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Physical Abuse (physical + abuse)
Kinds of Physical Abuse Selected AbstractsMAOA Alters the Effects of Heavy Drinking and Childhood Physical Abuse on Risk for Severe Impulsive Acts of Violence Among Alcoholic Violent OffendersALCOHOLISM, Issue 5 2010Roope Tikkanen Background:, A polymorphism in the promoter region of the monoamine oxidase A gene (MAOA) has been shown to alter the effect of persistent drinking and childhood maltreatment on the risk for violent and antisocial behaviors. These findings indicate that MAOA could contribute to inter-individual differences in stress resiliency. Methods:, Recidivism in severe violent crimes was assessed after 8 years of nonincarcerated follow-up in a male sample of 174 impulsive Finnish alcoholic violent offenders, the majority of whom exhibited antisocial (ASPD) or borderline personality disorder (BPD) or both. We examined whether MAOA genotype alters the effects of heavy drinking and childhood physical abuse (CPA) on the risk for committing impulsive recidivistic violent crimes. Results:, Logistic regression analyses showed that both heavy drinking and CPA were significant independent predictors of recidivism in violent behavior (OR 5.2, p = 0.004 and OR 5.3, p = 0.003) among offenders having the high MAOA activity genotype (MAOA-H), but these predictors showed no effect among offenders carrying the low MAOA activity genotype (MAOA-L). Conclusion:, Carriers of the MAOA-H allele have a high risk to commit severe recidivistic impulsive violent crimes after exposure to heavy drinking and CPA. [source] Populations at Risk Across the Lifespan: Case Studies: Psychological and Physical Abuse Among Pregnant Women in a Medicaid-Sponsored Prenatal ProgramPUBLIC HEALTH NURSING, Issue 5 2010Jennifer E. Raffo ABSTRACT Objectives: To document psychological and physical abuse during pregnancy among women enrolled in enhanced prenatal services (EPS); explore the associations between maternal risk factors and type of abuse; and examine the relationship between abuse and EPS participation. Design and Sample: Cross-sectional study utilizing screening data collected between 2005 and 2008. Convenience sample of Medicaid-insured pregnant women enrolled in EPS selected from urban and rural providers. Measures: A prenatal screening tool that included measures such as Cohen's Perceived Stress Scale-4, Patient Health Questionnaire-2, and Abuse Assessment Screen was used. Results: Logistic regressions showed that high perceived stress and lack of father support were associated with all types of abuse and abuse history. Women with risk factors, such as a positive depression screen (odds ratio [OR]=2.36), were associated with psychological abuse but not with physical abuse during pregnancy. Less than a 12th-grade education was associated with physical abuse (OR=1.64) but not psychological abuse during pregnancy. The amount or the timing of EPS participation was not significantly associated with abuse history or abuse during pregnancy. Conclusions: Risk factors, such as high perceived stress and lack of father support, may alert nurses to further explore abuse during pregnancy. Additional research is needed for understanding the relationship between abuse and EPS participation. [source] The impact of physical and sexual abuse on body image in eating disordersEUROPEAN EATING DISORDERS REVIEW, Issue 2 2005Tamás Treuer Abstract Objective The role of childhood sexual abuse as a risk factor for the development of eating disorders has gained considerable attention in the literature in the last few years, especially its role in bulimia nervosa. Although physical abuse was also frequently explored in the history of patients with eating disorders, its role was unclear in the aetiopathogenesis of these disorders. The goal of our study was to test the hypothesis, based on our clinical experience, that physical abuse is more frequent in eating disorders than thought previously and that the patient's distortion in body image is more severe in these cases. Method A standardized interview method was used to elicit details of physical and sexual abuse in a group of 63 patients with eating disorders. The frequency of laxative use and the severity of body image distortion was also examined with the Body Attitude Test. These clinical data were analysed on the whole sample and also on the subgroups of eating disorders. Results We found significantly more severe body image distortions in those patients who had been physically abused (p,<,0.05) and there were significantly more severe body image distortions in those patients who had a history of laxative abuse (p,<,0.001). Sexual abuse occured in 29%, physical abuse in 57% and laxative abuse in 46% within the whole sample of examined eating disorder patients. Physical abuse and laxative abuse were the most frequent in the binge eating/purging type of anorexia nervosa (92% and 69%). Also, these patients had the worse rates on sexual abuse and body image distortion items. According to our results, the presence of sexual abuse was not associated with more severe body image distortion in eating disorder patients. Conclusions Childhood physical abuse seems to be a more important factor in the development of body image distortion than had been thought before; its importance in this aspect may be greater than sexual abuse. Physical abuse, laxative abuse and the binge,purge subtype in anorexia nervosa are a considerable risk factor for the severity of the distortion in body image and their presence makes the prognosis of the eating disorder worse. Further studies of the nature of these relationships are warranted. