abuse

an act or a failure to act on the part of a caretaker or parent, which results in death, serious physical or emotional harm, sexual abuse or exploitation or act or failure to act which presents an imminent risk of serious harm.

• more injuries are attributed to initimate partner violence than to rape, muggings, and automobile accident's combine
• there is a documented incr in the incidence of all forms of child abuse
• rape is thought to be vastly under-reported
• abuse affects all races religions economic classes ages and education backgrounds

• physical- shaken baby symptoms, domestic abuse with strangulation, burns, battering, elder abuse with falls broken bones
• sexual- occurs without consent, based on power and control
• neglect- feeding, clothing, schooling, health or dental care, warmth, safety
• economic- unpaid bills, disconnection of heat, electricity, no money for food, rent and other necessities

• low self esteem, poor pulse control (frontal)
• depression, anxiety
• experienced or witness violence as a child, which teaches child violent behavior and justifies it as proper behavior
• substance use disorder which interferes with normal judgement, self-control and responsibilities priorities
• antisocial personality disorder
• lack of parenting skills, expectations for child beyoud their developmental level

• single parent living in poverty with no support system
• living a violent home where abuse occur to partner and children. in addition parents do not intervene to help the child, due to fear of their own retribution
• stressful events like divorce, loss of job, dealing with physical and mental illness
• practicing harsh discipline and verbal aggression model thru family for generations

• infant and children under 3 yrs if age secondary to their constant needs, crying, fussing coulpled with incr parental frustration
• pre-pubescence & teenager at riskfor secual abuse
• children with cognitive and developmental or emotional delays are at higher risk and unable to defend themselves
• children with attention or behavioral issues and difficult temperment accompanied by poor parental coping skills
• this familiar interaction then become cyclical (cycle of abuse continues- not knowing how to manage bc of learned behavior from parents)

• poverty in the home
• unemployment
• family stressor, single parenting
• housing issues
• lack of social support
• living in neighborhoods of high crime (children living in these areas have higher incidence of abuse, neglect, and sexual exploitation)- environment (think about Amina)

• female partners are the victim f majority family violence, but it can also be enacted on male partners
• victims are at greater risk when the plan to leave the relationship
• pregnancy inc the likelihood of violence, as does the consumption of alcohol and drugs- bc of pressure down stream effect
• children under 3 and children with disability have traits that make them more vulnerable
• abusers and victims may live in a violent environment (way of life)

• pre-occupation with violence, weapons, violent games, media influences especially in chidlren
• means to commit act, access to weapons
• patterns to bullying, witness or victim of abuse
• psychological vulnerability, feeling of inadequacy, weakness,, low self esteem
• command hallucinations, psychotic delusions, cognitive dysfunction
• comulative strss such as chronic hx of anger outburst, childhood neglect and abuse, social isolation, poverty & lack of resources

• neurophysiological influences:
• - temporal/frontal lobe (judgement- could be an infection, tumor, abuse)
• - limbic system- emotional alterations
• - amygdalodial nucleus (anxiety, rage and fear center)
• - hippocampus (learning and memory)
• - orbital cortex- (moral decision making)
• Biochemical:
• - norepinephrine (arousal)
• - serotonin (excess- feel good you don't want to feel anymore)
• - dopamine (perception- psychotic too much)

• Genetic influences (studies):
• - possible hereditary factor
• - genetic karotype XYY has been implicated (Jacob's syndrome) or 47XXY (klienfelter's syndrome) and tx induced testosterone rage
• Disorders of the brain (impaired inhibition):
• - organic brain syndrome
• - brain tumors (trauma) (limbic or temporal areas)
• - encephalitis
• - temporal lobe epilepsy

• NT theory
• - SSRI's aid in reduction of irritabilty
• - mood stabilizers dampen limbic irritability by reducing susceptibility to react (dec irritation) ie depakote, lamictal, lithium
• - beta blocker dampen excessive nor-adrenergic activity (low dose watch out for children)
• - antipsychotics modulate excessive dopaine activity

• freud
• unmet needs for satisfication and security result in an underdevelopment ego and a poor self-concept
• aggression and violence supply the individual with a dose of power and prestige that inc self-esteem

• modeling behavior more likely when perceived as prestigous or influential like parents
• media-video games, movies and even triumph over villians (when heroes use violence)

• aggresive behavior is primarily a product of one's culture and social structure
• the American culture was founded on a general acceptance of vilence as a means of solving problems
• societal influences also contribute to violence when individuals realize that their needs and deires are not being met relative to other people (injustice)

• initimate partner (emotional/physical)
• elderly abuse
• child abuse
• incest
• rape
• neglect

• domestic battering may be defined as pattern of coercive control fouunded on and supported by physical and/or sexual violence or threat of violence of an intimate partner
• approx 82% of victims are women (ages 25-34)- child bearing age
• this includes emotionally abusive behaviors that intimidates, manipulates, humiliate, frighten, terrorize, coerce, threaten blame and injured
• the means to escape is often filled with dear, and unacceptable choices in many cases lead to homelessness on the part of the victim

