Essay: Factors of family violence and relationship to mental disorders

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The Rwandan family experiences the violence which contributes to the mental health dysfunction. Violence is one of the consequences of conflicts (Vollmann, 2011& Agsten, 2013). In Rwandan context, we have examples of the men who beat up or kill their wives vice versa and children are witnesses of it, the children beat up or kill their parents, some children are raped by their parents, and some members of family receive the verbal abuse or bad behavioral actions in family area (eg: insults, verbal threats,..). Suffering from this kind of violence (physical, sexual, psychological and economical) has destructive effects on the individual, family and community level. According to Barnett, Miller-Perrin and Perrin (2005), family violence may take the form of intimate partner violence, child abuse, sibling bullying or elder abuse.

This study contributed to identify the factors of family violence and to understand the relationship between family violence and mental disorders among family members in Southern province of Rwanda.The results will be useful in order to establish the adequate strategies of prevention of mental desorders related to the violence in family and providing care to mental disorders patients in needs from violent families.

This study has four chapters: chapter one presents the research problem involving personal experience, Critical Literature Review, family violence theories, model analysis, operationalization of variables, gaps, hypothesis, research objectives and relevance .The chapter two consists of the research method implying research setting,participants,data collection instruments and procedure.The chapter three deals with the results presentation which implies results from descriptive analysis,verification of the hypothesis . The chapter four discusses the results and presents the limits. A conclusion highlights the gaps between the expected results and findings and it presents practical prospects.

1.1. Critical Literature Review
1. 1. 1. Family violence
1. 1. 1. 1. Overview about violence in family
According to Blume (1996), conflict theorists suggest that conflict is a positive force in society and that human groups must handle conflicts in productive ways. Sprey (1974) described the informal mechanisms that traditional community and family structures offered for the management of conflict. For example, in the extended/multigenerational household any conflict between intimates could be mediated by others who were not as intensely involved. Neighborhoods also offered ready access to concerned others who could assist with a family or other dispute. Lacking the support of concerned others, disputants may use violence in an attempt to achieve resolution. A complete systems analysis of violence (see Straus, 1973, for a partial example) would locate sources of violence (a) in the individuals; (b) in dyadic interactions as varied as infant/caregiver and teacher/student; and (c) in family subsystems, neighborhoods, communities, ethnic and religious groups, and the larger society.
Violence, behavior involving physical force intended to hurt, damage, or kill someone or something, is a social phenomenon. For an action to be considered violent, it needs a victim or a group of victims (Hyde-Nolan & Juliao, 2012).
Family violence is violence or abuse of any type, perpetrated by one family member against another family member, including child abuse, partner abuse and elder abuse (Ministry of health of New Zealand, 2016). According to NCJRS (n.d), family violence occurs throughout the country every day. It can include physical, sexual, and financial abuse, child abuse and neglect, and elder abuse.
Family violence may take the form of intimate-partner violence, child abuse, sibling bullying or elder abuse (Barnett, Miller-Perrin and Perrin ,2005).It exist many explanations for family violence: biological/organic, psychopathological, family systems, social learning, and feminist (Cunningham, Jaffe, Baker, Dick, Malla, Mazaheri, al. 1998).According to Gottman (1979) and Mead et al. (1990), the most frequent topics of conflict in marital relationships include communication, finances, children, sex, housework, jealousy, and in-laws (Net Industries, 2017).
National Institute of Statistics of Rwanda, Ministry of Health of Rwanda and ICF International (2016), in cases of violence in family, either person (husband or wife) can be the perpetrator of violence. 33% of women who reported ever having experienced spousal physical or sexual violence suffered from cuts, bruises, or aches; 16 % had eye injuries, sprains, dislocations, or burns; and 7 % had deep wounds, broken bones, broken teeth, or other serious injuries and 29 % of men who had ever experienced spousal physical or sexual violence suffered from cuts, bruises or aches.
