Talleres de promoción de buenos tratos en un hospital de alta complejidad / Workshop to encourage good manners in a tertiary care hospital

En los últimos años hubo un incremento en las consultas por violencia familiar en el Hospital de Pediatría Juan P. Garrahan. Reconociendo este hecho como un problema de salud, se decidió implementar talleres en salas de espera con el objetivo de visibilizar este fenómeno. En los mismos se realizan actividades de sensibilización y concientización con pacientes y sus familias sobre los buenos tratos en la infancia y vínculos respetuosos en la pareja. Se pretende con este escrito relatar la experiencia de los talleres de promoción de buenos tratos, planteando el desafío de coordinar acciones que permitan visibilizar la problemática y actuar en consecuencia, fomentando la reflexión de los profesionales de la salud (AU)

Over the past years there has been an increase in consultations at Hospital de Pediatría Juan P. Garrahan because of family violence. As the entity is recognized as a health problem, workshops were implemented in the waiting rooms to visualize this phenomenon. During these workshops, activities of sensitization and awareness building were conducted with the patients and their families about good manners in childhood and respectful bonds in the couple. The aim of this report was to present our experience with the workshops of good manners considering the challenge of coordinating actions that allow visualization of the problem and act on it, encouraging reflections of the health care professionals (AU)

Violencia de Pareja y Alexitimia en Mujeres Neoleonesas / Couple Violence and Alexithymia in Women from Nuevo Leon

Esta investigación tuvo como objetivos estimar los niveles de alexitimia y violencia de pareja (recibida y ejercida) en mujeres, asimismo estudiar la relación entre alexitimia y violencia. La escala de alexitimia de Toronto (TAS-20) y el Cuestionario de Violencia en la Pareja fueron aplicados a una muestra no probabilística de 118 mujeres mexicanas con pareja heterosexual. Se encontró alexitimia (TAS-20 ≥ 61) en el 42% de las mujeres, violencia recibida en el 25% y de violencia ejercida en el 5%. La violencia recibida fue mayor que la ejercida. La alexitimia se asoció con la violencia, más con la violencia recibida que con la ejercida. Se observó un patrón de violencia reactiva en el que la alexitimia actúa como un factor de riesgo. Esto probablemente se deba a los problemas de ajuste y control que la alexitimia conlleva. Se aconseja evaluar la alexitimia en los estudios e intervenciones en violencia de pareja.

The aims of this paper were: 1) to estimate the levels of couple violence (received and exercised) and alexithymia among women, and 2) to study the relationship among alexithymia and violence. The Questionnaire of Couple Violence and the 20-item Toronto Alexithymia Scale (TAS-20) were applied to a non-probability sample of 118 Mexican women with a heterosexual partner. Mean of age was 35 years old (SD = 10) ranking from 18 to 57. Regarding marital status, 53 of 118 women (45%) reported being married, 28 (24%) separated, 21 (18%) in free union with a partner, 11 (9%) single, 4 (3%) divorced and 1 (1%) widow. Indices of received violence and exerted violence that vary from 0 to 100 were calculated multiplying reported frequency by reported damage. Comparisons of means for Student's t-test, linear correlations, linear regression and path analysis were use for data analysis. Alexithymia (TAS-20 total scores ≥ 61) was found in 42% of women, received violence in 25% (scores of received violence index ≥ 30), and exercised violence in 5% (scores of received violence index ≥ 30). The mean of index of received violence was higher than the one of index of exerted violence (t[117] = 4.15, p < .01). Alexithymia was associated to violence. Its correlation was higher with received violence than with exerted violence. A reactive violence pattern was observed in which alexithymia acts as a risk factor. In this path model, alexithymia (TAS-20 total score) determined both the received damage as the index of exerted violence. The received damage determined the index of exerted violence. The variable of level of education was added as a determinant of the index of exerted violence, owing to model ran out degrees of freedom with only one variable exogenous (alexithymia).The model explained 21% of the variance of exerted violence and 19% of the variance of received damage with a close fit to the data (χ2 [1, N = 118] = 0.14, p = .71, GFI = 1, AGFI = .99, NFI = 1, CFI = 1, and RMSEA = 0). This relationship among alexithymia and violence could probably be due to the adjustment and control problems that alexithymia involves. It is suggested to assess alexithymia in new studies and interventions in couple violence.

