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Abuse

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Related Terms
  • Abortion, abuser, abusive, abusive relationship, antidepressants, assault, child abuse, child sexual abuse, domestic violence, molestation, rape, rape kit, SAFE kit, sexual assault, sexual assault forensic evidence kit, sexual molestation, sexual predator.

Background
  • Note: It is very important that victims suffering abuse contact the appropriate authorities immediately. Experts recommend that victims report the attack to police by calling 911, and get immediate medical attention. The safety of the abused victim should be considered first and foremost in all cases. The monograph below contains suggestions based on expert opinion, however, every abuse case should be treated individually. The information below should not be used or followed in place of qualified professional help.
  • Abuse is a term used to describe the mistreatment of a person. A person can be abused another person physically or emotionally. It is important to note that the victims do not cause the abuse. Abusers are responsible for their actions, even if they are under the influence of alcohol and/or drugs. However, these substances may make the abuse worse.
  • Domestic abuse: Domestic abuse typically occurs when an individual emotionally, verbally, or physically mistreats his/her spouse or intimate partner. However, victims may also include children and/or other family members. In some cases, abusers may also mistreat family pets. When the abuser inflicts physical harm onto the victim, it is called domestic violence. Domestic violence, which is considered a crime, is the most common cause of injury to women ages 15 to 44. In severe cases, domestic abuse can lead to murder.
  • Although adult males can be victims of domestic abuse, women are five to eight times more likely to be abused than males. Domestic abuse can occur during a heterosexual or homosexual relationship or after a relationship has ended.
  • The abuser uses fear, intimidation, and humiliation in an effort to control the victim. Over time, victims may become isolated from their friends and family members, making it even more difficult to leave the relationship. The abuse may be difficult to recognize at first and become progressively worse as time goes on.
  • Abuse typically occurs in cycles. When the abuser gets angry, tension grows and there is a breakdown in communication. Then the abuser verbally or physically mistreats the victim. Afterwards, abusers are usually apologetic. In some cases, the abuser will deny that the abuse ever took place. Sometimes the abuser may behave pleasantly and kindly towards the victim most of the time. This often makes it difficult for the victim to leave the abuser.
  • Individuals who are being abused are advised to leave their relationships. Abuse survivors are encouraged to seek the help of a friend, family member, or support group. Staff at emergency shelters can help victims file for court-ordered protection from the abuser, if necessary. If the abuser seeks treatment, including counseling, he/she may be able to change his/her behavior. However, the victim should avoid contact with the abuser until the abuser has received treatment and has shown that he/she is no longer abusive. Victims are also encouraged to seek counseling.
  • Sexual abuse: Sexual abuse occurs when an individual engages in any activity that is sexual in nature against the will of someone else. This may include exposing genitalia, touching or feeling individuals in an uncomfortable way, as well as vaginal, anal, or oral sex. Individuals who sexually abuse others are commonly called sexual predators.
  • In general, sexual abusers violate others because they feel the need to exert power, control, and/or humiliation over someone else.
  • Children may be sexually abused by a friend, neighbor, caregiver, teacher, stranger, or family member, including a parent, stepparent, aunt/uncle, or sibling. The abuser is usually older than the victim and he/she intimidates the victim into engaging in sexual activities. When children are sexually abused, it is often called molestation. Adults who sexually abuse children are called pedophiles.
  • Children are not emotionally prepared to handle sexual encounters. Even a two or three year-old, who does not know that sexual activity is wrong, will most likely develop psychological problems after being sexually abused. That is why each state in the United States has its own laws regarding the age of sexual consent. These laws prevent older individuals from sexually taking advantage of children and adolescents.
  • Adults may also fall victim to sexual abuse. The abuser may be a family member, spouse, intimate partner, or stranger. Sexual abuse may occur in combination with domestic abuse. It may also occur as an isolated incident. If the victim is forced to have vaginal, anal, or oral sex, it is called rape.

Signs and symptoms
  • General: Victims of abuse often try to hide the fact that they are or have been abused by someone. Because it is often difficult for victims of abuse, especially children, to leave abusive homes, coworkers, friends, family, teachers, daycare workers, and others should watch for warning signs of abuse. Recovery is possible for survivors of domestic and/or sexual abuse.