Rodrigues, Hall and Fincham (2005) referred to a study by Amato and Rogers (1997) found that being African American was associated with a higher likelihood of marital problems due to infidelity, jealousy, spending money, and drinking/drug use. According to Vollmann (2011) and Agsten (2013), Maslow’s Hierarchy of Needs guide us to identify root causes of conflicts (the need of belong , the need to love, the need of self-esteem, the need for growth). When one or more of these needs is threatened or is different with those of another, a conflict can arise.Sometimes what appears on the surface to be a simple issue can reflect deeper relational struggles about power and intimacy. For years, it has been claimed that male perpetrated domestic violence accounts 95% of intimate partner abuse (Hamberger&Potente, 1995), female perpetrated abuse is minimized and understood as either defensive or situational in nature , an isolated expression of frustration in communicating with an unsympathetic partner in contrast to the presumably intentional , pervasive and generally controlling behaviors exhibited by men(Henning,Jones& Holdford, 2003;Johnson&Leone, 2005). In the intimate partner violence, men are overwhelmingly the perpetrators and women overwhelmingly the victims (Hamel, ‎Nicholls, 2006).
Rodrigues, Hall and Fincham (2005) attested the instability of romantic unions in today’s society and identified predictors of divorce and dissolution. Sociodemographic and life course factors are considered first, followed by a discussion of individual difference factors, and concluding with an exploration of relationship/process variables that predict dissolution: gender, race, society/culture, income/employment, premarital cohabitation, premarital/marital birth, age at marriage, education, length of marriage, remarriage, parental divorce, and religiosity.
Pietromonaco, Barrett and Powers (2006) affirmed that conflict interactions generally induce stress, and they are likely to activate attachment behavior because they often raise concerns about the partner’s emotional availability and responsiveness (see Simpson et al., 1996).
In a postconflict situation, perpetrators of IPV may suffer from mental health problems as much as, or even more than, victims (Verduin, Engelhard, Rutayisire, Stronks, Scholte, 2012). Different forms of family violence
The Ministry of Health (2009) established the national policy on violence against women and children that was referred to several recent studies that demonstrate the extent of violence based on gender and its forms in Rwanda:a study conducted by MIGEPROF in 2004 in Rwanda showed that over 25% of women had been victims of sexual violence during the past five years, over 12% of women had experienced at least one act of physical violence (slapping, punching and kicking) and more than 13% were victims of psychological violence. Most of violence acts against women within their community are committed by their husbands or former partners. Over half of women(51%) revealed acts of violence they suffered and that they were victims of family emotional abuse (which includes deprivation of liberty and health care, confiscation of money, insults and verbal threats) and among these, 31% had been victims of physical violence, with a frequency of 2 to 3 times per year.

The Ministry of Health (2009) reported that 17% of women had an injury or a broken bone due to domestic physical or sexual violence during the last 12 months. Statistics compiled by police from the year 2005 to 2008, more than 6,000 rape cases reported to the Rwandan police, more than three quarters of victims were under 18 years. In this report, children and adolescents interviewed identified 3 main forms of violence: physical, sexual and psychological violence. The report indicated that most violence occurs at home, in the community, in forests and fields. Emotional or psychological violence
According to the Ministry of Health (2009),this violence is characterized by outcry,insults, vulgar remarks, sarcasm, ridicule, humiliation, contempt, threats, isolating the victim, intimidating him/her,to silence him/her or to feign indifference unto him/her, to think and decide for the others,etc. This violence can be committed verbally or non verbally. Examples: threats of murder, physical and social isolation, extreme jealousy and possessiveness, degradation and humiliating, criticism and insults permanent. Economic violence
According to the Ministry of Health (2009), this form of violence is characterized by deprivation of resources or financial means to access them. In the couple or family, it can be expressed through control of some or all financial and material resources of the couple and the family, it could include: depriving the victim of freedom of action, to ban or control his/her access to: food, clothing, transportation,…, to establish or maintain dependency relationship.Examples: Abandonment of the family, prevent access to health care or employment, do not give money to feed children. Physical violence
