Abuse Lecture


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Powerpoint presentation I gave November 3, 2009 on abuse to a group of college students.

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  • 1:100 sexual abuse 3:100 neglect 6-7:100 physical abuse 10.5:100 emotional abuse
  • Abuse Lecture

    1. 1. Abuse Tonya Wren, MD November 3, 2009
    2. 2. Definitions <ul><li>per Dictionary.com </li></ul><ul><ul><li>verb (used with object) </li></ul></ul><ul><ul><ul><li>to use wrongly or improperly; misuse: to abuse one's authority. </li></ul></ul></ul><ul><ul><ul><li>to treat in a harmful, injurious, or offensive way: to abuse a horse; to abuse one's eyesight. </li></ul></ul></ul><ul><ul><ul><li>to speak insultingly, harshly, and unjustly to or about; revile; malign. </li></ul></ul></ul><ul><ul><ul><li>to commit sexual assault upon. </li></ul></ul></ul>
    3. 3. Definitions <ul><li>Categories of abuse </li></ul><ul><ul><li>Domestic violence </li></ul></ul><ul><ul><li>Elder abuse </li></ul></ul><ul><ul><li>Child abuse </li></ul></ul><ul><ul><ul><li>Forms of all of the above </li></ul></ul></ul><ul><ul><ul><ul><li>Neglect </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Emotional Abuse </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Physical Abuse </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Sexual Abuse </li></ul></ul></ul></ul>
    4. 4. Definitions <ul><li>Neglect </li></ul><ul><ul><li>failure to meet a child’s basic needs </li></ul></ul><ul><ul><ul><li>housing </li></ul></ul></ul><ul><ul><ul><li>food </li></ul></ul></ul><ul><ul><ul><li>clothing </li></ul></ul></ul><ul><ul><ul><li>education </li></ul></ul></ul><ul><ul><ul><li>access to medical care </li></ul></ul></ul><ul><ul><ul><li>( http://www.cdc.gov/violenceprevention/pdf/CM-FactSheet-a.pdf ) </li></ul></ul></ul><ul><ul><li>is the most common reported and confirmed type of child abuse </li></ul></ul><ul><ul><ul><li>( &quot; Child Abuse and Neglect Statistics &quot;. National Committee to Prevent Child Abuse. 1998. http://web.archive.org/web/19980515052303/http://childabuse.org/facts97.html . ) </li></ul></ul></ul>
    5. 5. Definitions <ul><li>Emotional Abuse </li></ul><ul><ul><li>behaviors that harm self-worth or emotional well-being. </li></ul></ul><ul><ul><ul><li>name calling </li></ul></ul></ul><ul><ul><ul><li>shaming </li></ul></ul></ul><ul><ul><ul><li>rejection </li></ul></ul></ul><ul><ul><ul><li>withholding love </li></ul></ul></ul><ul><ul><ul><li>threatening </li></ul></ul></ul><ul><li>(http://www.cdc.gov/violenceprevention/pdf/CM-FactSheet-a.pdf) </li></ul>
    6. 6. Definitions <ul><li>Physical Abuse </li></ul><ul><ul><li>injury as a result of hitting, kicking, shaking, burning or other show of force. </li></ul></ul><ul><li>Sexual Abuse </li></ul><ul><ul><li>engaging a child in sexual acts </li></ul></ul><ul><ul><ul><li>fondling </li></ul></ul></ul><ul><ul><ul><li>rape </li></ul></ul></ul><ul><ul><ul><li>exposing a child to other sexual activities </li></ul></ul></ul><ul><li>(http://www.cdc.gov/violenceprevention/pdf/CM-FactSheet-a.pdf) </li></ul>
    7. 7. Statistics <ul><li>Child Abuse </li></ul><ul><ul><li>1 in 100 children (rates vary per region) </li></ul></ul><ul><ul><ul><li>1.5 to 26.3 per 1000 depending on state </li></ul></ul></ul><ul><ul><li>Possibly as high as 50% of cases unreported </li></ul></ul><ul><ul><li>http://www.acf.hhs.gov/programs/cb/pubs/cm07/chapter3.htm#subjects </li></ul></ul><ul><ul><li>Another source: </li></ul></ul><ul><ul><ul><li>14 percent of U.S. children experienced some form of child maltreatment: </li></ul></ul></ul><ul><ul><ul><ul><li>8 percent were victims of sexual abuse </li></ul></ul></ul></ul><ul><ul><ul><ul><li>22 percent were victims of child neglect </li></ul></ul></ul></ul><ul><ul><ul><ul><li>48 percent were victims of physical abuse </li></ul></ul></ul></ul><ul><ul><ul><ul><li>75 percent were victims of emotional abuse </li></ul></ul></ul></ul><ul><ul><li>http://www.cdc.gov/violenceprevention/pdf/CM-DataSheet-a.pdf </li></ul></ul>
    8. 8. Statistics <ul><li>Physical abuse </li></ul><ul><ul><li>Child </li></ul></ul><ul><ul><ul><li>http://www.cdc.gov/violenceprevention/pdf/CM-DataSheet-a.pdf </li></ul></ul></ul><ul><ul><li>Adult (domestic violence) </li></ul></ul><ul><ul><ul><li>25% of women and 7.6% of men raped and/or physically assaulted by a current or former spouse, cohabiting partner, dating partner, or acquaintance over their lifetime </li></ul></ul></ul><ul><ul><ul><li>http://www.abanet.org/domviol/statistics.html </li></ul></ul></ul>
