Abuse

Definitions

Abuse is a complex psychosocial problem that affects large numbers of adults as well as children throughout the world. It is listed in the Diagnostic and Statistic Manual of Mental Disorders (DSM-IV-TR ) under the heading of "Other Conditions That May Be a Focus of Clinical Attention." Although abuse was first defined with regard to children when it first received sustained attention in the 1950s, clinicians and researchers now recognize that adults can suffer abuse in a number of different circumstances. Abuse refers to harmful or injurious treatment of another human being that may include physical, sexual, verbal, psychological/emotional, intellectual, or spiritual maltreatment. Abuse may coexist

with neglect , which is defined as failure to meet a dependent person's basic physical and medical needs, emotional deprivation, and/or desertion. Neglect is sometimes described as passive abuse.

The costs of abuse to society run into billions of dollars annually in the United States alone. They include not only the direct costs of immediate medical and psychiatric treatment of abused people but also the indirect costs of learning difficulties, interrupted education, workplace absenteeism, and long-term health problems of abuse survivors.

Types of abuse

Physical

Physical abuse refers to striking or beating another person with the hands or an object, but may include assault with a knife, gun, or other weapon. Physical abuse also includes such behaviors as locking someone in a closet or other small space, depriving someone of sleep, burning, gagging, or tying them up, etc. Physical abuse of infants may include shaking them, dropping them on the floor, or throwing them against the wall or other hard object.

Sexual

Sexual abuse refers to inappropriate sexual contact between a child or an adult and someone who has some kind of family or professional authority over them. Sexual abuse may include verbal remarks, fondling or kissing, or attempted or completed intercourse. Sexual contact between a child and a biological relative is known as incest, although some therapists extend the term to cover sexual contact between a child and any trusted caregiver, including relatives by marriage. Girls are more likely than boys to be abused sexually; according to a conservative estimate, 38% of girls and 16% of boys are sexually abused before their eighteenth birthday.

Verbal

Verbal abuse refers to regular and consistent belittling, name-calling, labeling, or ridicule of a person; but it may also include spoken threats. It is one of the most difficult forms of abuse to prove because it does not leave physical scars or other evidence, but it is nonetheless hurtful. Verbal abuse may occur in schools or workplaces as well as in families.

Emotional/psychological

Emotional/psychological abuse covers a variety of behaviors that hurt or injure others even though no physical contact may be involved. In fact, emotional abuse is a stronger predictor than physical abuse of the likelihood of suicide attempts in later life. One form of emotional abuse involves the destruction of someone's pet or valued possession in order to cause pain. Another abusive behavior is emotional blackmail, such as threatening to commit suicide unless the other person does what is wanted. Other behaviors in this category include the silent treatment, shaming or humiliating someone in front of others, or punishing them for receiving an award or honor.

Intellectual/spiritual

Intellectual/spiritual abuse refers to such behaviors as punishing someone for having different intellectual interests or religious beliefs from others in the family, preventing them from attending worship services, ridiculing their opinions, and the like.

Child abuse

Child abuse first attracted national attention in the United States in the 1950s, when a Denver pediatrician named C. Henry Kempe began publishing his findings regarding x-ray evidence of intentional injuries to small children. Kempe's research was followed by numerous investigations of other signs of child abuse and neglect, including learning disorders , malnutrition, failure to thrive, conduct disorders, emotional retardation, and sexually transmitted diseases in very young children.

Statistics from the mid-1990s indicate that although child abuse is found at all levels of income and educational achievement in the United States, children born into poor families are 12 times as likely to be abused as the children of middle-class or wealthy families, without regard to race or ethnic background. About 25% of children who are abused or neglected are younger than two years of age. Both sexes are equally affected. As of 2000, between 1,000 and 1,200 children die each year in the United States as the result of physical abuse. Of those who survive, 20% suffer permanent physical injury. Children who suffer from birth defects, developmental delays, or chronic illnesses have a higher risk of being abused by parents or other caregivers.

Abused adults

The women's movement of the 1970s led not only to greater recognition of domestic violence and other forms of abuse of adults, but also to research into the factors in the wider society that perpetuate abusive attitudes and behaviors. As of 2002, women are still more likely than men to be the targets of abuse in adult life.

