Domestic Abuse & Health

Posttraumatic stress disorder (PTSD) associated with elevated hemoglobin A1c levels in low-income blacks with diabetes

2012-02-06T13:54:00.000-08:00

US Department of Health & Human Services:

CHRONIC DISEASE: Posttraumatic stress disorder (PTSD) associated with elevated hemoglobin A1c levels in low-income blacks with diabetes

The frequency of posttraumatic stress disorder (PTSD) ranges from 10 to more than 50 percent in urban primary care settings where the prevalence of trauma is high. There is also growing evidence that PTSD is linked with chronic disease, such as diabetes and heart disease, and with poorer health outcomes. In fact, a recent study found that PTSD was significantly associated with a hemoglobin (Hb) A1c level (a marker of diabetes control) greater than 7 percent among low-income minorities. The researchers recruited men and women with type 2 diabetes from four community-based primary care clinics in Harlem, New York City. In addition to demographic information, participants were screened for depressive symptoms and for lifetime PTSD. A total of 103 adults were included in the final analysis. Within the group, 12 percent had lifetime full PTSD, while another 12 percent had sub-threshold PTSD. Those with lifetime PTSD were significantly more likely to have an HbA1c level of greater than 7 percent compared to patients not experiencing PTSD symptoms.

The most common sources of trauma were childhood physical abuse (22 percent) and the death of a child (18 percent). Patients with PTSD were also more likely to suffer from depressive symptoms and to be taking a psychiatric medication. In addition to PTSD, patients with HbA1c levels above 7 percent had diabetes for 15 or more years and were more likely to be taking insulin. The researchers encourage physicians to consider a diagnosis of PTSD in low-income patients with diabetes who are experiencing poor glucose control. The study was supported in part by the Agency for Healthcare Research and Quality (T32 HS00066).

See "Associations between posttraumatic stress disorder and hemoglobin A1c in low-income minority patients with diabetes," by Samantha A. Miller, M.D., M.S., Carol A. Mancuso, M.D., Carla Boutin-Foster, M.D., M.S., and others in General Hospital Psychiatry 33, pp. 116-122, 2011.

HEALTHDAY: Ob-Gyns Should Screen for Domestic Abuse: Experts

2012-02-06T13:48:00.000-08:00

Intimate partner violence can be psychological or physical, occurs at all levels of society

By Robert Preidt

TUESDAY, Jan. 24 (HealthDay News) -- Obstetricians and gynecologists should screen all patients for intimate partner violence, including during prenatal visits, according to new recommendations from the American College of Obstetricians and Gynecologists.

In addition, ob-gyns should offer patients support, and have referral and resource information on hand to give to patients who are victims of abuse.

Intimate partner violence includes physical injury, psychological abuse, sexual assault, progressive isolation, stalking, deprivation, intimidation and reproductive coercion. The goal of these behaviors is to establish control over a partner.

The violence can occur among both heterosexual and same-sex partners and at every level of society, regardless of age, gender, income levels, race, ethnicity, religion or educational background, according to a news release from the college.

About one in four women has been physically and/or sexually assaulted by a current or former partner, and nearly 324,000 pregnant women are abused by their partners each year in the United States, researchers have found.

Intimate partner violence has been linked to poor pregnancy outcomes, including poor weight gain, infection, fetal injury, preterm delivery, low birth weight and stillbirth.

Signs and symptoms that a woman is experiencing violence include physical injuries, chronic headaches, chronic pelvic pain, irritable bowel syndrome, and recurrent vaginal infections. Violence is often linked to depression, anxiety, substance abuse, unintended pregnancy and suicide.

"Women of all ages experience intimate partner violence, but it is most prevalent among reproductive-age women," Dr. Maureen Phipps, chair of the college's Committee on Health Care for Underserved Women, said in the news release. "We have a prime opportunity to identify and help women who are being abused by incorporating this screening into our routine office visits with each and every patient."

The recommendations are published in the February issue of the journal Obstetrics & Gynecology.

SOURCE: American College of Obstetricians and Gynecologists, news release, Jan. 23, 2012

HealthDay

CDC: National Intimate Partner and Sexual Violence Survey

2012-02-06T13:44:00.000-08:00

CDC’s National Intimate Partner and Sexual Violence Survey (NISVS) is an ongoing, nationally-representative telephone survey that collects detailed information on sexual violence, stalking, and intimate partner violence victimization of adult women and men in the United States. The survey collects data on past-year experiences of violence as well as lifetime experiences of violence. The 2010 survey is the first year of the survey and provides baseline data that will be used to track trends in sexual violence, stalking and intimate partner violence. CDC developed NISVS to better describe and monitor the magnitude of these forms of violence in the United States.

Highlights of 2010 Findings

Sexual violence, stalking, and intimate partner violence are widespread in the United States. The findings in this report underscore the heavy toll of this violence, the immediate impacts of victimization, and the lifelong health consequences.

Women are disproportionally affected by sexual violence, intimate partner violence and stalking.

1.3 million women were raped during the year preceding the survey.
Nearly 1 in 5 women have been raped in their lifetime while 1 in 71 men have been raped in their lifetime.
1 in 6 women have been stalked during their lifetime. 1 in 19 men have experienced stalking in their lifetime.
1 in 4 women have been the victim of severe physical violence by an intimate partner while 1 in 7 men experienced severe physical violence by an intimate partner.
81% of women who experienced rape, stalking or physical violence by an intimate partner reported significant short or long term impacts related to the violence experienced in this relationship such as Post-Traumatic Stress Disorder (PTSD) symptoms and injury while 35% of men report such impacts of their experiences.
Women who had experienced rape or stalking by any perpetrator or physical violence by an intimate partner in their lifetime were more likely than women who did not experience these forms of violence to report having asthma, diabetes, and irritable bowel syndrome.
Men and women who experienced these forms of violence were more likely to report frequent headaches, chronic pain, difficulty with sleeping, activity limitations, poor physical health and poor mental health than men and women who did not experience these forms of violence.

Female victims of intimate partner violence experienced different patterns of violence than male victims.

Female victims experienced multiple forms of these types of violence; male victims most often experienced physical violence.

The majority of this victimization starts early in life.

Approximately 80% of female victims experienced their first rape before the age of 25 and almost half experienced the first rape before age 18 (30% between 11-17 years old and 12% at or before the age of 10).
About 35% of women who were raped as minors were also raped as adults compared to 14% of women without an early rape history.
28% of male victims of rape were first raped when they were 10 years old or younger.

Summary
Overall, lifetime and one year estimates for sexual violence, stalking and intimate partner violence were alarmingly high for adult Americans; with IPV alone affecting more than 12 million people each year. Women
are disproportionately impacted. They experienced high rates of severe intimate partner violence, rape and
stalking, and long-term chronic disease and other health impacts such as PTSD symptoms. NISVS also shows that most rape and IPV is first experienced before age 24, highlighting the importance of preventing this violence before it occurs to ensure that all people can live life to their fullest potential.

HealthDay: Neurologists Should Screen Patients for Abuse: Experts

2012-02-06T13:30:00.000-08:00

People with certain disorders might be more vulnerable to violence, says American Academy of Neurology

By Robert Preidt

Wednesday, January 25, 2012

WEDNESDAY, Jan. 25 (HealthDay News) -- Neurologists should screen their patients for abuse by family members, caregivers or other people, the American Academy of Neurology says in a new position statement.

Problems to look for include elder, sexual, child, financial and emotional abuse; bullying, cyberbullying and violence.

Certain neurologic disorders, such as Parkinson's disease, Alzheimer's disease or stroke, may raise the risk for abuse and neglect, the academy said.

The statement outlines 10 principles for neurologists to use when meeting with patients. These include integrating questions about abuse into a patient's medical history and routinely checking patients for past and ongoing violence.

The academy is also offering free training to members interested in learning how to deal with domestic violence issues in their communities.

"Neurologists see patients with neurologic disorders that may make them more susceptible to abuse or neglect. They also see patients with neurologic issues that may be either directly or indirectly related to mistreatment," statement lead author Dr. Elliott Schulman, of Lankenau Medical Center in Wynnewood, Penn., said in an academy news release.

More than 90 percent of all injuries caused by intimate partner violence occur to the head, face or neck and can result in traumatic brain injury, according to the statement.

It also noted that people with neurologic disorders such as stroke, Alzheimer's disease or Parkinson's disease may be at increased risk for abuse and neglect.

"By routinely asking about violence and abuse, the neurologist increases the opportunity for both identifying ongoing abuse and intervening when appropriate," Schulman said. "In addition to further physical and emotional harm, consequences of not asking about abuse might include failure of treatments and, when children are exposed to abuse, perpetuation of the cycle of abuse from generation to generation."

The statement appears Jan. 25 in the online issue of the journal Neurology.

SOURCE: American Academy of Neurology, news release, Jan. 18, 2012

HealthDay

Study: Child abuse bigger threat than SIDS

2012-02-06T13:24:00.000-08:00

4,600 children hospitalized with serious injuries

By Frederik Joelving

updated 2/6/2012 10:14:15 AM ET

MSNBC: Nearly 4,600 U.S. children were hospitalized with broken bones, traumatic brain injury and other serious damage caused by physical abuse in 2006, according to a new report.

Babies younger than one were the most common victims, with 58 cases per 100,000 infants. That makes serious abuse a bigger threat to infant safety than SIDS, or sudden infant death syndrome, researchers say in the report.

"There is a national campaign to prevent SIDS," said Dr. John Leventhal of Yale University, who led the new study. "We need a national campaign related to child abuse where every parent is reminded that kids can get injured."

The new study, published Monday in the journal Pediatrics, is the first broad U.S. estimate of serious injuries due to child abuse.

Based on data from the 2006 Kids' Inpatient Database, the last such numbers available, Leventhal's team found that six out of every 100,000 children under 18 were hospitalized with injuries ranging from burns to wounds to brain injuries and bone fractures.

The children spent an average of one week in the hospital; 300 of them died.

The rate of abuse was highest among children under one, particularly if they were covered by Medicaid, the government's health insurance for the poor. One out of every 752 of those infants landed in the hospital due to maltreatment.

"Medicaid is just a marker of poverty, and poverty leads to stress," said Leventhal, who is the medical director of the Yale-New Haven Children's Hospital Child Abuse Program.

Last year, a study from four U.S. states showed a clear spike in abusive brain injuries following the financial crash in late 2007, a finding researchers chalked up to the added pressure on parents.

Mom's hug revives baby that was pronounced dead
In that study, too, toddlers appeared to be at higher risk. That led researchers to suggest the maltreatment might have been triggered by crying.

If a caretaker shakes a baby violently to make him or her stop crying, they can cause "shaken baby syndrome," in which the brain bumps up against the skull and starts bleeding.

Leventhal said babies may also be more vulnerable that older kids.

"The most serious injuries tend to be in the younger kids," he told Reuters Health.

Home birth advocate dies in childbirth
The researchers estimate that the hospitalizations cost about $73.8 million in 2006, although that's only a fraction of the overall cost of abuse to society.

"This is a serious problem that affects young children," said Leventhal, whose team is now examining more recent data to refine the findings. "We need to figure out a way to help parents do better."

Copyright 2012 Thomson Reuters.

CDC: Child abuse and neglect cost the United States $124 billion

2012-02-06T13:17:00.000-08:00

For Immediate Release: February 1, 2012
Contact :CDC Division of News and Electronic Media
(404) 639-3286

Rivals cost of other high profile public health problems

The total lifetime estimated financial costs associated with just one year of confirmed cases of child maltreatment (physical abuse, sexual abuse, psychological abuse and neglect) is approximately $124 billion, according to a report released by the Centers for Disease Control and Prevention, published in Child Abuse and Neglect, The International Journal.

This study looked at confirmed child maltreatment cases, 1,740 fatal and 579,000 non–fatal, for a 12–month period. The lifetime cost for each victim of child maltreatment who lived was $210,012, which is comparable to other costly health conditions, such as stroke with a lifetime cost per person estimated at $159,846 or type 2 diabetes, which is estimated between $181,000 and $253,000. The costs of each death due to child maltreatment are even higher.

“No child should ever be the victim of abuse or neglect – nor do they have to be. The human and financial costs can be prevented through prevention of child maltreatment,” said Linda C. Degutis, Dr.P.H., M.S.N., director of CDC′s National Center for Injury Prevention and Control.