Diferencias de género en afrontamiento y violencia en la pareja / Gender differences in coping and violence in couple relationships

Este artículo tiene como objetivo estimar diferencias de género en el afrontamiento de problemas de la pareja y estudiar su relación con violencia en este contexto. Se realizó un estudio ex post facto transversal. A una muestra no probabilística de 223 mujeres y 177 hombres mexicanos con pareja heterosexual (51.5% mantenían relaciones de noviazgo, 47.5% estaban casados y 1% vivían en unión libre) se les aplicó la Escala de Estrategias de Manejo de Conflictos y Cuestionario de Violencia en la Pareja. Se observó una prevalencia del patrón de agresor activo, en el que la persona es incapaz de modificar su postura, adopta estrategias de evitación ante el conflicto y aparenta acomodarse, pero finalmente ejerce violencia contra la pareja, la cual reacciona con violencia cuanta más pasividad el agresor mostró durante el conflicto. Este modelo es válido para ambos géneros, aunque posee más potencia explicativa en hombres. Se hacen sugerencias para enfocar la terapia.

This paper aims to estimate gender differences in coping with couple relationships problems and studying its relation with violence in this context. A cross-sectional ex post facto study was carried out. The Scale of Conflict Management Strategies and Couple violence questionnaire were administered to a non-probability Mexican sample of 223 women and 177 men with heterosexual couples (51.5% of participants were dating relationships, 47.5% were married and 1% lived with a partner). Scale strategies for conflict management and violence in couple relationships questionnaire was applied. It was observed an active aggressor pattern, where the person is unable to modify his/her position and adopts evasive strategies before the conflict and seems to be fit. But finally violence appears against the couple, who reacts with violence the more passivenesses the aggressor showed during the conflict. This model is valid for both genders, though it has more explanatory power in men. Some suggestions to conduct the therapy were made.

Amor y violencia: otro coctel neuropatológico en el siglo XXI / Love and violence: another neuropathological cocktail in the XXI century

La violencia es una de las primeras causas de muerte en el mundo; paradójicamente, el principal generador de violencia es el mismo sitio donde usualmente se fundamenta el amor y la adecuada relación de pareja, esto es, el hogar. Aunque generalmente se asocia a la mujer como principal víctima de la violencia intrafamiliar, se ha notado un incremento de violencia contra los hombres, y en algunos países la proporción de agresión entre géneros es similar. El principal detonador de discusiones conyugales son los celos, que cuando se tornan patológicos los transforman en suspicacia, la suspicacia en odio, el odio en locura y la locura en desesperación y violencia, todo esto provoca víctimas mortales en forma de homicidios o suicidios. En Colombia se ha incrementado la relación patológica de amor y violencia en las relaciones de pareja, lo cual ha llevado a que en instituciones tan importantes para el funcionamiento de un país como las Fuerzas Militares se hayan implementados programas de apoyo psicológico específico con el fin de disminuir el índice de suicidio en este grupo laboral, entre muchos otros más. De otro lado, diversas investigaciones han encontrado alteraciones neurobiológicas en individuos violentos, incluyendo trastornos neuroanatómicos, genéticos y bioquímicas. Tratamientos farmacológicos y no farmacológicos que incluyen terapias de comportamiento y que tratan al individuo de manera tridimensional (cuerpo, mente y espíritu) parecen ayudar a promover un ambiente más amable para la vida en pareja que el conocido a la fecha de violencia intrafamiliar basada, un sinnúmero de veces, en dolorosas y evidentes evidencias...

Violence is one of the main causes of death worldwide; however, the main place of violence is the same where love and appropriate relationships usually resides, it is at home. Although women are considered the main victim in spousal violence, an increase of violence against men has also been recently reported; in some countries, the co-abuse is almost similar. The main triggers of conjugal violence are pathological jealousy which, if pathological, evolves toward suspicion, malevolence, craziness, madness, despair, and violence leading it to both homicides and suicides. In Colombia, the pathological linkage of love and violence is also present countrywide; it has lead to implement, in some specific social groups such as the army, newer psychological supports to help people to decrease the frequency of suicides in these social groups, among others. On the other hand, different investigations have shown neurobiological abnormalities in violent people including anatomical, genetic and biochemical markers. Pharmacological and behavioral approaches have been suggested to control violence. Among these, a tri-dimensional approach that look for homeostatic mind, body and spirit relationships seem to be helpful in providing a more harmonic atmosphere to couples and may be very useful to overcome domestic violence which until now is based in outstanding, albeit painful, evidences...

