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 coexistwith neglect, which is defined as fa ilure 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 physAbuse

KEY TERMS Cognitive restructuring An approach to psychotherapy that focuses on helping the patient examine distorted patterns of perceiving and thinking in order to change their emotional responses to people and situations. Dementia A group of symptoms (syndrome) associated with a progressive loss of memory and other intellectual functions that is serious enough to interfere with a person s ability to perform the tasks of daily life. Dementia impairs memory, alters personality, leads to deterioration in personal grooming, impairs reasoning ability, and causes disorientation. Flashback The re-emergence of a traumatic memory as a vivid recollection of sounds, images, and sensations associated with the trauma. The person having the flashback typically feels as if he or she is reliving the event. Incest Unlawful sexual contact between persons who are biologically related. Many therapists, however, use the term to refer to inappropriate sexual contact between any members of a family, including stepparents and stepsiblings. Stalking The intentional pursuit or surveillance of another person, usually with the intent of forcing that person into a dating or marriage relationship. Stalking is now punishable as a crime in all 50 states. ical 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,