  • Domestic abuse: Victims of domestic abuse may have frequent bruises or injuries that are said to be accidents. Victims may suffer from depression, frequent crying, frequent and sudden absences from work or school, frequent tardiness to work or school, isolation from friends or family, decreased productivity or attentiveness, anxiety, substance abuse, panic attacks, post-traumatic stress disorder, aggressive behaviors, low self-esteem, shame, and insufficient resources to be independent (such as money, credit cards, or vehicle). The victim may also make references to the abuser's anger or temper. Abuse can trigger suicide attempts, psychotic episodes, homelessness, and slow recovery from mental illness. Children exposed to domestic violence may experience a wide range of developmental problems, which may lead to emotional and behavioral problems. For instance, children who are abused or exposed to abuse may suffer from psychiatric disorders, aggressive behaviors, and low self-esteem. All of these factors may make it difficult for domestic abuse victims to leave abusers.
  • Sexual abuse: Children who have been sexually abused may experience an unusual interest in or avoidance of all things that are sexual in nature, as well as sleep problems, nightmares, depression, withdrawal from friends or family, seductive behaviors, refusal to go to school, behavioral problems at school, secretive behavior, and unusual behavior. Some children may make negative statements about their body, saying it is dirty or damaged. Some children may draw pictures or play games that relate to sexual molestation. Victims of prolonged sexual abuse may suffer from feelings of worthlessness and have an abnormal or distorted view of sex. The child may become withdrawn and mistrustful of adults. Children may have suicidal thoughts, talk about suicide, or try to commit suicide. Some children who have been sexually abused have difficulty relating to others except on sexual terms. Some sexually abused children become child abusers or prostitutes, or have other serious problems when they reach adulthood. These children may also molest others and they are also more likely to become victims as adults.
  • Individuals who are raped may have cuts, bruises, tears of the vagina and/or rectum, as well as swelling, bruising, or pain between their legs. If the victim was forced to perform oral sex, the throat may be sore. Some individuals may feel scared, nervous, shaky, or want to cry. Later the victim may feel guilty, sad, anxious, or angry. The victim may have problems sleeping or feel scared to be alone. Other victims may have problems trusting others and want to be alone all the time. Some victims may not want to have sex in the future because it brings back memories of the attack.

Diagnosis
  • Domestic abuse: Domestic abuse is suspected if patients have signs and symptoms characteristic of domestic abuse victims. Domestic violence may be suspected if the patient suffers from frequent injuries, such as broken bones, burns, severe bruises, or other injuries. Healthcare providers are required by law to report suspected cases of domestic abuse to the local authorities.
  • Sexual abuse: Sexual abuse in children is suspected if they have signs and symptoms characteristic of sexual abuse victims. The child's statements on the event(s) are especially important. A counselor may be consulted if the child is hesitant to talk about what happened. The counselor may ask the child to draw pictures or use dolls to show what happened to them.
  • If rape is suspected, a healthcare provider is required to use a sexual assault evidence kit, also called a sexual assault forensic evidence (SAFE) kit or rape kit, to gather evidence of the attack. This information gathered may be used to prosecute the abuser in court. A sexual assault evidence kit contains tools, such as cotton swabs, urine collection containers, sterile sample containers, and envelopes for holding physical evidence, such as hair, semen, blood, and body tissues. The patient's clothing is collected as evidence and he/she is provided with new clothes. Blood and urine samples are taken. Loose hairs or debris from the pubic region are collected. The nurse examines the body, including the legs, buttocks, face, and breasts for samples of semen. If semen is detected, a sample is collected. Swabs are also taken from the vagina, anus, and mouth to check for semen, sexually transmitted diseases, and infections. A pelvic exam is also performed. Pictures are taken of areas of the body that are bruised, cut, or injured. The sexual assault kit is then sealed in a box and secured at the hospital until given to the police for further laboratory analysis. Females who are suspected of being raped will undergo pregnancy testing.

