Abuse is defined as any action that intentionally harms or injures another person. Abuse also encompasses inappropriate use of any substance, especially those that alter consciousness (e.g. alcohol, cocaine, methamphetamines).
There are several major types of abuse: physical abuse, sexual abuse, substance abuse, elder abuse, and psychological abuse. All forms of abuse in the United States are illegal and have the potential to carry serious criminal penalties.
Physical abuse is the infliction of injury by another person. Physical abuse can happen to both children and adults of either gender and of any sexual orientation. The injuries can be inflicted by punching, kicking, biting, burning, beating, or use of a weapon such as a baseball bat or knife. Physical abuse can result in bruises, burns, poisoning, broken bones, and internal hemorrhages.
According to the United States Department of Health and Human Services Administration for Children and Families, in 2006 in the United States there were 1,530 child fatalities that resulted from child abuse (a rate of just over 2 deaths per 100,000 children). Of these, about three-quarters of the children were under four years old, with the largest number of deaths occurring in infants under one year old. In addition, about 905,000 children were victims of nonfatal maltreatment (a rate of about 12 children 12 per 1,000 population). Nearly three-quarters of these children were victims of repeated maltreatment. Nearly 83% of abused children were abused by a parent or a parent acting with another individual.
Physical abuse of adults primarily occurs against women. The United Nations Development Fund for Women estimates that one-third of all women in the world will be beaten, coerced into sex, or otherwise abused during their lifetime. Sixty-nine percent of women worldwide report that at some time during their life they have been abused by a spouse or man with whom they are intimate. Intimate partners also commit the majority of murders of women. Violence against women tends to increase in times of economic downturns and political or social chaos (e.g. when a country is at war). Domestic violence is also strongly linked to substance abuse among the perpetrators. The U. S. Department of Justice found that in domestic violence cases, 61% of the perpetrators and 36% of the victims had a substance abuse problem. The most common substance abused was alcohol. Males can be victims of physical abuse, especially in homosexual relationships, but the statistics for abuse against men are more poorly documented than for abuse against women and children.
Sexual abuse of a child refers to sexual behavior between an adult and child or between two children, one of whom is forcefully dominant or significantly older. Sexual behaviors can include touching breasts, genitals, and buttocks while the victim is either dressed or undressed. Sexual abuse behavior also includes exhibitionism, cunnilingus, fellatio, or penetration of the vagina or anus with sexual organs or objects. Pornographic photography also is a form of sexual abuse of children. The U.S. Department of Justice estimates that one in six victims of a sexual assault are under age 12. Despite publicity surrounding cases where a child is assaulted by a stranger, almost all sexual assaults against children are perpetrated by a family member (e.g. father, stepfather, aunt, uncle, sibling, cousin) or family intimate (e.g. a live-in lover or friend of the parent).
Sexual abuse also can take the form of rape. The legal definition of rape includes only slight penile penetration in the victim's outer vulva area. Complete erection and ejaculation are not necessary. Rape is the perpetration of an act of sexual intercourse when:
- will is overcome by force or fear (from threats, use of weapons, or use of drugs).
The National Coalition Against Domestic Violence (NCADV) estimates that 1 in 5 women and 1 in 33 men will be the victim of a rape or an attempted rape during their lifetime. According the U.S. Department of Justice, 54% of all rapes are of women under age 18. Rape can occur within the context of marriage. Marital rape accounts for about 25% of all rapes in the United States. Marital rape is often accompanied by physical and psychological abuse. In 90% of all rapes, the woman knows the rapist. Women who are victims of a sexual assault have a high chance of experiencing depression, posttraumatic stress disorder, developing substance abuse, and of becoming suicidal
Substance abuse is an abnormal pattern of substance usage leading to significant distress or impairment. Alcohol, street drugs, and prescription drugs are common substances of abuse. Substance abuse is often a contributing factor in physical and sexual abuse. Children of parents who are substance abusers are more likely to experience abuse than children living in households where there is no substance abuse. The National Committee to Prevent Child Abuse found that in the united States, 80% of child abuse cases were associated with substance abuse by the perpetrator.
The criteria for substance abuse is one or more of the following occurring within a 12-month period:
- recurrent substance use resulting in failure to fulfill obligations at home, work, or school.
Abuse of the elderly is common and occurs mostly because of caregiver burnout due to the high level of dependency and continuous care that frail, elderly individuals often require. The NCADV estimates that in 2007 there were 2.1 mission cases of elder abuse in the united States but that only 1 out of every 14 cases was reported to authorities. Victims tend to be over age 50 and highly dependent on their caregivers because of physical or mental disabilities. In 90% of the cases, the abuser is a family member.
