What is abuse?

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Abuse is a pattern of harmful behaviors directed at achieving and maintaining power over an individual. Types of abuse include physical, sexual, and mental or emotional. Abuse can also be a combination of any of these forms and can occur in various settings. Whether abuse takes the form of domestic violence, child abuse, or elder abuse, the person perpetrating the abuse aims to exert power and control over an often helpless victim.

Abuse occurs among people of all ages, genders, races, educational backgrounds, and socioeconomic groups. However, certain groups, especially women, are at greater risk for abuse. According to the U.S. Department of Justice, most victims of domestic and sexual abuse are women.

Abuse, especially if ongoing, can be physically and mentally harmful. It almost always results in psychological damage to its victims. Abuse can lead to increased anxiety and stress, low self-esteem, and mental illnesses including major depression and post-traumatic stress disorder.

Prolonged abuse may also put victims at risk for substance abuse or dependence, high-risk sexual behaviors (e.g., unprotected sex, multiple sex partners), poor health, poor academic or work performance, suicidal ideation, and untimely death.

Although victims may be unable to stop abuse while it is happening to them, they can get help and support for themselves. This includes calling local authorities in cases of emergency, especially in life-threatening situations, and promptly securing medical attention for any injuries sustained during the abuse.

Victims of abuse can find some relief and feel less alone by confiding in trusted individuals including friends, relatives, and other loved ones. Support groups for victims of abuse can also help abused individuals cope with their situation and may empower them to take the necessary steps to end the abuse.

Some abuse victims may seek support from family and friends. However, others may be in denial about their situation. Other people can help abuse victims by not ignoring signs of abuse – unexplained bruises, broken bones, or increased anxiety – and recognizing the need for medical attention, which may save a person’s life.

People can help someone in an abusive relationship simply by listening to them and letting them know help is available. A support system of caring friends and relatives can help ensure a victim takes necessary steps to end the abuse, such as leaving the spouse or perpetrator and/or reporting abuse to the authorities. A variety of health and social resources exist to provide timely assistance and support for victims of abuse. These include national coalitions such as the U.S. National Domestic Violence Hotline (1-800-799-SAFE or 7233) and local shelters, crisis centers and courts, or other law enforcement agencies. Healthcare professionals, such as physicians, nurses, social workers, school counselors, or psychologists may be able to provide referrals for such services. Other sources of information include telephone books and the Internet.

About abuse

Abuse is a pattern of harmful behaviors directed at achieving and maintaining power over an individual.

Healthy relationships involve mutual respect, trust, and consideration. The opposite is true of abusive relationships. In all cases, the person perpetrating the abuse aims to exert power and control over an often helpless victim.

Abuse can take various forms including:

  • Physical abuse. The willful infliction of physical pain or injury. Physical abuse includes shoving, punching, slapping, pinching, hitting, kicking, hair-pulling, choking, and other types of violent behavior. In severe cases, it may result in death.
  • Sexual abuse. The infliction of non-consensual sexual contact of any kind. It may include rape or sodomy, coerced nudity or sexual exhibitionism, inappropriate touching, photographing a victim in suggestive poses or forcing them to look at pornography, forcing sexual contact with a third party, or any other type of unwanted sexual contact.
  • Psychological abuse. The infliction of mental or emotional anguish. When a person behaves in a way that causes fear, mental anguish, and emotional pain or distress to others, the behavior can be regarded as abusive. It can range from name-calling or the “silent treatment” to intimidating and threatening an individual. Psychological abuse can also include neglect or isolating a victim from family, friends, and regular activities – either by force, threats, or through manipulation (e.g., controlling access to finances).

Abuse can also be a combination of any of these forms or others (e.g., domestic violence). In addition, abuse can occur among people of all ages (e.g., child abuse, elder abuse), genders, races, educational backgrounds, and socioeconomic groups. However, certain groups are at greater risk for abuse. In the United States, American Indian or Alaskan Native women and men report more violent victimization than women and men of other racial backgrounds.

Regardless of background, physical assault is widespread among adults in the United States. According to the U.S. Department of Justice, an estimated 1.9 million women and 3.2 million men are physically assaulted each year.

Most victims of domestic and sexual abuse are women. Sexual abuse of females often starts at an early age. More than half of all rapes of females occur before age 18 and 22 percent of these rapes occur before age 12.