According to the Ministry of Health (2009), this violence is the form that neighbors of the victim can easily discover, most often they lead victims to consult health facilities.The weapons used are mostly offhandweapons comprising household objects or the use body parts for slapping, kicking, butting, biting, scratches, burns, strangulation,… Sexual violence
Sexual violence is any sexual act or attempt to obtain a sexual act by violence or coercion, acts to traffic a person or acts directed against a person’s sexuality, regardless of the relationship to the victim ( According to the Ministry of Health (2009), sexual violence includes rape, coerced sexual intercourse, sexual intercourse with people who cannot give appropriate consent (children, people with disabilities), sexual harassment in the workplace, preventing someone from using birth control or protection to avoid HIV and STIs. Mugabe (2013) argues that sexual deprivation is a form of sexual violence among spouses. Factors of family violence
Hyde-Nolan and Juliao (2012) explained four main psychological theories which address the causes of family violence (FV): psychoanalytic theories of FV, social theories of FV, cognitive behavioural theories of FV and family and systems theories of FV. Psychodynamic theories of family violence
Three psychodynamic theories are discussed here: object relations theory, attachment theory and violence as trauma. Object relations theory
Hyde-Nolan and Juliao (2012) stipulated that human are motivated from their earliest childhood by need for significant relationships with others.Within objects relations theory, others are referred to as “objects”. The first years of life are extremely important for individuals to ensure the development of adequate emotional health in later life. Individual who lacked sufficient nurturing during infancy and childhood may find it difficult to maintain healthy self esteem, regulate their emotional responses and manage anxiety in later life. As a result, a search to fulfil dependency needs as an adult becomes both desperate and demanding, which could lead to relationships in which one is either an abuser or a victim. Evidence suggests that at least some men who commit intimate partner violence did not receive adequate nurturing in the first year of development. Attachment theory
Hyde-Nolan and Juliao (2012) defined attachment as a reciprocal , enduring emotional tie between an infant and a caregiver, with both parties actively contributing to the quality of the relationship. A child with secure attachment can explore the environment but when the child feels threatened, attachment behaviours are activated and the child will seek out the secure caregiver. Child abuse results in insecure and anxious attachment, which can be avoidant, ambivalent or disorganized. Anxious attachment can be viewed as a marker for later social and emotional problems and is most likely to occur in situation of maltreatment. Secure adults evidence comfort with closeness and intimacy, anxious-ambivalent adults show an excessive concern with closeness and worry that partners will leave, and avoidant adults evidence discomfort with closeness and intimacy (Pietromonaco et al., 2006). Distorted patterns of relating to others lay the foundation for the child’s model of the world, influence how the child responds and may prevent the child from developing a positive internal model of self. Research findings suggest that antisocial behaviour may be linked with early adverse family experiences, especially with patterns of insecure attachment. Several studies also have shown that insecure attachment occurs more often in populations of children who have experienced physical abuse or neglect. Moreover, attachment theory may explain the perpetuation of child maltreatment from one generation to the next. A central tenet of attachment theory is that a person’s attachment pattern in adulthood is a reflection of his or her attachment history (Hazan &Shaver, 1987). Violence as trauma
Hyde-Nolan and Juliao (2012) clarified how an individual incorporates internal defenses into his or her personality structure and how those defenses affect interpersonal relationships.Victims of abuse process this experience as a traumatic event, much like the response of individuals who suffer from post-traumatic stress disorder.The psychobiology explanation of post-traumatic stress offers shown why victims of abuse seem to experience abusive situations repeatedly.Victims of abuse appear to have a compulsion to repeat the trauma due to the inability to integrate their memories of abuse , as well as to incorporate their abusive experiences into their larger memory structure.
