Chapter 8 Abuse: Physical and Sexual
INTRODUCTION
Description: Abuse is a pattern of physical trauma that occurs within a continuing relationship. Although the definition of abuse requires only one episode of physical abuse, a pattern of escalating violence is more typical. (In at least one fourth of cases, there have been three or more episodes of violence in the 6 months preceding the report of abuse.) In the United States, women are at greater risk of injury or death at the hands of a domestic partner than from an unrelated attacker. Sexual abuse is a specific form of physical abuse that relates to trauma of a sexual nature or a pattern of coercive sexual activities. Sexual abuse includes, but is not limited to, disrobing, exposure, photography or posing, oral–genital contact, insertion of foreign bodies, and vaginal or rectal intercourse.
Prevalence: More than 1.5 million cases of domestic violence occur each year. It is estimated that between 5% and 25% of women treated for injuries in emergency rooms receive these injuries as a result of domestic violence. Of adults, 20% to 40% report abuse or sexual victimization before age 18 years, and 10% to 25% of wives report one or more episodes of sexual abuse.
ETIOLOGY AND PATHOGENESIS
Causes: Multiple factors. Alcohol or drugs are often involved, although they are not causative factors.
CLINICAL CHARACTERISTICS
Signs and Symptoms
• Physical abuse—Signs and symptoms are highly variable. (In almost 85% of reported cases, the injuries sustained are sufficient to require medical treatment. Between 5% and 25% of women treated for injuries in emergency rooms receive these injuries as a result of domestic violence. The correct diagnosis is rendered in less than 5% of women. The most frequent locations for injuries are the head, neck, chest, abdomen, and breasts. Upper-extremity injuries result from defensive efforts.)
