, 2010)

Page 7: EMOTIONAL DISTRESS AS ADDITIONAL SUFFERING IN ABUSED … · (Fouché & Schurink, cited in De Vos, 2011:316; Whittaker, 2009:34) •Two non-governmental organisations (NGOs) and one

• Several authors conclude that domestic violence poses a serious threat to public health and the emotional stability of women.

• Some scholars claim that abused women are not wives or girlfriends, but prisoners.

• Implications for emotional health arising from domestic abuse are severe and often life long.

(Eby, 2004; Ferrato, 2002; Georgiadess, 2003; Romito, 2008 Scott-Tilley, Tilton and Sandel, 2010)

Page 8: EMOTIONAL DISTRESS AS ADDITIONAL SUFFERING IN ABUSED … · (Fouché & Schurink, cited in De Vos, 2011:316; Whittaker, 2009:34) •Two non-governmental organisations (NGOs) and one

• Health care workers often have to do crisis management in domestic violence cases in order to keep the woman and her children safe.

• The emotional distress however, still remains after the safety crisis has been resolved.

• It is vital that health care workers also deal with the emotional distress in order to promote the general well- being of the abused woman and her family.

(Bornovalova et al., 2013; Tilton and Sandel, 2012)

Page 9: EMOTIONAL DISTRESS AS ADDITIONAL SUFFERING IN ABUSED … · (Fouché & Schurink, cited in De Vos, 2011:316; Whittaker, 2009:34) •Two non-governmental organisations (NGOs) and one

RESEARCH DESIGN AND METHOD • The goal of the study was to gain a clear

understanding of the emotional distress experienced by abused women.

• A qualitative study with a phenomenological approach was proposed.

• The exploratory research design was used to explore the emotional needs of abused women.

• A descriptive research design was also utilised in combination to provide a description of the emotional needs of abused women.

(Fouché & Schurink, cited in De Vos, 2011:316; Whittaker, 2009:34)

Page 10: EMOTIONAL DISTRESS AS ADDITIONAL SUFFERING IN ABUSED … · (Fouché & Schurink, cited in De Vos, 2011:316; Whittaker, 2009:34) •Two non-governmental organisations (NGOs) and one

• Two non-governmental organisations (NGOs) and one psychologist were approached to obtain the sample of 20 participants who took part in the study.

• Purposive sampling were used as the sample were chosen according to certain criteria.

• Snowball sampling was also used where four participants were referred by other participants.

(Whittaker, 2009:34)

Page 11: EMOTIONAL DISTRESS AS ADDITIONAL SUFFERING IN ABUSED … · (Fouché & Schurink, cited in De Vos, 2011:316; Whittaker, 2009:34) •Two non-governmental organisations (NGOs) and one

CRITERIA FOR INCLUSION

• They had to be female, between the ages of 22 and 60.

• They had to be in an abusive relationship at the time of the study, or had to have been in an abusive relationship fewer than six months previously.

• They had to be residing in or around Cape Town. • They had to have received professional help from

a social worker, psychologist or nursing sister during the preceding six months, or still be receiving such help.

Page 13: EMOTIONAL DISTRESS AS ADDITIONAL SUFFERING IN ABUSED … · (Fouché & Schurink, cited in De Vos, 2011:316; Whittaker, 2009:34) •Two non-governmental organisations (NGOs) and one

Profile of participants • The age of the sample of twenty women

varied between 23 and 49.

• Women of all ages and circumstances are exposed to intimate partner violence, not only those who still have children in the home.

• It is however significant that nineteen (95%) of the participants still had to care for dependent children in their homes.

(Danis and Lee, 2003:28)

Page 18: EMOTIONAL DISTRESS AS ADDITIONAL SUFFERING IN ABUSED … · (Fouché & Schurink, cited in De Vos, 2011:316; Whittaker, 2009:34) •Two non-governmental organisations (NGOs) and one

TRAUMATIC CHILDHOOD

• A significant number of women who report adult partner abuse also often have histories of childhood physical, sexual, and/or emotional abuse.