Elder abuse can take the form of physical abuse, psychological abuse, sexual abuse, or financial abuse. Examples of elder abuse include:
- withholding food, water, or medicines
Victims of psychological abuse can be of any age or gender. This form of abuse is often difficult to prove. It includes threatening the victim with violence, harassing them when the are outside the home (e.g. at school or work), denying the victim access to others (e.g. refusing to allow the victim to see friends, preventing use of the telephone), confining the victim to home, or destroying the victim's property. A woman with a physical disability has a greatly increased likelihood of being psychologically abused. Men who are unemployed but living in a household where the woman works are most likely to be psychological abusers. Almost all men who physically abuse women also psychologically abuse them.
Causes and symptoms
Children who have been abused usually exhibit a variety of symptoms that encompass behavioral, emotional, and psychosomatic problems (body problems caused by emotional or psychological disturbance). Children who have been physically abused tend to be more aggressive, angry, hostile, depressed, and have low self-esteem. Additionally, they exhibit fear, anxiety, and nightmares. Severe psychological problems may result in suicidal behavior or posttraumatic stress disorder. Physically abused children may complain of physical illness even in the absence of a cause. They also may develop eating disorders or encopresis. Children who are sexually abused may exhibit abnormal sexual behavior in the form of aggressiveness and hyperarousal. Adolescents may display promiscuity, sexual acting out, and homosexual exploration. Children who are psychologically abused or who witness psychological abuse are more likely to become psychological abusers as adults.
Physical abuse directed towards adults can ultimately lead to death. Approximately 50% of women murdered in the United States were killed by a former or current male partner. Approximately one-third of emergency room visits by women are prompted by an incident of domestic violence. Female victims who are assaulted by an intimate partner also have a higher rate of internal injuries and loss of consciousness than victims of stranger assault (e.g. mugging, robbery). As well as showing physical signs of abuse, adults who are abused often have poor health, difficulty concentrating, suicidal thoughts, clinical depression, low self-esteem, and a high rate of substance abuse. Many victims of abuse are afraid or unwilling to admit the abuse is occurring and will go to great lengths to disguise their situation.
Physical abuse should be suspected whenever children or adults have unexplained injuries, especially when these injuries occur with an unexpectedly high frequency. A report may be filed with the local family social services agency that will initiate investigations. A police report may also be made. The authorities normally will follow up the allegation of abuse.
Sexual abuse of both a child and an adult may be identified from information given by the victim. Victims can be assessed for signs of ejaculatory evidence from the perpetrator. Ejaculatory specimens can be retrieved from the mouth, rectum, and clothing. Tests for sexually transmitted diseases may be performed.
Elder abuse should be suspected if a dependent individual demonstrates a fear of the caregiver. Additionally, elder abuse can be suspected if there are signs indicating intentional delay of required medical care, an unexpected change in medical status, or a significant change in the elderly individual's financial status.
Substance abuse usually causes behavioral changes such as failure to perform expected tasks or inability to meet reasonable work and family responsibilities. It should be suspected in a person who continues to use their drug of choice despite recurrent negative consequences. The diagnosis can be made after administration of a comprehensive physical exam and a chemical abuse assessment by a therapist.
Both children and adults who are victims of physical or sexual abuse typically require immediate medical attention and long-term psychotherapy. Many victims of abuse, especially children who are sexually abused, take years to come to terms with the abuse. Therapists who specialize in treating victims of physical and sexual abuse can help the individual understand has happened and suggest ways to make positive steps toward moving past the abuse. Support groups can be helpful for some victims. When children are abused by the adults they live with, they may be removed from the abuser's home and placed in foster care or a group home. Psychological counseling and anger management should also be made available to the abuser. The effects of all types of abuse can last for years even with good mental health care. Children witnessing abuse, even if they were not abused themselves, also are often adversely affected and can benefit from psychotherapy.
Substance abusers may elect treatment or be sent to a treatment facility as part of a law enforcement proceeding. Treatment for substance abusers can be at either an inpatient or outpatient facility, depending on severity of addiction. Psychological counseling, behavior modification strategies, and medications may be to assist in abstinence. The individual should be encouraged to participate in community-centered support groups (e.g. Alcoholics Anonymous, Narcotics Anonymous). Support groups also exist for family members of substance abusers.
Toll-free telephone hotlines available 24 hours a day, 7 days a week can provide referrals and counseling for people in an abuse crisis situation. People calling these hotlines may choose to remain anonymous. A list of national hotlines in the United States can be found in the reference section of this article.
How an individual progresses after experiencing an abuse situation depends on the individual's personality, the type of abuse, the length of time the individual was abused, family support, and the professional support services available. Usually victims of abuse require extensive psychotherapy to deal with emotional distress associated with the incident. Perpetrators require further psychological evaluation and treatment. Victims of abuse may have a variety of emotional problems including depression, acts of suicide, post-traumatic stress disorder, and anxiety disorder. Many turn to substance abuse as a way to avoid dealing with their emotions. Children who experience sexual abuse may enter abusive relationships or have problems with intimacy as adults. Substance abusers may experience relapses since the cardinal feature of all addictive disorders is a tendency to return to symptoms. Elderly individuals may suffer from further medical problems and/or anxiety; in some cases neglect may precipitate death.