Child maltreatment has been shown to have many negative effects on survivors, including poorer health, social and emotional difficulties, and decreased economic productivity. This CDC study found these negative effects over a survivor′s lifetime generate many costs that impact the nation′s health care, education, criminal justice and welfare systems.
Key findings:

The estimated average lifetime cost per victim of nonfatal child maltreatment includes:

$32,648 in childhood health care costs
$10,530 in adult medical costs
$144,360 in productivity losses
$7,728 in child welfare costs
$6,747 in criminal justice costs
$7,999 in special education costs

The estimated average lifetime cost per death includes:

$14,100 in medical costs
$1,258,800 in productivity losses

Child maltreatment can also be linked to many emotional, behavioral, and physical health problems. Associated emotional and behavioral problems include aggression, conduct disorder, delinquency, antisocial behavior, substance abuse, intimate partner violence, teenage pregnancy, anxiety, depression, and suicide.
Past research suggests that child maltreatment is a complicated problem, and so its solutions cannot be simple. An individual parent or caregiver′s behavior is influenced by a range inter–related factors such as how they were raised, their parenting skills, the level of stress in their life, and the living conditions in their community. Because of this complexity, it is critical to invest in effective strategies that touch on all sectors of society.

“Federal, state, and local public health agencies as well as policymakers must advance the awareness of the lifetime economic impact of child maltreatment and take immediate action with the same momentum and intensity dedicated to other high profile public health problems –in order to save lives, protect the public′s health, and save money,” said Dr. Degutis.

Several programs have demonstrated reductions in child maltreatment and have great potential to reduce the human and economic toll on our society. Several examples of effective programs include:

Nurse–Family Partnership, an evidence–based community health program. Partners a registered nurse with a first–time mother during pregnancy and continues through the child′s second birthday. http://www.nursefamilypartnership.org/
Early Start, provides coordinated, family–centered system of services: http://www.dds.ca.gov/earlystart/ California′s response to federal legislation providing early intervention services to infant and toddlers with disabilities and their families.
Triple P, a multilevel parenting and family support system: http://www.triplep–america.com/ Aims to prevent severe emotional and behavioral disturbances in children by promoting positive and nurturing relationships between parent and child.

The article, "The economic burden of child maltreatment in the United States and implications for prevention," is available at http://www.sciencedirect.com/science/journal/aip/01452134.

CDC′s Injury Center works to prevent injuries and violence and their adverse health consequences. For more information on public health child maltreatment prevention activities and research, please visit http://www.cdc.gov/ViolencePrevention/childmaltreatment.

If you know or suspect a child is being abused, contact the National Child Abuse Hotline at 1–800–4–A–CHILD or visit the Childhelp website.

HealthDay - Violence Against Women Can Take Lifelong Toll: Study

2012-01-03T17:06:00.000-08:00

By Serena Gordon
HealthDay Reporter
TUESDAY, Aug. 2, 2011 (HealthDay News) -- Women who've suffered from gender-based violence are more likely to develop anxiety disorders or other mental woes, experience physical and mental disabilities, and have worse quality of life than other women, new research shows.

Gender-based violence includes rape and other forms of sexual assault, intimate-partner violence (such as spouse abuse) and stalking.

Risks for these long-term problems rose with the intensity of abuse. For example, women who'd experienced three or four types of gender-based violence had 10 times the odds of developing an anxiety disorder than women who haven't experienced such violence, the study found. The odds of a woman who'd been subjected to such violence developing a substance abuse problem were almost six times higher than for a woman who hasn't experienced gender-based violence.

"Gender-based violence is a public health problem and occurs to many women. Women need to recognize that the social and psychological problems they are experiencing may be related to their past or current exposure to violence and not pass these reactions off to other causes," said the study's lead author, Susan Rees, a senior research fellow at the University of New South Wales in Sydney, Australia.

Results of the study are published in the Aug. 3 issue of the Journal of the American Medical Association.
In the United States, more than 20 percent of women have experienced intimate-partner violence, stalking or both. A full 17 percent have reported rape or attempted rape, according to background information in the study.

The data for Rees' study came from a national survey done in Australia on mental health and well-being. The survey included over 4,400 women between the ages of 16 and 85 years old.

In that group, 1,218 women (27 percent) reported experiencing at least one form of gender-based violence, while 139 had been exposed to three or more forms of gender-based violence.

The average age that women were first raped was 13 years old and 12 years old for sexual assault. The average age that women were beaten by a partner or stalked was 22 years old.

The more violence a woman was exposed to, the greater her risk of developing mental illnesses, according to the study.

For example, about 15 percent of women who had been subjected to one form of gender-based violence experienced post-traumatic stress disorder (PTSD). But, if women were subjected to three or more forms of gender-based violence, that number jumped to more than 56 percent, the investigators found.

Suicide rates were significantly higher for women who'd experienced gender-based violence. The average rate of attempted suicide was 1.6 percent for all women in the study, but it was 6.6 percent for women who'd experienced one form of violence, and 34.7 percent for women exposed to three or more types of violence.

Rates of physical and mental disabilities were also much higher for women who had experienced gender-based violence. These women also tended to report an impaired quality of life.

Even though the study team had expected the findings, "the extent and strength of the associations we found was surprising and very concerning," Rees said.

Furthermore, this type of aggression "often occurs repeatedly, unlike other traumas such as exposure to natural disasters, so you get a compounding effect. Gender-based violence is unfortunately still largely considered a personal and private matter, making help-seeking very difficult for many women, so they rarely received the support trauma survivors need to assist recovery," Rees noted.

One U.S. expert said the findings need to be heeded closely.

"This study really demonstrated the extent of gender-based violence and the long-term consequences of violence against women," said Andrea Gielen, director of the Center for Injury Research and Policy at the Johns Hopkins Bloomberg School of Public Health in Baltimore. "There are huge implications for health services; this is not just a one-time treatment in the ER for a broken bone. People who treat women for any health-related issues need to think about the extent that such violence can affect women," Gielen said.

Gielen added that in the United States, a measure of help is on the way. The federal government on Monday adopted recommendations from the Institute of Medicine on preventive services for women's health, and one new rule is that health care insurers must cover the cost of screening and counseling for domestic violence.

"Any woman is who experiencing gender-based violence needs to realize that there are things she can do, there are hotlines she can call, there are resources available," Gielen said. "Talking about the experience with an informed and supportive health professional is a good thing to do to move on."

More information
The U.S. Department of Health and Human Services Office on Women's Health has advice on how to help a friend who's being abused.

Copyright © 2011 HealthDay. All rights reserved.

Reuters Health: Murder, suicide top medical deaths in pregnancy

2012-01-03T16:56:00.000-08:00

Wednesday, October 26, 2011
By Kerry Grens

NEW YORK (Reuters Health) - Expectant mothers are more likely to die from murder or suicide than several of the most common pregnancy-related medical problems, U.S. researchers have found.

Roughly half of those women who died violently had had some sort of conflict with their current or former partners leading up to the death, causing experts to call for more thorough screening and follow up for domestic problems during pregnancy check-ups.

"I think that there's still an under-appreciation of the risk (for murder and suicide) and probably less screening than should be done," said Dr. Linda Chambliss, director of maternal fetal medicine at St. Joseph's Hospital and Medical Center in Phoenix, who did not participate in the new work.

The study shows that about three out of every 100,000 women who are pregnant or have a child less than one year old are murdered, and two out of every 100,000 kill themselves.

Those numbers remained fairly constant from 2003 to 2007, the years that the researchers examined.
They pulled their data from the Centers for Disease Control and Prevention's National Violent Death Reporting System, which includes 17 states.

Murder and suicide were more common causes of death than medical conditions related to the pregnancy, according to a different set of data.

For instance, fewer than two out of every 100,000 women died from either pregnancy-related bleeding, improper development of the placenta, or preeclampsia, a complication of high blood pressure that can occur during pregnancy.

Dr. Christie Palladino, the lead author of the study, told Reuters Health that deaths from medical problems during pregnancy have dropped in recent decades.

"We've seen improvements in the more traditional causes of death, likely due to advances in medical care and public health practices. But the rate of injury seems to remain constant," said Palladino, an obstetrician-gynecologist at Georgia Health Sciences University in Augusta.

This finding is especially troubling, she said, because violent deaths can be stopped.

"Even if the numbers are relatively small, you're talking about something that's preventable. It doesn't have to be there at all," agreed Chambliss.

Some groups of women were at a greater risk of violent death.

Women who died by suicide, for example, were more likely to be white or Native American, unmarried and over 40. Older women and those under 24 were at greater risk of being murdered, as were African Americans and unmarried women.

Palladino said her study, published in the journal Obstetrics & Gynecology, likely underestimated the number of violent deaths among pregnant women.

The National Violent Death Reporting System includes all records of violent deaths in the participating states, but in some cases the pregnancy status of the victim was unknown, and Palladino and her colleagues excluded those records from the study.

Palladino said pregnancy is a prime opportunity for working to prevent suicides and murders, particularly those related to domestic violence, because women regularly see health care providers.

"We want to make sure we intervene before we get to these really disastrous consequences," she said.
SOURCE: http://bit.ly/u2Dgjy Obstetrics & Gynecology, November, 2011.

Reuters Health

Reuters: Early sexual abuse increases heart risks

2012-01-03T16:51:00.000-08:00

Sunday, November 13, 2011
CHICAGO (Reuters) - Women who were repeatedly sexually abused as girls have a 62 percent higher risk of heart problems later in life compared with women who were not abused, U.S. researchers said on Sunday.

The findings, presented at the American Heart Association meeting in Orlando, Florida, underscored the lasting physical effects of early sexual abuse.

Much of the increased risk was related to coping strategies among abuse survivors such as overeating, alcohol use and smoking.

"The single biggest factor explaining the link between severe child abuse and adult cardiovascular disease was the tendency of abused girls to have gained more weight throughout adolescence and into adulthood," Janet Rich-Edwards of Brigham and Women's Hospital in Boston, who led the study, said in a statement.
The team analyzed data from a study of more than 67,000 nurses. Nine percent of these women had reported severe physical abuse and 11 percent reported being raped in their childhood or adolescence.
The team found that repeated episodes of forced sex in childhood or adolescence translated into a 62 percent higher risk of heart attacks and strokes later in life.

Physical abuse also took a toll. Women who had been beaten in their youth had a 45 percent higher risk of heart trouble.

There was no increased heart risk in women who reported mild to moderate physical or sexual abuse.
Much of the effect was related to higher rates of obesity, smoking, alcohol use, high blood pressure and diabetes, which accounted for 41 percent of the increased risk of heart problems among women who had been physically abused and 37 percent of the association with sexual abuse, the team said.

The findings suggest severe physical and sexual abuse are significant risk factors for future heart disease, and women and their doctors need to take steps to reduce this risk.

"We need to learn more about specific psychological, lifestyle, and medical interventions to improve the health of abuse survivors." Rich-Edwards said in a statement.

(Reporting by Julie Steenhuysen; Editing by Peter Cooney)

Reuters Health

CDC: Sexual Violence, Stalking, and Intimate Partner Violence Widespread in the US

2012-01-03T16:47:00.000-08:00

CDC

December 14, 2011

New survey finds these types of violence affect the health of millions of adults

On average, 24 people per minute are victims of rape, physical violence, or stalking by an intimate partner in the United States, according to findings released today by the Centers for Disease Control and Prevention. Over the course of a year, that equals more than 12 million women and men. Those numbers only tell part of the story – more than 1 million women reported being raped in a year and over 6 million women and men were victims of stalking in a year, the report says.

“This landmark report paints a clear picture of the devastating impact these violent acts have on the lives of millions of Americans,” said Secretary of Health and Human Services Secretary Kathleen Sebelius. “The information collected in this ongoing survey will serve as a vital tool in the Administration′s efforts to combat domestic violence and sexual abuse. And the report underscores the importance of our Administration′s work to combat domestic violence and sexual assault.”

The National Intimate Partner and Sexual Violence Survey, or NISVS, is one of CDC′s latest public health surveillance systems and is designed to better describe and monitor the magnitude of sexual violence, stalking and intimate partner violence victimization in the United States. It is the first survey of its kind to provide simultaneous national and state-level prevalence estimates of violence for all states. Launched in 2010, NISVS also provides data on several types of violence that have not previously been measured in a national population-based survey.