Domestic violence

Domestic violence refers to the physical, emotional, and sexual abuse of a spouse or domestic partner. Early research into the problem of wife battering focused on middle-class couples, but it has since been recognized that spouse abuse occurs among wealthy professional couples as well. In addition, studies done in the late 1980s and 1990s indicate that domestic violence also occurs among gay and lesbian couples. It is estimated that four million women in the United States are involved in abusive marriages or relationships; moreover, most female murder victims are killed by their spouse or partner rather than by strangers.

Domestic violence illustrates the tendency of abusive people to attack anyone they perceive as vulnerable; most men who batter women also abuse their children; some battered women abuse their children; and abusive humans are frequently cruel to animals.

Elder abuse

Elder abuse has also become a subject of national concern in the last two decades. As older adults are living longer, many become dependent for years on adult caregivers, who may be either their own adult children or nursing home personnel. Care of the elderly can be extremely stressful, especially if the older adult is suffering from dementia . Elder abuse may include physical hitting or slapping; withholding their food or medications; tying them to their chair or bed; neglecting to bathe them or help them to the toilet; taking their personal possessions, including money or property; and restricting or cutting off their contacts with friends and relatives.

Abusive professional relationships

Adults can also be abused by sexually exploitative doctors, therapists, clergy, and other helping professionals. Although instances of this type of abuse were dismissed prior to the 1980s as consensual participation in sexual activity, most professionals now recognize that these cases actually reflect the practitioner's abuse of social and educational power. About 85% of sexual abuse cases in the professions involve male practitioners and female clients; another 12% involve male practitioners and male clients; and the remaining 3% involve female practitioners and either male or female clients. Ironically, many of these abusive relationships hurt women who sought professional help in order to deal with the effects of childhood abuse.

Stalking

Stalking, or the repeated pursuit or surveillance of another person by physical or electronic means, is now defined as a crime in all 50 states. Many cases of stalking are extensions of domestic violence, in that the stalker (usually a male) is attempting to track down a wife or girlfriend who left him. However, stalkers may also be casual acquaintances, workplace colleagues, or even total strangers. Stalking may include a number of abusive behaviors, including forced entry to the person's home, destruction of cars or other personal property, anonymous letters to the person's friends or employer, or repeated phone calls, letters, or e-mails. About 80% of stalking cases reported to police involve men stalking women.

Workplace bullying

Workplace bullying is, like stalking, increasingly recognized as interpersonal abuse. It should not be confused with sexual harassment or racial discrimination. Workplace bullying refers to verbal abuse of other workers, interfering with their work, withholding the equipment or other resources they need to do their job, or invading their personal space, including touching them in a controlling manner. Half of all workplace bullies are women, and the majority (81%) are bosses or supervisors.

Causes of abuse

The causes of interpersonal abuse are complex and overlapping. Some of the most important factors are:

• Early learning experiences: This factor is sometimes described as the "life cycle" of abuse. Many abusive parents were themselves abused as children and have learned to see hurtful behavior as normal childrearing. At the other end of the life cycle, some adults who abuse their elderly parent are paying back the parent for abusing them in their early years.
• Ignorance of developmental timetables: Some parents have unrealistic expectations of children in terms of the appropriate age for toilet training, feeding themselves, and similar milestones, and attack their children for not meeting these expectations.
• Economic stress: Many caregivers cannot afford part-time day care for children or dependent elderly parents, which would relieve some of their emotional strain. Even middle-class families can be financially stressed if they find themselves responsible for the costs of caring for elderly parents before their own children are financially independent.
• Lack of social support or social resources: Caregivers who have the support of an extended family, religious group, or close friends and neighbors are less likely to lose their self-control under stress.
• Substance abuse: Alcohol and mood-altering drugs do not cause abuse directly, but they weaken or remove a person's inhibitions against violence toward others. In addition, the cost of a drug habit often gives a substance addict another reason for resenting the needs of the dependent person. A majority of workplace bullies are substance addicts.
• Mental disorders: Depression, personality disorders , dissociative disorders, and anxiety disorders can all affect parents' ability to care for their children appropriately. A small percentage of abusive parents or spouses are psychotic.
• Belief systems: Many men still think that they have a "right" to a relationship with a woman; and many people regard parents' rights over children as absolute.
• The role of bystanders: Research in the social sciences has shown that one factor that encourages abusers to continue their hurtful behavior is discovering that people who know about or suspect the abuse are reluctant to get involved. In most cases, bystanders are afraid of possible physical, social, or legal consequences for reporting abuse. The result, however, is that many abusers come to see themselves as invulnerable.