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Prevalence and Impact of Childhood Maltreatment in Incarcerated YouthAMERICAN JOURNAL OF ORTHOPSYCHIATRY, Issue 3 2010Daniel Coleman The prevalence of childhood maltreatment and the magnitude of the association of maltreatment with internalizing mental health symptoms were examined in 398 incarcerated youth. The prevalence of abuse greatly exceeded general population rates. The proportion of variance in mental health symptoms accounted for by maltreatment was small but developmentally significant. Sexual abuse is a markedly stronger predictor of internalizing mental health problems in incarcerated youth than physical abuse. Consistent with a bio-psychological model of trauma, dissociation at the time of sexual abuse was the strongest nondemographic predictor of mental health symptoms. Physical abuse was associated with more internalizing mental health problems for children from families with mental health problems and families with lower socioeconomic status. Implications for practice and research are discussed. [source] Risk factors for adult male criminality in ColombiaCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 2 2001Joanne Klevens Objectives This study sought to establish, in Colombia, the importance of factors alleged to be causes or correlates of adult criminality according to the published literature from other countries. Methods A comparison was made of arrested male offenders from ages 18 to 30 (n = 223) and similar community controls (n = 222) selected from five cities in Colombia as to their family background, exposure to abuse, family stressors, perceived care and history of childhood disruptive behaviour problems. Results Compared with neighbourhood controls from similar social classes, offenders were significantly more likely to report having had parents with less education, a mother under the age of 18 or over the age of 35 at time of birth, family members involved in crime, experiencing extreme economic deprivation, parental absence, family conflict, severe punishments, physical abuse, and maternal unavailability, rejection and lack of supervision. Prevalence of childhood disruptive behaviour problems was similar among offenders and controls. These findings appear to be independent of economic status, family size or type, birth order, or primary caregiver. Although the independent contribution of most of these factors is small, once all others have been controlled for, their cumulative effect is strong. Conclusions The findings obtained in this Latin American setting do not support the generalized view that adult antisocial behaviour is necessarily preceded by a history of childhood behaviour problems. However, they do add evidence for the importance of family factors in the risk for adult criminality. Copyright © 2001 Whurr Publishers Ltd. [source] The relationship between childhood trauma history and the psychotic subtype of major depressionACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2010B. A. Gaudiano Gaudiano BA, Zimmerman M. The relationship between childhood trauma history and the psychotic subtype of major depression. Objective:, Increasing evidence exists linking childhood trauma and primary psychotic disorders, but there is little research on patients with primary affective disorders with psychotic features. Method:, The sample consisted of adult out-patients diagnosed with major depressive disorder (MDD) at clinic intake using a structured clinical interview. Patients with MDD with (n = 32) vs. without psychotic features (n = 591) were compared as to their rates of different types of childhood trauma. Results:, Psychotic MDD patients were significantly more likely to report histories of physical (OR = 2.81) or sexual abuse (OR = 2.75) compared with non-psychotic MDD patients. These relationships remained after controlling for baseline differences. Within the subsample with comorbid post-traumatic stress disorder, patients with psychotic MDD were significantly more likely to report childhood physical abuse (OR = 3.20). Conclusion:, Results support and extend previous research by demonstrating that the relationship between childhood trauma and psychosis is found across diagnostic groups. [source] Childhood adversity in alcohol- and drug-dependent women presenting to out-patient treatmentDRUG AND ALCOHOL REVIEW, Issue 4 2001RAINE BERRY Abstract Eighty alcohol- and/or drug-dependent women who were consecutive admissions to a representative out-patient alcohol and drug service in Christchurch were interviewed with the aim of establishing the extent of exposure to childhood adversity including childhood sexual, physical and emotional abuse and parental problems. The results show that a sizeable percentage of the women came from backgrounds characterized by parental conflict and alcohol and drug problems. Within their first 15 years 51% were subjected to sexual abuse involving attempted or completed oral, anal or vaginal intercourse and 39% were exposed regularly to physical abuse perpetrated by their parents or main parental figures. Over half reported experiencing emotional abuse rated as being ,very distressing' and two-thirds had been exposed to ,very distressing' parental problems. The main implication for clinical practice arising from the results of this study is the need for the development of a broader approach to alcohol and drug service provision. In order to achieve positive treatment outcomes, alcohol and drug services may need to routinely screen and plan treatment for childhood adversity and associated problems in all clients presenting for alcohol and drug treatment. [source] The impact of physical and sexual abuse on body image in eating disordersEUROPEAN EATING DISORDERS REVIEW, Issue 2 2005Tamás Treuer Abstract Objective The role of childhood sexual abuse as a risk factor for the development of eating disorders has gained considerable attention in the literature in the last few years, especially its role in bulimia nervosa. Although physical abuse was also frequently explored in the history of patients with eating disorders, its role was unclear in the aetiopathogenesis of these disorders. The goal of our study was to test the hypothesis, based on our clinical experience, that physical abuse is more frequent in eating disorders than thought previously and that the patient's distortion in body image is more severe in these cases. Method