Key findings in the NISVS 2010 Summary Report include:

For women:

High rates of sexual violence, stalking, and intimate partner violence were reported by women.

Nearly 1 in 5 women has been raped at some time in her life.
One in 4 women has been a victim of severe physical violence by an intimate partner in her lifetime.
One in 6 women has experienced stalking victimization during her lifetime in which she felt very fearful or believed that she or someone close to her would be harmed or killed. Much of stalking victimization was facilitated by technology, such as unwanted phone calls and text messages.

Almost 70 percent of female victims experienced some form of intimate partner violence for the first time before the age of 25.
Approximately 80 percent of female victims of rape were first raped before age 25.
Female victims of violence (sexual violence, stalking, intimate partner violence) were significantly more likely to report physical and mental health problems than female non–victims.
Across all forms of violence (sexual violence, stalking, intimate partner violence), the vast majority of victims knew their perpetrator (often an intimate partner or acquaintance and seldom a stranger).

For men:

About 1 in 7 men has experienced severe physical violence by an intimate partner at some point in their lifetime.
One in 19 men has experienced stalking victimization at some point during their lifetime in which they felt very fearful or believed that they or someone close to them would be harmed or killed.
Almost 53 percent of male victims experienced some form of intimate partner violence for the first time before age of 25
More than one-quarter of male rape victims were first raped when they were 10 years old or younger.
Male victims of violence (sexual violence, stalking, intimate partner violence) were significantly more likely to report physical and mental health problems than male non-victims.

“This report highlights the heavy toll that sexual violence, stalking, and intimate partner violence places on adults in this country. These forms of violence take the largest toll on women, who are more likely to report immediate impacts and long-term health problems caused by their victimization,” said Linda C. Degutis, Dr.P.H., M.S.N., director of CDC′s National Center for Injury Prevention and Control. “Much victimization begins early in life, but the consequences can last a lifetime.”

The report findings also underscore violence as a major public health burden and demonstrate how violence can have impacts that last a lifetime. For instance, the findings indicate female victims of violence had a significantly higher prevalence of long-term health problems, including irritable bowel syndrome, diabetes, frequent headaches, chronic pain, and difficulty sleeping. And nearly twice as many women who were victims of violence reported having asthma, compared to women who did not report violence victimization.
“The health problems caused by violence remind us of the importance of prevention,” said Howard Spivak, M.D., director of the Division of Violence Prevention in CDC′s Injury Center. “In addition to intervening and providing services, prevention efforts need to start earlier in life, with the ultimate goal of preventing all of these types of violence before they start.”

NISVS provides data that can help inform policies and programs aimed at preventing violence as well as addressing the specific information needs of state and national governmental and nongovernmental organizations, while providing an initial benchmark for tracking the effectiveness of prevention efforts.
For more information about NISVS, including the executive summary and study details, please visit http://www.cdc.gov/violenceprevention/nisvs.

CDC′s Injury Center works to prevent injuries and violence and their adverse health consequences.

For more information about sexual violence, please visit:

http://www.cdc.gov/violenceprevention/sexualviolence/

For more information about intimate partner violence prevention, please visit: http://www.cdc.gov/ViolencePrevention/intimatepartnerviolence.

If you or someone you know is the victim of:

Sexual violence, contact the Rape, Abuse, and Incest National Network (RAINN) hotline at 1-800-656-HOPE.Intimate partner violence, contact your local battered women's shelter or the National Domestic Violence Hotline at 800-799-SAFE (7233) or visit the National Domestic Violence Hotline website.

Additional resources:

On domestic violence, sexual violence, funding, research, and international issues: National Online Resource Center on Violence Against Women.
On sexual violence including statistics, research, statutes, training curricula, prevention initiatives and program information: National Sexual Violence Resource Center.
To watch webinars that discuss the NISVS findings, please visit PreventConnect, a national online project dedicated to the primary prevention of sexual assault and domestic violence.

HealthDay: Abuse May Alter Child's Brain Activity

2012-01-03T16:43:00.000-08:00

Exposure to violence has a measurable effect, researchers say

MedLine Plus

By Robert Preidt

Friday, December 9, 2011

Related MedlinePlus Page

Child Abuse

FRIDAY, Dec. 9 (HealthDay News) --Children who are abused or exposed to family violence have changes in brain activity similar to those seen in combat veterans, a new study finds.

The brains of these children become increasingly "tuned" for identifying possible sources of danger, said U.K. researchers who used functional imaging to monitor brain activity.

When the study authors showed pictures of angry faces to children with a history of abuse, the children's brains showed increased activity in the anterior insula and amygdala, which are involved in detecting threat and anticipating pain.

These changes don't indicate brain damage but are the brain's way of adapting to a challenging or dangerous environment, study author Eamon McCrory, of University College London, explained.
The study appears in the Dec. 6 issue of the journal Current Biology.

"Enhanced reactivity to a biologically salient threat cue such as anger may represent an adaptive response for these children in the short term, helping keep them out of danger," McCrory said in a journal news release. "However, it may also constitute an underlying neurobiological risk factor increasing their vulnerability to later mental health problems, and particularly anxiety."

The findings are important because of the large numbers of children who are exposed to family violence.
"This underlines the importance of taking seriously the impact for a child of living in a family characterized by violence. Even if such a child is not showing overt signs of anxiety or depression, these experiences still appear to have a measurable effect at the neural level," McCrory said.

SOURCE: Current Biology, news release, Dec. 5, 2011

HealthDay

Abused girls may have higher risk of heart disease, stroke as adults

2012-01-03T16:40:00.000-08:00

American Heart Association

November 13, 2011

Study Highlights:

Women who experienced unwanted sexual activity as children or adolescents had a higher risks for heart attacks, heart disease and strokes as adults compared to women who reported no unwanted sexual activity.
Severe physical abuse as children or teens also was associated with an increased risk of cardiovascular disease as adults.

ORLANDO, FLA., Nov. 13, 2011 — Sexually and physically abused girls may have higher risks for heart attacks, heart disease and strokes as adults, according to research presented at the American Heart Association’s Scientific Sessions 2011.

In the study, compared to women who weren’t molested or raped as children or teens, women who reported:

Repeated episodes of forced sex in childhood or adolescence had a 62 percent higher risk of cardiovascular disease as adults.
Severe physical abuse in childhood or adolescence was associated with a 45 percent increased risk of cardiovascular events.

Mild to moderate physical or sexual abuse was not associated with increased risk.

“The single biggest factor explaining the link between severe child abuse and adult cardiovascular disease was the tendency of abused girls to have gained more weight throughout adolescence and into adulthood,’ said Janet Rich-Edwards, Sc.D., M.P.H., lead author of the study and associate professor in the Department of Medicine at Brigham and Women’s Hospital in Boston, Mass.

The researchers studied the associations of child and adolescent abuse with confirmed cardiovascular disease events such as heart attacks and strokes from 1989-2007 among 67,102 women in the Nurses’ Health Study II. Eleven percent reported forced sexual activity during childhood and adolescence and 9 percent reported severe physical abuse.

Associations of severe abuse were stronger for stroke than for heart attack. Risk factors such as adult body mass index, smoking, alcohol use, hypertension and diabetes accounted for 41 percent of the association of severe physical abuse and 37 percent of the association of forced sex with cardiovascular disease events. “These traditional cardiovascular risk factors explain about 40 percent of the association we see between abuse and cardiovascular disease – which suggests that other factors may play an important role, such as increased stress reactivity among people with a history of abuse,” said Rich-Edwards.

Researchers conducted the study with primarily white nurses, so further research should be done with different socio-demographic groups, Rich-Edwards said.

“Women who experience abuse need to take special care of their physical and emotional well-being to reduce their risk of chronic disease,” Rich-Edwards said. “Primary care health professionals need to consider childhood abuse histories of women as they transition into adulthood but to help the health professionals prevent cardiovascular disease among women with a history of abuse, we need to learn more about specific psychological, lifestyle, and medical interventions to improve the health of abuse survivors.”

Co-authors are: Susan Mason, Ph.D.; Kathryn Rexrode, M.D.; Donna Spiegelman, Sc.D.; Eileen Hilbert, M.S.; Ichiro Kawachi, Ph.D.; Hee-Jin Jun, Sc.D. and Rosalind Wright, M.D.

Author disclosures are on the abstract.

The National Institutes of Health funded the study.

Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding .

###

NR11-1134 (SS11/Rich-Edwards)

Note: Actual presentation is 3:45 p.m. ET on Monday, Nov. 14.

NEW for Scientific Sessions 2011:

All downloadable video/audio interviews, B-roll, animation and images related to this news release are located on the right column of the release link

http://newsroom.heart.org/pr/aha/_prv-abused-girls-may-have-higher-risk-217758.aspx, along with general Sessions multimedia resources. Video clips with researchers/authors of studies will be added to the release links after embargo.

Follow news from AHA Scientific Sessions 2011 via Twitter: http://twitter.com/#!/heartnews . Follow #AHANews2011.

For Media Inquiries:

AHA News Media in Dallas: (214) 706-1396

AHA News Media Office, Nov. 12-16

at the Orange County Convention Center: (407) 685-5410

For Public Inquiries: (800)-AHA-USA1 (242-8721)

2008-2011 Domestic Abuse, Health, and Consequences to Society

2011-09-16T09:19:00.000-07:00

Compiled by M.A.S.O. ~ Massachusetts Survivors Outreach

2011 Studies

January 4 - HealthDayNews - Survey Finds Much Victimization of Children Goes Unreported– By UNH - Nearly 60 percent of 10-to-17-year-olds surveyed in a newstudy say they were victims of violence, abuse or crime in the past year.However, fewer than half said that authorities ever learned about whathappened.

"The hidden nature of childhood victimizationhas multiple sources. Clearly, children and adolescents are easily intimidatedby offenders and fear retaliation."

http://domestic-abuse-violence.blogspot.com/2011/04/survey-finds-much-victimization-of.html

February 23 - MedLinePlus - PTSD Risk in WomenTied to Genetics - Heavily traumatized civilian women with twocopies of a specific single nucleotide polymorphism (SNP) in the ADCYAP1R1gene were more likely to show PTSD with an odds ratio of 1.66 (95% CI 1.32 to2.09) relative to similar women without the condition, Kessler and colleaguesfound.

About one-third ofthe 763 women in the study were diagnosed with PTSD.

Among the individualPTSD symptoms, hyperarousal was the one most strongly associated with the CCgenotype.

http://domestic-abuse-violence.blogspot.com/2011/03/ptsd-risk-in-women-tied-to-genetics.html

February 24 - Science Daily - Strong Link Found Between Victimization, Substance Abuse - Researchers compared victimization experiences of unwanted sexualactivity, neglect, physical violence, and assault with a weapon,

Three times as many lesbians as heterosexual women reported childhoodsexual abuse.

Regardless of sexual identity, women who reported two or morevictimization experiences had two to four times the prevalence of alcoholdependence, drug abuse or drug dependence as women who reported novictimization, she said.

http://domestic-abuse-violence.blogspot.com/2011/03/strong-link-found-between-victimization.html

March 18 - Medline Plus - Domestic Abuse Often Escapes Notice of ER Staff: Study -Most not identified as victims when treated in emergency department – By UPenn - Three of four domestic violence victims treated in hospital emergencydepartments are not identified as victims of abuse, a new study reveals.

80% of women whoreported domestic assaults to police came to an emergency department at leastonce during the four years after the reported assault. Only 28% of the women were ever identified inEDs as victims of domestic violence.

http://domestic-abuse-violence.blogspot.com/2011/04/domestic-abuse-often-escapes-notice-of.html

March 31 - Moms With Tough Childhoods More Likely toHave Smaller Babies: Study - Abuse, poverty during amother's youth is associated with heightened health risks for the nextgeneration

http://domestic-abuse-violence.blogspot.com/2011/04/moms-with-tough-childhoods-more-likely.html

April 16 – CDC – CDC Report: Adverse Childhood ExperiencesReported by Adults

Overall, 59.4% ofrespondents reported having had at least one ACE while 8.7% reported five ormore ACEs.

The most common ACEs were: Separated or divorced parents, Verbalabuse, Family member with depression or mental illness, Witness of domesticviolence, Physical abuse, Sexual abuse.

