Abuse is hurtful mistreatment of other people. It may include physical, sexual, or emotional (ee-MO-shun-al) mistreatment of children or adults.
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Child sexual abuse
Intimate partner violence
Shaken baby syndrome
What Is Abuse?
Abuse is a form of violence in which one person harms another physically or emotionally. The abuser often uses an advantage of size, power, or influence to hurt or mistreat the target of the abuse, who may be smaller, younger, or weaker. Abusers can include:
- a parent, guardian, or teacher who hits a child
- a parent or guardian who neglects a child
- a caregiver who hits or shakes a crying baby
- a caregiver who hits or neglects an elderly or disabled person
- a spouse, a date, or an intimate partner who beats or rapes the other intimate partner
- an adult who asks or forces a child to engage in sexual activity
- anyone who taunts or harms another because of age, race, gender, beliefs, or sexual orientation.
Abuse is a problem for the person who has been abused, for those who witness the abuse, and for society at large. Statistics indicate that abuse may contribute to a cycle of violence whereby abused children can grow up to become abusive adults and parents.
Why Do People Behave in Abusive Ways?
There is no single cause for abusive behavior, but there are many factors that seem to make it likelier that an adult will abuse others. Growing up in an abusive family is one contributing factor. Other factors include:
- alcohol or substance abuse that leads to loss of self-control
- unemployment, lack of education, discrimination, and other factors that cause financial difficulties
- marital problems
- undiagnosed mental illness
antisocial personality disorder that leads the abuser to disregard the
rights of others
- lack of coping skills to deal with anger and impulsive behavior
- lack of coping skills to deal with stressful situations, such as the care of a disabled child or a dependent elder.
Abusers often want to deny the seriousness of the problem, evade responsibility for their own abusive behavior, and shift blame to the other person. Abusers may say that the person being abused was "asking for it," but abuse is not the fault of the child or adult who has been abused. No one "deserves" to be abused or neglected.
Abuse does not always cause bruises that one can see. Emotional abuse targets the feelings and spirit of the person being abused, instead of the body. Forms of verbal and emotional abuse may include repeated name calling, hurtful ridicule (RI-di-kyool), harsh criticism, cruel and disrespectful words, bullying, and threats of violence or harm. Emotional abuse can have serious long-term consequences:
- It may damage a developing child's sense of self-esteem.
- It may make it difficult for a child to make friends.
- It may make it difficult for a child to concentrate on schoolwork.
- It may make a child cautious or fearful about his or her safety, even in safe surroundings and situations.
- It may make a child seem too grown-up in behavior.
- It may be contribute to feelings of depression, hopelessness, and anger.
When verbal abuse includes threats of violence, it may indicate that physical abuse and sexual abuse also are occurring.
"Why doesn't she just leave him?" observers often wonder when they become aware of family violence. The answer most likely is what psychologist and researcher Martin Seligman and his colleagues call "learned helplessness," a form of passivity and hopelessness that people experience when they come to believe that abuse and violence are inevitable and inescapable components of their lives. People who experience violence regularly may give up trying to avoid or escape that violence. They may become passive and unable to create safety for themselves or their families.
In her work on battered wives, psychologist Lenore Walker discovered that these women often remain with battering husbands because of learned helplessness. She found that battered wives who had learned to be helpless and passive needed counseling and therapy before they could learn how to escape from the abusive situation. Even if abused partners want to leave their abusers, leaving may not be an easy option. The abusing partner may increase the level of violence if the abused partner tries to leave the home. The abusing partner also may forbid contact with friends, neighbors, or inlaws; may withhold money or car keys; may stalk the abused partner; or may threaten children or pets.
Physical abuse affects the body as well as the head, heart, and spirit. Physical abuse may include a pattern of hitting, kicking, pushing, shoving, shaking, spanking, and harsh physical punishment. It may cause bruising or more serious injury, and even if it is called "tough love," it is in fact a form of violence. Physical abuse, particularly family violence, often is kept secret by the abuser, by the person being abused, and by other family members who fear the consequences of confronting the abuser. Signs that a child may be abused may include:
- unusual injuries that are not the result of normal play activities, for example, black eyes; injuries to cheeks and ears; injuries to stomach, back, thighs, and buttocks; human bite marks; and cigarette burns
- unusual tiredness or trouble sleeping or nightmares
- unusual sadness or crying
- unusual violence toward classmates or siblings or pets
- avoidance of parents or caregivers, such as reluctance to go home after school
- the same behaviors that result from emotional abuse
Family violence often is referred to as domestic abuse. It includes all forms of intimate partner violence (spouse abuse or wife battering), child abuse and neglect, elder abuse, and child sexual abuse. Intimate partner violence most often involves men who are abusive toward female partners. Female-to-male domestic abuse also occurs, as does male-to-male and female-to-female abuse in same-sex couples.