Aftereffects

Abuse affects all dimensions of human development and existence.

Physical and neurobiological

In addition to such direct results of trauma as broken bones or ruptured internal organs, physically abused children often display retarded physical growth and poor coordination. Malnutrition may slow the development of the brain as well as produce such dietary deficiency diseases as rickets. In both children and adults, repeated trauma produces changes in the neurochemistry of the brain that affect memory formation. Instead of memories being formed in the normal way, which allows them to be modified by later experiences and integrated into the person's ongoing life, traumatic memories are stored as chaotic fragments of emotion and sensation that are sealed off from ordinary consciousness. These traumatic memories may then erupt from time to time in the form of flashbacks.

Cognitive and emotional

Abused children develop distorted patterns of cognition (knowing) because they are stressed emotionally by abuse. As adults, they may suffer from cognitive distortions that make it hard for them to distinguish between normal occurrences and abnormal ones, or between important matters and relatively trivial ones. They often misinterpret other people's behavior and refuse to trust them. Emotional distortions include such patterns as being unable to handle strong feelings, or being unusually tolerant of behavior from others that most people would protest.

Social and educational

The cognitive and emotional aftereffects of abuse have a powerful impact on adult educational, social, and occupational functioning. Children who are abused are often in physical and emotional pain at school; they cannot concentrate on schoolwork, and consequently fall behind in their grades. They often find it hard to make or keep friends, and may be victimized by bullies or become bullies themselves. In adult life, abuse survivors are at risk of repeating childhood patterns through forming relationships with abusive spouses, employers, or professionals. Even though a survivor may consciously want to avoid re-abuse, the individual is often unconsciously attracted to people who remind him or her of the family of origin. Abused adults are also likely to fail to complete their education, or they accept employment that is significantly below their actual level of ability.

Treatment

Treatment of the aftereffects of abuse must be tailored to the needs of the specific individual, but usually involves a variety of long-term considerations that may include legal concerns, geographical relocation, and housing or employment as well as immediate medical or psychiatric care.

Medical and psychiatric

In addition to requiring immediate treatment for physical injuries, abused children and adults often need long-term psychotherapy in order to recover from specific mental disorders and to learn new ways of dealing with distorted thoughts and feelings. This approach to therapy is known as cognitive restructuring. Specific mental disorders that have been linked to childhood abuse include major depression, bulimia nervosa , social phobia , Munchausen syndrome by proxy, generalized anxiety disorder , post-traumatic stress disorder , borderline personality disorder , dissociative amnesia , and dissociative identity disorder . Abused adults may develop post-traumatic stress disorder, major depression, or substance abuse disorders. At present, researchers are focusing on genetic factors as a partial explanation of the fact that some people appear to react more intensely than others to being abused.

Legal considerations

Medical professionals and, increasingly, religious professionals as well, are required by law to report child abuse to law enforcement officials, usually a child protection agency. Physicians are granted immunity from lawsuits for making such reports.

Adults in abusive situations may encounter a variety of responses from law enforcement or the criminal justice system. In general, cases of spouse abuse, stalking, and sexual abuse by professionals are taken more seriously than they were two or three decades ago. Many communities now require police officers to arrest the aggressor in domestic violence situations, and a growing number of small towns as well as cities have shelters for family members fleeing violent households. All major medical, educational, and legal professional societies, as well as mainstream religious bodies, have adopted strict codes of ethics, and have procedures in place for reporting cases of abuse by their members. Abuse in the workplace, however, is still a relatively new area of concern, and people affected by it have relatively few legal protections or resources as of 2002.

Prevention

Prevention of abuse requires long-term social changes in attitudes toward violence, gender roles, and the relationship of the family to other institutions. Research in the structure and function of the brain may help to develop more effective treatments for the aftereffects of abuse and possibly new appoaches to help break the intergenerational cycle of abuse. At present, preventive measures include protective removal of children or elders from abusive households; legal penalties for abusive spouses and professionals; and educating the public about the nature and causes of abuse.

Resources

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition, text revised. Washington, DC: American Psychiatric Association, 2000.