Treatment
  • General: Individuals who are victims of domestic or sexual abuse should seek help. Individuals who are abused often suffer from depression or low self-esteem, making it difficult to seek help. There are many support groups and organizations available to help individuals leave abusive relationships and recover from abuse. A complete recovery is possible for survivors of domestic or sexual abuse.
  • Individuals who suspect a friend, family member, coworker, student, or child is being abused should offer help to the victim. In some cases, individuals are required to call the local authorities if abuse is suspected. For instance, if a teacher suspects a student is being abused, he/she must call the Department of Child Services (DCS).
  • Abortion (non-surgical and surgical): If a female who is raped becomes pregnant, she may consider preventing or terminating her pregnancy. The decision to end a pregnancy is very personal. Counseling is offered to all individuals who are considering abortion.
  • Up to 72 hours after rape, women can receive medication to prevent their pregnancies. The U.S. Food and Drug Administration (FDA) has approved two drugs for emergency contraception: levonorgestrel (Plan B®) and levonorgestrel/ethinyl estradiol (Preven®). These drugs are similar to birth control pills, but they contain higher dosages of hormones. The first dose of emergency contraception pills can be taken up to 72 after the rape occurs. The second dose is taken 12 hours after the first. These drugs are most effective when taken as soon as possible after intercourse. These drugs are not considered abortive because they work by preventing or delaying the release of an egg (ovulation), thereby preventing the pregnancy from occurring. These drugs may also slow the movement of the egg or sperm in the fallopian tubes, making it harder for an embryo to implant in the uterus. Emergency contraception is available over-the-counter for women ages 18 and older. Victims of rape who are younger than 18 years old can receive these drugs from their healthcare providers. Emergency contraception pills have been shown to prevent about 75-89% of pregnancies after unprotected sex. Side effects may include nausea, vomiting, abdominal pain, fatigue, headache, and changes in menstrual bleeding. If the patient does not start menstruating within three weeks of treatment, she may be pregnant and she should consult her healthcare provider.
  • Up to nine weeks after rape, women can receive medications to end their pregnancies. This is called non-surgical abortion. A healthcare provider may prescribe hormone pills called mifepristone (RU-486® or Mifeprex®). The patient takes three of these pills by mouth at the doctor's office on the first day. Two days later, the patient must return to doctor's office. If it is unclear whether or not the pregnancy has ended, the patient will receive two tablets of another medication called misoprostol (Cytotec®). After treatment, patients may experience vaginal bleeding for nine to 30 days or longer. Fourteen days after treatment, patients should visit their healthcare providers to ensure that the pregnancy has ended. Side effects may include cramping, pelvic pain, headache, tiredness, difficulty sleeping, anxiety, leg or back pain, as well as vaginal burning, itching, or discharge.
  • Serious risks include prolonged bleeding, fetus not passing completely from body, (making surgery necessary), nausea, vomiting, diarrhea, and pain. Patients should discuss the potential health risks and benefits of non-surgical abortions with their healthcare providers.
  • Surgical abortion is also an option. During surgical abortions that are performed between six and 12 weeks of pregnancy, a vacuum-like instrument is inserted into the uterus. Although the patient is awake during the procedure, the patient receives sedatives and the doctor may numb the cervix to reduce pain.
  • If the surgical abortion is performed after 12 weeks of pregnancy, the doctor inserts a hollow tube into the uterus before using the vacuum to remove the fetal tissues. Patients usually receive medications to make the uterine contract, which helps reduce bleeding.
  • Risks of surgical abortion include excessive bleeding, infection of the uterus or fallopian tubes, damage to the uterus or cervix, and emotional or psychological distress. Surgical abortion may also increase the risk of infertility in the future. The risks of surgical abortion increase as the woman gets further along in her pregnancy. These risks vary among patients, depending on their age, overall health, how far along they are in their pregnancies, and the type of abortion performed. Therefore, patients should discuss the potential risks and benefits of abortion with their healthcare providers.