    9. 9. Statistics <ul><li>Sexual abuse </li></ul><ul><ul><li>1 in 6 women </li></ul></ul><ul><ul><ul><li>College-age women 4 times more likely to be sexually assaulted </li></ul></ul></ul><ul><ul><li>1 in 33 men </li></ul></ul><ul><ul><li>http://www.rainn.org/statistics </li></ul></ul>
    10. 10. Myths about domestic violence <ul><li>MYTH: Battered women hate men. Battered women need to learn that not all men are bad. </li></ul><ul><li>FACT: Battered women do not hate men. They hate being battered. </li></ul><ul><li>MYTH: A man's home is his castle. No one should interfere with the family. </li></ul><ul><li>FACT: Battery is a crime! No one has the right to beat another person. </li></ul><ul><li>MYTH: A woman who gets beaten brings it upon herself by nagging or provoking her spouse. </li></ul><ul><li>FACT: People are beaten for reasons as ridiculous as the dinner being cold, the TV being turned to the wrong channel, the baby crying. Abusive people refuse to control their violent impulses. Even where the person may have reason to be angry, they have no right to express their anger violently. </li></ul><ul><li>MYTH: Domestic violence is a &quot;loss of control.&quot; </li></ul><ul><li>FACT: Violent behavior is a choice. Perpetrators use it to control their victims. Domestic violence is about batterers using their control, not losing their control. Their actions are very deliberate. </li></ul><ul><li>http://www.letswrap.com/dvinfo/myths.htm </li></ul>
    11. 11. Myths about domestic violence <ul><li>MYTH: If the victim didn't like it, she would leave. </li></ul><ul><li>FACT: Being beaten hurts and no one likes it. There are many reasons why victims remain with abusers including their fear of further violence, the financial hardship of leaving, religious reasons, their emotional attachment to their partners, and their belief that families should stay together. </li></ul><ul><li>MYTH: Middle and upper class women do not get battered as frequently as poor women. </li></ul><ul><li>FACT: Domestic violence occurs in all socio-economical levels. Because women with money usually have more access to resources, poorer women tend to utilize community agencies, and are therefore more visible </li></ul><ul><li>MYTH: Batterers are violent in all their relationships. </li></ul><ul><li>FACT: Batterers choose to be violent toward their partners in ways they would never consider treating other people. </li></ul><ul><li>MYTH: Alcohol/Drugs cause battering behavior. </li></ul><ul><li>FACT: Although many abusive partners also abuse alcohol and/or drugs, this is not the underlying cause of the battering. Many batterers use alcohol/drugs as an excuse to explain their violence. </li></ul><ul><li>http://www.letswrap.com/dvinfo/myths.htm </li></ul>
    12. 12. Myths about sexual abuse <ul><li>Normal-appearing, well educated, middle-class people don't molest children. </li></ul><ul><li>People are too quick to believe an abuser is guilty, even if there is no supporting evidence. </li></ul><ul><li>Child molesters molest indiscriminately. </li></ul><ul><ul><li>most sex abuse involves a gradual &quot;grooming&quot; process in which the perpetrator skillfully manipulates the child into participating (Berliner & Conte, 1995). To ensure the child's continuing compliance, sex offenders report using bribes, threats and force (Elliott et al.,1995). </li></ul></ul><ul><ul><li>Often the trust of family members is groomed as well </li></ul></ul><ul><ul><li>Children who are being abused would immediately tell their parents. </li></ul></ul><ul><ul><li>Sex offenders typically seek to make the victim feel as though he or she caused the offender to act inappropriately, and convince the child that they are the guilty party. </li></ul></ul><ul><ul><li>Boys seem to have a particularly difficult time dealing with sexual abuse and are even less likely to report it than girls </li></ul></ul><ul><li>http://www.leadershipcouncil.org/1/res/csa_myths.html </li></ul>