Baumeister, Roy F., PhD. Evil: Inside Human Violence and Cruelty. New York: W. H. Freeman and Company, 1999.

Beers, Mark H., MD. "Behavior Disorders in Dementia." Chapter 41 in The Merck Manual of Geriatrics, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 2000.

"Child Abuse and Neglect." Section 19, Chapter 264 in The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 1999.

Herman, Judith, MD. Trauma and Recovery. 2nd ed., revised. New York: Basic Books, 1997.

Marcantonio, Edward, MD. "Dementia." Chapter 40 in The Merck Manual of Geriatrics, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 2000.

Morris, Virginia. How to Care for Aging Parents. New York: Workman Publishing, 1996.

Rutter, Peter, MD. Sex in the Forbidden Zone: When Men in Power— Therapists, Doctors, Clergy, Teachers, and Others— Betray Women's Trust. New York: Jeremy P. Tarcher, Inc., 1989.

Stout, Martha, PhD. The Myth of Sanity: Tales of Multiple Personality in Everyday Life. New York: Penguin Books, 2001.

Walker, Lenore E., PhD. The Battered Woman. New York: Harper & Row, Publishers, 1979.

Weitzman, Susan, PhD. "Not to People Like Us": Hidden Abuse in Upscale Marriages. New York: Basic Books, 2000.

PERIODICALS

Carter, Ann. "Abuse of Older Adults." Clinical Reference Systems Annual (2000): 12.

Gibb, Brandon E., Lauren B. Alloy, Lyn Y. Abramson, and others. "Childhood Maltreatment and College Students' Current Suicidal Ideation: A Test of the Hopelessness Theory." Suicide and Life-Threatening Behavior 31 (2001): 405-415.

Lieb, Roselind. "Parental Psychopathology, Parenting Styles, and the Risk of Social Phobia in Offspring: A Prospective-Longitudinal Community Study." Journal of the American Medical Association 284 (December 13, 2000): 2855.

Plunkett, A., B. O'Toole, H. Swanston, and others. "Suicide Risk Following Child Sexual Abuse." Ambulatory Pediatrics 1 (September-October 2001): 262-266.

Redford, Jennifer. "Are Sexual Abuse and Bulimia Linked?" Physician Assistant 25 (March 2001): 21.

Steiger, Howard, Lise Gauvin, Mimi Israel, and others. "Association of Serotonin and Cortisol Indices with Childhood Abuse in Bulimia Nervosa." Archives of General Psychiatry 58 (September 2001): 837.

Strayhorn, Joseph M., Jr. "Self-Control: Theory and Research." Journal of the American Academy of Child and Adolescent Psychiatry 41 (January 2002): 7-16.

van der Kolk, Bessel. "The Body Keeps the Score: Memory and the Evolving Psychobiology of PTSD." Harvard Review of Psychiatry 1 (1994): 253-265.

ORGANIZATIONS

American Academy of Child and Adolescent Psychiatry. 3615 Wisconsin Avenue, NW, Washington, DC 20016-3007. (202) 966-7300. Fax: (202) 966-2891. <www.aacap.org>.

C. Henry Kempe National Center for the Prevention and Treatment of Child Abuse and Neglect. 1205 Oneida Street, Denver, CO 80220. (303) 321-3963.

National Institute of Mental Health. 6001 Executive Boulevard, Room 8184, MSC 9663, Bethesda, MD 20892-9663. (301) 443-4513. <www.nimh.nih.gov>.

OTHER

Campaign Against Workplace Bullying. P. O. Box 1886, Benicia, CA 94510. <www.bullybusters.org>.

Rebecca J. Frey, Ph.D.

Abuse

Definition

Abuse is defined as anything that is harmful, injurious, or offensive. Abuse also includes excessive and wrongful misuse of a substance. There are several major types of abuse: physical and sexual abuse of a child or an adult, substance abuse, elderly abuse, and emotional abuse.

Description

Physical abuse of a child is the infliction of injury by another person. The injuries can include punching, kicking, biting, burning, beating, or pulling the victim's hair. The physical abuse inflicted on a child can result in bruises, burns, poisoning, broken bones, and internal hemorrhages. Physical assault against an adult primarily occurs with women, usually in the form of domestic violence. It is estimated that approximately three million children witness domestic violence every year.