Research shows that child abuse and spouse abuse often happen in the same families. But even if child abuse does not take place along with spouse abuse, the child who witnesses family violence experiences many problems. Family violence limits the child's ability to feel safe and protected at home, and it may force the child to favor one parent over the other. It also may cause emotional and behavioral (bee-HAY-vyor-al) problems for the child at school or among peers. It may also lead to a broken home or custody dispute if a wife leaves the home for a battered women's shelter or if a child is removed from the home by a government child protection agency.
Child abuse and neglect
Child abuse is mistreatment of a child by a parent, older child, or other adult. Physical abuse toward a child may include hitting or kicking, pushing and shoving, or other types of harsh physical punishment. More than half of all cases of child abuse are believed to affect children younger than 8 years old.
Shaken baby syndrome
Parents and caregivers who shake a baby to try to make the baby stop crying can cause very serious injuries. Shaking a baby can cause bleeding inside the baby's eyes and brain. This may lead to vomiting, seizures * , brain swelling, blindness, hearing loss, mental retardation, brain damage, coma * , or even death. Shaken babies may or may not have bruises on other parts of their bodies that might signal physical abuse, but researchers estimate that up to 80 percent of serious head injuries in children younger than 2 years are the result of shaking. It is never okay to shake a baby for any reason.
* seizures (SEE-zhurz) are'storms' in the brain that occur when the electrical patterns of the brain are interrupted by powerful, rapid bursts of electri-cal energy. This may cause a person to fall down, make jerky movements, or stare blankly into space.
* coma is an unconscious state, like a very deep sleep. A person in a coma cannot awaken, move, see, or speak.
* incontinent means unable to control urination or bowel movements.
* dementia (de-MEN-sha) is a term that describes any condition that causes a person to lose the ability to think, remember, and act.
Go to Court
According to tradition and common law, children are the "personal property" of their parents, and parents have the right to decide how to raise their own children. When parents abuse or neglect their children, however, government agencies may step in, because it is the government's responsibility to protect the safety and well-being of all children in the community. Doctors, teachers, school counselors, social workers, or neighbors may report child abuse to the police. Police or local child protection agencies may investigate homes in which possible abuse has been reported. Family courts may remove children from the home and appoint temporary guardians for them. And family courts may order a custody evaluation to decide whether it is safe for a child to be returned to a home in which the child has been abused.
Children face many difficulties when they are required to testify in court. Court testimony causes anxiety for all witnesses, but for those who have been abused, the testimony itself can be especially difficult. Being required to remember and discuss past abuses may lead to intensified symptoms of post-traumatic stress disorder. Being challenged by attorneys about the reliability and accuracy of recall of events can be distressing. And being involved in a family court case can carry stigma within a child's peer group. Most important, testifying against a parent or family member whom the child loves may cause the child to feel guilty or disloyal, as if he or she is the abuser who has caused harm rather than the other way around. Doctors, social workers, and foster parents all can create a support network to help children prepare for court testimony and to care for them before and after the court date.
Elder abuse and neglect
Elder abuse may occur in families or in institutions such as nursing homes. Abuse may include neglect, hitting, pushing, shaking, giving elders too much medication, and putting elders in restraints that prevent them from leaving a bed or wheelchair. Elders who cannot take care of themselves, who are incontinent * , who need assistance with activities of daily living, or who wander away due to dementia * may be difficult and frustrating to caregivers, but it is never okay to hit or push an elderly person.
Sexual abuse is unwanted, inappropriate, or forced sexual touching, contact, and behavior. Abusers may be male or female, and the person who is sexually abused may be adult or child, male or female, very young or very old, intimate partner or spouse, neighbor, student, or date. Incest is the term for sexual abuse by a member of one's own family. Sexual abusers often believe that the activity is a form of love or intimacy. Abusers may claim that the victim said "no" but that the abuser knew the victim meant "yes." But people who have been abused experience the violation of their personal boundaries and privacy as assault and violence.
Child Sexual Abuse
Child sexual abuse occurs when an adult or an older child pressures or forces a younger child into sexual activity. Sexual activity may involve pornography * , inappropriate touching by the child or the adult, or genital * penetration of the child's vagina * , anus * , or mouth. The abuser may be a family member or someone outside the family, but often it is someone the child knows and trusts. Sometimes sexual abuse happens only once, but in many cases it happens repeatedly with one particular adult.
Children who do not understand sexual behavior cannot give consent for that behavior. An abuser may want to believe that a child is a willing partner in sexual activity, but this is not true. Young children do not understand the complexity or long-term consequences of sexual behavior. They cannot consent to behavior they do not understand.
An adult who sexually abuses a child often tells the child to keep the sexual activity secret. Children who have been sexually abused often comply with the request to keep the activity secret because they feel ashamed and confused, because they do not understand the behavior and have difficulty explaining it to responsible adults, and because the behavior makes them uncomfortable and fearful. Children who try to tell their secret to an adult sometimes encounter disbelief, but they need to keep trying to tell the secret, because doctors, teachers, and school counselors can help children improve this difficult situation.
If thinking about the abuse is particularly difficult, children may lock away all knowledge of the abuse in the deepest part of their memories, keeping the abuse secret even from themselves. This form of amnesia (am-NEE-zha), or memory loss, can last for many years according to many experts. Adults who have been abused as children report sometimes discovering a key to the deepest parts of the memory many years after the abuse has stopped. Known as "repressed memory," adult recall of child sexual abuse is considered a controversial topic.
