| I.
What Is Domestic Violence?
In the past two
decades, there has been growing recognition of
the prevalence of domestic violence in our society.
Moreover, it has become apparent that some individuals
are at greater risk for victimization than others.
Domestic violence has adverse effects on individuals,
families, and society in general.
Domestic violence
includes physical abuse, sexual abuse, psychological
abuse, and abuse to property and pets (Ganley,
1989). Exposure to this form of violence has considerable
potential to be perceived as life-threatening
by those victimized and can leave them with a
sense of vulnerability, helplessness, and in extreme
cases, horror. Physical abuse refers to any behavior
that involves the intentional use of force against
the body of another person that risks physical
injury, harm, and/or pain (Dutton, 1992). Physical
abuse includes pushing, hitting, slapping, choking,
using an object to hit, twisting of a body part,
forcing the ingestion of an unwanted substance,
and use of a weapon. Sexual abuse is defined as
any unwanted sexual intimacy forced on one individual
by another. It may include oral, anal, or vaginal
stimulation or penetration, forced nudity, forced
exposure to sexually explicit material or activity,
or any other unwanted sexual activity (Dutton,
1994). Compliance may be obtained through actual
or threatened physical force or through some other
form of coercion. Psychological abuse may include
derogatory statements or threats of further abuse
(e.g., threats of being killed by another individual).
It may also involve isolation, economic threats,
and emotional abuse.
II. Prevalence
of Domestic Violence
Domestic violence
is widespread and occurs among all socioeconomic
groups. In a national survey of over 6,000 American
families, it was estimated that between 53% and
70% of male batterers (i.e., they assaulted their
wives) also frequently abused their children (Straus
& Gelles, 1990). Other research suggests that
women who have been hit by their husbands were
twice as likely as other women to abuse a child
(CWP, 1995).
Over 3 million
children are at risk of exposure to parental violence
each year (Carlson, 1984). Children from homes
where domestic violence occurs are physically
or sexually abused and/or seriously neglected
at a rate 15 times the national average (McKay,
1994). Approximately, 45% to 70% of battered women
in shelters have reported the presence of child
abuse in their home (Meichenbaum, 1994). About
two-thirds of abused children are being parented
by battered women (McKay, 1994). Of the abused
children, they are three times more likely to
have been abused by their fathers.
Studies of the
incidence of physical and sexual violence in the
lives of children suggest that this form of violence
can be viewed as a serious public health problem.
State agencies reported approximately 211,000
confirmed cases of child physical abuse and 128,000
cases of child sexual abuse in 1992. At least
1,200 children died as a result of maltreatment.
It has been estimated that about 1 in 5 female
children and 1 in 10 male children may experience
sexual molestation (Regier & Cowdry, 1995).
III. Domestic
Violence as a Cause of Traumatic Stress
As the incidence
of interpersonal violence grows in our society,
so does the need for investigation of the cognitive,
emotional and behavioral consequences produced
by exposure to domestic violence, especially in
children. Traumatic stress is produced by exposure
to events that are so extreme or severe and threatening,
that they demand extraordinary coping efforts.
Such events are often unpredicted and uncontrollable.
They overwhelm a person's sense of safety and
security.
Terr (1991) has
described "Type I" and "Type II"
traumatic events. Traumatic exposure may take
the form of single, short-term event (e.g., rape,
assault, severe beating) and can be referred to
as "Type I" trauma. Traumatic events
can also involve repeated or prolonged exposure
(e.g., chronic victimization such as child sexual
abuse, battering); this is referred to as "Type
II" trauma. Research suggests that this latter
form of exposure tends to have greater impact
on the individual's functioning. Domestic violence
is typically ongoing and therefore, may fit the
criteria for a Type II traumatic event.
With repeated
exposure to traumatic events, a proportion of
individuals may develop Posttraumatic Stress Disorder
(PTSD). PTSD involves specific patterns of avoidance
and hyperarousal. Individuals with PTSD may begin
to organize their lives around their trauma. Although
most people who suffer from PTSD (especially,
in severe cases) have considerable interpersonal
and academic/occupational problems, the degree
to which symptoms of PTSD interfere with overall
functioning varies a great deal from person to
person.