In this model,the trauma is repeated emotionally,behaviorally, physiologically and via the neuroendocrine (i.e.,fight or flight patterns) pathways for abused individuals.Victims of abuse emotionally repeat the trauma by aligning themselves with people who will continue to abuse them in the same way and behaviourally repeat the trauma through repetition, re-enactment and displacement of the abusive experience. A result, victims remain vulnerable to further situations of abuse because they are unable to defend themselves. Social theories of family violence
Four social theories of FV are discussed: control theory, resource theory, exosystem factors theory and social isolation theory Control theory
Hyde-Nolan and Juliao (2012) argued that many family conflicts result from an individual’s need to obtain and maintain power and control within a relationschip(s). The motivation underlying the abuser’s behaviour is the power and control that she or he is able to exert over other members of the family.The more powerful members of families (e.g., fathers, parents, husbands) often use the threat or use of force or the threat or use of violence to obtain compliance from less powerful family members (e.g.,children, wives). Threats, force and violent behaviours are intended to prohibit the less powerful members of the family from engaging in behaviour that the controlling individual does not want,while establishing a demand for “desirable” behaviours to occur.The abuser may feel the need to gain control over how other family members of the family think and feel. Abusers, in an effort to maintain control over other members of the family, may use many forms of intimidation, such us coercion, isolation, economic abuse and denial of personal blame. The victim(s) typically learn how to respond to the various forms of intimidation, although the struggle to challenge the abuse/abuser may become too overwhelming or dangerous for the victim(s). As a result, the victim(s) may begin to modify his/her/their own behaviour, slowly giving up control in order to survive and avoid continued abuse. Isolating the victim from any social contacts may be the most harmful form of intimidation the abuser uses because the possibility of escape for the victim(s) is greately reduced in the absence of social support.
Mugabe (2013) identified patriarchy, power and culture as the root causes of Gender based violence in Rwanda. Patriarchy is a structural force that influences power relations, whether they are abusive or not. Resource theory
Hyde-Nolan and Juliao (2012) explained in the following way, a relationship between wealth and violence: men with high income and social standing have access to a wide variety of resources with which to control their wives behavior and men with limited or no wealth and resources may resort to physical force or violence more quickly. Exosystem factor theory
According to Hyde-Nolan and Juliao (2012) the life stressors are specific life events or experiences that are perceived by the individual as exceeding his or her resources. Stressors/or life events, can serve as predictors of FV stressors/life events may include experiences such as job loss, an extramarital affair, moving to a new home, or daily hassles such as traffic and paying bills. There may be a direct relationship between hunsband-to- wife violence and the perception and the frequency of stressors. Stress results in FV only when other specific factors are present, including a personal history of growing up in a violent family, low material satisfaction and social isolation. Social isolation theory
Hyde-Nolan and Juliao (2012) affirmed that child abuse and neglect are associated with isolation of the parent- child relationship from social support systems. Based on this perspective, understanding child maltreatment requires looking beyond high risk families to neighbourhoods and larger systems that have higher rates of child maltreatment. Family problems were considerably worse when were isolated rather than part of a community. Cognitive/behavioral theories of family violence Social learning theory
Hyde-Nolan and Juliao (2012) stipulated that individuals learn social behaviors by observing and imitating other people. The individuals become aggressive toward family members because their aggressive behaviour is learned through operant conditioning and observing behavior in role models. Operant conditioning is the strengthening of behaviours through positive and negative reinforcement, as well as the suppression of behaviours through punishment. Research points to both short-and long-term negative effects associated with physical punishement, such as increased physical aggressiveness, antisocial behavior, poor parent-child relationships during childhood, aggression, criminal behavior, mental health problem, and partner or spousal abuse in adulthood.Several studies have indicated that individuals who were abused in childhood are at greater risk for abusing their own children in adulthood. Men who observed their fathers abusing their mothers when they were children are at an increased risk for abusing their wives.Researchers have found that young adults who observed and experienced abuse when they were children are more likely to be in an abusive intimate relationship as either abuser or victim. Behavioral genetics
According to Hyde-Nolan and Juliao (2012), a reviewed of the behavioural genetics literature demonstrated that the characteristics of aggression and antisocial behaviour seem to be genetically influenced. Both heredity and environment impact the perpetuation of Family violence from one generation to the next. Reactive aggression
According to Hyde-Nolan and Juliao (2012) justified the theory of reactive aggression which focuses on emotional and cognitive processes leading to behavioural responses .The following events occur when an individual experiences an unpleasant situation:an aversive stimulus results in a negative emotional response, the negative emotional responses then leads to an urge to hurt others or thoughts of hurting others and the urge to hurt results in aggressive behavior unless inhibiting factors are present.The desire and thoughts may be immediately followed by rage and violent behaviours towards their spouses unless something happens to derail them. Learned helplessness