In the United States, nearly 5.3 million women age 18 and older experience physical abuse, and about 1.5 million women are raped or sexually assaulted each year. In most cases, violence against women is perpetrated by an intimate partner, spouse, or someone acquainted with the victim.  

In 2003, there were about 906,000 abused children in the United States, according to the Department of Health and Human Services. Neglect – inadequate food, housing, clothes, medical care, or supervision – is the most common form of child abuse. Infants aged 3 and younger experienced the highest rate of abuse, with girls being slightly more victimized than boys. In most cases, child abuse is perpetrated by parents.

Abuse almost always results in psychological damage to its victims. It can lead to increased anxiety and stress, low self-esteem, and mental illnesses including major depression, eating disorders (e.g., anorexia nervosa, bulimia nervosa), and post-traumatic stress disorder.

Ongoing abuse may also put victims at risk for substance abuse or dependence, high-risk sexual behaviors (e.g., unprotected sex, promiscuity), poor health, poor academic or work performance, suicidal ideation, and untimely death. In addition, research indicates that children who experience domestic violence are also more likely to experience domestic and psychological abuse as adults or grow up to become abusive themselves. 

Risk factors for abuse

Mental health experts have identified several risk factors related to abuse, both for abuse victims and perpetrators.

Risk factors for victimization include:

  • A prior history of intimate partner violence
  • Age
  • Female gender
  • Having substance abuse problems and/or engaging in high-risk sexual behaviors (e.g., promiscuity)
  • Lack of education and/or employment
  • Being of a different ethnic background than a partner (for men)
  • Having a greater education level than a partner (for women)
  • Having a jealous or possessive partner (for women)

People with the following risk factors may be more likely to abuse:

  • History of childhood physical or psychological abuse
  • Low self-esteem, income, and/or academic achievement
  • Substance abuse problems
  • Mood disorders (e.g., depression), an inability to control anger, and/or a prior history of being abusive
  • Emotional dependence and insecurity
  • Belief in strict gender roles, such as male dominance and aggression in relationships
  • The desire for power and control in relationships

Elder abuse

The U.S. National Center on Elder Abuse estimates that between 1 million and 2 million Americans age 65 or older are victims of abuse each year. Elder abuse can be physical, emotional, or psychological. It can also take the form of financial exploitation and intentional or unintentional neglect of an older adult by a caregiver.

Elder abuse usually occurs at a victim’s home, not in institutional settings such as nursing homes. Perpetrators are usually family or other household members or paid caregivers.

Risk factors for elder abuse include discord in the family created by an older person’s presence, history and pattern of domestic violence and/or substance abuse within the family nucleus, social isolation, and lack of knowledge or caregiving skills.

Caregiver stress is another important risk factor. Caregivers can feel trapped and alone while caring for the daily needs of a person, especially if the role is unfamiliar if they lack training, or are also faced with financial stress. In addition, caregivers can also be abused. They frequently experience physical or psychological abuse, especially if the patient has emotional or neurological issues, such as dementia.

Most cases of elder abuse are not reported to authorities. Certain societal attitudes may make it easier for elder abuse to continue without detection or intervention. These factors include a devaluation or lack of respect for elderly people and the conventional belief that matters inside a home are private. Certain cultural factors, such as language barriers, may also make elder abuse or neglect difficult to distinguish.

Signs indicative of elder abuse include:

  • Any bruises, grip marks, or other injuries indicating physical abuse.
  • Refusal to return to a medical facility for treatment of repeat injuries.
  • Being uncommunicative, showing a lack of interest in social contacts, or acting unreasonably fearful or suspicious. This may indicate emotional or psychological abuse.
  • Unexplained vaginal or anal bleeding and sexually transmitted diseases (e.g., herpes). This can suggest sexual abuse.
  • Life circumstances do not match the victim’s lifestyle, including large withdrawals from bank accounts and unusual ATM activity, switching of financial accounts, or any other signs of financial abuse or fraud.
  • Sunken eyes, unexplained weight loss, bedsores, or dehydration. These can indicate neglect.

Like any form of abuse, elder abuse is not an acceptable response to any problem or situation. In such cases, it is extremely important for other relatives or loved ones to intervene on behalf of an elderly victim. Physicians, mental health professionals, home health care workers, and others who provide services to older people can also intervene to ensure that abuse stops and that both the abuser and victim receive the necessary help. People who suspect elder abuse can call the Eldercare Locator at 1-800-677-1116 for a referral to the appropriate agency in the area.