A standardized interview method was used to elicit details of physical and sexual abuse in a group of 63 patients with eating disorders. The frequency of laxative use and the severity of body image distortion was also examined with the Body Attitude Test. These clinical data were analysed on the whole sample and also on the subgroups of eating disorders. Results We found significantly more severe body image distortions in those patients who had been physically abused (p,<,0.05) and there were significantly more severe body image distortions in those patients who had a history of laxative abuse (p,<,0.001). Sexual abuse occured in 29%, physical abuse in 57% and laxative abuse in 46% within the whole sample of examined eating disorder patients. Physical abuse and laxative abuse were the most frequent in the binge eating/purging type of anorexia nervosa (92% and 69%). Also, these patients had the worse rates on sexual abuse and body image distortion items. According to our results, the presence of sexual abuse was not associated with more severe body image distortion in eating disorder patients. Conclusions Childhood physical abuse seems to be a more important factor in the development of body image distortion than had been thought before; its importance in this aspect may be greater than sexual abuse. Physical abuse, laxative abuse and the binge,purge subtype in anorexia nervosa are a considerable risk factor for the severity of the distortion in body image and their presence makes the prognosis of the eating disorder worse. Further studies of the nature of these relationships are warranted. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Childhood Maltreatment and Migraine (Part II).HEADACHE, Issue 1 2010Emotional Abuse as a Risk Factor for Headache Chronification (Headache 2010;50:32-41) Objectives., To assess in a headache clinic population the relationship of childhood abuse and neglect with migraine characteristics, including type, frequency, disability, allodynia, and age of migraine onset. Background., Childhood maltreatment is highly prevalent and has been associated with recurrent headache. Maltreatment is associated with many of the same risk factors for migraine chronification, including depression and anxiety, female sex, substance abuse, and obesity. Methods., Electronic surveys were completed by patients seeking treatment in headache clinics at 11 centers across the United States and Canada. Physician-determined data for all participants included the primary headache diagnoses based on the International Classification of Headache Disorders-2 criteria, average monthly headache frequency, whether headaches transformed from episodic to chronic, and if headaches were continuous. Analysis includes all persons with migraine with aura, and migraine without aura. Questionnaire collected information on demographics, social history, age at onset of headaches, migraine-associated allodynic symptoms, headache-related disability (The Headache Impact Test-6), current depression (The Patient Health Questionnaire-9), and current anxiety (The Beck Anxiety Inventory). History and severity of childhood (<18 years) abuse (sexual, emotional, and physical) and neglect (emotional and physical) was gathered using the Childhood Trauma Questionnaire. Results., A total of 1348 migraineurs (88% women) were included (mean age 41 years). Diagnosis of migraine with aura was recorded in 40% and chronic headache (,15 days/month) was reported by 34%. Transformation from episodic to chronic was reported by 26%. Prevalence of current depression was 28% and anxiety was 56%. Childhood maltreatment was reported as follows: physical abuse 21%, sexual abuse 25%, emotional abuse 38%, physical neglect 22%, and emotional neglect 38%. In univariate analyses, physical abuse and emotional abuse and neglect were significantly associated with chronic migraine and transformed migraine. Emotional abuse was also associated with continuous daily headache, severe headache-related disability, and migraine-associated allodynia. After adjusting for sociodemographic factors and current depression and anxiety, there remained an association between emotional abuse in childhood and both chronic (odds ratio [OR] = 1.77, 95% confidence intervals [CI]: 1.19-2.62) and transformed migraine (OR = 1.89, 95% CI: 1.25-2.85). Childhood emotional abuse was also associated with younger median age of headache onset (16 years vs 19 years, P = .0002). Conclusion., Our findings suggest that physical abuse, emotional abuse, and emotional neglect may be risk factors for development of chronic headache, including transformed migraine. The association of maltreatment and headache frequency appears to be independent of depression and anxiety, which are related to both childhood abuse and chronic daily headache. The finding that emotional abuse was associated with an earlier age of migraine onset may have implications for the role of stress responses in migraine pathophysiology. [source] Self-harm and substance use in a community sample of Black and White women with binge eating disorder or bulimia nervosaINTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 4 2002Faith-Anne Dohm Abstract Objective This study evaluated rates of self-harm and substance use in women with either bulimia nervosa (BN) or binge eating disorder (BED) and assessed whether differences in self-harm and substance use are related to sexual or physical abuse. Method Alcohol abuse, self-harm, and use or abuse of various illicit drugs were evaluated in a sample of 53 women with BN and 162 women with BED. Results Self-harm and substance use generally did not differentiate BED and BN cases, but rates of self-harm and substance use were elevated among women with a history of sexual or physical abuse relative to women without such a history. Discussion Elevated rates of self-harm and substance use may not be related uniquely to BN diagnostic status, but may be related to a characteristic shared by women with BN and BED, such as a history of sexual or physical abuse. © 2002 