¿Violencia episódica o terrorismo íntimo? Una propuesta exploratoria para clasificar la violencia contra la mujer en las relaciones de pareja / Episodic violence or intimate terrorism? An exploratory proposal to classify violence against women in the context of intimate couple relationships

Introduction The concern of this paper comes from a reflection on the phenomenon of violence against women in the context of intimate couple relationships. Even though studies dealing with the issue tend to focus on the presence of physical violence, it should not be forgotten that in the same relationships several types of emotional and sometimes sexual violence may co-exist. Violent men intentionally aim to create a threatening climate against women. To do so, they resort to devaluations, insults, threats, maltreatment, shouting, contempt, intolerance, humiliations, jealousy and accusations. Nevertheless, women are often unaware of many of them given the social tolerance towards overall abuse and the lack of institutional alternatives. There are, however, some difficulties to operationalize these behaviours. It is particularly difficult to measure the characteristic pattern followed by these relationships as this may involve very subtle forms of violence. Likewise, results obtained in the physical and psychological dimensions are usually kept as separate areas or they are presented at best in a mixed form to show the prevalences from the different surveys carried out. This article is a theoretical and statistical exercise aimed at constructing a typology of male violence against women. Its starting point is a proposal posing that in heterosexual relationships two types of violence are present. The first one may be called episodic violence, where one or both members of the couple carry out some violent act without the desire to control or dominate the other partner. In the other one, defined as intimate terrorism, the man acts out with the clear purpose of exerting both a violent and non-violent control and dominion over the woman's actions, thoughts, and emotions. Although it is certainly arguable, it might be interesting to analyze this classification for it is risky to suppose that there are couple relationships where a symmetry in the use of violence exists both on the part of men and women -that is, that women are as violent as men. It is risky because it distorts violence's gender nature by presupposing that the same behaviour may be exerted with the same physical and symbolic strength and that it will have similar consequences. However, we think it is worth taking it into account as a starting point for this analysis. To do so, a database derived from a study conducted among a sample of women attending general medical consultation was used. The main analysis axis was the indicator of having experienced a physically violent behaviour on the part of the partner during the last year. This was related to five emotional violence dimensions which represent different modalities as to their intentionality and impact. The groups thus formed were analyzed considering some variables which were previously regarded as associated to this form of violence, including demographic features, and some other features related to household income participation and the distribution of household keeping chores in the women's families. Specific features regarding the violent relationship, such as the motives behind the physical violence episodes and the role played by alcohol abuse on the part of the male partner in these episodes, were also considered. Method A database derived from a transversal ex post facto study conducted with a 345-women sample attending first-time or subsequent medical attention in a first level institution was analyzed. A structured questionnaire made up of different areas was applied. The following areas were included in this study: 1. Socio-demographic variables from each woman, her male partner and her family. 2. A violence severity scale containing 22 different types of physically violent behaviours from men against women, and 36 emotional violence types. A previous analysis of the latter showed five conceptually congruous dimensions: Devaluation, Threatening behaviours, Intimidation, Hostility, and Abusive expectations. 3. Features of both the relationship and the violent episodes. 4. Alcohol abuse on the part of the partner. To construct the typology, women who had experienced at least one physical violence attack by their partners during the last twelve months were classified, regardless of the frequency and severity of such behaviour. With this sub-sample, a multidimensional escalation analysis was performed with the five emotional violence dimensions reported and these were considered as <>. Decisions were then taken as to the configuration obtained and the women were classified in three groups considering both the presence and severity of the physical violence experienced and the frequency of the different forms of emotional violence. Based on these groups classification, variance and chi square analysis were carried out with the variables selected to observe whether these effectively differentiated the women from each group. Results The resulting emotional violence dimensions allowed us to obtain a typology of the sub-sample of women who had experienced physical violence (30% of the total). With this, three groups were formed: 1. episodic physical violence, including women who did not report any threats nor intimidation or devaluation (12.5%); 2. intimidating physical violence, including women who reported threats and intimidation and some or no devaluation (12.5%), and 3. intimate terrorism, which refers to women who suffered very frequent threats and intimidations together with occasional to frequent devaluations (5%). The latter is the highest risk group. Women belonging to this group were older (35 years) than those from the other two groups and so were their partners (40 years). They reported having more children and having lived longer with the abusing partner. Three out of each five had a paid job, mainly informal, and took charge of the money income responsibility of their households. Male partners were the main income providers only in 40% of the instances. Role genders in these families were very traditional as the male partners seldom helped with household keeping cores. Male partners had alcohol abuse-related problems and, in fact, one out of each three got aggressive when he had had any alcohol. The main reasons behind physical violence were male drunkenness, jealousy, and women protecting their offspring. At the other end are the women we classified in the episodic violence group. These were the youngest in the study even when compared to non-abused and intimidating violence victims. These women and their couple's household income participation, and the family members' participation in household keeping cores were similar to those in the no violence group. Their partners had also used alcohol in a comparable amount to that of the intimidating violence group. The main reasons underlying physical violence were male anger and male jealousy, and drunkenness to a lesser degree. Conclusions A considerable amount of women, nearly one out of each three, had experienced some form of physical violence in their couple relationship during the last year, and one out of each five had suffered violence in an abusive context of threats, intimidation and devaluation. Given this, it is important to focus on any type of physical violence as a part of a primary preventive perspective.