Hyde-Nolan and Juliao (2012) clarified reasons why victims of family violence often choose to stay in somewhat unpredictable and volatile family relationships.The theory of learned helplessness explained the loss of will that accompanies repeated barriers to escape from an aversive situation. Hyde-Nolan and Juliao (2012) referred to Seligman findings: sometimes dogs would learn that their behaviours did not bring about the expected or desired outcome in situations where barriers (electric shock) were present. As a result, the dogs would stop engaging in the behaviour even once the barriers were removed. Much like the dogs that learned to be helpless after being subjected to electric shocks with no ability to escape, battered women may fall into the same pattern. Experiencing repeated beatings or other abuse may lead a woman to become passive because she feels that nothing she does will result in positive outcome. Family and systems theories of family violence
Hyde-Nolan and Juliao (2012) explained family and systems theories focus on the family unit and individual behaviours within the context of interpersonal relationships, family systems, and larger societal systems, as well as how these relate to the formation and maintenance of FV. Family unit consists only of husband, wife and children, without grandmothers, uncles ,etc.(Longman dictionary,1999).The detailed discussion of three family and system theories are followed: family systems theory, family life cycle theory and microsystem factor theories (including the sub-theories of intrafamilial stress and dependency relations). Family systems theory
Hyde-Nolan and Juliao (2012) justified family systems theory based on the idea that each individual should be viewed not in isolation but in terms of interactions, transitions and relationships within the family. A central tenet of this theory is that what affects one individual affects the entire family system and what affects the family system affects each member as well. Family systems theory provides a framework for observing and understanding general characteristics of human relationships, individual functioning within the nuclear family, ways in which emotional problems are transmitted to the next generation, which is particularly important when attempting to understand FV. It is important to remember that the family system is a sub- system within larger systems, such as the community, which interact with and influence one another and contribute to the maintenance of particular patterns of behaviour. Family life cycle theory
Hyde-Nolan and Juliao (2012) affirmed that, to understand families, we must examine transition in the family experience. At its early inception, family life cycle theorists divided family development into discrete stages, with specific tasks to be performed at each stage. These stages tend to coincide with family members entering and exiting due to marriage, death, addition of a child,or a young adult leaving the parental home.Approximately the family life cycle includes six stages: single young adulthood,joining of families(the new couple), families with young children,families with adolescents,families launching children and moving on, and families in later life.The stress that results from life cycle transitions can lead to violence within the family system. The most dangerous time in a FV relationship occurs during marital/ partner separation when serious physical harm or death is more likely to occur. Microsystem factor theories
Hyde-Nolan and Juliao (2012) insisted on stresses that inherently exist within the family as a social structure. The interactions between the developing individual and the immediate setting (e.g., home, school) where the individual interacts with others.The two microsystem factor theories that are discussed next are intrafamilial stress theory and dependency relations theory. Intrafamilial stress theory
Hyde-Nolan and Juliao (2012) showed the different factors which contribute to intrafamilial stress such as having more children than the parents can afford overcrowded living conditions, and having children with disabilities.These situations can place a significant burden on the family system, particularly in terms of time and resources, which may contribute to violent behaviour.The ecological perspective indicates that intrafamilial stress and beliefs regarding parenting also may interact. The association between parental stress and the risk of child abuse varies as a result of the parent’s belief in implementing corporal punishment. Dependency relations theory
Hyde-Nolan and Juliao (2012) explained the role of dependency in FV has been found in child, elder, and spousal abuse.Based on the concept that victims of abuse are dependent on their abusers, children remain dependent on their abusers because they tend to be smaller and weaker than adults and are unable to escape from an abusive family or violent neighbourhood or support themselves. Some elderly become frail, sick, dependent and difficult to care for, which results in stress for their caregivers and dependency on their abusers. Even some well-meaning caretakers, who are most often relatives, may lose control when under stress and become abusive toward their elderly family members. Some older people may become dependent on family members for basic care, which may be a risk factor for abuse.In spousal abuse, economic dependency may be a reason that explains why many woman stay in abusive marriages.Maltreated wives may have little or no income of their own and thus may believe that they would not be able to support themselves or their children if they were to leave the abusive relationship. Hyde-Nolan and Juliao (2012), complex behaviors,complicated thinking patterns, individuals psychologies and the interactions among individuals and systems all can play a role in FV.