by Wiley Periodicals, Inc. Int J Eat Disord 32: 389,400, 2002. [source] What happens when people disclose sexual or physical abuse to staff at a community mental health centre?INTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 2 2002Kirsty Agar ABSTRACT: The files of 200 users of a community mental health centre revealed that 46% of the files contained documentation of sexual or physical abuse as children or adults. Only 36% of summary formulations and 33% of treatment plans for the abused clients mentioned the abuse. Only 22% of the abused clients received abuse-focused therapy. Response rates were lower for clients who were male or had a schizophrenia spectrum diagnosis, and if the clinician was male or a psychiatrist. None of the alleged crimes, past, recent or ongoing, was reported to legal authorities. Development of unit policies and training programmes to ensure appropriate response to abuse histories is recommended. [source] Injuries to the head, face, mouth and neck in physically abused children in a community settingINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 5 2005A. M. CAIRNS Summary. Objectives. The aims of the present study were to identify the incidence of orofacial injuries found within a cohort of physically abused children, and examine demographic data surrounding the alleged perpetrator, the location in which the alleged assault occurred, the mechanism of injury and the actual orofacial injury incurred. Methods. The research took the form of a retrospective study of clinical case records of children with suspected physical abuse from 1 June 1998 to 31 May 2003. Seven hundred and fifty case records were identified and 390 (46·7%) were available for data extraction. Results. Fifty-nine per cent (n = 230) of children had signs of abuse on the head, face or neck. The alleged perpetrator was the mother in 104 cases (26·7%), the father in 100 (25·6%) and mother's partner in 49 other cases (12·6%). More than half (53·3%) of the alleged abuse occurred in the child's home; in 32·3% of cases, the location was not recorded. Other locations included outside in a public place, school and at the home of the alleged abuser. Some 23·4% (n = 54) had been punched or slapped around the head, neck or face, 17·4% (n = 40) had been struck by an object, and 15·2% (n = 35) had allegedly sustained multiple modes of injury. Bruising to the head, neck or face was seen in 95·2% (n = 219) of children, and 32·6% (n = 75) had abrasions; 65·2% (n = 150) of the bruises and 22·9% (n = 53) of the abrasions were on the face. Conclusions. Fifty-nine per cent of physically abused children in the present cohort had orofacial signs of abuse which would be easily visible to a dental practitioner. The commonest injuries were bruises and abrasions. This concurs with previous reports in the literature and highlights the important role of dental practitioners in the recognition of children who have been abused. [source] Screening for Abuse and Neglect of People with DementiaJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2010Aileen Wiglesworth PhD OBJECTIVE: To investigate characteristics of people with dementia and their caregivers (CGs) that are associated with mistreatment in order to inform clinicians about screening for mistreatment. DESIGN: A convenience sample of CG,care recipient (CR) dyads were assessed for literature-supported factors associated with mistreatment, and evidence of mistreatment for the prior year was collected. An expert panel considered the evidence and decided on occurrences of psychological abuse, physical abuse, and neglect based on criteria adopted before data collection. SETTING: Participants' homes. PARTICIPANTS: One hundred twenty-nine persons with dementia and their CGs. MEASUREMENTS: CG and CR characteristics (demographic, health, and psychosocial variables), relationship characteristics, and three elder abuse and neglect detection instruments. RESULTS: Mistreatment was detected in 47.3%. Variables associated with different kinds and combinations of mistreatment types included the CG's anxiety, depressive symptoms, social contacts, perceived burden, emotional status, and role limitations due to emotional problems and the CR's psychological aggression and physical assault behaviors. The combination of CR's physical assault and psychological aggression provided the best sensitivity (75.4%) and specificity (70.6%) for elder mistreatment as defined by the expert panel. This finding has potential to be useful as a clinical screen for detecting mistreatment. CONCLUSIONS: The findings suggest important characteristics of older adults with dementia and their CGs that have potential for use in a clinical screening tool for elder mistreatment. Potential screening questions to be asked of CGs of people with dementia are suggested. [source] The Psychological Impact of Domestic Violence on Spanish Women,JOURNAL OF APPLIED SOCIAL PSYCHOLOGY, Issue 11 2005M. Pilar Matud This study examined the psychological impact of partner violence on 240 Spanish women who were identified as abused, comparing them to a control group of 240 non-abused women. The abused women suffered more long-lasting anxiety and insomnia, severe depression, and somatic symptomatology, and also had lower self-esteem than did the non-abused women. The severity of the psychological abuse was correlated positively with the severity of the physical abuse, while the number of years of abuse endured correlated with the women's age and number of children. The most relevant variable for predicting severe depression, social dysfunction, anxiety and insomnia, and somatic symptoms was low self-esteem. [source] Social learning, sexual and physical abuse, and adult crimeAGGRESSIVE BEHAVIOR, Issue 6 2009Richard B. Felson Abstract This research examines the relationship between childhood physical and sexual abuse and the types of crimes committed by male adult offenders. We use the method of discriminant prediction to determine whether independent and dependent variables are related in ways that theories predict. Our analyses of data from the Survey of Inmates in State and Federal Correctional Facilities suggest that offenders model specific behaviors to which they have been exposed. Male offenders who were sexually abused as a child are more likely to commit sexual offenses, particularly sexual offenses against children, than nonsexual offenses. Offenders who were physically abused are more likely to engage in violent offenses than nonviolent offenses. Further analyses show that sexual offenders, and to a lesser extent violent offenders, are likely to specialize in those offenses. Our results are consistent with a social learning approach. They address a heretofore neglected issue: what exactly do children model when they are mistreated. Aggr. Behav. 