Sexual abuse of a child refers to sexual behavior between an adult and child or between two children, one of whom is dominant or significantly older. The sexual behaviors can include touching breasts, genitals, and buttocks; either dressed or undressed. The behavior also can include exhibitionism, cunnilingus, fellatio, or penetration of the vagina or anus with sexual organs or objects.

Pornographic photography also is used in sexual abuse with children. Reported sex offenders are 97% male. Reports of child pornography have increased since with the popularity of the Internet. Females more often are perpetrators in child-care settings, since children may confuse sexual abuse by a female with normal hygiene care. The 1990s and early 2000s were rocked by reports of sexual abuse of children committed by Catholic priests. Most of the abuse appeared to have occurred during the 1970s and a prominent report released early in 2004 stated that as many as 10.667 children were sexually abused by more than 4,300 priests. Sexual abuse by stepfathers is five times more common than with biological fathers. Sexual abuse of daughters by stepfathers or fathers is the most common form of incest.

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 whether:

• will is overcome by force or fear (from threats or by use of drugs).
• mental impairment renders the victim incapable of rational judgment.
• if the victim is below the legal age established for consent.

Substance abuse is an abnormal pattern of substance usage leading to significant distress or impairment. The criteria include 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.
• using substance in situations that are physically dangerous (i.e., while driving).
• recurrent substance-related legal problems.
• continued usage despite recurrent social and interpersonal problems (i.e., arguments and fights with significant other).

Abuse of the elderly is common and occurs mostly as a result of caretaker burnout, due to the high level of dependency frail, elderly patients usually require. Abuse can be manifested by physical signs, fear, and delaying or not reporting the need for advanced medical care. Elderly patients also may exhibit financial abuse (money or possessions taken away) and abandonment.

Emotional abuse generally continues even after physical assaults have stopped. In most cases it is a personally tailored form of verbal or gesture abuse expressed to illicit a provoked response.

Causes and symptoms

Children who have been abused usually have a variety of symptoms that encompass behavioral, emotional, and psychosomatic problems (body problems caused by emotional or mental 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 suffer from eating disorders and encopresis, or involuntary defecation caused or psychic origin. 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—in some situations—homosexual contact.

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 consultations by women were prompted due to domestic violence. Female victims who are married also have a higher rate of internal injuries and unconsciousness than victims of stranger assault (mugging, robbery). Physical abuse or rape also can occur between married persons and persons of the same gender. Perpetrators usually sexually assault their victims to dominate, hurt, and debase them. It is common for physical and sexual violence to occur at the same time. A large percentage of sexually assaulted persons were also physically abused in the form of punching, beating, or threatening the victim with a weapon such as a gun or knife. Usually males who are hurt and humiliated tend to physically assault people whom they are intimately involved with, such as spouses and/or children. Males who assault a female tend to have experienced or witnessed violence during childhood. They also tend to abuse alcohol, to be sexually assaultive, and are at increased risk for assaultive behavior directed against children. Jealous males tend to monitor a women's movements and whereabouts and to isolate other sources of protection and support. They interpret their behavior as betrayal of trust and this causes resentment and explosive anger outbursts during periods of losing control. Males also may use aggression against females in an effort to control and intimidate partners.

Abuse in the elderly usually occurs in the frail, elderly community. The caretaker is usually the perpetrator. Caretaker abuse can be suspected if there is evidence suggesting behavioral changes in the elderly person when the caretaker is present. Additionally, elderly abuse can be possible if there are delays between injuries and treatment, inconsistencies between injury and explanations, lack of hygiene or clothing, and prescriptions not being filled.

Diagnosis

Children who are victims of domestic violence frequently are injured attempting to protect their mother from an abusive partner. Injuries are visible by inspection or self-report. Physical abuse of an adult may also be evident by inspection with visible cuts and/or bruises or self-report.

KEY TERMS

Encopresis— Abnormalities relating to bowel movements that can occur as a result of stress or fear.

Sexual abuse of both a child and an adult can be diagnosed with a history from 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.

Elderly abuse can be suspected if the elderly patient demonstrates a fear of the caretaker. Additionally, elderly abuse can be suspected if there are signs indicating intentional delay of required medical care or a change in medical status.