  • Antidepressants: Many abuse victims suffer from depression and low self-esteem. Some victims may benefit from medications called anti-depressants. Serotonin-reuptake inhibitors (SSRIs) are antidepressants that increase the amount of the neurochemical serotonin in the brain. This helps improve the patient's mood and energy levels. Commonly prescribed SSRIs include fluoxetine (Prozac®), paroxetine (Paxil®), sertraline (Zoloft®), citalopram (Celexa®), and fluvoxamine (Luvox®). SSRIs may cause side effects such as nausea, sexual dysfunction (including reduced desire or orgasm difficulties), headache, diarrhea, agitation, nervousness, rash, restlessness, increased sweating, weight gain, drowsiness, or insomnia.
  • Another class of drugs, called tricyclic antidepressants (TCAs), are typically used to treat moderate to severe depression. Commonly prescribed TCAs include amitriptyline (Elavil®), protriptyline (Vivactil®), desipramine (Norpramin®), nortriptyline (Aventyl® or Pamelor®), trimipramine (Surmontil®), and perphenazine (Triavil®). TCAs may cause side effects, including dry mouth, constipation, bladder problems, sexual problems, blurred vision, dizziness, drowsiness, skin rash, and weight gain or weight loss.
  • Psychotherapy: Victims of domestic or sexual abuse may benefit from psychotherapy. During psychotherapy, victims usually meet with a qualified therapist once or several times a week. Programs may last anywhere from several months to years. Programs are tailored to the individuals needs. Sometimes therapy will involve the victim and members of the family. The therapist will help the victim understand what happened to them. It is important that the victim understands he/she is not at fault. Over time, the therapist helps the victim learn how to trust others and maintain healthy relationships with others.
  • Support groups: Joining a support group for abuse survivors may help victims cope in the aftermath of abuse. For instance, individuals who are raped may seek help from their local rape crisis centers. Support groups usually provide counseling, self-defense classes, education programs, and legal help.

Integrative therapies
  • Good scientific evidence:
  • Psychotherapy: Psychotherapy is an interactive process between a person and a qualified mental health professional. The patient will explore thoughts, feelings, and behaviors to help with problem solving. Women with post-traumatic stress symptoms related to childhood sexual abuse may decrease their symptoms slightly more with cognitive-behavioral therapy than present-centered therapy.
  • Psychotherapy cannot always fix mental or emotional conditions. Psychiatric drugs are sometimes needed. In some cases, symptoms may get worse if the proper medication is not taken. Not all therapists are qualified to work with all problems. Use cautiously with serious mental illness or some medical conditions because some forms of psychotherapy may stir up strong emotional feelings and expression.
  • Traditional or theoretical uses lacking sufficient evidence:
  • Art therapy: Art therapy involves many forms of art to treat anxiety, depression, and other mental and emotional problems. Art therapy became a mental health profession in the 1930s. Today it is practiced in hospitals, clinics, public and community agencies, wellness centers, educational institutions, businesses, and private practices. Art therapy has been used to treat abusive parents, as well as victims of sexual abuse. However, studies have not been performed to determine whether this treatment is effective.
  • Art therapy may evoke distressing thoughts or feelings. Use under the guidance of a qualified art therapist or other mental health professional. Some forms of art therapy use potentially harmful materials. Only materials known to be safe should be used. Related clean-up materials (like turpentine or mineral spirits) that release potentially toxic fumes should only be used with good ventilation.
  • Kundalini yoga: Kundalini yoga is a type of yoga that uses many therapies, including physical postures, chanting, mediation, breathing exercises, and visualization. Proponents claim that it increases oxygen capacity, boosts blood flow, balances the glandular system, strengthens the nervous system, and increases self-awareness, vitality, peace of mind, concentration, and self-confidence. Kundalini yoga has been suggested as a possible rehabilitation treatment for sexual offenders. However, studies in humans are needed to determine whether this treatment is effective.
  • Avoid exercises that involve stoppage of breath with heart or lung problems, insomnia, poor memory, or poor concentration. Avoid certain inverted poses with disc disease of the spine, fragile or atherosclerotic neck arteries, risk for blood clots, extremely high or low blood pressure, glaucoma, detachment of the retina, ear problems, severe osteoporosis, or cervical spondylitis. Use cautiously with mental disorders as some techniques may cause an altered state of consciousness. Kundalini yoga is considered safe and beneficial for use during pregnancy and lactation when practiced under the guidance of expert instruction. Teachers of yoga are generally not medically qualified and should not be regarded as sources of medical advice for the management of clinical conditions.