Mutabaruka (2016) showed that Bateson would always return to the idea of communications and relations or interactions between and among people ; the behavior of person X affects person Y, and the reaction of person Y to person X’s behavior will then affect person X’s behavior, which in turn will affect person Y, and so on. Bateson called this the “vicious circle”. He then discerned two models of schismogenesis: symmetrical and complementary. Symmetrical relationships are those in which the two parties are equals, competitors, such as in sports. Complementary relationships feature an unequal balance, such as dominance-submission (parent-child), or exhibitionism-spectatorship (performer-audience).Bateson studied the people of the Balinese village Bajoeng Gede and later described the style of Balinese relations as stasis instead of schismogenesis. Their interactions were “muted” and did not follow the schismogenetic process because they did not often escalate competition, dominance, or submission. According to Morin, antagonisms suppose and reduce any connection or any integration. Family violence and mental disorders Trauma and Post Traumatic Stress Disorders What is trauma?
Baessler (2014) explained trauma through historic perspective:trauma was first introduced in the DSM-III as a catastrophic stressor that would evoke significant symptoms of distress in most people.It was characterized as a rare and overwhelming event that had a more powerful effect than common experiences such as bereavement, chronic illness, business losses or marital conflict.Traumatic events in the DSM-III included rape, torture, incarceration in a death camp, exposure to civil war and others.The concept of trauma was reviewed in the 1994 publication of the DSM-IV;as a result, the definition of trauma was expanded to include both the overwhelming event itself and the person’s psychological response to it.The way it was first understood, anyone who was exposed to war, rape, torture, etc. would be traumatized.
Trauma and PTSD have existed throughout human history and long before the DSM included them in its inventory.For about 200 years before 1994, the psychiatric symptoms of traumatized people were diagnosed as Shell Shock, Combat Fatigue, War Neurosis, etc.Clinicians who were treating trauma survivors, both military and civilian, were struck by the strong physiological and psychological symptoms they were exhibiting.An event is therefore considered traumatic and capable of producing PTSD, in cases where a person has an intense emotional response to it consisting of overwhelming fear, helplessness, horror.
However, by 1994, it was recognised that most of the people who are exposed to traumatic events do not develop PTSD. DSM-V brought main changes about trauma: the traumatic response has been removed,a fourth category of symptoms was added: negative cognitions and mood (e.g. persistent self-blame or blaming others),sexual violation is a specific traumatic stressor,the exposure no longer needs to be direct (the person can have learnt about a traumatic event that happened to a close family member or close friend),more attention is paid now to :PTSD in children,the military,dissociative symptoms. .Kinds of trauma
Baessler (2014) explained three kinds of trauma: primary trauma, secondary or vicarious trauma and trans-generational trauma.
1. Primary trauma: directly experiencing the traumatic event.
2. Secondary or vicarious trauma is characterized by the following elements: the traumatic event didn’t happen to you,you learn about it because somebody tells you what happened to them, you read about the traumatic event, you see pictures, you watch a movie, but your own life was never in danger,the symptoms that you develop can be similar to those of primary trauma,however, they are usually weaker and vanish more quickly.
According to Mathes (2011), CAPACITAR work in most of the countries showed how vicarious or secondary trauma is another level of trauma encountered in a broad cross section of people:caregivers, social workers, teachers, medical professionals, psychologists, trauma workers, police, military, humanitarian or aid workers, religious, community and development leaders, hospice workers, HIV/AIDS caregivers and those serving the impoverished in their communities. Even if these persons have not been exposed directly to a traumatic or life-threatening event, they can still begin to manifest traumatic stresss symptoms.