Substance abuse can be suspected in a person who continues to indulge in their drug of choice despite recurrent negative consequences. The diagnosis can be made after administration of a comprehensive exam and standardized chemical abuse assessments by a therapist.

Treatment

Children who are victims of physical or sexual abuse typically require psychological support and medical attention. A complaint may be filed with the local family social services agency that will initiate investigations. The authorities usually will follow up the allegation or offense. Children may also be referred for psychological evaluation and/or treatment. The victim also may be placed in foster care pending the investigation outcome. The police also may investigate physical and sexual abuse of an adult. The victim may require immediate medical care and long-term psychological treatment. It is common for children to be adversely affected by domestic violence situations and the local family services agency may be involved.

Substance abusers should elect treatment, either inpatient or outpatient, depending on severity of addiction. Long term treatment and/or medications may be utilized to assist in abstinence. The patient should be encouraged to participate in community centered support groups.

Prognosis

The prognosis depends on the diagnosis. Usually victims of physical and sexual abuse require therapy 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, or anxiety. Children of sexual abuse may enter abusive relationships or have problems with intimacy as adults. The substance abuser may experience relapses, since the cardinal feature of all addictive disorders is a tendency to return to symptoms. Elderly patients may suffer from further medical problems and/or anxiety, and in some cases neglect may precipitate death.

Prevention

Prevention programs are geared to education and awareness. Detection of initial symptoms or characteristic behaviors may assist in some situations. In some cases treatment may be sought before incident. The professional treating the abused persons must develop a clear sense of the relationship dynamics and the chances for continued harm.

Resources

BOOKS

Behrman, Richard E., et al, editors. Nelson Textbook of Pediatrics. 16th ed. W. B. Saunders Company, 2000.

PERIODICALS

Plante, Thomas G. "Another Aftershock: What Have We Learned from the John Jay Report?." America (March 22, 2004): 10.

ORGANIZATIONS

National Clearinghouse on Child Abuse and Neglect Information. 330 C Street SW, Washington, DC 20447. (800) 392-3366.

OTHER

Elder Abuse Prevention. 〈http://www.oaktrees.org/elder〉.

National Institute on Drug Abuse. 〈http://www.nida.nih.gov〉.

ABUSE.
1. Wrong or improper use of anyone or anything. The term is often (usually emotively) applied to language:
Some native speakers claim that the use of the language is deteriorating. One charge is ethical: people are said to be abusing the language, more so than in the past, with intent to conceal, mislead, or deceive, generally through euphemism or obscure language. Usually, the accusation is directed principally against politicians, bureaucrats, and advertisers, but the abuse is felt to have an adverse effect on the language as such. Certainly, the contemporary mass media facilitate the rapid and widespread dissemination of such language abuses. The other charge is aesthetic or functional: people are said to be using the language less elegantly or less efficiently than in the recent past, a charge that is commonly directed against young people. The charge may or may not have some justification, but in any case is impossible to substantiate. (‘Standards of English’, section 1.11 in Quirk et al., A Comprehensive Grammar of the English Language, 1985).

2. Harsh or coarsely insulting language: to hurl abuse at people. See STYLE, SWEARING.

abuse.
1. Violation of established uses in Classical architecture.

2. Corruption of form. Abuses according to Palladio included brackets, consoles, or modillions supporting (or seeming to support) a major structural load, e.g. a column; broken or open-topped pediments; exaggerated overhangs of cornices; and rusticated or banded columns (see band). Perrault and others identified further abuses: pilasters and columns physically joined, especially at the corner of a building; coupled columns (which Perrault himself employed at the east front of the Louvre in Paris); distortion of metopes by making them wider and rectangular instead of square in abnormally large intercolumniations; omission of the bottom part of the Ionic abacus; Giant Orders instead of an assemblage of Orders; an inverted cavetto moulding joining the plinth under a column-base to the cornice of a pedestal; architrave-cornices (as in Hellenistic Ionic); and entablatures broken or interrupted immediately above a column. Through use many abuses have become acceptable aspects of Classicism.