• violence from one person to another is an act of serious abuse of power
• the abuse can occur in the form of family, spouse, child abse or from external sources such as terror attacks (63%) homeless women
• family violence occurs across all economic and educational background
• a person who is mentally ill is no more likely to harm a stranger in the communuty than anyone. in fact maybe victimized especially if transient (homeless)
• the key factor that predicts violence in past hx of violnce and criminal past

• 1 in 5 teens who have been in relationships reports being hit, slapped or pushed by their partner
• 1 in 3 say they are texted 10-30 times a hour by a partner inquiring about where they are, who they are with, and what they are doing
• 1 in 5 teens have been asked to engage in sex by cell phone or the internet whne they do not want to
• 67% of parents did not know their teens was having sex
• 58% of parents were unaware that they teen had been hit slapped or push

• represents all ages, racial, religious, cultural, educational, and socioeconomic groups
• low self-esteem, powerless
• denial of severity of issue
• inadequate support systems
• harbors feelings of both anger and terror
• som grew up in abusive homes (traits)
• learned helplessness, individual comes to understand regardless of their behaviior, the outcome will be unpredictable and usually undesirable

• low self esteem
• pathological jealousy
• dual personality- nice and mean
• limited coping ability
• experienced abuse or extreme discipline
• difficulty accepting adult role
• severe stress reaction
• views spouse as personal possession
• children become the target when they try to protect their caregiver from abuse

• Phase I: tension building phase- mild anger and aggression victim takes blames. simple small degrading
• Phase II: acute battering phase- tension inc serious abuse occurs, victim covers up or seeks help, angry then hit
• Phase III: honeymoon phase- calm loving, respite with promises to stop, apologizes, romantic gestures, victim wants to believe and stay
• cycle restarts:- periods escalattion/de-escalation- with periods in between, shorter violence increases

• fear of their lives or the lives of their children
• fear of retaliation by the partner
• fear of losing custody of the children
• lack of financial resources
• lack of support network
• religious reason, culturl reasons
• having hope that the partner will change, and they can have a good times again

• provide shelter info, reach out to social worker if pt wants
• while interviewing:
• - provide safe environment
• - be direct, honest and professional
• - use language pt understands
• - be attentive and actively listen, ot must make decison
• - if pt reports children or other vulnerable members in the house are being abused, you must report it. (so safety for pt is important here)

• Erik Erickson- 1963 the worst sin is mutaliation of a child's spirit
• children are vulnerable, powerless and trusting
• although many of us may experience a stress reactions from time to time, when it is a child experiences traumatic stress, their ability to function and interact with other is forever changed - hard for them to trust

• parents who abuse 90% were abused themselevs as children
• experience stressful situations due to poverty, lack of resouces, unemployment, health issues
• are socially, emotionally, culturally isolated
• lack of coping skills, anger easily
• lack of self esteem, poor impulse control
• using substances or alcohol
• have negative perception of normal child behavior
• if multiple factors are present, abuse potential increases
• help someone pick up the peices

• physical abuse: any non accidental, physical injury caused by a parent, caregiver or other
• s/s
• - unexplained injuries, bites, bruises black eye
• - child is frighten of adults, shrinks at their touch
• - afraid to go home, request to stay out late go with teacher or coach
• - child reports injury by caregiver or parent
• changes in behavior, mood or activities- chx is school work
• - ie otherwise calm, friendly child becomes isolated, sullen, hostile

• emotional abuse: is chronic failure of a parent or caregiver to provide the child with hope love support and the tools to be able to develop a sound healthy personality
• s/s
• delay in development physically & emotionally (acting young)
• extremes in behavior, overly demanding or passive agressive
• attempts suicide
• acts very adult like or very infant like, make rock or bang head, bite nails, self injure (trying to self soothe)
• - foster children

• describe child as evil and needs punishment
• uses very harsh discipline- foriegners
• has a hx of their own abuse
• offers conflicting or unconvincing explanation for injuries
• constantly blames or belittles and berates child- he makes me drink
• under concerned with child's being
• refuses help for the child
• overtly rejects the child

• sexual abuse includes any kind of sexual act or sexualized behavior with a child
• it includes not only intercourse but fonding the child's genitals, forcing a child to fondling an adult's genitals, mouth to genital contact or rubbing the adult genitals on th child
• other types of sexual abuse may also takplace, even though they may not involve physical contact- like an adult exposing themselves to a child, showing porno pics/videos, taking naked pics of child

• strangers molest children however 80% of cases are from known peeps to the child- often authority figures child trust
• could be a parent, step parent, adult relative, a family friend, a neighbor, a babysitter a teach/coach, older sibling cousin
• while children understand what a stranger is they are often caught off guard when it comes to someone the know and trust

• offender usually manipulates the child into engaging in sexual activity, using threats, bribes, or aggressive persuasion and convincing the child that they have no choice to participate
• the children most susceptiable to theses assaults have obedient complaint, respectful personalities
• exploitation- child is induced or coerced to enagage in sexually explicit conduct for purpose of promoting performance and or sexual pleasure of adult
• incest- sexual contact or exploitation between close relative ie stepparents or sibling ect