35:489,501, 2009. © 2009 Wiley-Liss, Inc. [source] Disciplinary history, adult disciplinary attitudes, and risk for abusive parentingJOURNAL OF COMMUNITY PSYCHOLOGY, Issue 3 2001Mary E. Bower-Russa In an attempt to identify factors that could contribute to intergenerational physical abuse, the specific childhood disciplinary experiences of adolescents and young adults were assessed, and these childhood experiences were related to the subjects' assessment as to whether specific disciplinary tactics were abusive or appropriate in child rearing. Consistent with previous research, few maltreated persons viewed their own experiences as abusive. Moreover, personal experience with a disciplinary event was associated with a decreased tendency to view that particular form of discipline as inappropriate. Finally, a history of severe physical punishment, failure to acknowledge an abusive history when it had occurred, and adult attitudes regarding physical discipline were associated with selecting more punitive disciplinary strategies when individuals were faced with child misbehavior in an analog parenting task. © 2001 John Wiley & Sons, Inc. [source] Anger and assaultiveness of male forensic patients with developmental disabilities: links to volatile parentsAGGRESSIVE BEHAVIOR, Issue 4 2008Raymond W. Novaco Abstract This study with 107 male forensic patients with developmental disabilities investigated whether exposure to parental anger and aggression was related to anger and assaultiveness in a hospital, controlling for background variables. Patient anger and aggression were assessed by self-report, staff-ratings, and archival records. Exposure to parental anger/aggression, assessed by a clinical interview, was significantly related to patient self-reported anger, staff-rated anger and aggression, and physical assaults in hospital, controlling for age, intelligence quotient, length of hospital stay, violent offense history, and childhood physical abuse. Results are consonant with previous findings concerning detrimental effects of witnessing parental violence and with the theory on acquisition of cognitive scripts for aggression. Implications for clinical assessment and cognitive restructuring in anger treatment are discussed. Aggr. Behav. 34:380,393, 2008. © 2008 Wiley-Liss, Inc. [source] Retrospective accounts of recurrent parental physical abuse as a predictor of adult laboratory-induced aggressionAGGRESSIVE BEHAVIOR, Issue 3 2004Brian K. Moe Abstract Child abuse has been frequently associated with adult aggression in its many forms. The Point Subtraction Aggression Paradigm (PSAP) is a popular laboratory-based procedure derived from the retaliatory responses of participants engaged in a monetary-reinforced computer game. PSAP responses have been found to discriminate between participants with and without violent, antisocial, substance abuse, and even contact-sport athletic histories. The present study provided an initial test of the sensitivity of the PSAP and the Overt Aggression Scale (OAS) in discriminating between college students (n=28) with and without reported histories of recurrent physical abuse as defined by incidents of being pushed, shoved, struck, punched, or threatened with physical violence by a parent more than once every six weeks over 15 years of upbringing. PSAP responses were substantially higher (d=2.1) among participants reporting histories of recurrent parental physical abuse, with 46% (as opposed to 0% for controls) of these individuals generating PSAP responses in excess of 400 (average found for violent parolees). Group differences on the OAS were also considerable (>1 SD). Larger factorial designs examining relationships between a range of developmental variables (e.g., domestic abuse, physical abuse, sexual abuse, parental divorce, family climate, etc.) and adult PSAP responding may help advance present knowledge regarding the impact of childhood adversity on psychological development. Aggr. Behav. 30:217,228, 2004. © 2004 Wiley-Liss, Inc. [source] Reduced right hemisphere activation in severely abused violent offenders during a working memory task: An fMRI studyAGGRESSIVE BEHAVIOR, Issue 2 2001Adrian Raine Abstract This study uses functional magnetic resonance imaging (fMRI) to address two important gaps in our knowledge of brain functioning and violence: (1) What are the brain correlates of adults in the community who have suffered severe physical abuse early in life and who go on to perpetrate serious violence in adulthood? (2) What characterizes those who experience severe physical abuse but who refrain from serious violence? Four groups of participants recruited from the community (controls, severe physical child abuse only, serious violence only, and severely abused, seriously violent offenders) underwent fMRI while performing a visual/verbal working memory task. Violent offenders who had suffered severe child abuse show reduced right hemisphere functioning, particularly in the right temporal cortex. Abused individuals who refrain from serious violence showed relatively lower left, but higher right, activation of the superior temporal gyrus. Abused individuals, irrespective of violence status, showed reduced cortical activation during the working memory task, especially in the left hemisphere. Brain deficits were independent of IQ, history of head injury, task performance, cognitive strategy, and mental activity during the control task. Findings constitute the first fMRI study of brain dysfunction in violent offenders, and indicate that initial right hemisphere dysfunction, when combined with the effects of severe early physical abuse, predisposes to serious violence but that relatively good right hemisphere functioning protects against violence in physically abused children. Aggr. Behav. 