El presente trabajo es un ejercicio teórico y estadístico para construir una tipología de la violencia masculina hacia la mujer. Parte de una propuesta que plantea que en las relaciones heterosexuales ocurren dos tipos de violencia física. Uno de éstos puede denominarse violencia episódica, donde uno o ambos integrantes de la pareja realizan algún acto violento sin que esté presente el deseo de controlar o dominar al otro integrante. En el otro, definido como terrorismo íntimo, el hombre actúa con una clara intención de ejercer un control y dominio tanto violentos como no violentos sobre las conductas, pensamientos y emociones de la mujer. Los grupos construidos se analizan según algunas variables que previamente se ha considerado que se pueden asociar con esta forma de violencia, como las características demográficas, las características relacionadas con la participación económica y la distribución de las labores domésticas en las familias de las mujeres y las características específicas de la relación violenta, en particular el uso de alcohol por parte de la pareja. Método Se analizó una base de datos derivada de un estudio transversal y ex post facto realizado con una muestra de 345 mujeres que asistieron a atención médica de primera vez o subsecuente a una institución del primer nivel en el Distrito Federal. Para construir la tipología, se eligió a las mujeres que habían sufrido al menos una manifestación de violencia física por su pareja en los últimos 12 meses, y se realizó un análisis de escalamiento multidimensional a partir de cinco dimensiones de la violencia emocional. Con base en la clasificación de grupos, se realizaron análisis de varianza y de chi cuadrada con variables demográficas, y otras que la bibliografía ha reportado como relevantes. Resultados Un 30% de las mujeres había sufrido algún episodio de violencia física en el último año. Éstos se clasificaron de la siguiente manera: 1. con violencia física episódica, que incluye a aquellas que no reportaron amenazas, ni intimidación y devaluación (12.5% de la población total); 2. violencia física intimidatoria, que incluye mujeres que reportaron amenazas e intimidación y poca o ninguna devaluación (12.5% de la población total); y 3. terrorismo íntimo, referido a mujeres que sufrieron amenazas e intimidaciones muy frecuentes junto con una devaluación que va de <> a <> (5% de la población total). Este último grupo es el de más alto riesgo; las mujeres que lo integraron fueron de mayor edad que las de los otros grupos, al igual que sus parejas. Reportaron tener más hijos y más años de vivir con el maltratador, en promedio 18. Tres de cada cinco mujeres tenía un trabajo remunerado, en su mayoría de manera informal, y llevaban la responsabilidad económica del hogar, así como la carga de las actividades domésticas. Sus parejas tenían un consumo de alcohol problemático; de hecho, uno de cada tres se ponía agresivo al ingerirlo. Conclusiones No encontramos relaciones físicamente violentas libres de violencia emocional, ya que, aun cuando la violencia episódica ocurrió sin manifestaciones de amenazas, intimidación y devaluación, las mujeres sí reportaron comportamientos hostiles y expectativas abusivas de parte de sus parejas. Los resultados obtenidos en torno a las variables sociodemográficas, las relacionadas con la participación económica y con las actividades domésticas de las mujeres y sus familiares, y el consumo de alcohol, pueden utilizarse para elaborar un instrumento breve que permita la detección de mujeres en situación de alto riesgo de violencia de pareja. Además, permiten reflexionar en la necesidad de plantear políticas públicas estructurales para enfrentar este problema, como la creación de empleos dignos y bien remunerados para las mujeres. Destaca igualmente la importancia de contar con programas que aborden el consumo de alcohol y la violencia en los hombres, considerando ambos aspectos como ejes de la construcción de la masculinidad tradicional.