    13. 13. Myths about sexual abuse <ul><li>Children who are being abused will show physical evidence of abuse. </li></ul><ul><ul><li>even with proven penetration, in up to 95% of cases genital examinations will be essentially normal. </li></ul></ul><ul><li>If asked about abuse, children tend to exaggerate and are prone to making false accusations. </li></ul><ul><ul><li>researchers found a significant tendency among the children to deny or minimize their experiences </li></ul></ul><ul><li>By using repeated interviews, therapists or police can easily implant false memories and cause false accusations among children of any age </li></ul><ul><ul><li>In fact, research shows that children are more likely to fail to report negative experiences that actually did happen to them, than falsely remember ones that did not. </li></ul></ul><ul><li>http://www.leadershipcouncil.org/1/res/csa_myths.html </li></ul>
    14. 14. Signs of Physical Abuse <ul><li>Consider the possibility of physical abuse when the child : </li></ul><ul><ul><li>Has unexplained burns, bites, bruises, broken bones, or black eyes </li></ul></ul><ul><ul><li>Has fading bruises or other marks noticeable after an absence from school </li></ul></ul><ul><ul><li>Seems frightened of the parents and protests or cries when it is time to go home </li></ul></ul><ul><ul><li>Shrinks at the approach of adults </li></ul></ul><ul><ul><li>Reports injury by a parent or another adult caregiver </li></ul></ul><ul><li>Consider the possibility of physical abuse when the parent or other adult caregiver : </li></ul><ul><ul><li>Offers conflicting, unconvincing, or no explanation for the child's injury </li></ul></ul><ul><ul><li>Describes the child as &quot;evil,&quot; or in some other very negative way </li></ul></ul><ul><ul><li>Uses harsh physical discipline with the child </li></ul></ul><ul><ul><li>Has a history of abuse as a child </li></ul></ul><ul><ul><li>http://www.childwelfare.gov/pubs/factsheets/signs.cfm </li></ul></ul>
    15. 15. Signs of Neglect <ul><li>Consider the possibility of neglect when the child : </li></ul><ul><ul><li>Is frequently absent from school </li></ul></ul><ul><ul><li>Begs or steals food or money </li></ul></ul><ul><ul><li>Lacks needed medical or dental care, immunizations, or glasses </li></ul></ul><ul><ul><li>Is consistently dirty and has severe body odor </li></ul></ul><ul><ul><li>Lacks sufficient clothing for the weather </li></ul></ul><ul><ul><li>Abuses alcohol or other drugs </li></ul></ul><ul><ul><li>States that there is no one at home to provide care </li></ul></ul><ul><li>Consider the possibility of neglect when the parent or other adult caregiver : </li></ul><ul><ul><li>Appears to be indifferent to the child </li></ul></ul><ul><ul><li>Seems apathetic or depressed </li></ul></ul><ul><ul><li>Behaves irrationally or in a bizarre manner </li></ul></ul><ul><ul><li>Is abusing alcohol or other drugs </li></ul></ul><ul><ul><li>http://www.childwelfare.gov/pubs/factsheets/signs.cfm </li></ul></ul>
    16. 16. Signs of Sexual Abuse <ul><li>Consider the possibility of sexual abuse when the child : </li></ul><ul><ul><li>Has difficulty walking or sitting </li></ul></ul><ul><ul><li>Suddenly refuses to change for gym or to participate in physical activities </li></ul></ul><ul><ul><li>Reports nightmares or bedwetting </li></ul></ul><ul><ul><li>Experiences a sudden change in appetite </li></ul></ul><ul><ul><li>Demonstrates bizarre, sophisticated, or unusual sexual knowledge or behavior </li></ul></ul><ul><ul><li>Becomes pregnant or contracts an STD, particularly if under age 14 </li></ul></ul><ul><ul><li>Runs away </li></ul></ul><ul><ul><li>Reports sexual abuse by a parent or another adult caregiver </li></ul></ul><ul><li>Consider the possibility of sexual abuse when the parent or other adult caregiver : </li></ul><ul><ul><li>Is unduly protective of the child or severely limits the child's contact with other children, especially of the opposite sex </li></ul></ul><ul><ul><li>Is secretive and isolated </li></ul></ul><ul><ul><li>Is jealous or controlling with family members </li></ul></ul><ul><li>http://www.childwelfare.gov/pubs/factsheets/signs.cfm </li></ul>