These findingsreinforce that adverse childhood experiences are common across racial/ethnicgroups and states, further reinforcing the need to expand evidence-based child abuse prevention programs such as home visitingand parent education.

http://domestic-abuse-violence.blogspot.com/2011/04/cdc-report-adverse-childhood.html

April 20 - Sciencedaily.com- Biological Links Found BetweenChildhood Abuse and Adolescent Depression - history of physical, sexual or emotionalabuse in childhood substantially increases the risk of depression inadolescence by altering a person's neuroendocrine response to stress.

http://domestic-abuse-violence.blogspot.com/2011/05/biological-links-found-between.html

April 28 - University of Southern California and Cincinnati Children’s Hospital Medical Center, University ofCincinnati College of Medicine. - - ChildSexual Abuse Imapct - 23yo Study - Results of many analyses, both withincircumscribed developmental stages and across development, indicated thatsexually abused females (on average) showed deleterious sequelae across a hostof biopsychosocial domains including:earlier onsets of puberty, cognitive deficits, depression, dissociativesymptoms, maladaptive sexual development, hypothalamic–pituitary–adrenalattenuation, asymmetrical stress responses, high rates of obesity, more majorillnesses and healthcare utilization, dropping out of high school, persistentposttraumatic stress disorder, self-mutilation, Diagnostic and StatisticalManual of Mental Disorders diagnoses, physical and sexual revictimization,premature deliveries, teen motherhood, drug and alcohol abuse, and domesticviolence. Offspring born to abused mothers were at increased risk for childmaltreatment and overall maldevelopment.

http://domestic-abuse-violence.blogspot.com/2011/04/child-sexual-abuse-imapct-23yo-study.html

May 10 - Post-Traumatic Childhood - For every soldier returning from Iraqand Afghanistan withsymptoms of depression or PTSD, there are around 10 children in the United Stateswho are traumatized by exposure to family violence, sexual abuse, neglect andassault, with consequences comparable to those of adult exposure to war-zoneviolence.

The Pew Charitable Trusts estimates that the annualcost of childhood maltreatment like this is$103.8 billion.

Untreated,traumatized children become failing adults who populate our jails and overwhelmour human services agencies. Cutting the development of effective treatmentswill produce many years of increasing costs and unquantifiable human misery

http://domestic-abuse-violence.blogspot.com/2011/05/post-traumatic-childhood.html

May 17ScienceDaily.com -Deprivation and Neglect Found to Age Children's Chromosomes - Study, led by researchers at Children's Hospital Boston and TulaneUniversity, shows that early adversity even affects children's chromosomes --prematurely shortening the chromosome tips, known as telomeres, and hasteninghow quickly their cells "age."

"The telomere isdesigned to protect the chromosome, so accelerating how early in life telomereslose length correlates with shortened life span," says Charles Nelson,PhD, director of the Laboratories of Cognitive Neuroscience at Children's andprincipal investigator of BEIP. "Shortened telomeres may lead to healthconsequences downstream."

http://domestic-abuse-violence.blogspot.com/2011/05/deprivation-and-neglect-found-to-age.html

May 26 - TheAnnapolis Chronic Fatigue and Fibromyalgia Research Center. - Abuse History MoreCommon in Those With Pelvic Pain, CFS, and Fibromyagia - Childhood Trauma and Risk for ChronicFatigue Syndrome: Association With Neuroendocrine Dysfunction

http://domestic-abuse-violence.blogspot.com/2011/05/abuse-history-more-common-in-those-with.html

May 26 - Ritual Abuse and Torture-based MindControl: Reducing and Preventing Re-contact with Abusers -The two primary forms of re-contact w/ abusers include reporting back by phoneor written correspondence, and physically returning to abusers to be abusedagain. Perpetrators of ritual abuse and mind control attempt to coerce theirvictims into submission and service to the abuser group for a lifetime.Abuser methods of exerting long-term contact and control vary in relation tothe level of psychological sophistication of the abusers and the size of theabusers’s criminal network.
Some abuser groups rely primarily on threats to force their victims intocompliance and to prevent their victims from escaping. For some of thesegroups, these are empty threats. They make claims of having more power thanthey have. Some abuser groups have larger criminal networks and thus, morepower to carry out their threats. But, they too reliably overstate theirpower to maximally terrorize their victims. This is not to dismiss thereality that these abusers commit murder, but it is to say that they lie andexaggerate their power. Clearly, people who systematically abuse otherslie to further their own interests. Words are just one more tool ofmanipulation to control their victims. Everythingthey say should be questioned and examined for underlying motives andfeasibility.
Many of these abusers also manipulate their victims’ attachment needs, that is,their basic survival needs and needs for security and love, usually beginningin early childhood. They also go to great lengths to try to make theirvictims believe that the victims are accomplices to the abuse, that theyare as evil as their abusers themselves, and that they are unworthy andincapable of belonging anywhere but with the abusers.
Some abuser groups go a step further and manipulate their victims’psychological capacity to form dissociated self-states in response to extremepain and terror. I am using the term, “dissociated self-states,” here to referto states of consciousness with some sense of self that exist out of theconscious awareness of the most-often conscious parts of the psyche, and thattypify DSM-IV Dissociative Identity Disorder, and forms of Dissociative DisorderNot Otherwise Specified in which self-states exist internally, affecting thepsyche from within, but never assume complete control of executive functions(e.g., purposive action).
These Machiavellian abusers systematicallytorture their victims for the intended purpose of coercing their victims’psyches into forming new dissociated self-states that they then work to exploit. They “torture-hypno-condition” these self-states, that is, they usetorture, hypnosis, and behavioral conditioning, to try to coerce thesedissociated self-states into fulfilling functions that serve the abusers. (Ithank Hans Ulrich Gresch, Ph.D., psychologist, mind control survivor, andrespected colleague, for the term, “torture-hypno-conditioning,” the mostsuccinct descriptive phrase that I have found that explains what occurs in mosttorture-based mind control programming; see: http://www.mind-control.psychoprobleme.de/).These abusers “program” some of these dissociatedself-states to take on “reporter” and “re-contact” functions, that is, toreport to the abusers on a regular basis from a distance, and to return to theabusers as directed.
In many cases, even though the survivor is working hard to break free of her orhis abusers, these programmed self-states continue to report to, and return to,the abusers, often out of the conscious awareness of the most-often consciousparts of the psyche. Ongoing access allows the abusers to retaliate againsttheir victims for attempting to break free and to escalate their abuse andprogramming in efforts to increase their control of their victims.

http://domestic-abuse-violence.blogspot.com/2011/05/ritual-abuse-and-torture-based-mind.html

June 13 - Boston.com - Study ties bullying, domestic violence - Boys who are bullies are nearly four times as likely as non-bullies togrow up to physically or sexually abuse their female partners, a study led byresearchers from the Harvard School of Public Health found. http://domestic-abuse-violence.blogspot.com/2011/07/study-ties-bullying-domestic-violence.html

June 30 - msnbc.com - Effects of sexual abuse last for decades,study finds - Younggirls who are the victims of sexual abuse experience physical, biological andbehavioral problems that can persist for decades after, a new study shows. http://domestic-abuse-violence.blogspot.com/2011/07/effects-of-sexual-abuse-last-for.html

June 30 - RobertHughes Univ of Illinois- How Custody EvaluatorsThink about Domestic Violence - some domestic violence involves the use ofextreme forms of control that forces apartner to do something she does not want to do. Johnson labeled this form ofviolence as "intimate terrorism."

These findings raiseimportant questions about the degree to which domestic violence is beingthoughtfully considered in custody decisions. It is important for the legal system to develop training and policiessuch that custody evaluators can appropriately consider custody arrangements indomestic violence situations. http://domestic-abuse-violence.blogspot.com/2011/07/how-custody-evaluators-think-about.html

July 5 - MedPageToday - When child abuse has beensubstantiated, a number of risk factors can predict the likelihood that abusewill be repeated if the child is returned to the care of the abuser,according to a prospective cohort study.

When the parentsor caregivers were in their teens or twenties, were survivors of abuse, and hadnever taken parenting classes -- the child faced a 54% risk of being harmedagain, wrote Suzanne R. Dakil, MD, and colleagues from the University of TexasSouthwestern Medical Center in Dallas.
Risks higher even higher -- 60% -- for children younger than 8.5 yrs who were returned to parents that hadtaken parenting class, the researchers reported online in the Archives ofPediatrics and Adolescent Medicine.
Because both Federal and state lawsencourage keeping children in the family home if possible after abuse, it'scrucial that accurate ways of predicting future risk be identified, Dakil'sgroup stated.

44% of childrenwere reported to child welfare authorities againafter the index report.

http://domestic-abuse-violence.blogspot.com/2011/07/risk-factors-predict-repeat-abuse.html

TUESDAY, July 19 - (HealthDayNews) -- A new study provides evidencethat stress from domestic violenceduring pregnancy may make offspring more prone to stress as an adult. http://domestic-abuse-violence.blogspot.com/2011/08/study-hints-at-how-stress-of-domestic.html

TUESDAY, Aug. 2 (HealthDay News) – Long Term Affects To Heath - Women who've suffered fromgender-based violence are more likely to develop anxiety disorders or othermental woes, experience physical and mental disabilities, and have worsequality of life than other women, new research shows.

In the United States,more than 20% of women have experienced intimate-partner violence, stalking orboth. A full 17% have reported rape or attempted rape, according to backgroundinformation in the study.

15% of women whohad been subjected to one form of gender-based violence experienced (PTSD). -Subjected to 3 or more forms of gender-based violence, that number jumped tomore than 56%, the investigators found.

"This study really demonstrated theextent of gender-based violence and the long-term consequences of violenceagainst women," saidAndrea Gielen, director of the Center for Injury Research and Policy at theJohns Hopkins Bloomberg School of Public Health in Baltimore. "There are huge implications for health services; this is not justa one-time treatment in the ER for a broken bone. People who treat women forany health-related issues need to think about the extent that such violence canaffect women," Gielen said.

http://domestic-abuse-violence.blogspot.com/2011/08/violence-against-women-can-take.html

August 2, 2011 - HealthDay - Violence Against Women Can Take Lifelong Toll: Study - Women who've suffered from gender-based violence are more likely to develop anxiety disorders or other mental woes, experience physical and mental disabilities, and have worse quality of life than other women, new research shows. Gender-based violence includes rape and other forms of sexual assault, intimate-partner violence (such as spouse abuse) and stalking. http://domestic-abuse-violence.blogspot.com/2012/01/healthday-violence-against-women-can.html

Wednesday, October 26, 2011 - Reuters Health - Murder, suicide top medical deaths in pregnancy - Expectant mothers are more likely to die from murder or suicide than several of the most common pregnancy-related medical problems, U.S. researchers have found.

http://domestic-abuse-violence.blogspot.com/2012/01/reuters-health-murder-suicide-top.html

November 13, 2011 - Reuters - Early Sexual Abuse Increases Heart Risks - CHICAGO (Reuters) - Women who were repeatedly sexually abused as girls have a 62 percent higher risk of heart problems later in life compared with women who were not abused, U.S. researchers said on Sunday.

http://domestic-abuse-violence.blogspot.com/2012/01/reuters-early-sexual-abuse-increases.html

November 13, 2011 - American Heart Association - Abused girls may have higher risk of heart disease, stroke as adults -

Study Highlights: Women who experienced unwanted sexual activity as children or adolescents had a higher risks for heart attacks, heart disease and strokes as adults compared to women who reported no unwanted sexual activity. Severe physical abuse as children or teens also was associated with an increased risk of cardiovascular disease as adults.

http://domestic-abuse-violence.blogspot.com/2012/01/abused-girls-may-have-higher-risk-of.html

December 9, 2011 - MedLine Plus - Abuse May Alter Child's Brain Activity. Children who are abused or exposed to family violence have changes in brain activity similar to those seen in combat veterans, a new study finds. "This underlines the importance of taking seriously the impact for a child of living in a family characterized by violence. Even if such a child is not showing overt signs of anxiety or depression, these experiences still appear to have a measurable effect at the neural level," McCrory said.

http://domestic-abuse-violence.blogspot.com/2012/01/healthday-abuse-may-alter-childs-brain.html

December 14, 2011 - Contact: CDC Division of News & Electronic Media - (404) 639-3286 - Sexual Violence, Stalking, and Intimate Partner Violence Widespread in the US - New survey finds these types of violence affect the health of millions of adults. On average, 24 people per minute are victims of rape, physical violence, or stalking by an intimate partner in the United States, according to findings released today by the Centers for Disease Control and Prevention. Over the course of a year, that equals more than 12 million women and men. Those numbers only tell part of the story – more than 1 million women reported being raped in a year and over 6 million women and men were victims of stalking in a year, the report says. http://www.cdc.gov/media/releases/2011/p1214_sexual_violence.html

http://domestic-abuse-violence.blogspot.com/2012/01/cdc-sexual-violence-stalking-and.html

2010 Studies

January 25 - MedPage Today - MEDICAL NEWS: Domestic Abuse May Affect ReproductiveFreedom - In some abusive relationships, men may usestrategies to force women to become pregnant, including sabotaging their birthcontrol, researchers reported. Morethan half of the women surveyed -- 53% -- reported physical or sexual partnerviolence.
Approximately a third of the women who reported partner violence also reportedpregnancy coercion or birth control sabotage. Altogether, the effect of both partner violence and reproductive controlnearly doubled a woman's odds of unintended pregnancy (OR 1.99, 95% CI 1.11 to3.58)

Among the reasons men would want their partners to bear children: "It ranges from things likewanting to leave a legacy, to a straightforward desire for attachment, tohaving absolute control over her body," Miller said.

