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

Examples of Co-occurring Disorders

Substance Abuse DisordersMood DisordersSleep DisordersAnxiety DisordersPersonality DisordersSomatoform Disorders

Somatoform Disorders

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

Anxiety Disorders

PTSDAcute Stress DisorderGeneral Anxiety DisordersPanic Disorders

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

Thank you for all that you do !