Forms of Family Violence and Abuse (2)

                                                      

Child Sexual Abuse: Is the involvement of children in sexual activities which they do not fully comprehend and to which they do not or cannot freely give consent. This act violates child's trust in the adult that is supposed to protect him/her. Threat to the child and others keeps the child quiet. This threat results in confusion, shame, and helplessness. The effect may last a lifetime and affect mental health even if is guarded as a family secret.  

Observable Signs of Sexual Abuse: The observable signs of child sexual abuse include physical aggression, excessive masturbation, social withdrawal, low self-esteem, impaired school performance, sleep disturbance, STD's, bleeding, soreness, itching, urinary tract infection (UTI), pregnancy, bruises, swelling, redness, fracture, burns, and unkempt appearance.

School Violence: School violence is usually related to child drug use, child's access to guns, antisocial and impulsive behaviours, other common causes of school violence include family dysfunction, community unresponsiveness, interpersonal disputes, and bullying and harassment by peers.

Child Abduction: research has shown that most abduction is done by a parent 70% are by the fathers, 25% by their mothers. Parents that are likely to abduct include those that have threatened or attempted it in the past, suspect abuse by the other parent, may be paranoid, may intend to use it as revenge, punishment, trophy, or one that strongly believes that child be raised in his or her home country.

Child Abuse Assessment and Intervention: Explore and be aware of your own attitude to abuse survivors so as not to be judgmental. Do a thorough history and physical assessment. Use private, quiet uninterrupted environment. Honestly tell the purpose of the interview to the victim and also that there will be pending physical assessment. 

Use a calm and supportive approach, and as much possible interview child separately first, before joint interview with parent or guardian. In the course of the interview sessions, pay attention to child's looks and behaviour, mother's understanding of the problem, discrepancies in their stories, and parent's emotional responses. All your assessment should be fully documented.

Intimate Partner Violence (IPV): IPV is a pattern of coercive and assaultive behaviour between intimate and dating partners. Abuse of female partners is the most common form of IPV. Female violence is more often in self-defense.  The end result of most IPV is homicide or homicide-suicide. Leaving or an attempt to leave by the victim increases homicide risk. There is a higher homicide risk with handgun, history of having contemplated suicidal idea or attempt, battering during pregnancy, sexual abuse, substance use, extreme jealousy, and controlling behaviour ("if I can't have you, no one can").

Few women kill their abusers if there is no intervention. Assessment of IPV should be part of mental health assessment. Ask partners about history of conflicts, "pushing and shoving", and quality of relationship. Be careful to observe for signs of uneasiness, hesitation, and looking away. Be supportive, making the victim know that she is not alone.

Describe and map the extent of injuries. Assess for attribution e.g. self-blame. Assess for depression, PTSD, and anxiety. It is mandatory for abusers (who happens to be mostly men) to be treated. Treatment includes confronting the violence, affirming that responsibility lies with the abuser, behaviour therapy, anger control, attitude change to women, couple counselling, and cognitive behaviour therapy (CBT).   

The woman should be empowered, using laws, community resources, support groups, and safe shelters. Mutually set goals with the victim. Mutually consider and choose from options. Help mobilize natural, social and professional supports.

Rape and Sexual Assault: Affects men, women and children, especially women and children. Sexual assault is a forced act of sexual contact without consent. It is usually done to humiliate, defile or dominate the victim. Rape is a felony, yet majority is rape cases go unreported. Survivors of marital rape do not seek care because of embarrassment and humiliation. 

Careful assessment and questioning is needed. In caring for the victim of rape, listen, avoid being judgmental, and provide appropriate emotional support. All observation and assessment should be fully documented. 

1. In the acute stage of a rape, assess for fear, shock, disorganization, and restlessness.
 

      2.  In the second stage, assess for flashbacks, phobias to places and people, and sexual difficulties.     Encourage the victim to discuss feelings. Explore options e.g. changing phone number. Explore available community services and support groups. 

      3. Refer for physical treatment and psychotherapy. 

4. Plan for a follow-up phone contact in a few days.
 

Elder Abuse: statistics shows that there are about 5 million elderly persons are abused annually in the US. Spouse abuse overlaps with elder abuse. The abused does not report for fear of being isolated or abandoned. Signs of elderly people’s abuse include bruises on the arms, wrists, ankles, lacerations on the face, vaginal lacerations, fractures (broken bones), and evidence of poor nutrition, poor hygiene, and dehydration, flinching and shrinking away in the presence of abuser.

The main way to assist and care for such people  include reporting a suspected abuse to the appropriate quarters, counselling, psychotherapy, substance abuse and treatment of the abuser, if necessary.