27:111,129, 2001. © 2001 Wiley-Liss, Inc. [source] Improving Child Protection in the Emergency Department: A Systematic Review of Professional Interventions for Health Care ProvidersACADEMIC EMERGENCY MEDICINE, Issue 2 2010Amanda S. Newton PhD Abstract Objectives:, This systematic review evaluated the effectiveness of professional and organizational interventions aimed at improving medical processes, such as documentation or clinical assessments by health care providers, in the care of pediatric emergency department (ED) patients where abuse was suspected. Methods:, A search of electronic databases, references, key journals, and conference proceedings was conducted and primary authors were contacted. Studies whose purpose was to evaluate a strategy aimed at improving ED clinical care of suspected abuse were included. Study methodologic quality was assessed by two independent reviewers. One reviewer extracted the data, and a second checked for completeness and accuracy. Results:, Six studies met the inclusion criteria: one randomized controlled trial (RCT), one quasi-RCT, and four observational studies. Study quality ranged from modest (observational studies) to good (trials). Variation in study interventions and outcomes limited between-study comparisons. The quasi-RCT supported self-instructional education kits as a means to improve physician knowledge for both physical abuse (mean ± standard deviation [SD] pretest score = 13.12 ± 2.36; mean ± SD posttest score = 18.16 ± 1.64) and sexual abuse (mean ± SD pretest score = 10.81 ± 3.20; mean ± SD posttest score = 18.45 ± 1.79). Modest-quality observational studies evaluated reminder systems for physician documentation with similar results across studies. Compared to standard practice, chart checklists paired with an educational program increased physician consideration of nonaccidental burns in burn cases (59% increase), documentation of time of injury (36% increase), and documentation of consistency (53% increase) and compatibility (55% increase) of reported histories. Decisional flow charts for suspected physical abuse also increased documentation of nonaccidental physical injury (69.5% increase; p < 0.0001) and had a similar significant effect as checklists on increasing documentation of history consistency and compatibility (69.5 and 70.0% increases, respectively; p < 0.0001) when compared to standard practice. No improvements were noted in these studies for documentation of consultations or current status with child protective services. The introduction of a specialized team and crisis center to standardize practice had little effect on physician documentation, but did increase documentation of child protective services involvement (22.7% increase; p < 0.005) and discharge status (23.7% increase; p < 0.02). Referral to social services increased in one study following the introduction of a chart checklist (8.6% increase; p = 0.018). A recently conducted multisite RCT did not support observational findings, reporting no significant effect of educational sessions and/or a chart checklist on ED practices. Conclusions:, The small number of studies identified in this review highlights the need for future quality studies that address care of a vulnerable clinical population. While moderate-quality observational studies suggest that education and reminder systems increase clinical knowledge and documentation, these findings are not supported by a multisite randomized trial. The limited theoretical base for conceptualizing change in health care providers and the influence of the ED environment on clinical practice are limitations to this current evidence base. ACADEMIC EMERGENCY MEDICINE 2010; 17:117,125 © 2010 by the Society for Academic Emergency Medicine [source] MAOA Alters the Effects of Heavy Drinking and Childhood Physical Abuse on Risk for Severe Impulsive Acts of Violence Among Alcoholic Violent OffendersALCOHOLISM, Issue 5 2010Roope Tikkanen Background:, A polymorphism in the promoter region of the monoamine oxidase A gene (MAOA) has been shown to alter the effect of persistent drinking and childhood maltreatment on the risk for violent and antisocial behaviors. These findings indicate that MAOA could contribute to inter-individual differences in stress resiliency. Methods:, Recidivism in severe violent crimes was assessed after 8 years of nonincarcerated follow-up in a male sample of 174 impulsive Finnish alcoholic violent offenders, the majority of whom exhibited antisocial (ASPD) or borderline personality disorder (BPD) or both. We examined whether MAOA genotype alters the effects of heavy drinking and childhood physical abuse (CPA) on the risk for committing impulsive recidivistic violent crimes. Results:, Logistic regression analyses showed that both heavy drinking and CPA were significant independent predictors of recidivism in violent behavior (OR 5.2, p = 0.004 and OR 5.3, p = 0.003) among offenders having the high MAOA activity genotype (MAOA-H), but these predictors showed no effect among offenders carrying the low MAOA activity genotype (MAOA-L). Conclusion:, Carriers of the MAOA-H allele have a high risk to commit severe recidivistic impulsive violent crimes after exposure to heavy drinking and CPA. [source] Drinking, Alcohol Problems and the Five-Year Recurrence and Incidence of Male to Female and Female to Male Partner ViolenceALCOHOLISM, Issue 1 2005Raul Caetano Background: This study examined the 5-year incidence and recurrence of male to female (MFPV) and female to male partner violence (FMPV) as well as their