# Situation: A 30-year-old woman comes to the emergency room (ER) with bruises on both upper arms in different stages of healing. She says she fell down the stairs. Her husband stays in the waiting area. In a private room with the nurse, she admits that her husband has hit her many times over the past 2 years. She tells the nurse, "He only hits me when I come home late. I deserve it." Which BEST explains her statement?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629984  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: A 30-year-old woman comes to the emergency room (ER) with bruises on both upper arms in different stages of healing. She says she fell down the stairs. Her husband stays in the waiting area. In a private room with the nurse, she admits that her husband has hit her many times over the past 2 years.

She tells the nurse, "He only hits me when I come home late. I deserve it." Which BEST explains her statement?

## 보기

1. Projection of her own anger onto her husband
2. Denial that keeps the abuse hidden from other people
3. The reconciliation phase of the cycle of violence
4. Self-blame, often reinforced by the abuser **✔ 정답**

**정답: 4**

## 해설

Victims of intimate partner violence often blame themselves, a belief the abuser commonly reinforces and that is linked with learned helplessness and low self-esteem. The nurse responds that the violence is not her fault. She has openly acknowledged the abuse, so her statement is not denial.

## 심화 해설

Why the statement reflects self-blame

The patient’s words, “He only hits me when I come home late. I deserve it,” show that she has internalized responsibility for the violence. This is not a neutral description of the abuser’s behavior; she is explaining the abuse as a logical consequence of her own actions. In intimate partner violence, self-blame is a common cognitive and emotional response that develops over time, especially when the abuser repeatedly tells the victim that she provoked or deserved the abuse. The abuser’s message becomes part of the victim’s own thinking, which lowers self-esteem and contributes to learned helplessness .

Key point! The patient is not denying the abuse. She openly states that her husband has hit her many times. Therefore, option 2 is incorrect because denial would involve minimizing, hiding, or refusing to acknowledge the violence.

How the abuser reinforces self-blame

The abuser often creates a pattern in which violence is framed as punishment for the victim’s perceived failure. In this case, the husband’s violence is linked to her coming home late. Over time, the victim may begin to believe that if she simply followed the rules, the abuse would stop. This belief keeps her focused on changing her own behavior rather than recognizing the abuser’s choice to use violence. The research on attachment weaponisation describes how abusers alternate cruelty with care and use grooming or trauma-sharing to deepen emotional entrapment . Within that dynamic, self-blame is not a sign of weakness but a predictable psychological consequence of coercive control.

Watch out! Self-blame can look like insight or acceptance, but it is actually a distorted belief that the victim has control over the abuser’s violence. The nurse should gently but clearly state that the violence is not her fault.

Why the other options do not fit

| Option | Why it is incorrect |
| --- | --- |
| 1. Projection | Projection means attributing one’s own unacceptable feelings to another person. The patient is not projecting anger onto her husband; she is blaming herself. |
| 2. Denial | Denial would involve refusing to acknowledge the abuse. This patient has already admitted the abuse in a private conversation, so denial is not the primary mechanism. |
| 3. Reconciliation phase | The reconciliation phase of the cycle of violence involves the abuser apologizing, showing remorse, or promising change. The patient’s statement is about her own responsibility, not about a period of calm or affection after an abusive episode. |

Clinical nursing implication

When a victim says she deserves the abuse, the nurse should avoid arguing or immediately trying to convince her otherwise. A more effective response is to validate her feelings while offering a different perspective: “No one deserves to be hit. Violence is never your fault.” This approach maintains trust and opens the door for safety planning. The nurse should also assess for other signs of coercive control, such as isolation, monitoring, or threats, because self-blame often coexists with broader patterns of domination .

In women who have experienced intimate partner violence, self-blame can function as a coping strategy that helps the victim make sense of an unpredictable and terrifying situation . However, it is also associated with greater psychological distress and may delay help-seeking. Recognizing self-blame early allows the nurse to provide trauma-informed care that gently challenges the abuser’s narrative without shaming the patient.

## 임상 시나리오

Responding to Self-Blame in IPVTherapeutic communication that breaks the cycle of internalized guilt
When a victim says "I deserve it", this reflects self-blame that the abuser has systematically reinforced. The nurse's priority is to state clearly: "The violence is not your fault."

Self-blame is linked to learned helplessness and low self-esteem. The victim may believe that changing her own behavior will stop the abuse, which keeps her focused on self-monitoring rather than recognizing the abuser's choice to use violence.

CautionDo not confuse self-blame with denial. This patient openly acknowledges the abuse, so denial is not present. Avoid statements that imply the victim provoked the violence or that she should modify her behavior to prevent it.

## 핵심 개념

- **Self-Blame** — A cognitive response in abuse victims where they internalize responsibility for the violence, often reinforced by the abuser's messages.
- **Learned Helplessness** — A psychological state where repeated abuse leads the victim to believe they cannot change or escape the situation.
- **Intimate Partner Violence** — Physical, sexual, or psychological harm by a current or former partner, often involving a pattern of power and control.
- **Cycle of Violence** — A pattern in abusive relationships with tension-building, acute explosion, and reconciliation/honeymoon phases.
- **Denial** — A defense mechanism where a person refuses to accept reality or facts, minimizing or hiding the abuse.

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