  • Music therapy: Music is an ancient tool of healing that was recognized in the writings of Pythagoras, Aristotle, and Plato. The modern discipline of music therapy began early in the 20th Century with community musicians visiting veterans' hospitals around the country to play for those suffering from the traumas of war. Patients' responses led to the hiring of musicians by hospitals. Music is used to influence physical, emotional, cognitive, and social well-being. It is used to improve quality of life for healthy people, as well as those who are disabled or ill. It may involve either listening to or performing music, with or without the presence of a music therapist. Although music therapy has been used to treat victims of abuse, research is lacking. Studies in humans are needed to determine whether this treatment is effective.
  • Psychotherapy: Psychotherapy is an interactive process between a person and a qualified mental health professional. The patient will explore thoughts, feelings and behavior to help with problem solving. Psychotherapy has been used to treat victims of abuse and neglect, as well as sexual predators. However, research is needed to determine whether psychotherapy is beneficial for these patients.
  • Psychotherapy cannot always fix mental or emotional conditions. Psychiatric drugs are sometimes needed. In some cases, symptoms may get worse if the proper medication is not taken. Not all therapists are qualified to work with all problems. Use cautiously with serious mental illness or some medical conditions because some forms of psychotherapy may stir up strong emotional feelings and expression.
  • Yoga: Yoga is an ancient system of relaxation, exercise, and healing. Yoga has been described as "the union of mind, body, and spirit," which addresses physical, mental, intellectual, emotional, and spiritual dimensions towards an overall harmonious state of being. Healthy individuals with the aim of achieving relaxation, fitness, and a healthy lifestyle often practice yoga. Although yoga has been suggested as a possible rehabilitation treatment for sexual offenders, studies have not been performed to determine whether it is effective. Further research is needed.
  • Yoga is generally considered to be safe in healthy individuals when practiced appropriately. Avoid some inverted poses with disc disease of the spine, fragile or atherosclerotic neck arteries, risk for blood clots, extremely high or low blood pressure, glaucoma, detachment of the retina, ear problems, severe osteoporosis, or cervical spondylitis. Certain yoga breathing techniques should be avoided in people with heart or lung disease. Use cautiously with a history of psychotic disorders. Yoga techniques are believed to be safe during pregnancy and breastfeeding when practiced under the guidance of expert instruction (the popular Lamaze techniques are based on yogic breathing). However, poses that put pressure on the uterus, such as abdominal twists, should be avoided in pregnancy.

Prevention
  • Domestic abuse: Education is important to prevent domestic abuse. Individuals should be aware that domestic violence is a crime. Medical professionals, counselors, teachers, and others should learn how to recognize signs and symptoms of abuse to take action. Individuals should also be aware of organizations that offer help to victims of domestic abuse.
  • Oftentimes, domestic abuse starts off as verbal and emotional abuse. Individuals should learn how to identify abuse so that they can take action before the abuse becomes physical. Family or marriage counseling may help prevent the problem from escalating.
  • The National Coalition Against Domestic Violence recommends that victims of domestic abuse create a safety plan. Victims should find a safe place to go to in the home if an argument begins. Avoid rooms that do not have an exit. Avoid rooms with potential dangers, such as the kitchen. Individuals should know who to contact in a crisis. Victims should establish a code word or sign among trusted family or friends to let them know if they need help. Victims should memorize important phone numbers. Victims should always have money and change on hand. Keep important papers and documents, including social security cards, birth certificates, marriage license, credit cards, bank statements, health insurance cards, and records of past incidents of abuse in a place where they can be easily accessed. Medications and other important items should also be easily accessible.
  • Individuals may take self-defense classes so that they can better defend themselves.
  • Sexual abuse: Parents or caregivers should teach children about the privacy of body parts and explain what sexual abuse is.
  • Parents or caregivers should teach children what to do if another child or adult touches them inappropriately. The child should yell or scream for help. If sexual abuse occurs, the child should immediately tell an adult.