Signs of abuse in adults

People may have trouble recognizing that they are in an abusive relationship. Recognizing abuse can be especially hard for an individual who has lived with it for many years, sometimes in multiple relationships. As a result of ongoing abuse, victims may be in denial and unaware that certain behavior is unacceptable. They might also erroneously think that they bring it on themselves by misbehaving or not living up to an abuser’s expectations.

There are various warning signs that may indicate an abusive relationship. These include:

  • Any type of physical abuse, such as slapping, pushing, grabbing, shaking, smacking, kicking or punching, and any type of sexual abuse (e.g., rape, inappropriate touching).
  • Controlling all aspects of a person’s life, including personal finances, how they dress, who they go out with, what they say in public and constant accounting of a person’s time.
  • Frequent humiliation. For instance, if a partner belittles a person but says that they are doing it out of love.
  • Threatening harm or death if the person tries to leave the relationship.
  • Twisting the truth to make it seem as if the person is to blame for their abusive actions.
  • Constantly becoming jealous or angry when one wants to spend time separately with friends or other loved ones.

Recognizing someone else is being abused is equally important, especially if victims are in denial and do not realize the life-threatening consequences of their situation.

Signs that might indicate a friend or loved one is in an abusive relationship include:

  • Unexplained bruises, broken bones, sprains, or other marks on the body indicative of battery.
  • Excessive guilt, fear, or shame for no apparent reason.
  • Extreme secrecy and/or withdrawal from friends and family.
  • Avoidance of school, work, and social events with excuses that do not seem to make sense.

Coping tips for victims of abuse

Without help, abuse may continue and worsen. The first step toward self-assertion is to realize that everyone has the right to be treated with respect and not be physically, sexually, or verbally abused by another individual.

The most effective way to end the cycle of abuse is by reporting it as soon as possible. Victims of abuse may find this difficult, either out of fear or because they do not want to betray someone they love. While victims are often unable to stop abuse while it is happening to them, there is much they can do to get help and support.

Abuse victims should ensure their personal safety first. This includes calling local authorities in cases of emergency, especially in life-threatening situations, and getting away from the abuser as soon as possible.

In cases of rape or sexual assault, victims are encouraged not to wash, comb or cleanse any part of their body and if possible, not change their clothes. This will enable hospital staff to collect evidence (e.g., semen) for the authorities that may be later used to arrest a perpetrator.

On the other hand, individuals in ongoing abusive relationships may not be able to immediately leave an abuser. Because self-esteem can suffer tremendously during prolonged abuse, victims of abuse may not be able to take care of themselves or take the necessary steps to leave an abusive relationship. At this time, getting help and support from relatives, friends and other loved ones is an important step in changing the situation.

Other tips for coping with ongoing abuse include:

  • Visit the nearest medical facility or hospital as soon as possible to treat any injuries sustained during abuse.
  • Confide in trusted individuals. This may include friends, relatives, neighbors, coworkers, teachers, primary care physicians or mental health professionals (e.g., psychiatrists), professors, and religious or spiritual leaders (e.g., priests, rabbis).
  • Keep money handy for transportation (e.g., taxis, buses) in case a fast escape is necessary. Vital documents such as birth certificates, passports, social security cards, driver’s licenses, and other forms of personal identification should also be kept available.
  • Keep spare change, calling cards, or cell phones ready or charged for immediate access to communication.
  • Keep a diary or journal. Writing about traumatic events such as abuse is emotionally therapeutic and it may also prove helpful if evidence of abuse is later needed by law enforcement agencies. Keep a copy of the journal and any other evidence in a safe location, such as with a trusted friend or in a password-protected computer file.
  • End the abusive relationship. Perhaps the most difficult step, but it also is the most likely way to ensure that abuse stops completely.
  • Get mental health treatment (e.g., counseling). Many victims of abuse find that painful emotions may linger even after the abuse ends. Talking to a mental health professional such as a psychologist is one way to sort through the complicated feelings and reactions that being abused creates, and the process can help to rebuild feelings of safety, confidence, and self-esteem. It can also help a person identify patterns in their relationships to help avoid future abusive relationships.
  • Join support groups for victims of abuse. These groups, either in-person or on the Internet, can be especially helpful for individuals with limited personal support systems.
  • Avoid obsessing about the abusive relationship or incident after it is over. It should be noted that this is not suggesting denial. However, constantly rehashing the abuse in such cases may affect one’s emotional health.
  • Engage in activities that boost self-esteem, such as learning a new skill or hobby or joining a local social group. Doing so may also keep one from constantly thinking about the abuse.