• Childhood abuse, has been found to have wide-ranging consequences, including post-traumatic stress disorder, anxiety, depression, cognitive distortions, interpersonal problems and low self-esteem.

(Bornovalova et al., 2012; Carlson, McNutt, Choi, and Rose, 2002:724; Flinck et al., 2005 )

Page 19: EMOTIONAL DISTRESS AS ADDITIONAL SUFFERING IN ABUSED … · (Fouché & Schurink, cited in De Vos, 2011:316; Whittaker, 2009:34) •Two non-governmental organisations (NGOs) and one

• Self-destructive behaviours such as suicide attempts and substance abuse, anger, and revictimization might also be some of the consequences.

• Most of the participants (75%) in this study indicated that they had a difficult childhood.

• At least 11 participants (55%) indicated that they were abused or maltreated as children as illustrated by the following accounts:

Page 20: EMOTIONAL DISTRESS AS ADDITIONAL SUFFERING IN ABUSED … · (Fouché & Schurink, cited in De Vos, 2011:316; Whittaker, 2009:34) •Two non-governmental organisations (NGOs) and one

• “My mom and dad were separated. My mom was not so nice with me. She always swore and called me names... still today.” Amy

• “My mom dumped me when I was two. I was also tied up by my step dad and raped. I have been beaten with his fists.... I was sent to a Reformatory. I was 16 when I had my first child. It was my step-dad’s child. The baby was given up for adoption.” Rosy

• “I was an illegitimate child. I always felt that no one cared about me. I was molested when I was 10 years old. I had a ‘wonderful’ mom who ignored everything.” Tina

Page 21: EMOTIONAL DISTRESS AS ADDITIONAL SUFFERING IN ABUSED … · (Fouché & Schurink, cited in De Vos, 2011:316; Whittaker, 2009:34) •Two non-governmental organisations (NGOs) and one

CONTINUOUS FAMILY DISHARMONY • Continuous family disharmony often happens

because of controlling behaviours displayed by abusive men.

• Pressure tactics such as guilt tripping, threats to withhold money and manipulating children all contribute to family disharmony.

(Groves, Kagee, Maman, Moodley and Rouse, 2012; Levendosky and Graham-Berman, 2001:171)

Page 23: EMOTIONAL DISTRESS AS ADDITIONAL SUFFERING IN ABUSED … · (Fouché & Schurink, cited in De Vos, 2011:316; Whittaker, 2009:34) •Two non-governmental organisations (NGOs) and one

• At least 16 of the participants (80%) indicated that they experienced family disharmony whilst in the abusive relationship as gathered from the excerpts below.

• Family disharmony varied from tension because of unfaithfulness (“He has several girlfriends.” Olive),

• behavioural problems with children (“The child of 15 also gives me problems. He is now on TIK” Florry),

• to children witnessing the abuse (“And he always fights in front of our daughter. She is still young.” Beth)

Page 24: EMOTIONAL DISTRESS AS ADDITIONAL SUFFERING IN ABUSED … · (Fouché & Schurink, cited in De Vos, 2011:316; Whittaker, 2009:34) •Two non-governmental organisations (NGOs) and one

• Some children will typically stand up for their abused mother, as confirmed in Kay’s statement (“She would help me by hitting him back”).

• Several authors observe that family disharmony usually contributes to emotional distress of abused women.

Carlson, 1997:291; Flinck et al. 2005:387; Groves, Kagee, Maman, Moodley and Rouse, 2012; Levendosky and Graham-Berman 2001:171; and Mullender and Hague, 2005:1321)

Page 25: EMOTIONAL DISTRESS AS ADDITIONAL SUFFERING IN ABUSED … · (Fouché & Schurink, cited in De Vos, 2011:316; Whittaker, 2009:34) •Two non-governmental organisations (NGOs) and one

DEPRESSION

• Depression is the one of the inevitable consequences of emotional distress.