"It's about power and control," Mays said. "It's another wayof saying, 'this girl's taken, this girl's mine.'”

"Women in abusiverelationships are sometimes forced to bear children as a means to keepthem dependent on their partner and sometimes as a means to justify additional-- and sometimes more severe -- abuse," Bonomi said.

http://domestic-abuse-violence.blogspot.com/2011/01/medical-news-domestic-abuse-may-affect.html

Victims of Intimate Partner Violence at Significantly Increased Risk of Psychiatric Disorders

2011-09-16T08:17:00.000-07:00

Source: American Psychiatric Association

ARLINGTON, Va. (Aug. 1, 2011) — Mental disorders are significantly more common among victims of intimate partner violence than among nonvictims, according to research appearing in the August issue of the American Psychiatric Association’s journal Psychiatric Services.

Of adults interviewed, about 5 percent reported being victims of intimate partner violence including 5.6 percent of women and 5.8 percent of men. New onset of psychiatric disorders was more than twice as common among victims, 22 percent, compared to nonvictims, 9.7 percent. More than 25,000 adults participated in the study, including 1,600 who reported being victims of intimate partner violence, as part of the National Epidemiologic Survey on Alcohol and Related Conditions.

For most of the violent acts, the frequency of the acts directly related to the incidence of a psychiatric disorders—an increased frequency of the violent acts contributed to increased risk of developing a psychiatric disorder. Intimate partner violence was associated with an increased risk of posttraumatic stress disorder (PTSD), major depressive disorder, substance use disorders, bipolar disorder, panic disorder and generalized anxiety disorder.

The study looked at adults who reported being married, recently married, or in a romantic relationship in the past 12 months and looked at minor and severe forms of intimate partner violence. As with previous research, they did not find significant different between genders. Men and women were equally likely to have injuries requiring to medical care, however, women were more likely to be victims of sexual violence.

The authors conclude, “Intimate partner violence is highly prevalent in the United States, affects both men and women, and is associated with onset of a broad range of psychiatric disorders.” Health care providers have an opportunity to intervene and to lower the risk of psychiatric disorder onset.

The researchers, led by Mayumi Okuda, M.D., are affiliated with the New York State Psychiatric Institute and the Department of Psychiatry, College of Surgeons of Columbia University.

The American Psychiatric Association is a national medical specialty society whose physician members specialize in the diagnosis, treatment, prevention and research of mental illnesses, including substance use disorders. Visit the APA at www.psych.org and www.HealthyMinds.org.

CDC Awards $7M to Prevent Teen Dating Violence

2011-09-16T07:27:00.001-07:00

Did you know?
In a nationwide survey of students in grades 9-12, nearly one in 10 students reported being hit or physically hurt on purpose by a boyfriend or girlfriend at least once in the past 12 months.

What is CDC doing to prevent teen dating violence?
On September 13th, Vice President Biden announced the Centers for Disease Control and Prevention (CDC) awarded grants for its new teen dating violence prevention initiative, Dating Matters™: Strategies to Promote Healthy Teen Relationships. The funding will aid local health departments in leading their communities in developing, implementing, and evaluating a comprehensive approach to prevent teen dating violence before it starts. The grant is expected to cover five years of teen dating violence prevention program activities in the following cities:

Baltimore, Maryland
Ft. Lauderdale, Florida
Chicago, Illinois
Oakland/Hayward, California

CDC developed the initiative to respond to the serious public health issue of teen dating violence. The roll-out of the initiative will help CDC examine the cost, feasibility, sustainability, and effectiveness of a comprehensive approach to prevent teen dating violence in four high-risk urban communities.

Learn More

Learn more about CDC’s Dating Matters Initiative
Visit CDC's Violence Prevention web site.
Learn about Vice President’s Biden Efforts to End Violence Against Women.
Contact DatingMatters@cdc.gov for more information.

Centers for Disease Control and Prevention (CDC) Releases Latest Data on Deaths

2011-08-26T11:05:00.000-07:00

“Surveillance for Violent Deaths — National Violent Death Reporting System, 16 States, 2008,” appears in the August 26, 2011 online edition of Morbidity and Mortality Weekly Report Surveillance Summaries (MMWR).

Report Highlights:

The new report compiled data on 16,138 deaths in 2008 from 16 NVDRS states. A majority of these deaths were:

Suicides (58.7%)
Homicide/legal intervention deaths (26.4%)
Deaths of undetermined intent (14.5%)

NVDRS provides a comprehensive picture by combining once fragmented pieces of information from:

Death certificates
Coroner/medical examiner reports
Toxicology results
Law enforcement reports
And other reports related to each death

Data are used to inform prevention efforts by providing a more complete understanding of the circumstances preceding deaths in these 16 states.

To Learn More:

View an electronic copy of this document.
Data from the NVDRS states is available online through WISQARS™ (Web-based Injury Statistics Query and Reporting System)
About CDC’s violence prevention efforts: www.cdc.gov/violenceprevention
Follow the CDC on Facebook: www.facebook.com/vetoviolence

ABSTRACT

HOMICIDE PATTERNS

"Escalated interpersonal conflicts with an intimate partner, a friend, or another acquaintance remained the primary preceding circumstances for homicide. These circumstances were vastly more common than random acts of violence, hate crimes, or drive by shootings. For incidents with male victims, arguments with an acquaintance other than an intimate partner most often preceded homicide. Homicides with female victims were most often a result of intimate partner violence. Similar findings were provided in previous reports and studies (7--9,21). These findings provide more evidence that homicides are most commonly perpetrated by someone known to the victim, and strategies designed to reduce interpersonal and relationship conflicts might be valuable for prevention efforts.

Homicide-followed-by-suicide (i.e., homicide-suicide) incidents continued to be rare in 2008. However, they did account for the greatest proportion of violent incidents that involved multiple deaths. Similar to other reports and previous data years, perpetrators of homicide-suicide incidents were mostly white males of mid-late adulthood (i.e., aged 35--54 years) and victims were mostly females who were either current of former intimate partners of the perpetrator (21,23,24). As expected, intimate partner problems were among the most common circumstances preceding these incidents (7--9,21); however, job/financial problems and mental health problems were two to three times more common among perpetrators in 2008 versus those in 2007.

PREVENTION OPPORTUNITIES

NVDRS continues to show that interpersonal conflicts and relationship problems, particularly with an intimate partner, are common circumstances preceding a violent event.

In addition to demonstrating the need to address the situational stressors highlighted in this report, prevention strategies also need to focus on community level factors. For example, changing cultural and social norms (e.g., attitudes condoning the use of violence as a means of resolving conflict) and addressing the social and economic conditions within communities that often give rise to violence (e.g., inequities with regard to the distribution of and access to resources and opportunities, social isolation and lack of connectedness among persons, families, and communities) might further help prevent violence.

CONCLUSION

Accurate, timely, and comprehensive surveillance data can be used to monitor the occurrence of violence-related fatal injuries and assist public health and other authorities in the development, implementation, and evaluation of programs and policies that reduce and prevent violent deaths and injuries at the national, state, and local levels (36,37). Continued development and expansion of NVDRS is critical to the public health and criminal justice communities at the federal, state, and local levels that work to reduce the personal, familial, and societal costs of violence. Further efforts are needed to increase the number of states participating in NVDRS, with the ultimate goal of full national representation, including all 50 states, the District of Columbia, and U.S. territories.

CIRCUMSTANCES - Circumstances preceding fatal injury, by manner of death --- National Violent Death Reporting System, 16 states, 2008 (ABSTRACTED)

SUICIDE/UNDETERMINED

Intimate partner problem: problems with a current or former intimate partner that appear to have contributed to the suicide.
Other legal problem: decedent was facing civil legal problems (e.g., a child custody or civil lawsuit).
Perpetrator of interpersonal violence in previous month: decedent perpetrated interpersonal violence (e.g., being sought by police for assault or having been issued a restraining order resulting from recent violence) during the previous month.
Victim of interpersonal violence in previous month: decedent was the target of interpersonal violence in the past month.

HOMICIDE

Other argument, abuse, conflict: conflict between decedent and suspect was over something other than money, property, or drugs.
Jealousy ("lovers' triangle"): jealousy or distress over an intimate partner's relationship or suspected relationship with another person led to the homicide.
Intimate-partner violence--related: homicide is related to conflict between current or former intimate partners; includes the death of actual intimate partners and nonintimate partner decedents killed to cause pain to an intimate partner (e.g., child or parent).

Key STATS - Suicides

30.9% - Intimate Partner Problem - 32.2% of Males and 25.9% Females who commit suicide.

27.9% - Crisis in past or impending 2 weeks - 29% Males and 24% Females

74.6% - Depression - 74.2% Males and 75.4 Females

9.3% - Anxiety - 8.4% Males and 11.4% Female

1.6% - PTSD

KEY STATS - Homicides

22.9% Married

10.2% Spouse/Intimate partner (current or former)

.8% Other intimate partner involvement

18.1% Females Age 35-44

18.7% Males Age 20-24

53.5% Black, Non-hispanic Males

50.7% White Females

52.2% Mudered at home

18.4% Intimate partner-violence-related - 7.6% Males and 51.6% Females

24.3% Assault/Homicide

KEY STATS - Undetermined Death

11.1% Intimate partner problem

14.7% Crisis in past or impending 2 weeks

To see entire report, please visit the CDC's website.

Study links persistent depression to childhood abuse

2011-08-24T11:32:00.000-07:00

Sunday, August 14, 2011
By Kate Kelland, MedLine Plus

LONDON (Reuters) - Doctors treating people for depression should delve into the childhoods of their patients before prescribing, because a history of mistreatment has a significant impact on their illness and ability to recover, scientists said Monday.

Researchers who conducted a combined analysis of 26 studies involving more than 23,000 people found that those who suffered maltreatment as children were twice as likely as those who had normal childhoods to develop persistent and recurrent depression -- one of the world's most common and costly mental illnesses.

Those who had stressful or abusive childhoods were also less likely to be helped with drug or psychological treatment, the analysis found, suggesting doctors and scientists should look for new kinds of treatments and ways of intervening earlier.

"Identifying those at risk of multiple and long-lasting depressive episodes is crucial from a public health perspective," said Andrea Danese of the Institute of Psychiatry(IoP) at King's College London, who led the study.

Danese said the study showed that prevention and early intervention measures to target childhood maltreatment could prove vital in helping prevent the major global health problem.

"Knowing that individuals with a history of maltreatment won't respond as well to treatment may also be valuable for clinicians in determining patients' prognosis," he added.

Depression is a major cause of mortality, disability, and economic burden worldwide and the World Health Organization predicts that by 2020, depression will be the second leading contributor to the global burden of disease across all ages.

In Britain, experts say it affects at least one in 10 people at any one time and can lead to long-term sick leave, relationship breakdown or unemployment. According to a 2006 study, depression is responsible for 100 million lost working days a year in England and Wales alone at a cost of 9 billion pounds ($14.6 billion).

