|
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.
|