• A significant number of abused women suffer from depression, which is often ignored or misdiagnosed.

• Research indicates an association between partner violence and women’s depression.

• All 20 participants (100%) indicated that in some or other stage in their abusive relationship they experienced feelings of depression, as can be seen from the excerpts.

(Lourens and Kruger, 2013: 248; Pineless, Mineka and Zinbarg, 2008:170; Wiehe, 1998:91).

Page 26: EMOTIONAL DISTRESS AS ADDITIONAL SUFFERING IN ABUSED … · (Fouché & Schurink, cited in De Vos, 2011:316; Whittaker, 2009:34) •Two non-governmental organisations (NGOs) and one

• Depression varied from feelings of depression (“I get very depressed.” Olive),

• taking medication (“I take medication. I cannot cope without my medicine.” Tina),

• to psychiatric treatment (“I was booked into a clinic where I received psychiatric treatment.” Sally).

• Three participants (15%) had received psychiatric treatment while in the abusive relationship.

• These findings are supported by literature. (Buchbinder and Goldblatt, 2011: 851-873; Callaghan, 1995:12; Leiner, Compton, Houry and Kaslow, 2008: 473-481)

Page 27: EMOTIONAL DISTRESS AS ADDITIONAL SUFFERING IN ABUSED … · (Fouché & Schurink, cited in De Vos, 2011:316; Whittaker, 2009:34) •Two non-governmental organisations (NGOs) and one

POST-TRAUMATIC STRESS DISORDER

• Research showed that battered women reported higher levels of stress than women who did not experience abuse.

• Symptoms like a pounding and racing heartbeat, trembling hands, headaches and sleep problems were common in abused women.

• It is thus clear that domestic violence could contribute to post-traumatic stress disorder.

(Bollen et al., 1999:39; Eby 2004:221; Vetten, 2007)

Page 28: EMOTIONAL DISTRESS AS ADDITIONAL SUFFERING IN ABUSED … · (Fouché & Schurink, cited in De Vos, 2011:316; Whittaker, 2009:34) •Two non-governmental organisations (NGOs) and one

• Ten participants (50%) indicated that they experienced physical symptoms related to PTSD.

• These symptoms varied from a pounding heart (“My heart already beats so fast...” Ivy), trembling hands (“My hands are sometimes very shaky...” Diane), headaches (“I suffer from bad headaches”. Hope) and sleep problems (“I struggle to sleep.” Beth).

Page 29: EMOTIONAL DISTRESS AS ADDITIONAL SUFFERING IN ABUSED … · (Fouché & Schurink, cited in De Vos, 2011:316; Whittaker, 2009:34) •Two non-governmental organisations (NGOs) and one

• Research concurs that post-traumatic stress disorder with symptoms such as anxiety, hyper-vigilance, sleep difficulties, problems with concentration, irritability and feelings of detachment are common in abused women.

• It is clear that female victims of intimate partner violence may develop PTSD and its consequences at an alarming rate.

Eby, 2004:221; Scott-Tilley, Tilton and Sandel, 2010:26 and Krause, Kaltman, Goodman and Dutton, 2008:86)

Page 30: EMOTIONAL DISTRESS AS ADDITIONAL SUFFERING IN ABUSED … · (Fouché & Schurink, cited in De Vos, 2011:316; Whittaker, 2009:34) •Two non-governmental organisations (NGOs) and one

SUICIDAL FEELINGS

• Suicidal thoughts might be more common in abused women than in non-abused women.

• Some women who are in an abusive relationship think of suicide as the only way to escape their situation.

• The fact that domestic violence is often still seen as a private matter enhances the “trapped” feeling of some abused women.