• have difficulty walking, sitting, bruising in inner thigh
• suddenly refuses to chx for gym or to participate in physical activities
• reports nightmare, bed wetting or blood in stool
• experiences sudden chx in appetite
• demonstrates bizarr, sophicated or unusual sexual knowledge or behavior
• becomes pregnant or contracts STD
• frequent bladder infection or anal bleeding
• parent or caregiver hide child wont allow for interview without their presence
• parent or caregiver keeps secrets, engaged in fondling and seductive behavior with child

• beglect: is a failure to meet the basic needs of a child by nor providing enough food, shelter, basic supervision, necessary medical or mental health treatment, adequate educational or emotional support
• suspect neglect if child displays:
• dirty, body odor, inadequate clothes/shoes for weather
• begs for or steals money or food
• needs medical and dental care
• frequent absences dos not participants in events
• states no one home to provide care, walking home in bad weather

• the incestuous relationship (generalization)= often accompanied by an impaired spousal relationship
• The father is:
• domineering,impulsive physically abusive, with possible unconscious homosexual tendencies, difficulty achieving a stable hetersexual relationship

• The mother is:
• passive, submissive and denigrates her role as wife and mother. often aware of the incestous relationship but uses denial or keeps quiet out of fearr of being abused by abused by her husband or that he will leave the home

• life is full of:
• - a fundamental lack of trust that arises out of an unsatisfactory parent-child relationship
• - low self esteem and poor sense of identity
• - absence of pleasure with sexual activity
• - promiscuity
• Later in life:
• - if they come forward with their story they are often estranged from family since they gave the family secrets and remains estrange forever
• - they often wait until the person dies, before revealing their story and begin the healing process later in life

• bruising bleeding in unexpected areas
• unexplained recurrent injuries
• fear of partner/caregiver
• self blame for abuser's actions
• unkempt dirty cloths
• dehydration
• partner or care give will not leave pt alone for assessment or questions

• all states have mandatory reporting if you suspect/actual abuse of vulnerable population
• completely and accurately document objective and subjective data
• get good hx be attentive use therapeutic communication and provide basic care to injury
• if your facility has one, utilize trauma specific interventions
• provide psychological first aid and help pt develop safety plan
• make approriate referral to social services and support group

• rape is an act of aggression not passion. it is the expression of power and dominance by means of sexual violence morst commonly by men over women although men can also be rape victims
• types: acquaintence rape (date rape)
• martital rape crime in all states
• statutory rape- person under legal age

• attach most often in own neighborhood
• highest risk group 16-34
• stranger rape are crime of power and opportunity, wrong place wrong time
• in study of prison rape it says victims are not chosen by their dress or looks but environment (could be anyone)
• 63% use weapons most frequently a knife (terrorize but doesn't use)

• the mother or major female influence in the males life has been described as 'seductive but rejecting' towards the child
• the female is dominant, but quick to withdraw loves when child does not maeet expectation
• home is abusive or father or male figure is brutal, the child will send anger towards femailes since feels powerless against males
• chances of becoming victimizer inc when coupled with any other etiology r/t violence like a hx of violent or criminal intent

• rape surivivor experience overwhelming sense of powerlessness and intimidation
• two emotional patterns may emerge;
• -an expressed response pattern (sobbing, restlessness, tension is displayed)
• - controlled response pattern- feelings are masked, calm, subdue and may manisfest itself within days or weeks of the attack
• symptoms that can occur are as follows: h/a, sleep pattern disturbances, fatigue, rage humilation, self-blame, preoccupation with fear, safety, death
• deal with physiological issues such as bruises, vaginal or rectal pain, fear of pregnancy & std

• depends on a number protective factors: victims resilliency, age, ego strength, social support, and how they were treated initially after the assault (think about how rn responds to them)
• nightmares, night terror, sleep disturbances
• phobias and fear, avoiding intimacy and sexual relationships
• can become a compound rape reaction in which person develops PTSD, depression, suicidality and even psychotic behaviors
• can also becomes silent reaction- in which a person tells no oneand suppresses the anxiety until a future time when forced to face a sexual crisis in their life and reactives the trauma

• 1. provide a sense of safety
• - staying with the client (your pressence) to provide security basic needs and comfort
• - provide privacy but do not isolate them or leave them in a room
• - tending to physical injuries- ask if you can help
• - promoting trust non-judgemental statements
• - getting a rape trauma specialist/pyschiatrist/psychologist to the pt as soon as possible
• - pt should not shower until forensic evidence is colleced

• Crisis intervention: 6-8 weeks with client input from the start, involve coping skills, validation, personal decisions, resource acquisition- get them thru emotional/physical injury
• safe house/shelter: shelter with a variety of services, legal police, individual or group counseling, jobs, child care, peer support, financial aid (domestic violence)
• Family therapy: parenting classes, therapy with extended fam members, referral to agencies (extend to anyone who can help/support)

• safety during violent episode
• safety when preparing to leave
• safety in the home
• safety at job or public
• safety with order of protection
• safety w/drug or alcohol
• safety w/my emotional health
• items to take when i leave
• numbers i must keep on me at all times.