Thursday, August 7, 2008

Types and Impact of Abuse

The goal of this topic is to provide a brief review of types and degrees of abuse and neglect. As a field of practice, it is simply too complex to fully highlight every nuance of abuse and neglect. It is important to help you start to see how abuse and neglect may be related to your sexual timeliness. The treatment approaches also vary and will not be reviewed here.

Abuse can occur in a variety of ways. The major areas of physical, emotional or sexual abuse. These types are simply categories to help describe the abuse. They may overlap . For example, a child can be emotionally manipulated (put down) and threatened before he/she is sexual molested.

Physical abuse includes any behavior that causes or contributes to a physical injury to another person. These injury can include severe forms of injury such as broken bones, internal injuries, burns, scars, broken skin wounds to less severe forms of injury such as cuts, bruises, fat lips, or black eyes. The abuse can be direct or indirect. Direct abuse is when the physical contact is caused by the body of the perpetrator. Indirect abuse is when a third object in involved. For example, if I hit you with my fist, I made direct contact to you. If I threw the lamp at you, and missed you but to get out of the way you tripped and feel and bruised yourself, I was an indirect cause of the injury. Because I threw the lamp in the first place, I am ultimately a cause of the abuse.

Examples of physical abuse include the following:

  • Bruises on legs, arms, or buttocks not requiring medical treatment.
  • Superficial welts, scratches, or abrasions.
  • Hair pulling that does not remove hair.
  • Minor burns, blisters, or abrasions.
  • Superficial injuries that are very widespread.
  • Small cut requiring stitches.
  • 2nd degree (moderately severe) burns.
  • Sprains, mild concussions, broken teeth.
  • Hair pulling that results in hair removal.
  • Extensive cuts requiring stitches.
  • Head injuries.
  • Internal injuries.
  • 3rd degree burns to any area of the body.
  • Minor burns to an extensive area of the body.
  • Injuries resulting in impairment to sight, hearing, or mental abilities.
  • Burns or bruises to the genital area.
  • Extensive and multiple bruises in various states of healing indicating a pattern of abuse.
  • Cuts, bruises, or abrasions on face, neck, or shoulders.
  • Minor burns on face or abdomen.
  • Preventing a child from breathing for a short period of time.
  • Administering to a child any harmful substance or any substance that results in harm to the child.
  • Major physical injury requiring long-term medical treatment, inpatient care, or alternate placement.

Sexual abuse can include a range of behaviors. These include the extreme forms of abuse such as rape, molestation, prostitution, or incest. Other forms of childhood sexual abuse include exploitation, use of a power relationship (teacher/student, caretaker/child, professional/client). Less extreme forms of abuse can include manipulation of others for sexual pleasure, voyeurism and exhibitionism. Sexual abuse also includes sexual harassment and verbal degradation. Depending on your jurisdiction, sexual contact as an adult with a minor under age 16 or 18 is by statute a form of sexual assault and result in automatic criminal contact if revealed.

Examples of Sexual Abuse include the following

  • Sexual innuendoes or provocative statements
  • Engaging in sexual behavior in front of another person.
  • Exposes him/herself to the another person
  • Fondling the or touching the breast or genital area for other than hygienic purposes.
  • An adult or older child has engaged a child in sexual intercourse, masturbation, or oral genital sex.
  • Sexual contact with an adult such as sexual intercourse, masturbation, or oral genital sex without permission or permission is withdrawn.

Emotional Abuse The third classic type of abuse is emotional abuse which involves negative statements about the other person. Some incidents of emotional abuse might be onetime events, but often there is a pervasive pattern of negative statements. Two types of emotional abusive relationships can be between adults to children (i.e., parents) and partners..

Distinction between OVERT and COVERT abuse.

A lot of research and practice emphasizes overt abuse which I define as abuse that is easily recognized. There usually is a specific person, behavior, event, time, place when the abuse is described. In therapy, a client will say “my partner did.. . . . .” and describe in great detail what happened. Covert abuse is equally as damaging but is often “covered and not recognized.” I use the concept to apply to any setting where there is an atmosphere of fear. Hence statements such “I can give you something to cry about” creates an atmosphere of impending physical abuse. Another example, “Don’t make me get the belt.” A third example, “What until your father get’s home. “ In my approach, I label these behaviors as covert physical abuse. The threat is the key to recognizing abuse. The difficulty, however is that covert abuse is very difficult to recognize. A client may report that he or she is vigilant for the next abusive event. Such a client may shudder simply because of a look from a partner, friend, or parent.

Abuse versus Neglect

Abuse is typically an active behavior. I “do” something, or something is “done” to me. Just as damaging is the concept of neglect. Neglect is the failure to provide the necessary resources to another person. In terms of emotional and physical neglect, it is often recognizable. Emotional neglect can be the failure to provide emotional support. Physical neglect can be the failure to provide appropriate nutrition, shelter, or clothing. Sexual abuse could be the failure to provide adequate sexual education. Both covert abuse and neglect is very difficult to recognize. It is only after the fact and through the recognition of the indicators of abuse that covert abuse and/or neglect can be identified.

Below are typical indicators of symptoms of abuse and neglect. Review the indicators and correlate with your sexual history.

Classic Behavior Indicators

  • When abuse occurs as a child, some of these following signs may be present. Consider the extrapolation of these indicator to adults as well.
  • Displays agitated or angry, uncontrollable behaviors, tantrums,
  • Displays anxious behaviors (nail biting, teeth grinding, rocking, etc.)
  • Often belittles self ("I'm bad, naughty, evil, etc.')
  • Resists authority or desperately tries to please fearing repercussions, exhibits excessive guilt.
  • Shows fear of a particular person or place.
  • Thoughts involves themes of sexual acts, torture, bondage, humiliation, abuse.
  • Hurts others sexually or physically.
  • Acts aggressively around pets.
  • Mimics adults' sexual behavior (intercourse, french kissing, etc.)
  • Has age inappropriate sexual knowledge (is sexually knowledgeable beyond their years or generally accepted standards).

Emotional Indicators

  • Has lots of new fears; becomes "clingy," withdrawn, regressed.
  • Shows inappropriate emotions or no emotions at all.
  • Is fearful that others hate them, are angry with them, wants to hurt, punish or kill them.
  • Is fearful that 'someone is after them" or going to hurt them; is watchful for strangers.
  • Has low self esteem.
  • Is unable to form friendships..
  • Is self destructive; intentionally inflicts harm on self.
  • Appears to be in a "fog."
  • Has excessive mood swings
  • Increased chemical use
  • Increased sexual behavior
  • Suicide thoughts, statements or gestures.

Personal Victimization History

Work on an abuse history. Include the details such as your age, the details (who/what/when/where) and your reaction. Also include your response today. Reflect on how the abuse impacted your sexual behavior, and identity. In writing your abuse history, include:

overt and covert abuse

physical, sexual, emotional abuse

and include both abuse and neglect.

Often, individuals may not label the events as “abuse” because they do not know that they were not at fault, because they liked or respected the perpetrator and/or could not believe that the person would harm them. Sometimes a person may think the abuse is a “normal” part of life. You might review the indicators of abuse. Consider if any indicators are present. Might there be a particular event or source of the indicators?

Sometimes an individual’s abuse history contributes to the acting out cycle. The consequences of abuse vary, and can contribute to relational, sexual and other problems. Due to your experiences in your abuse history you may have difficulty recognizing and expressing feelings. This abuse might interfere with the ability to express feelings and to empathize with others.

If the history of abuse is significant, either in terms of the impact of abuse and/or the amount of use, it is strongly recommended that you complete this assignment under the care of a mental health clinician.

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