| 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.
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