relationship with drinking and alcohol problems among intact couples in the United States. Methods: A national sample of couples 18 years of age or older were interviewed in 1995 and again in 2000. Results: Recurrence is slightly higher for FMPV (44%) than MFPV (39%), whereas incidence rates are similar for these two types of violence (MFPV, 5.7%; FMPV, 6%). Cross-tabulations show that a higher frequency of drinking five or more drinks on occasion is positively associated with the overall occurrence of MFPV and with both the recurrence and the overall occurrence of FMPV. Male alcohol problems are associated with a higher recurrence of MFPV and higher overall MFPV. Female alcohol problems are associated with incidence of FMPV. In multivariate analysis, black ethnicity, male unemployment, and severe physical abuse during childhood are associated with recurrence of MFPV. Black ethnicity, male unemployment, male employment status as "retired/other," female age, and couples in which the female drinks more are associated with recurrence of FMPV. Incidence of MFPV is associated with cohabitation, Hispanic ethnicity, and man's observation of violence between parents. Male unemployment, male observation of violence between parents, and man's drinking volume predict incidence of FMPV. Conclusions: Volume of drinking is the only alcohol indicator associated with intimate partner violence once the effects of other factors are controlled in multivariate analysis. Both MFPV and FMPV are areas of health disparity across whites, blacks, and Hispanics. Factors of risk that predict recurrence and incidence can be identified and used in prevention efforts. [source] The Changing Focus of Child Maltreatment Research and Practice Within PsychologyJOURNAL OF SOCIAL ISSUES, Issue 4 2006Mark Chaffin Professions functionally define a field by the types of behaviors or circumstances to which they direct their attention and efforts. For psychology and mental health professionals concerned with child maltreatment, child sexual abuse has been the dominant interest over the past two decades and has been virtually synonymous with child maltreatment within psychology. This is discrepant from the broader scope of child maltreatment, as seen both in child welfare populations and in the general population. In child welfare, sexual abuse is an important but nonetheless relatively less frequent issue. Child neglect and physical abuse dominate child welfare caseloads, and historically always have. The disconnect between the interests of mental health professionals and child welfare appears to be waning, both in terms of dialogue within psychology and apportioning of research resources. This article examines what this emerging change may mean for practice and research in terms of the changing nature of populations involved, different types and locations of services, different roles and new multidisciplinary alliances. [source] Why Have Child Maltreatment and Child Victimization Declined?JOURNAL OF SOCIAL ISSUES, Issue 4 2006David Finkelhor Various forms of child maltreatment and child victimization declined as much as 40,70% from 1993 until 2004, including sexual abuse, physical abuse, sexual assault, homicide, aggravated assault, robbery, and larceny. Other child welfare indicators also improved during the same period, including teen pregnancy, teen suicide, and children living in poverty. This article reviews a wide variety of possible explanations for these changes: demography, fertility and abortion legalization, economic prosperity, increased incarceration of offenders, increased agents of social intervention, changing social norms and practices, the dissipation of the social changes from the 1960s, and psychiatric pharmacology. Multiple factors probably contributed. In particular, economic prosperity, increasing agents of social intervention, and psychiatric pharmacology have advantages over some of the other explanations in accounting for the breadth and timing of the improvements. [source] Universal problems during residency: abuse and harassmentMEDICAL EDUCATION, Issue 7 2009Shizuko Nagata-Kobayashi Objectives, Perceived abuse or harassment during residency has a negative impact on residents' health and well-being. This issue pertains not only to Western countries, but also to those in Asia. In order to launch strong international preventive measures against this problem, it is necessary to establish the generality and cultural specificity of this problem in different countries. Therefore, we investigated mistreatment among resident doctors in Japan. Methods, In 2007, a multi-institutional, cross-sectional survey was conducted at 37 hospitals. A total of 619 residents (409 men, 210 women) were recruited. Prevalence of mistreatment in six categories was evaluated: verbal abuse; physical abuse; academic abuse; sexual harassment; gender discrimination, and alcohol-associated harassment. In addition, alleged abusers, the emotional effects of abusive experiences, and reluctance to report the abuse to superiors were investigated. Male and female responses were statistically compared using chi-square analysis. Results, A total of 355 respondents (228 men, 127 women) returned a completed questionnaire (response rate 57.4%). Mistreatment was reported by 84.8% of respondents (n = 301). Verbal abuse was the most frequently experienced form of mistreatment (n = 256, 72.1%), followed by alcohol-associated harassment (n = 184, 51.8%). Among women, sexual harassment was also often reported (n = 74, 58.3%). Doctors were most often reported as abusers (n = 124, 34.9%), followed by patients (n = 77, 21.7%) and nurses (n = 61, 17.2%). Abuse was reported to have occurred most frequently during surgical rotations (n = 98, 27.6%), followed by rotations in departments of internal medicine (n = 76, 21.4%), emergency medicine (n = 41, 11.5%) and anaesthesia (n = 40, 11.3%). Very few respondents reported their experiences of abuse to superiors (n = 36, 12.0%). The most frequent emotional response to experiences of abuse was anger (n = 84, 41.4%). Conclusions, Mistreatment during residency is a universal phenomenon. Deliberation on the occurrence of this universally wrong tradition in medical culture will lead to the establishment of strong preventive methods against it. Current results indicate that alcohol-associated harassment during residency is a Japanese culture-specific problem and effective preventive measures against this are also urgently required. [source] Cutaneous Manifestations of Child AbusePEDIATRIC DERMATOLOGY, Issue 4 2006Liborka Kos M.D. Yet the most common manifestations of child abuse are cutaneous. This article reviews cutaneous manifestations of physical abuse, including bruises, lacerations, abrasions, human bites, and burns. It also discusses ways that dermatologists can differentiate abusive injuries from accidental ones as well as from the many dermatologic conditions that can mimic child abuse. Finally, we review what actions the dermatologist should take when suspecting abuse in a patient. [source] Childhood trauma and marital outcomes in adulthoodPERSONAL RELATIONSHIPS, Issue 4 2006MARK A. WHISMAN Although existing research suggests that certain childhood traumas such as childhood sexual abuse are associated with interpersonal (e.g., marital) difficulties in adulthood, there has been limited research on interpersonal sequelae of other types of traumas. In addition, the association between childhood traumas and interpersonal outcomes has often been limited to a particular outcome such as divorce, and existing studies have rarely controlled for the co-occurrence of other traumas when evaluating interpersonal outcomes. The current study sought to evaluate the associations between 7 childhood traumas and 2 marital outcomes,marital disruption (i.e., divorce and separation) and marital satisfaction,in a large, national probability sample. Results from univariate and multivariate analyses indicated that (a) probability of marital disruption was higher among people who during childhood had experienced physical abuse, rape, or serious physical attack or assault; and (b) current marital satisfaction was lower among people who during childhood had experienced rape or sexual molestation. Results support the importance of childhood traumas in predicting 2 important marital outcomes. [source] Prevalence and Impact of Childhood Maltreatment in Incarcerated YouthAMERICAN JOURNAL OF ORTHOPSYCHIATRY, Issue 3 2010Daniel Coleman The prevalence of childhood maltreatment and the magnitude of the association of maltreatment with internalizing mental health symptoms were examined in 398 incarcerated youth. The prevalence of abuse greatly exceeded general population rates. The proportion of variance in mental health symptoms accounted for by maltreatment was small but developmentally significant. Sexual abuse is a markedly stronger predictor of internalizing mental health problems in incarcerated youth than physical abuse. Consistent with a bio-psychological model of trauma, dissociation at the time of sexual abuse was the strongest nondemographic predictor of mental health symptoms. Physical abuse was associated with more internalizing mental health problems for children from families with mental health problems and families with lower socioeconomic status. Implications for practice and research are discussed. [source] Mediating Pathways Explaining Psychosocial Functioning and Revictimization as Sequelae of Parental Violence Among Adolescent MothersAMERICAN JOURNAL OF ORTHOPSYCHIATRY, Issue 2 2009Taryn Lindhorst PhD Adolescent mothers are at high risk for negative life events, such as previous childhood physical abuse, impaired psychosocial functioning, and young adulthood revictimization. However, little is known about the potential pathways in these events; hence, little is known about opportunities for intervention. This study used structural equation modeling to investigate mediators of the effects of parental child abuse on later psychosocial functioning and revictimization (in the form of intimate partner violence and sexual violence) among adolescent mothers, with longitudinal data spanning 2.4 years. On psychological distress in the final time period, parental physical child abuse had an early and then maintained effect but also effects mediated by earlier psychological distress and revictimization. Psychological distress rather than substance use appeared as the primary psychosocial factor mediating the effects of parental violence on both future distress and revictimization. For prevention of further psychosocial impairment and revictimization, these findings indicate the need for early intervention with adolescent mothers who come from abusive families and who display higher levels of psychological distress. [source] Victimization of Children With DisabilitiesAMERICAN JOURNAL OF ORTHOPSYCHIATRY, Issue 4 2007Irit Hershkowitz PhD Children with disabilities (CWDs) are more likely to be victims of child abuse but may have more difficulty than their typically developing (TD) peers reporting their experiences. In this study, the authors examined the characteristics of abuse reported by CWDs based on forensic statements made by 40430 alleged abuse victims, 11% categorized as children with minor disabilities, and 1.2% categorized as children with severe disabilities. Proportionally more of the CWDs than of the TD children were allegedly victims of sexual rather than physical abuse. CWDs failed to disclose abuse and delayed disclosure more often than TD suspected victims. CWDs were more likely than TD children to be abused by parent figures and to experience physical abuse resulting in body injury or serious sexual offenses, including those involving penetration, repeated abuse, use of force, and threats. Higher levels of disability were associated with increased risk of sexual abuse. Both the heightened incidence of severe abuse among and the failure to disclose abuse by CWDs should be sources of considerable concern to social welfare and criminal justice agencies. [source] | ||||||||||||||||