3. Trans-generational trauma
Baessler (2014) affirmed that trans-generational trauma occurs when a trauma is transferred from the first generation of trauma survivors to younger generation(s).
According to Mathes (2011) argued that when trauma is viewed at a systemic or global level, intergenerational and cultural patterns, as well as religious and social mores, can be seen as contributing factors. Our lives mirror our family and societal histories. In many families and cultures trauma is often repeated from generation to generation. The Scriptures speak of the “sins of the fathers affecting the third generation.” The indigenous peoples counsel us to remember that “whatever we do affects all beings to the seventh generation. Sandra (1997) also has studied how traumatic affect gets passed on to each successive generation”. Consequences of trauma is PTSD
 Definition of PTSD
For difining PTSD, the following elements are considered:
1. Traumatic experience: the person experienced or witnessed an event that involved actual or threatened death or serious injury to self and/or others (Kӧbach & Elbert , 2015).
Baessler (2014) clarified that after the traumatic event, the following symptoms are present:
1. Re-experience (distressing memories, nightmares and flashbacks)
2. Avoidance / Numbness(avoiding stimuli associated with the event, inability to remember, loss of interest in previously pleasurable activities, feeling of detachment from others, loss of strong emotions)
3. Hyperarousal (insomnia, hypervigilance, irritability, exaggerated starting responses, loss of concentration).
4. Duration of these symptoms: more than a month
5. Strong negative impact on daily life
Kӧbach and Elbert (2015) clarified how to conduct the diagnosis of posttraumatic stress disorder based on different criteria such as:
A CRITERIA: Exposure to actual or threatened death, serious injury or sexual violence in one (or more) of the following ways: directly experiencing the traumatic event, witnessing in person, the event(s) as it occurs to others,learning that the traumatic event happened to a close family member or close friend(in cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental), experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse) unless this exposure is work-related.
B CRITERIA: Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: recurrent, involuntary and intrusive distressing memories of the traumatic event(s), recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s), dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring (such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings), intense of prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s),marked physiological reactions to internal or external cues that symbolize of resemble an aspect of the traumatic event.
C CRITERIA: Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic (event(s) occurred, as evidence by one or both of the following: avoidance of or efforts to avoid distressing memories, thoughts, of feelings about or closely associated with the traumatic event(s), avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
D CRITERIA:Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:inability of remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs),persistent and exaggerated negative beliefs or expectations about oneself, others, of the world (e.g., “I am bad”, “No one can be trusted”, “The world is completely dangerous”, “My whole nervous system is completely ruined”),persistent, distorted cognitions about the cause of consequences of the traumatic event(s) that lead the individual to blame himself/herself or others, persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame), markedly diminished interest or participation in significant activities,feelings of detachment or estrangement from others, persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings)
Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects, reckless and self-destructive behavior, hypervigilance, exaggerated startle response, problems with concentration, sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).
F CRITERIA: Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month.
G CRITERIA: the disturbance causes clinically significant distress or impairment in social, occupational or impairment in social, occupational or other important areas of functioning.
H CRITERIA: the disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.
According to Munyadamutsa & Mahoro (2008), the prevalence of PTSD in Rwanda is 28.54% (female: 32, 01%, male: 23, 57%).
Spousal abuse has serious psychological and emotional consequences, including post-traumatic stress disorder, depression, and low self-esteem. In addition, when there are children involved, battering appears to be related to serious behavioral problems, as well as emotional and cognitive developmental difficulties (Gortner,Gollan, Jacobson,1997).
Mugabe (2013,p:94) identified five consequences of gender based violence emerged as the most important such as : sexually transmitted infections including HIV (78.6%),unwanted pregnancies (46.1%), death (30.0%); trauma and other psychological problems (25.2%); family conflict (23.1%).
According to Jacqueline (1999), prevalence of mental health problems among battered women was 47.6% in 18 studies of depression ,17.9% in 13 studies of suicidality, 63.8% in 11 studies of posttraumatic stress disorder (PTSD), 18.5% in 10 studies of alcohol abuse, and 8.9% in four studies of drug abuse. Criteria of major depressive disorder
Kӧbach and Elbert (2015) identified the following criteria of major depressive disorder:
A: 1. Depressed mood nearly every day (e.g., feels sad, empty, hopeless, appears tearful) .In children or adolescents, can be irritable mood.