Danese, whose study was published in the American Journal of Psychiatry Monday, told a briefing that previous research has found that people who were maltreated as children also have biological scars from those experiences.

Around one in 10 children worldwide is exposed to maltreatment including psychological, physical or sexual abuse or neglect and as a result abnormalities can show up in biological areas that are particularly sensitive to stress, such as the brain and the immune system, he said.

These biological changes could potentially explain why depressed people with a history of maltreatment are less likely to respond well to treatment and may give clues for research aimed at finding more effective treatments, the scientists said.

"Whilst we still do not know exactly what type of treatment may improve the care of maltreated individuals, it may be that new treatments based on the biological vulnerabilities associated with childhood maltreatment could prove an exciting avenue for research," said Rudolf Uher, also of the IOP, who worked with Danese on the research.

A study published earlier this month found that childhood hardship, including suffering abuse or losing a parent or having a parent with addiction problems, also raised the risk of a range of chronic physical illnesses in later life, such as diabetes, heart disease or asthma

(Reporting by Kate Kelland, editing by Paul Casciato)

Reuters Health

Study Hints at How Stress of Domestic Violence Might Be Passed to Unborn Child

2011-08-10T13:10:00.000-07:00

Doesn't show cause-and-effect, but suggests low-stress pregnancies are best

Tuesday, July 19, 2011

TUESDAY, July 19 (HealthDay News) -- A new study provides evidence that stress from domestic violence during pregnancy may make offspring more prone to stress as an adult.

However, the research doesn't directly prove a cause-and-effect relationship.

It may be difficult to ever prove that stress affecting the bodies of stressed-out pregnant mothers disrupts the inner chemistry of their children. The study does point to the importance of a low-stress pregnancy, however.
"Healthy development starts in the womb, and it is not only nutritional," said study co-author Axel Meyer, an evolutionary biologist at the University of Konstanz in Germany. "Behavioral and emotional factors are important, and the effects are long-lasting."

In recent years, scientists have tried to understand how stress during pregnancy affects the fetus, possibly by altering genes. Research has suggested that anxious and stressed mothers are more likely to have children who develop attention and behavior problems and other issues, said Thomas G. O'Connor, director of the Wynne Center for Family Research at the University of Rochester Medical Center in new York.

It's challenging to figure out whether there's a direct link because many factors other than maternal stress -- such as the environment in which a child is raised -- could explain why kids turn out the way they do.

In science, the gold standard of research is to randomly assign groups of subjects to undergo different treatments or experiences and watch what happens to them. But it would be unethical to expose pregnant mothers to stress. So, researchers examine the effects of stress on pregnant animals, or they try to look backwards to find women who were stressed while pregnant and examine how it may have affected their offspring.

In this study, researchers looked at the genes of women and their children that are thought to be connected to stress.

They found that genetically, mothers stressed by domestic violence appear to "program their offspring to respond in a more costly way when exposed to stressors," Meyer said. The genes in the women themselves weren't affected by exposure to domestic violence.

Meyer said the ongoing stress of the domestic relationships may have been the key problem for the women. "Data from many studies suggest that stressors need not be physical," he said. "Emotional neglect, ongoing familial conflict and other severe forms of adversity may also take their toll."

Could something in the women that makes them more likely to become victims of domestic violence be passed down to their children? Probably not. The researchers linked domestic violence during pregnancy to genetic differences in their children, but they didn't find a link to mothers who experienced domestic violence before pregnancy.

How is the research helpful? "If it really were the case that stress in pregnancy did have persistent effects, then we should invest a great deal more effort and resources in trying to improve well-being in pregnancy," said O'Connor. "It would presumably be cost-effective because you're preventing something from happening."
The study appears in the July 19 issue of Translational Psychiatry.

SOURCES: Axel Meyer, Ph.D., professor, evolutionary biology, University of Konstanz, Germany; Thomas G. O'Connor, Ph.D., director, Wynne Center for Family Research, University of Rochester Medical Center, New York; July 19, 2011, Translational Psychiatry

HealthDay

Violence Against Women Can Take Lifelong Toll: Study Released

2011-08-05T12:34:00.000-07:00

Research shows how rates of mental and physical illness rise, quality of life falls

By Serena Gordon
HealthDay Reporter
TUESDAY, Aug. 2 (HealthDay News) -- Women who've suffered from gender-based violence are more likely to develop anxiety disorders or other mental woes, experience physical and mental disabilities, and have worse quality of life than other women, new research shows.

Gender-based violence includes rape and other forms of sexual assault, intimate-partner violence (such as spouse abuse) and stalking.

Risks for these long-term problems rose with the intensity of abuse. For example, women who'd experienced three or four types of gender-based violence had 10 times the odds of developing an anxiety disorder than women who haven't experienced such violence, the study found. The odds of a woman who'd been subjected to such violence developing a substance abuse problem were almost six times higher than for a woman who hasn't experienced gender-based violence.

"Gender-based violence is a public health problem and occurs to many women. Women need to recognize that the social and psychological problems they are experiencing may be related to their past or current exposure to violence and not pass these reactions off to other causes," said the study's lead author, Susan Rees, a senior research fellow at the University of New South Wales in Sydney, Australia.

Results of the study are published in the Aug. 3 issue of the Journal of the American Medical Association.
In the United States, more than 20 percent of women have experienced intimate-partner violence, stalking or both. A full 17 percent have reported rape or attempted rape, according to background information in the study.

The data for Rees' study came from a national survey done in Australia on mental health and well-being. The survey included over 4,400 women between the ages of 16 and 85 years old.

In that group, 1,218 women (27 percent) reported experiencing at least one form of gender-based violence, while 139 had been exposed to three or more forms of gender-based violence.

The average age that women were first raped was 13 years old and 12 years old for sexual assault. The average age that women were beaten by a partner or stalked was 22 years old.

The more violence a woman was exposed to, the greater her risk of developing mental illnesses, according to the study.

For example, about 15 percent of women who had been subjected to one form of gender-based violence experienced post-traumatic stress disorder (PTSD). But, if women were subjected to three or more forms of gender-based violence, that number jumped to more than 56 percent, the investigators found.

Suicide rates were significantly higher for women who'd experienced gender-based violence. The average rate of attempted suicide was 1.6 percent for all women in the study, but it was 6.6 percent for women who'd experienced one form of violence, and 34.7 percent for women exposed to three or more types of violence.

Rates of physical and mental disabilities were also much higher for women who had experienced gender-based violence. These women also tended to report an impaired quality of life.

Even though the study team had expected the findings, "the extent and strength of the associations we found was surprising and very concerning," Rees said.

She noted that "the nature of gender-based violence is particularly insidious because it occurs in the very situations where the victim/survivor usually expects to enjoy conditions of safety, security and love, particularly the home."

Furthermore, this type of aggression "often occurs repeatedly, unlike other traumas such as exposure to natural disasters, so you get a compounding effect. Gender-based violence is unfortunately still largely considered a personal and private matter, making help-seeking very difficult for many women, so they rarely received the support trauma survivors need to assist recovery," Rees noted.

One U.S. expert said the findings need to be heeded closely.

"This study really demonstrated the extent of gender-based violence and the long-term consequences of violence against women," said Andrea Gielen, director of the Center for Injury Research and Policy at the Johns Hopkins Bloomberg School of Public Health in Baltimore. "There are huge implications for health services; this is not just a one-time treatment in the ER for a broken bone. People who treat women for any health-related issues need to think about the extent that such violence can affect women," Gielen said.

Gielen added that in the United States, a measure of help is on the way. The federal government on Monday adopted recommendations from the Institute of Medicine on preventive services for women's health, and one new rule is that health care insurers must cover the cost of screening and counseling for domestic violence.
"Any woman is who experiencing gender-based violence needs to realize that there are things she can do, there are hotlines she can call, there are resources available," Gielen said. "Talking about the experience with an informed and supportive health professional is a good thing to do to move on."

More information
The U.S. Department of Health and Human Services Office on Women's Health has advice on how to help a friend who's being abused.

SOURCES: Susan Rees, Ph.D., Australian Research Council QE-11 Senior Research Fellow, Psychiatry Research and Teaching Unit, University of New South Wales, Sydney, Australia; Andrea Gielen, Sc.D., director, Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore; Aug. 3, 2011, Journal of the American Medical Association

Last Updated: Aug. 02, 2011
Copyright © 2011 HealthDay. All rights reserved.

Study ties bullying, domestic violence

2011-07-20T11:22:00.000-07:00

June 13, 2011

Boston.com

Boys who are bullies are nearly four times as likely as non-bullies to grow up to physically or sexually abuse their female partners, a study led by researchers from the Harvard School of Public Health found. With growing public concern over bullying, the authors said they wanted to examine the tie to domestic abuse because both abusers and bullies are driven by the desire to exert control over another person.

The researchers surveyed 1,491 men between ages 18 and 35 who were recruited from three Boston community health centers. Of the 241 men who reported being violent toward a partner in the previous year, 64.3 percent said they had bullied other children during their school days. After using statistical methods to account for other factors that affect both bullies and abusers, such as exposure to parental violence, the researchers found that the 92 participants who said they had frequently engaged in bullying were 3.8 times more likely to have later abused their adult partners.

Risk Factors Predict Repeat Abuse

2011-07-06T12:08:00.000-07:00

By Nancy Walsh, Staff Writer, MedPage Today

Published: July 05, 2011

Reviewed by Zalman S. Agus, MD; Emeritus Professor

University of Pennsylvania School of Medicine and

Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

When child abuse has been substantiated, a number of risk factors can predict the likelihood that abuse will be repeated if the child is returned to the care of the abuser, according to a prospective cohort study.

For instance, when the parents or caregivers were in their teens or twenties, were survivors of abuse, and had never taken parenting classes -- the child faced a 54% risk of being harmed again, wrote Suzanne R. Dakil, MD, and colleagues from the University of Texas Southwestern Medical Center in Dallas.

But the risk was higher even higher -- 60% -- for children younger than 8.5 years who were returned to parents that had taken parenting class, the researchers reported online in the Archives of Pediatrics and Adolescent Medicine.

Because both Federal and state laws encourage keeping children in the family home if possible after abuse, it's crucial that accurate ways of predicting future risk be identified, Dakil's group stated.

Previous research into risk factors for repeated abuse has been limited in its focus primarily on individual factors, rather than the interaction of many factors.

To look for patterns of characteristics associated with risk of repeated abuse, Dakil and colleagues used a statistical technique known as recursive partitioning analysis, which can identify multiple variables associated with a given outcome.

They identified 2,578 children in the National Survey for Child and Adolescent Well-Being who remained in the home after a report of abuse, following them for five years.

Child characteristics included in the analyses were age, sex, race, and health, while caregiver characteristics included age, marital and employment status, education, and physical and emotional health.

Family and environmental characteristics included stress from unemployment, poverty, or drug use, social support, and domestic violence.

A total of 44% of children in the sample were reported to child welfare authorities again after the index report.

Bivariate analysis determined that these repeated reports were more likely when the child was between 3 years and 10 years of age and had behavior disturbances or developmental delays.
A new report also was more likely if caregivers were younger, had themselves been abused, and were limited in their employment because of health or emotional problems.

A family factor associated with repeated report was income below $20,000, while active domestic violence was less likely.

The finding of lower risk in the presence of domestic violence may be explained by the possibility that children in such homes are more likely to be removed or to be provided with closer support and monitoring, according to the researchers.

The recursive partitioning analysis identified risk clusters beginning with the determination of whether the index case had been substantiated, and found that in unsubstantiated cases, 56% were reported a second time.

Among the 1,252 substantiated index cases, 38% involved a second report.

However, this rose to 86% when the caregiver had a history of abuse and was younger than 33.5 years, the child was younger than 12.5 years but showed no behavioral difficulties, and when five or more children were present in the home.

A cluster of characteristics associated with low incidence of repeated abuse -- 26% -- was a substantiated index report, older age of the caregiver, no parenting classes, and non-African-American race.

"The findings, which go beyond prior research via a data-driven approach to identifying risk clusters, demonstrate that some risk factors, when combined, are powerful predictors of a child's future abuse risk," wrote Dakil and colleagues.

The finding that risk was still high in cases where there had been parenting classes suggests that classes may not be adequate for high-risk families, and additional support or removal might be considered, they noted.