Helping a loved one cope with the abuse

Although some victims may turn to their family, friends, and other loved ones for support, others may be in denial about their situation. Nonetheless, friends and family may still provide support.

Tips for helping a loved one cope with abuse include:

  • Acknowledge signs of abuse. These can include unexplained bruises, broken bones, sprains, or other types of marks that may indicate physical abuse. Behaviors including withdrawal from friends or family and mood changes such as increased anxiety or depression may also indicate abuse.
  • Recognize when they need medical attention. When abuse victims are in denial, they may not realize how badly they are hurt.
  • Talk to them in private and let them know support is available.
  • Tell them that they deserve better treatment and that the abuse is not their fault.
  • Be supportive and non-judgmental.
  • Do not force them into decisions. Although it can be difficult to see someone getting hurt, ultimately the person being abused has to decide to act.
  • Help them take action. This can be done by offering to get them information (e.g., phone numbers of abuse hotlines or support groups), assisting them in developing a safety plan or helping them talk with another supportive individual such as a relative, primary care physician or mental health professional.
  • Encourage them to report the abuse to local authorities, especially in life-threatening situations.
  • Continue being supportive after they end the abusive relationship. Even though the relationship was abusive, some victims may still feel sad and lonely once it is over. They will need time to grieve the loss of the relationship.

Resources available for abuse victims

In cases of emergency, abuse victims are urged to get away from their abuser or perpetrator and contact a local law enforcement agency as soon as possible. However, if danger is not life-threatening there are various resources available for individuals experiencing abuse.

Victims of abuse should realize that they are not alone or helpless, even if they may feel as though they are. A variety of local health and social services exist to provide timely assistance and support. These services typically address the underlying causes of abuse as well as help stop it and prevent recurrence. Health care professionals, such as physicians, nurses, social workers or psychologists may be able to provide referrals for such services. Other sources of information include telephone books and the Internet.

For instance, national coalitions can provide crisis intervention and referrals to in-state and out-of-state resources, such as women’s shelters or crisis centers. These include:

  • U.S. National Domestic Violence Hotline. 1-800-799-SAFE or 7233. www.ndvh.org
  • Childhelp USA® National Child Abuse Hotline. 1-800-422-4453. www.childhelpusa.com

Shelters and crisis centers usually provide 24-hour, emergency shelter for victims and their children. They also provide advice on legal matters, advocacy and support services and evaluation and monitoring of abusers. Some shelters have staff members who speak multiple languages.

Medical facilities such as clinics or hospitals can also provide invaluable assistance. These facilities treat injuries and can also refer abuse victims to safe housing and other local resources. Counseling or mental health centers are another helpful option because they provide treatment for psychological trauma (e.g., post-traumatic stress disorder) that affects abuse victims. However, individuals in abusive relationships (e.g., domestic violence) should not attempt to convince an abuser to attend couples or marriage counseling. This type of family therapy is not appropriate for abusive relationships.Local courts and law enforcement agencies can help abuse victims obtain court orders, which legally mandate an abuser stay away from them or face arrest. These are usually referred to as orders of protection or restraining orders. Courts and other law enforcement agencies can also refer victims to local advocates, who are often available throughout the community, for assistance with necessary paperwork and guidance in the legal process.

Questions for your doctor regarding abuse

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions regarding abuse:

  • How can I help my friend who is in an abusive relationship?
  • If I report my husband to the authorities for child abuse, will my child be taken away?
  • Do you know any shelters or crisis centers for victims of domestic violence?
  • I grew up in an abusive household. Am I at risk of becoming abusive towards my family and loved ones?
  • What can I do to prevent becoming abusive towards my family and loved ones?
  • Where can I get help so that I can stop hitting my child?
  • How can I protect myself from being a victim of assault and other types of violence?
  • I am scared my partner/spouse may kill me if I report the abuse to authorities. What should I do to protect myself?
  • I am 75 years old and I suspect my family is misusing my credit cards. I worry that I will have no one to take care of me if I confront them. What should I do to protect my finances as well as myself?
  • I suspect my child is being abused, how can I get him/her to confide in me?

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Tom Perry, M.D., attended Tulane University and graduated Magna Cum Laude with a B.S. degree in Parasitology. He received his M.D. degree in 1983 from the University of Virginia School of Medicine, where he gained extensive research experience, including studies conducted through the National Institutes of Health.