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
3. Significant weight loss when not dieting of weight gain or decrease of increase in appetite nearly every day. In children, consider failure to make expected weight gains.
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day
6. Fatigue of loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
9. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt of a specific plan for committing suicide.
B: The symptoms cause clinically significant distress or impairement in social, occupational, or other important areas of functioning.
C: The episode is not attributable to the physiological effects of a substance or to another medical condition.
D: The occurrence of the major depressive episode is not better explained by schizoaffective disorder, etc
E: There has never been a manic episode or a hypomanic episode.
According to Munyadamutsa & Mahoro (2008), prevalence of depression in Rwandan population is 20.49%.
According to (2010), children who frequently witness violence between their caretakers have increased risk of mental health problems such as depression, anxiety and posttraumatic stress disorder.
Spousal abuse has serious psychological and emotional consequences, including post-traumatic stress disorder, depression, and low self-esteem. In addition, when there are children involved, battering appears to be related to serious behavioral problems, as well as emotional and cognitive developmental difficulties (Gortner,Gollan, Jacobson,1997). Anxiety disorders
According to American Psychiatric Association (1994), anxiety disorders contains these disorders: panic attack disorder, agoraphobia, specific phobia, social phobia, generalized anxiety disorder,…
Van Heugten and Wilson (2008) found the links between exposure to intimate partner violence and increased mental health problems such as depression, anxiety and post-traumatic stress disorder (Fergusson & Horwood, 1998; Fleming, et al., 2007; Humphreys, 2001; Margolin & Vickerman, 2007; Martin, Langley, & Millichamp, 2006; O’Keefe, 1996). Also more prevalent are addictions and suicide attempts, and behaviour problems including truancy. Links have been found between youth offending and aggression and exposure to intimate partner violence as children or adolescents (Fergusson & Horwood, 1998; Fleming, et al., 2007; Herrera & McCloskey, 2001).
According to (2010), children who frequently witness violence between their caretakers have increased risk of mental health problems such as depression, anxiety and posttraumatic stress disorder.Also more prevalent are addictions and suicide attempts, and behavior problems including truancy. In addition, they note, researchers have found higher rates of youth aggression and criminal behavior among adolescents who have been exposed to parental violence. Antisocial Personality Disorder
According to American Psychiatric Association (1994),Antisocial Personality Disorderis a pattern of disregard for, and violation of, the rights of others.
Diagnostic criteria for Antisocial Personality Disorder:
A. There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three (or more) of the following:
1) Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest.
2) Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
3) Impulsivity or failure to plan ahead.
4) Irritability and aggressiveness, as indicated by repeated physical, fights or assaults.
5) Reckless disregard for safety of self or others
6) Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
7) Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.
B. The individual is at least age 18years.
C. There is evidence of conduct disorder with onset before age 15 years.
When there are children are involved in Spousal abuse, battering appears to be related to serious behavioral problems, as well as emotional and cognitive developmental difficulties (Gortner,Gollan, Jacobson,1997).
Patrick (2010) explained a triarchic model. Psychopathy encompasses three distinct phenotypic constructs: disinhibition is tendencies toward impulsiveness, irresponsibility, oppositionality, and anger/hostility; boldness defined as the nexus of high dominance, low anxiousness, and venturesomeness; and meanness is tendencies toward callousness, cruelty, predatory aggression, and excitement seeking.
McAdams and Foster (2009) affirmed that the family is a central factor in the development and reduction of antisocial behaviors and delinquency. Consequently, school-based interventions to strengthen positive family involvement seem best suited to address the current trends in youth aggression and unmet mental health needs (Epstein, 2001). Schools and mental health centers report an increase in children who display externalizing behavior problems, which refers to a range of rule breaking behaviors and conduct problems, including physical and verbal aggression, defiance, lying, stealing, truancy, delinquency, physical cruelty and criminal acts.

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