  • Parents or caregivers should teach children not to talk to strangers.
  • Parents or caregivers should always listen to their children. It is often difficult for sexual abuse victims to talk about what happened to them. It may also be difficult for parents to believe their children if the suspected attacker is someone close to the family. However, parents should not ignore or discredit the child's account of what happened.
  • Parents or caregivers should know who their children are spending time with.
  • Parents or caregivers should monitor their children's Internet use. Sexual predators are known to engage young children in sexual conversations online. Parents or caregivers should consider blocking certain websites that are inappropriate for children.
  • Individuals should not walk alone at night. Individuals should avoid poorly lit areas at night. Walking in well-lit areas with groups may discourage sexual predators from attacking.
  • Individuals can take self-defense classes so that they can fight against an attacker when they are threatened.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. American Academy of Child & Adolescent Psychiatry. .
  2. Department of Health and Human Services. .
  3. Family Violence Prevention Fund. .
  4. Fegert JM. Child sexual abuse. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2007 Jan;50(1):78-89.
  5. Kolar KR, Davey D. Silent victims: children exposed to family violence. J Sch Nurs. 2007 Apr;23(2):86-91.
  6. Kristensen E, Lau M. Women with a history of childhood sexual abuse. Long-term social and psychiatric aspects. Nord J Psychiatry. 2007;61(2):115-20.
  7. Mitchell KJ, Finkelhor D, Wolak J. Youth internet users at risk for the most serious online sexual solicitations. Am J Prev Med. 2007 Jun;32(6):532-7.
  8. National Coalition Against Domestic Violence. .
  9. National Domestic Violence Hotline. .
  10. Natural Standard: The Authority on Integrative Medicine. . Copyright © 2007.
  11. Rape Abuse & Incest National Network. .
  12. Sachs-Ericsson N, Kendall-Tackett K, Hernandez A. Childhood abuse, chronic pain, and depression in the National Comorbidity Survey. Child Abuse Negl. 2007 May;31(5):531-47.

Causes
  • General: It is important to note that abuse is never the victim's fault. Oftentimes, victims feel as though they brought the abuse on themselves. They might feel like they did something wrong and deserve to be yelled at or perhaps they were too flirtatious and gave the abuser the wrong impression. However, this is not the case. The abuser is the only person to blame.
  • Anyone can be a victim of domestic or sexual abuse. Therefore, individuals should educate themselves and their children about abuse so that they can identify and prevent potentially harmful situations.
  • Domestic abuse: Individuals who were abused or exposed to domestic abuse during childhood have an increased risk of becoming abusers. Other factors that may cause individuals to abuse others include stress, financial difficulties, depression, jealousy, substance abuse, and mental illness.
  • Sexual abuse: Several factors may cause individuals to sexually abuse children. It has been suggested that stress, difficulty controlling anger, isolation from family or friends, alcohol, drug abuse, personal history of being abused, lack of nurturing qualities, personal problems (e.g. unemployment or marital problems), and/or mental health problems (e.g. anxiety or depression) may cause an individual to sexually abuse a child. In addition, some cultural beliefs may lead to sexual abuse of a child. For instance, beliefs that children are property, parents have the right to control their children, and girls should be genitally mutilated to assure that they are virgins until marriage, may lead to sexual abuse.
  • Sexual predators may abuse adults because they feel the need to exert power, control, and/or humiliation over someone else.

Where to get help
  • General: Individuals who suffer from domestic or sexual abuse are encouraged to report the incidents to their local police departments. Individuals can also call 911 for immediate help. It is never too late to report incidents of abuse. Individuals can call abuse hotlines for information, help, and support. Abuse hotlines are anonymous and free of charge.
  • Domestic abuse: Victims of domestic abuse can call the National Domestic Violence Hotline at: 1-800-799-7233.
  • Individuals can report abuse to the Department of Social and Health Services at: 1-866-363-4276.
  • Child abuse can be reported to the Department of Child Services at: 1-800-800-5556.
  • Sexual abuse: Sexual abuse can be reported to the National Sexual Assault Hotline at: 1-800-656-4673.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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