And the increased risk seen with low income and behavior difficulties signals a need for assistance in basics such as housing, employment, medical care, and behavioral services.
In contrast, lower-risk families might not need these intensive services.

"These findings might be useful to [child protection services] in identifying at-risk children and making evidence-based decisions regarding child placement, families' service needs, and the duration and intensity of monitoring that families require," the researchers concluded.

They acknowledged that their study was limited by reliance on caseworker reports, which can be influenced by high worker turnover, and families being lost to follow-up.

The authors reported no financial disclosures.

Primary source: Archives of Pediatrics and Adolescent Medicine
Source reference:
Dakil S, et al "Recidivism in the child protection system: identifying children at greatest risk of reabuse among those remaining" Arch Pediatr Adolesc Med 2011; DOI:10.1001/archpediatrics.2011.129.

Please go to MedPage Today for more information.

Effects of sexual abuse last for decades, study finds

2011-07-05T10:36:00.000-07:00

Levels of so-called stress hormone are altered for years, sometimes causing physical and mental problems, researchers find

By Joan Raymond, msnbc.com contributor

updated 6/30/2011 2:19:34 PM ET

Young girls who are the victims of sexual abuse experience physical, biological and behavioral problems that can persist for decades after, a new study shows.

Researchers, who tracked a group of girls ranging in age from 6 to 16 at the start of the study in 1987 for the next 23 years, found that they had higher rates of depression and obesity, as well as problems with regulation of brain chemicals, among other issues, compared to a control group of girls who were not abused.

The racially-diverse group of 80 girls, who lived in the Washington, D.C., area, were victims of incest, broadly defined as suffering sexual abuse by a male living within the home. On average, the girls were abused for about two years prior to the abuse coming to the attention of child protective services. Some girls were abused when they were as young as age 2.

Compared to a non-abused control group, the researchers found the study participants, all of whom were provided three therapy sessions on average in group and individual settings, suffered severe effects during different stages of their lives, which affected their sexual and cognitive development, mental and physical health, as well as their brain chemical profile. Study participants were more likely to be sexually active at younger ages, have lower educational status, and have more mental health problems.

As children, they had higher levels of cortisol, the so-called "stress hormone," which is released in high levels during the body’s "fight or flight" response. But by about age 15, testing showed that cortisol levels were below normal, compared to the control group. Lower levels of cortisol have been linked to a decrease in the body’s ability to deal with stress, as well as problems with depression and obesity. Lower levels of the hormone have also been linked to post-traumatic stress disorder.

“The cortisol levels (of some study participants) wound up looking like Vietnam vets,” says study co-author Dr. Frank Putnam, professor of pediatrics and psychiatry at Cincinnati Children's Hospital Medical Center. “That tells us they are in a chronic state of stress, and never feel safe.”

During the last assessment, when study participants were in their 20s, their cortisol levels remained lower than the control group, on average. “That tells us their stress response system is burned out,” says Putman, which could explain why some are doing so poorly in life.”

The long-term effects of the abuse “were absolutely profound,” says lead author and child psychologist Penelope Trickett, USC professor of Social Work. “It’s just not mental health issues. Some of these women are suffering from a lot of problems today like sleep issues, poor health utilization, and have a lot of risky behaviors. It’s very disturbing.”

Trickett says some women who have been sexually abused themselves have told her the findings validated their realities. “A woman came up to me once at a talk and identified herself as a childhood victim of sexual abuse and thanked me for these findings and for trying to shed light on this issue.”

She also noted that not all of the 80 women in the study are extremely disabled from their experience. In the abused group, some 40 percent are obese as adults, compared to 20 percent in the control group. “But that still means that almost 60 percent of the abused group are not obese,” says Trickett. “The groups are statistically different, and that’s important. But both groups have variability. The abused group just has more variability within the group.”

Trickett also says the findings don’t mean that once someone is abused they are destined to a lifetime of struggle.

“These women are more likely to have problems in mental health and physical health than those who haven’t been abused,” she said. “But it really varies to what degree they are disabled by these challenges. Some are managing their lives pretty well, considering what they went through.”

Though the study participants received some psychological counseling there was no specific treatment for childhood trauma and sexual abuse in the late 1980s. “Three or four sessions isn’t a lot of treatment; it’s some, but it’s little compared to today,” says Trickett. According to Putnam, evidence-based treatments, such as trauma-focused cognitive-behavioral therapy, came about in the 1990s.

“But the big question is does treatment prevent these things from happening or reverse what has happened,” says Putnam. “And the answer is we don’t know.”

The researchers hope that study data are used to develop more comprehensive treatment programs. “What is clear here is that abuse is not something that’s a one-time fix,” says Trickett.

Prevention and getting kids into treatment early is “the first step,” says Carolyn Landis, a clinical psychologist with Rainbow Babies & Children’s Hospital in Cleveland, Ohio. “To see how these girls suffer into adulthood is extremely troubling,” she says.

“From my perspective, this data, especially regarding cortisol levels, can help professionals identify kids who may be at risk much earlier. We need to sensitize people and then find ways to help kids be safe.”

© 2011 msnbc.com. Reprints
http://www.msnbc.msn.com/id/43594639/ns/health-health_care/

How Custody Evaluators Think about Domestic Violence

2011-07-05T10:24:00.000-07:00

Robert Hughes, Jr.

University of Illinois at Urbana-Champaign, Professor of Human Development

Posted: 06/30/11 04:34 AM ET

One of the most challenging aspects of custody decisions is the issue of domestic violence. About 20% of divorces require judges to appoint a custody evaluator to assist in the determination of custody arrangements. There are a wide range of estimates (50% - 90%) of the extent to which these divorce cases involve aggression and violence. One of the central questions that the custody evaluator must decide is whether the domestic violence is likely to continue and how to handle custody arrangements in a way that does not put family members at-risk of further violence. At present there are no universal standards for conducting custody evaluations and most custody evaluators have little training in domestic violence.

In a recent study Megan Haselschwerdt, Jennifer Hardesty and Jason Hans (Journal of Interpersonal Violence, 2011) examined how custody evaluators think about domestic violence in their decisions regarding custody. They conducted in-depth interviews with a small sample (N=23) of custody evaluators that had on average about 14 years of experience conducting evaluations.

Even among behavioral scientists there has been much debate about the nature of domestic violence. Professor Michael Johnson at the University of Michigan has clarified the dispute by explaining that there are two major types of domestic violence. On the one hand, some violence is the result of stressful situations in which husbands or wives lash out in physical or verbal aggression. He called this "situational violence." On the other hand, some domestic violence involves the use of extreme forms of control that forces a partner to do something she does not want to do. Johnson labeled this form of violence as "intimate terrorism." He also notes that in addition to physical violence, intimate terrorists use psychological abuse, isolation and intimidation to control their partners.

Custody evaluators are likely to encounter couples who are engaged in both types of violent situations. How custody evaluators assess violence can influence their recommendations about custody outcomes. These researchers found that custody evaluators tended to hold a view that either viewed violence as situational violence or intimate terrorism.

The custody evaluators whose views tended towards viewing aggression as situational violence reported less training in domestic violence. This group generally viewed domestic violence as stress induced, normative and mutual. As a result, these evaluators minimized spouse abuse as relevant to child custody decisions. They also thought that false allegations of violence were common. In terms of custody and parenting plans, they prioritized coparenting and father-child relationships.

On the other hand, custody evaluators who characterized domestic violence as intimate terrorism took a different view of custody. They were more likely to report extensive training in domestic violence. These evaluators viewed spouse abuse as a significant factor in determining child custody. They thought that false allegations of abuse were rare. This group of evaluators distinguished between types of violence and expressed strong views that custody and parenting plans should be different for each of these types of violence. In the case of intimate terrorism, they prioritized victim safety over ongoing contact with fathers.

Although based on a small sample of custody evaluators, these findings raise important questions about the degree to which domestic violence is being thoughtfully considered in custody decisions. It is important for the legal system to develop training and policies such that custody evaluators can appropriately consider custody arrangements in domestic violence situations.

FOR MORE INFORMATION:
http://www.huffingtonpost.com/robert-hughes/how-custody-evaluators-th_b_886703.html?ref=email_share

Science Isn't Golden - “Parental Alienation Syndrome:" Another Alarming DSM-5 Proposal

2011-06-14T14:09:00.000-07:00

Matters of the mind and heart

by Paula J. Caplan, Ph.D.

“Parental Alienation Syndrome:" Another Alarming DSM-5 Proposal

Using a medicalizing label to mask child sexual abuse

Published on June 6, 2011 by Paula J. Caplan, Ph.D. in Science Isn't Golden

Using a medicalizing label to mask child sexual abuse

Among the scientifically unwarranted and socially dangerous proposals that the Diagnostic and Statistical Manual-5 authors have not yet seen fit to rule out is the addition of something its advocates call Parental Alienation Syndrome. This is a medical-sounding term for nothing more than "She's a vengeful woman who's trying to make her children tell horrific lies about their father."

What often gets short shrift, as a result, is even the consideration of the possibility that the children are truly being molested. Virtually everything that is sometimes a sign that a child is being molested - such as fearfulness when it is time for a visit with the abuser or vaginal bleeding or infection in a 2-year-old - is instead interpreted as further "proof" that the mother has PAS. In these two examples, through use of PAS, the child's fearfulness is cast as the result of the mother's efforts to make the child frightened of the father or terrified of not pleasing her by wanting the visit to take place, and the vaginal problems are assumed to be caused by the mother in order to provide fake evidence of the molesting. If this sounds far-fetched, it is not. I have both done research and consulted in court cases about this.

As Dr. Julie Ancis, who has conducted extensive research about such cases, has noted:

[Richard] Gardner [who invented PAS] claimed that many reports of [child sexual abuse] in the context of divorce cases were false allegations. In this connection, it is important to note that Bala and Schuman (1999) found that only 1.3% of mothers' allegations of abuse by their children's fathers were deemed by civil court judges to be intentionally false, in contrast to 21% of cases in which fathers had made such allegations against mothers. And Meier (2009) reports after reviewing the research that it is a mistaken belief that mothers' allegations in child custody proceedings that fathers have sexually abused their children are usually false. [2]

Gardner not only thought up this label but also condoned adults' sexual assaults on children and said that reports of child sexual abuse were elevated because sexually voyeuristic social workers made them. [1,2] Despite the fact that some judges have quite rightly forbidden the use of the term in their courts, it remains widely used in other courts and sounds more impressive coming from the lips of a testifying mental health professional than "She's just a lying, angry woman."

Ancis writes further:

Gardner's (1998) questionable ethics and clinical judgment are reflected in (but are by no means limited to) the following: (1) he recommends joint interviews with an accused father and child in which the father directly confronts the child about the allegation, and (2) he interprets a child's overt expression of fear of possible retaliation by the father as evidence of the child's embarrassment about lying rather than as possibly a valid fear of a truthtelling child whose father is abusive.

The construct of PAS is unscientific, composed of a group of general symptoms with no empirical basis....

Major professional bodies, including the American Psychological Association, have discredited PAS on the grounds that it is misused indomestic violence cases and that there is no scientific evidence of such a "syndrome." The more recent APA Online document Issues and Dilemmas in Family Violence (http://www.apa.org/pi/essues.html), particularly Issue 5, describes the tendency of family courts to miminize a context of violence, falsely accusing the mother of alienation and granting custody to the father in spite of his history of violence. The National Council on Juvenile and Family Court Judges' 2006 manual states that "parental alienation syndrome or PAS has been discredited by the scientific community" and "should therefore be ruled inadmissible" (p. 19). A number of prominent figures, including Dr. Paul J. Fink, past president of the American Psychiatric Association and president of theLeadership Council on Mental Health, Justice, and the Media, and Professor Jon R. Conte of the University of Washington Social Welfare Doctoral Faculty have also discredited PAS and its lack of scientific basis (see Bruch, 2001).

When applied to a parent in a case involving an allegation of child sexual abuse, it is nearly always applied to a woman whose child is allegedly being molested by the father. Despite not yet being in the DSM, PAS has in some courts proven an astonishingly effective vehicle for deflecting the focus from the abuser and simply claiming that the woman must be lying, and coaching her children to lie, because she has the alleged mental illness of PAS. [1] The claim is that without cause, she wants to turn the children against their father.