* pornography (por-NAH-gra-fee)refers to any material, like mag-azines or videos, that shows sexual behavior an d is meant to cause sexual excitement.
* genital refers to the external sexual organs.
* vagina (va-JY-na) Is the canal in females that leads from the uterus (the organ where a baby develops) to the outside of the body.
* anus is the opening at the end of the digestive system, through which waste leaves the body.
Signs of abuse
Even if children deny to themselves or others that sexual abuse has taken place, signs may include:
- redness, swelling, pain, or bleeding of the genitals, anus, or mouth
- questions about sexual activity at a very early age
- sexual acts, words, or drawings at an unusually early age
- avoidance of certain people and places
- unusal fear or jumpiness at the mention of certain people or places
- sudden start of bed-wetting or soiling (losing control of bowel movements)
- sexually transmitted diseases
- urinary tract infections or pregnancy in young girls
Like other forms of abuse, child sexual abuse is never the child's fault. Children who have been sexually abused often benefit from therapy to help heal the emotional hurt caused by abuse.
Discrimination and Hate Crimes
Sometimes people are abused because of race or ethnic background, disabilities, gender, sexual orientation, or religious beliefs. White supremacy, lynching, gay bashing, and ethnic cleansing are a few of the terms associated with these forms of abuse and violence. In many areas of the United States and the world, hate crimes are not yet specifically against the law.
How Do Doctors Treat People Who Have
People who have been abused often try to keep the abuse secret. They may be confused, ashamed, or afraid. They also may be trying to protect the person who has hurt them or trying to protect themselves from further abuse. Remaining silent, however, is not an effective way to end abuse. Confiding in a doctor can lead to protection from further abuse. A doctor who diagnoses abuse can treat injuries and infections that result from abuse and can refer patients to counselors, therapists, social workers, and child protection agencies.
Who? Whom? How Often?
While no two abuse cases are exactly the same, there are some common patterns.
- Husbands abuse wives more often than wives abuse husbands.
- Male children are beaten more often than female children.
- Child abuse is more likely to occur in families that also experience intimate partner violence.
- Children with disabilities, particularly mental retardation or other cognitive (intellectual) impairment, are at higher risk of sexual abuse than other children.
- Approximately 3 of every 100 men in the United States assault an intimate partner.
- Approximately one of every four girls in the United States experiences sexual abuse.
- Approximately one of every six boys in the United States experiences sexual abuse.
- Approximately 90 percent of cases of child abuse are attributed to parents or other family caregivers. Only 10 percent of cases of child abuse are attributed to strangers.
- Approximately 80 percent of children who are sexually abused know their abusers.
Abuse is an international problem. In 2001, the World Health Organization is scheduled to publish its first World Report on Violence and Health covering child abuse, youth violence, intimate partner violence, sexual violence, elder abuse, and other topics. Find this organization on the Internet at http://www.who.int/violence_injury_prevention .
How Do Mental Health Professionals Help
People Who Have Been Abused?
Sometimes it is necessary for the person being abused to get immediate protection. Shelters can provide women and children with a temporary safe place to stay. Foster care is a way for children to get immediate protection from abuse in the home. Although this can be a difficult situation for a family, sometimes it is necessary in order to keep abused people safe from severe injury or even death from family violence. Social workers and child protection agencies often provide these kinds of services. After immediate concerns for safety and injury have been attended to, therapists can help people who have been abused with their emotional
National Domestic Violence Hotline. This is a 24-hour hotline. In cases
of immediate life-threatening emergency, dial 911.
Lee, Sharice A. The Survivor's Guide. Thousand Oaks, CA: Sage Publications, 1995. Written for teens and preteens recovering from child sexual abuse, this guide fits in pocket or backpack.
Pucci, Linda M., and Lynn M. Copen. Finding Your Way: What Happens When You Tell About Abuse. Thousand Oaks, CA: Sage Publications, 2000. This easy-to-understand book can help children feel safer in cases when abuse requires legal intervention or a family court appearance.
National Center for Injury Prevention and Control, Mailstop K65, 4770
Buford Highway NE, Atlanta, GA 30341-3724. NCIPC is a division of the
Centers for Disease Control and Prevention. It posts fact sheets at its
website on intimate partner violence, rape, and male batterers.
American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove
Village, IL 60007-1098. This organization posts fact sheets at its
website on physical and emotional child abuse, child sexual abuse,
shaken baby syndrome, and children in court cases.
American Humane Association, 63 Inveerness Drive East, Englewood,
This is an advocacy organization that aims to protect children and
animals from abuse, neglect, and cruelty. It posts fact sheets at its
website on child abuse and neglect and shaken baby syndrome.
is a website sponsored by the Nemours Foundation, created and
maintained by the medical experts at the A. I. duPont Hospital for
Children, Wilmington, DE. It posts articles and information for kids,
teens, and parents about abuse and related topics.