Bibliography

Gwilt (1903);
W. Papworth (1852)

a·buse • v. / əˈbyoōz/ [tr.] 1. use (something) to bad effect or for a bad purpose; misuse: the judge abused his power. ∎  make excessive and habitual use of (alcohol or drugs, esp. illegal ones). 2. treat (a person or an animal) with cruelty or violence, esp. regularly or repeatedly:. ∎  assault (someone, esp. a woman or child) sexually. ∎  use or treat in such a way as to cause damage or harm: he had been abusing his body for years. ∎  speak in an insulting and offensive way to or about (someone). • n. / əˈbyoōs/ 1. the improper use of something: alcohol abuse. ∎  unjust or corrupt practice: human rights abuses. 2. cruel and violent treatment of a person or animal: signs of physical abuse. ∎  violent treatment involving sexual assault, esp. on a repeated basis. ∎  insulting and offensive language.

Abuse

What Is Abuse?

Why Do People Behave in Abusive Ways?

Emotional Abuse

Physical Abuse

Sexual Abuse

Child Sexual Abuse

Discrimination and Hate Crimes

How Do Doctors Treat People Who Have Been Abused?

How Do Mental Health Professionals Help People Who Have Been Abused?

Resources

Abuse is hurtful mistreatment of other people. It may include physical, sexual, or emotional (ee-MO-shun-al) mistreatment of children or adults.

KEYWORDS

for searching the Internet and other reference sources

Battering

Child abuse

Child neglect

Child sexual abuse

Family violence

Incest

Interpersonal violence

Intimate partner violence

Shaken baby syndrome

Victimology

Family violence may lead to “learned helplessness,” a form of passivity and hopelessness that people experience when they believe that abuse is an inevitable and inescapable part of their lives. Shelters often offer counseling and therapy to help battered women learn how to overcome learned helplessness and escape from abusive situations. Stock Boston

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.

Learned Helplessness

“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.

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.

Emotional Abuse

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.

Physical Abuse

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

When Children 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.

Family violence

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 electrical 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.

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.

* 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.

Sexual Abuse

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.

* pornography

(por-NAH-gra-fee) refers to any material, like magazines or videos, that shows sexual behavior and 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.

Consent

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.

Secrecy

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.

Repressed memories

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.

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
• unusual 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

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.

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 Been Abused?

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.

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 wounds and post-trauma stress. Family therapists can teach families better coping skills, better parenting skills, and more effective ways to deal with anger, frustration, conflict, and the aftermath of earlier cycles of violence.

Hate crimes are not yet specifically illegal in many areas of the United States and the world. In 1998, actress Ellen DeGeneres spoke out in favor of hate crimes legislation after a college student named Matthew Shepard was killed in a gay-bashing hate crime in Laramie, Wyoming. Getty Source/Liaison

See also

Antisocial Personality Disorder

Brain Injuries

Bullying

Families

Personality Disorders

Post-Traumatic Stress Disorder

Rape

Therapy

Violence

Resources

Hotline

National Domestic Violence Hotline. This is a 24-hour hotline. In cases of immediate life-threatening emergency, dial 911. Telephone 800-799-7233

Books

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.

Organizations

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. Telephone 770-488-1506 http://www.cdc.gov/ncipc/factsheets

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. Telephone 847-434-4000 http://www.aap.org

American Humane Association, 63 Inveerness Drive East, Englewood, CO 80112-5117.

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. Telephone 800-227-4645 http://www.americanhumane.org

KidsHealth.org 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. http://www.kidshealth.org

ABUSE

Everything that is contrary to good order established by usage. Departure from reasonable use; immoderate or improper use. Physical or mental maltreatment. Misuse. Deception.

To wrong in speech, reproach coarsely, disparage, revile, and malign.

abuse sb. XV. — (O)F. abus or L. abūsus, f. abūs-, pp. stem of abūtī, f. AB- + ūtī USE.
So abuse vb. XV. abusive XVI.

abuse •abstruse, abuse, adduce, Ballets Russes, Belarus, Bruce, burnous, caboose, charlotte russe, conduce, deduce, deuce, diffuse, douce, educe, excuse, goose, induce, introduce, juice, Larousse, loose, luce, misuse, moose, mousse, noose, obtuse, Palouse, papoose, produce, profuse, puce, recluse, reduce, Rousse, seduce, sluice, Sousse, spruce, traduce, truce, use, vamoose, Zeus •cayuse • calaboose • mongoose •Aarhus • verjuice • couscous •footloose • ventouse • refuse •Odysseus • Idomeneus • hypotenuse •Syracuse