    17. 17. Signs of Emotional Abuse <ul><li>Consider the possibility of emotional maltreatment when the child : </li></ul><ul><ul><li>Shows extremes in behavior, such as overly compliant or demanding behavior, extreme passivity, or aggression </li></ul></ul><ul><ul><li>Is either inappropriately adult (parenting other children, for example) or inappropriately infantile (frequently rocking or head-banging, for example) </li></ul></ul><ul><ul><li>Is delayed in physical or emotional development </li></ul></ul><ul><ul><li>Has attempted suicide </li></ul></ul><ul><ul><li>Reports a lack of attachment to the parent </li></ul></ul><ul><li>Consider the possibility of emotional maltreatment when the parent or other adult caregiver : </li></ul><ul><ul><li>Constantly blames, belittles, or berates the child </li></ul></ul><ul><ul><li>Is unconcerned about the child and refuses to consider offers of help for the child's problems </li></ul></ul><ul><ul><li>Overtly rejects the child </li></ul></ul><ul><li>http://www.childwelfare.gov/pubs/factsheets/signs.cfm </li></ul>
    18. 18. Reporting <ul><li>Important facts about reporting </li></ul><ul><ul><li>You don’t have to prove it. </li></ul></ul><ul><ul><li>You don’t have to confront the offender. </li></ul></ul><ul><ul><li>You don’t have to be sure the abuse happened. </li></ul></ul><ul><li>Who is legally obligated to report? </li></ul><ul><ul><li>http://www.rainn.org/pdf-files-and-other-documents/Public-Policy/Legal-resources/08SouthCarolina%28Children%29.pdf </li></ul></ul>
    19. 19. What to do… <ul><li>… when someone comes to you and tells you he or she has been abused. </li></ul><ul><ul><li>Listen. Don’t talk. </li></ul></ul><ul><ul><li>Don’t interrogate. </li></ul></ul><ul><ul><li>Don’t judge. </li></ul></ul><ul><ul><ul><li>Don’t deny or confirm. </li></ul></ul></ul><ul><ul><li>It’s ok to not know what to say. </li></ul></ul><ul><ul><li>Reassure them they did nothing wrong. </li></ul></ul><ul><ul><li>http://www.helpguide.org/mental/child_abuse_physical_emotional_sexual_neglect.htm </li></ul></ul>
    20. 20. Signs of an abusive relationship <ul><li>Does your partner tease you in a hurtful way in private or in public? </li></ul><ul><li>Does your partner call you names such as &quot;stupid&quot;? </li></ul><ul><li>Does your partner act jealous of your friends, family, or co-workers? </li></ul><ul><li>Does your partner get angry about clothes you wear or how you style your hair? </li></ul><ul><li>Does your partner check-up on you by calling, driving by, or getting someone else to? </li></ul><ul><li>Does your partner insist on knowing who you talk with on the phone? </li></ul><ul><li>Does your partner blame you for his problems or his bad mood? </li></ul><ul><li>Does your partner get angry so easily that you feel like you're &quot;walking on eggshells&quot;? </li></ul><ul><li>Does your partner hit walls, drive dangerously, or do other things to scare you? </li></ul><ul><li>Does your partner often drink or use drugs and/or insist that you drink or use drugs with him? </li></ul>
    21. 21. Signs of an abusive relationship <ul><li>Have you lost friends or no longer see some of your family because of your partner? </li></ul><ul><li>Does your partner accuse you of being interested in someone else? </li></ul><ul><li>Does your partner read your mail, go through your purse, or other personal papers? </li></ul><ul><li>Does your partner keep money from you, keep you in debt, or have &quot;money secrets?“ </li></ul><ul><li>Has your partner kept you from getting a job, or caused you to lose a job? </li></ul><ul><li>Has your partner sold your car, made you give up your license, or not repaired your car? </li></ul><ul><li>Does your partner threaten to hurt you, your children, family, friends, or pets? </li></ul><ul><li>Does your partner force you to have sex when you do not want to or in ways that you do not want to? </li></ul><ul><li>Does your partner threaten to kill you or himself if you leave? </li></ul><ul><li>Is your partner like &quot;Dr. Jekyll and Mr. Hyde,&quot; acting one way in front of other people and another way when you are alone? </li></ul>
    22. 22. What to do… <ul><li>… if you think you’re in an abusive relationship. </li></ul><ul><ul><li>Get help. </li></ul></ul><ul><ul><li>GET OUT. </li></ul></ul>
    23. 23. Other Resources <ul><li>www.apsac.org (American Professional Society on the Abuse of Children) </li></ul><ul><li>www.rainn.org (Rape, Abuse, & Incest National Network) </li></ul><ul><li>http://www.cdc.gov/violenceprevention/pdf/PreventingChildSexualAbuse-a.pdf </li></ul><ul><li>National Domestic Violence Hotline </li></ul><ul><li>1-800-799-7233 (www.ndvh.org) </li></ul>