The Diagnostic
and Statistical Manual of Mental Disorders - Fourth
Edition (DSM-IV; APA, 1994) stipulates that in
order for an individual to be diagnosed with posttraumatic
stress disorder, he or she must have experienced
or witnessed a life-threatening event and reacted
with intense fear, helplessness, or horror. The
traumatic event is persistently reexperienced
(e.g., distressing recollections), there is persistent
avoidance of stimuli associated with the trauma,
and the victim experiences some form of hyperarousal
(e.g., exaggerated startle response). These symptoms
persist for more than one month and cause clinically
significant impairment in daily functioning. When
the disturbance lasts a minimum of two days and
as long as four weeks from the traumatic event,
Acute Stress Disorder may be a more accurate diagnosis.
It has been suggested
that responses to traumatic experience(s) can
be divided into at least four categories (for
a complete review, see Meichenbaum, 1994). Emotional
responses include shock, terror, guilt, horror,
irritability, anxiety, hostility, and depression.
Cognitive responses are reflected in significant
concentration impairment, confusion, self-blame,
intrusive thoughts about the traumatic experience(s)
(also referred to as flashbacks), lowered self-efficacy,
fears of losing control, and fear of reoccurrence
of the trauma. Biologically-based responses involve
sleep disturbance (i.e., insomnia), nightmares,
an exaggerated startle response, and psychosomatic
symptoms. Behavioral responses include avoidance,
social withdrawal, interpersonal stress (decreased
intimacy and lowered trust in others), and substance
abuse. The process through which the individual
has coped prior to the trauma is arrested; consequently,
a sense of helplessness is often maintained (Foy,
1992).
IV. Possible
Signs and Symptoms of Domestic Violence in Children
and Adolescents
More than half
of the school-age children in domestic violence
shelters show clinical levels of anxiety or posttraumatic
stress disorder (Graham-Bermann, 1994). Without
treatment, these children are at significant risk
for delinquency, substance abuse, school drop-out,
and difficulties in their own relationships.
Children may exhibit
a wide range of reactions to exposure to violence
in their home. Younger children (e.g., preschool
and kindergarten) oftentimes, do not understand
the meaning of the abuse they observe and tend
to believe that they "must have done something
wrong." Self-blame can precipitate feelings
of guilt, worry, and anxiety. It is important
to consider that children, especially younger
children, typically do not have the ability to
adequately express their feelings verbally. Consequently,
the manifestation of these emotions are often
behavioral. Children may become withdrawn, non-verbal,
and exhibit regressed behaviors such as clinging
and whining. Eating and sleeping difficulty, concentration
problems, generalized anxiety, and physical complaints
(e.g., headaches) are all common.
Unlike younger
children, the pre-adolescent child typically has
greater ability to externalize negative emotions
(i.e., to verbalize). In addition to symptoms
commonly seen with childhood anxiety (e.g., sleep
problems, eating disturbance, nightmares), victims
within this age group may show a loss of interest
in social activities, low self-concept, withdrawal
or avoidance of peer relations, rebelliousness
and oppositional-defiant behavior in the school
setting. It is also common to observe temper tantrums,
irritability, frequent fighting at school or between
siblings, lashing out at objects, treating pets
cruelly or abusively, threatening of peers or
siblings with violence (e.g., "give me a
pen or I will smack you"), and attempts to
gain attention through hitting, kicking, or choking
peers and/or family members. Incidentally, girls
are more likely to exhibit withdrawal and unfortunately,
run the risk of being "missed" as a
child in need of support.
Adolescents are
at risk of academic failure, school drop-out,
delinquency, and substance abuse. Some investigators
have suggested that a history of family violence
or abuse is the most significant difference between
delinquent and non delinquent youth. An estimated
1/5 to 1/3 of all teenagers who are involved in
dating relationships are regularly abusing or
being abused by their partners verbally, mentally,
emotionally, sexually, and/or physically (SASS,
1996). Between 30% and 50% of dating relationships
can exhibit the same cycle of escalating violence
as marital relationships (SASS, 1996).