(Bollen et al., 1999:39; Joyner, Theunisen, De Villiers, Suliman, Hardcastel and Seedat, 2007:15)

Page 31: EMOTIONAL DISTRESS AS ADDITIONAL SUFFERING IN ABUSED … · (Fouché & Schurink, cited in De Vos, 2011:316; Whittaker, 2009:34) •Two non-governmental organisations (NGOs) and one

• “I am stressed out. At times I want to kill myself. At one stage things were too much for me. I felt that life was not worth living for.” Meg

• “Sometimes I do not want to live any more.” Amy

• “I do not feel good about myself, because he always belittles me. I don’t like this life.” Cathy

• “I burst into tears... I cannot take it any longer... sometimes I wish I was dead.” Olive

Page 32: EMOTIONAL DISTRESS AS ADDITIONAL SUFFERING IN ABUSED … · (Fouché & Schurink, cited in De Vos, 2011:316; Whittaker, 2009:34) •Two non-governmental organisations (NGOs) and one

• Although it was not directly explored 13 (65%) of the participants indicated that they had entertained thoughts of wanting to end their lives.

• Meg’s statement sums up the general feeling experienced by the 13 participants:

• “I am stressed out. At times I want to kill myself. At one stage things were too much for me. I felt that life was not worth living for.”

Page 33: EMOTIONAL DISTRESS AS ADDITIONAL SUFFERING IN ABUSED … · (Fouché & Schurink, cited in De Vos, 2011:316; Whittaker, 2009:34) •Two non-governmental organisations (NGOs) and one

ATTEMPTED

SUICIDE • At least three (15%) of the 20 participants

indicated that they had attempted suicide to escape from their situation, as can be seen from the excerpts.

• These attempts varied from cutting wrists (“I have already cut my wrists.” Rosy) to an overdose of pills (“I have already taken an overdose of pills.” Beth; “I wanted to kill myself already because of the entire struggle. I have taken an overdose of pills…Twice.” Cathy).

Page 34: EMOTIONAL DISTRESS AS ADDITIONAL SUFFERING IN ABUSED … · (Fouché & Schurink, cited in De Vos, 2011:316; Whittaker, 2009:34) •Two non-governmental organisations (NGOs) and one

• Suicide attempts are often more likely to be reported in women who are abused by their intimate partners than women who are not abused.

• It is estimated that battered women are five times more likely to attempt suicide than non-battered women.

• One study noted that a quarter of their abused participants had attempted suicide.

(Bollen et al., 1999:39; Callaghan,1995:12; Vincent and Jouriles, 2002:86)

Page 37: EMOTIONAL DISTRESS AS ADDITIONAL SUFFERING IN ABUSED … · (Fouché & Schurink, cited in De Vos, 2011:316; Whittaker, 2009:34) •Two non-governmental organisations (NGOs) and one

• On-going family disharmony often occurs as abusive men attempt to control their female partners, and this could be addressed through family counselling and other interventions.

• Depression as a sign of emotional distress in abused women should be dealt with in a multi- disciplinary approach where health care workers could play a meaningful role.

Page 38: EMOTIONAL DISTRESS AS ADDITIONAL SUFFERING IN ABUSED … · (Fouché & Schurink, cited in De Vos, 2011:316; Whittaker, 2009:34) •Two non-governmental organisations (NGOs) and one

• Post-traumatic stress disorder is often an on-going occurrence in abused women’s lives as a result of the violence.

• Health care workers should all have adequate knowledge of and insight into post-traumatic stress disorder and crisis intervention.

• Care of abused women who also present with thoughts of suicide and attempted suicide, should receive a high priority and a relevant intervention plan should be compiled to address this.

Page 39: EMOTIONAL DISTRESS AS ADDITIONAL SUFFERING IN ABUSED … · (Fouché & Schurink, cited in De Vos, 2011:316; Whittaker, 2009:34) •Two non-governmental organisations (NGOs) and one

• Emotional support should be given to abused women by means of counselling or support groups.

• A holistic approach to domestic violence would enable health care workers to address the different needs of abused women and their families.

• A multi-disciplinary team approach including social workers, nursing sisters, doctors psychologists and psychiatrists would be meaningful in rendering services to abused women also addressing their emotional needs.