V. Helping
Children and Adolescents Exposed to Domestic Violence
For some children
and adolescents, questions about home life may
be difficult to answer, especially if the individual
has been "warned" or threatened by a
family member to refrain from "talking to
strangers" about events that have taken place
in the family. Referrals to the appropriate school
personnel could be the first step in assisting
the child or teen in need of support. When there
is suggestion of domestic violence with a student,
consider involving the school psychologist, social
worker, guidance counselor and/or a school administrator
(when indicated). Although the circumstances surrounding
each case may vary, suspicion of child abuse is
required to be reported to the local child protection
agency by teachers and other school personnel.
In some cases, a contact with the local police
department may also be necessary. When in doubt,
consult with school team members.
If the child expresses
a desire to talk, provide them with an opportunity
to express their thoughts and feelings. In addition
to talking, they may be also encouraged to write
in a journal, draw, or paint; these are all viable
means for facilitating expression in younger children.
Adolescents are typically more abstract in their
thinking and generally have better developed verbal
abilities than younger children. It could be helpful
for adults who work with teenagers to encourage
them to talk about their concerns without insisting
on this expression. Listening in a warm, non-judgmental,
and genuine manner is often comforting for victims
and may be an important first step in their seeking
further support. When appropriate, individual
and/or group counseling should be considered at
school if the individual is amenable. Referrals
for counseling (e.g., family counseling) outside
of the school should be made to the family as
well. Providing a list of names and phone numbers
to contact in case of a serious crisis can be
helpful.
References
American Psychiatric
Association (1994). Diagnostic and statistical
manual of mental disorders (4th ed.). Washington,
DC: Author.
Carlson, B. E.
(1984). Children's observations of interpersonal
violence. In A. R. Edwards (Ed.), Battered women
and their families (pp. 147-167). New York: Springer.
Child Welfare
Partnership (1995). Domestic violence summary:
The intersection of child abuse and domestic violence.
Published by Portland State University.
Dutton, M.A. (1994).
Post-traumatic therapy with domestic violence
survivors. In M.B. Williams & J.F. Sommer
(Eds.), Handbook of post-traumatic therapy (pp.
146-161). Westport, CT: Greenwood Press.
Dutton, M.A. (1992).
Women's response to battering: Assessment and
intervention. New York: Springer.
Foy, D.W. (1992).
Introduction and description of the disorder.
In D. W. Foy (Ed.), Treating PTSD: Cognitive-Behavioral
strategies (pp 1-12). New York: Guilford.
Ganley, A. (1989).
Integrating feminist and social learning analyses
of aggression: Creating multiple models for intervention
with men who battered. In P. Caesar & L. Hamberger
(Eds.), Treating men who batter (pp. 196-235).
New York: Springer.
Graham-Bermann,
S. (1994). Preventing domestic violence. University
of Michigan research information index. UM-Research-WEB@umich.edu.
McKay, M. (1994).
The link between domestic violence and child abuse:
Assessment and treatment considerations. Child
Welfare League of America, 73, 29-39.
Meichenbaum, D.
(1994). A clinical handbook/practical therapist
manual for assessing and treating adults with
post-traumatic stress disorder. Ontario, Canada:
Institute Press.
Regier, D.A.,
& Cowdry, R.W. (1995). Research on violence
and traumatic stress (program announcement, PA
95-068). National Institute of Mental Health.
Sexual Assault
Survivor Services (1996). Facts about domestic
violence. SASS home page at http://www.portup.com.
[This site may have moved.]
Straus, M.A.,
& Gelles, R.J. (1990). Physical violence in
American families. New Brunswick, NJ: Transaction
Publishers.
Terr, L. (1991).
Childhood trauma: An outline and overview. American
Journal of Psychiatry, 148, 10-20.
©1996
by The American Academy of Experts in Traumatic
Stress, Inc.
Please visit this page again. More articles will
appear here shortly.
|