Because of the use of PAS as a tactic by many CSA perpetrators to influence decision makers and the court system, abused children have been placed in the hands of their abusers (Childress, 2006). It is estimated that "over 58,000 children a year are ordered into unsupervised contact with physically or sexually abusive parents following divorce in the United States" (http://www.leadershipcouncil.org/1/pas/1.html) and that PAS was used in a large number of these cases. [2]

The DSM-5 editors could at any time have already struck PAS from their planned additions but have so far chosen not to.

If this alarms you, and especially if PAS has been used against you, please consider going to dsm5.org before their June 15 cutoff date for input from the public arrives, and send them your concerns. Please urge everyone else you can think of to do the same. The DSM-5 authors will do themselves and the manual's reputation no favors if they include PAS, and they need to hear from people whom the label has harmed.

[1] Paula J. Caplan. (2004) What is it that's being called "Parental Alienation Syndrome"? In Paula J. Caplan & Lisa Cosgrove (Eds.), Bias in psychiatric diagnosis. Lanham, MD: Rowman & Littlefield.

[2] Julie R. Ancis. Parental alienation syndrome.http://awpsych.org/index.php?option=com_content&view=article&id=1...

References from Ancis article quotations

American Psychological Association (APA). (1996). Report on Violence and the Family: Issues and Dilemmas in Family Violence. APA Presidential Task Force on Violence and the Family. Washington, DC: Author. Retrieved from http://www.nnflp.org/apa/intro.html.
Bala, N., & Schuman, J. (1999). Allegations of sexual abuse when parents have separated. Canadian Family Law Quarterly 17, 191-241.
Bruch, C. (2001). Parental Alienation Syndrome and Parental Alienation: Getting it wrong in child custody cases. Family Law Quarterly, 35(3), 527-552. Retreived from http://ezproxy.gsu.edu:3305/HOL/Page?handle=hein.journals/famlq35...
Gardner, R. A. (1998). The Parental Alienation Syndrome (2nd ed.). Creskill, New
Jersey: Creative Therapeutics, Inc.
Meier, J. S. (2009, January). Parental Alienation Syndrome and parental
alienation: Research reviews. National Online Resource Center on Violence Against Women, 1-17. Retrieved fromhttp://www.leadershipcouncil.org/1/pas/1.html
National Council of Family Court Judges (2006). Navigating Custody and
Visitation Evaluations in Cases with Domestic Violence: A Judge's Guide. Retrieved from http://www.ncjfcj.org/content/blogcategory/256/302/

Biological Links Found Between Childhood Abuse and Adolescent Depression

2011-05-26T09:36:00.000-07:00

ScienceDaily (Apr. 20, 2011) — Kate Harkness has found that a history of physical, sexual or emotional abuse in childhood substantially increases the risk of depression in adolescence by altering a person's neuroendocrine response to stress.

Adolescents with a history of maltreatment and a mild level of depression were found to release much more of the stress hormone cortisol than is normal in response to psychological stressors such as giving a speech or solving a difficult arithmetic test.

"This kind of reaction is a problem because cortisol kills cells in areas of the brain that control memory and emotion regulation," explains Dr. Harkness, a professor in the Department of Psychology and an expert in the role of stress and trauma in adolescent depression. "Over time cortisol levels can build up and increase a person's risk for more severe endocrine impairment and more severe depression."

At severe levels of depression, Dr. Harkness' team saw that the youths with a history of maltreatment had a total blunting of the endocrine response to stress. These findings suggest that the normal operation of the stress response system can breakdown in severely depressed adolescents.

These results are important because they show that environmental stress in childhood changes the function of the brain in ways that may cause and/or maintain severe psychiatric disorders such as depression.

Dr. Harkness recently presented her findings at the International Society for Affective Disorders Conference in Toronto. The research was funded by the Ontario Mental Health Foundation and conducted in collaboration with Queen's researcher Jeremy Stuart and Kathy Wynne-Edwards from the University of Calgary.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Queen's University.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Abuse History More Common in Those With Pelvic Pain, CFS, and Fibromyagia

2011-05-26T09:30:00.000-07:00

by The Annapolis Chronic Fatigue and Fibromyalgia Research Center.
Although the research findings are mixed, I have found a history of abuse to be common in my CFS/FMS patients. In one study, exposure to childhood trauma was associated with a 6-fold increased risk of CFS and this was associated with the stress hormone changes seen in CFS (see abstract below). And as many as 70% have suffered physical or emotional abuse-as opposed to 15% of healthy people and 45% of those with other rheumatologic problems.¹ In another study, 18-33% of patients with Interstitial Cystitis had a history of sexual abuse.²

We have also seen in our practice that the pelvic pain , is sometimes associated with hysterectomy at a young age associated with a history of childhood sexual abuse, with the psyche seemingly trying to create a "clean sweep" of the pelvic area surgically.

Meanwhile, physicians continue this abuse pattern by invalidating and not adequately treating the medical problems that can occur downstream from abuse issues, and treating women with these severe processes like they are crazy. It is like treating people with crushing chest pain and a massive heart attack like they were crazy because hostility and depression are associated with an increased heart attack risk.

Whether or not associated with a history of abuse, or whether or not CFS/FMS are also present, pelvic pain can be a major problem, and deserves to be treated. So whether it is vaginal pain (e.g., vulvodynia) or bladder pain (e.g., interstitial cystitis), here is information on pelvic pain in women that can help ease the pain.

Study Abstract

Childhood Trauma and Risk for Chronic Fatigue Syndrome: Association With Neuroendocrine Dysfunction

Journal: Arch Gen Psychiatry. 2009;66(1):72-80
Authors: Christine Heim, PhD; Urs M. Nater, PhD; Elizabeth Maloney, MS, DrPH; Roumiana Boneva, MD, PhD; James F. Jones, MD; William C. Reeves, MD, MSc
Author Affiliations: Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine (Drs Heim and Nater), and Chronic Viral Diseases Branch, National Center for Zoonotic, Vector-borne, and Enteric Diseases, Centers for Disease Control and Prevention (Drs Nater, Maloney, Boneva, Jones, and Reeves), Atlanta, Georgia

Context
Childhood trauma appears to be a potent risk factor for chronic fatigue syndrome (CFS). Evidence from developmental neuroscience suggests that early experience programs the development of regulatory systems that are implicated in the pathophysiology of CFS, including the hypothalamic-pituitary-adrenal axis. However, the contribution of childhood trauma to neuroendocrine dysfunction in CFS remains obscure.

Objectives
To replicate findings on the relationship between childhood trauma and risk for CFS and to evaluate the association between childhood trauma and neuroendocrine dysfunction in CFS.

Design, Setting, and Participants
A case-control study of 113 persons with CFS and 124 well control subjects identified from a general population sample of 19 381 adult residents of Georgia.

Main Outcome Measures
Self-reported childhood trauma (sexual, physical, and emotional abuse; emotional and physical neglect), psychopathology (depression, anxiety, and posttraumatic stress disorder), and salivary cortisol response to awakening.

Results
Individuals with CFS reported significantly higher levels of childhood trauma and psychopathological symptoms than control subjects. Exposure to childhood trauma was associated with a 6-fold increased risk of CFS. Sexual abuse, emotional abuse, and emotional neglect were most effective in discriminating CFS cases from controls. There was a graded relationship between exposure level and CFS risk. The risk of CFS conveyed by childhood trauma further increased with the presence of posttraumatic stress disorder symptoms. Only individuals with CFS and with childhood trauma exposure, but not individuals with CFS without exposure, exhibited decreased salivary cortisol concentrations after awakening compared with control subjects.

Conclusions
Our results confirm childhood trauma as an important risk factor of CFS. In addition, neuroendocrine dysfunction, a hallmark feature of CFS, appears to be associated with childhood trauma. This possibly reflects a biological correlate of vulnerability due to early developmental insults. Our findings are critical to inform pathophysiological research and to devise targets for the prevention of CFS.

References

¹Castro I, Barrantes F, Tuna M, Cabrera G, Garcia C, Recinos M, Espinoza LR, Garcia-Kutzbach A. Prevalence of Abuse in Fibromyalgia and Other Rheumatic Disorders at a Specialized Clinic in Rheumatic Diseases in Guatemala City. Clin Rheumatol. 2005 Jun;11(3):140-145.
²J Urol. 2008 Nov; 180(5):2029-33 10.1016/j.juro. 2008.07.053

Post-Traumatic Childhood

2011-05-26T09:22:00.000-07:00

The New York Times Opinion Pages
By BESSEL A. van der KOLK
Published: May 10, 2011

Brookline, Mass. ~ AS a young psychiatrist, I worked with Vietnam War combat veterans and confronted the astonishing lack of resources to help these men and women who had sacrificed so much for their country. Three decades later, that situation has greatly improved. First, we named the problem — post-traumatic stress disorder — and then in 1989 Congress created the National Center for PTSD to help suffering veterans.

Their plight has also led to a greater recognition of the impact of violence on children. For every soldier returning from Iraq and Afghanistan with symptoms of depression or PTSD, there are around 10 children in the United States who are traumatized by exposure to family violence, sexual abuse, neglect and assault, with consequences comparable to those of adult exposure to war-zone violence. We have made progress in treating these children, but that progress is threatened by a drastic budget cut proposed by the White House.

Rather than being subjected to bullets and bombs, children are victimized by those who are meant to care for them. These are children like a 3-year-old girl in Anchorage who was found by a police officer in her crib, hungry, underweight and covered in her own feces; an 11-year-old boy in New York City who has had violent outbursts since he was sexually molested, and whose terror of being alone makes him a subject of ridicule by his classmates; or a 14-year-old girl in Boston who set fire to a church and repeatedly attempted suicide after being beaten at home. The Pew Charitable Trusts estimates that the annual cost of childhood maltreatment like this is $103.8 billion.

Inspired by the work of the National Center for PTSD, Congress authorized the establishment of the National Child Traumatic Stress Network in 2001 to evaluate and develop treatments for traumatized children nationwide, with a budget that is now $40 million — about the cost of keeping 40 soldiers fighting in Afghanistan for one year.

President Obama’s 2012 budget has proposed a 70 percent reduction in financing for the network. That would be devastating for these children. The network has knitted together 130 clinics and universities in 38 states that specialize in helping traumatized children and adolescents. It has allowed the members to develop treatment programs and to hire and educate the staff to run them, enabling 322,000 children nationwide to get treatment from July 2002 to September 2009.

According to the latest figures available, 2.9 million children were mistreated in 2006, many of whom manifested serious behavioral and psychological problems. The network has started to document how trauma affects developing brains differently from those of adults exposed to wartime violence.

It has also been evaluating what interventions are most effective for different groups of children. Two have been most thoroughly studied and found to be effective: cognitive behavioral therapy and treatments to help children regulate their emotions. Children who receive these treatments were shown to function substantially better afterward.

Most traumatized children now do not even receive a proper mental health assessment. Moreover, hundreds of thousands of them are numbed by powerful drugs that help control their “bad behavior,” but that don’t deal with the imprint of terror and helplessness on their minds and brains. Drugs can sedate, but they do not help children deal with trauma — in fact, they may prevent recovery by interfering with learning and the formation of relationships, essential preconditions for becoming functioning adults.

The proposed budget cut for the network would mean that it no longer can develop and test effective treatments for these children. This is unfortunate since we are just beginning to look at what treatments can produce the best outcomes, and to learn from the cases in which these treatments do not work.

Untreated, traumatized children become failing adults who populate our jails and overwhelm our human services agencies. Cutting the development of effective treatments will produce many years of increasing costs and unquantifiable human misery.

Bessel A. van der Kolk, a professor of psychiatry at Boston University School of Medicine, is the founder and medical director of the Trauma Center at the Justice Resource Institute.

Ritual Abuse and Torture-based Mind Control: Reducing and Preventing Re-contact with Abusers

2011-05-26T09:11:00.000-07:00

End Ritual Abuse The Website of Ellen P. Lacter, Ph.D.

Cautionary Notes: This is one of the more distressing pages on my website. Survivors in therapy should read this webpage only after their therapists have first read it and assessed that the survivor would benefit from reading it. If a survivor does not have a therapist, I strongly recommend that she/he obtain a therapist and only read this webpage with the therapist’s approval. Information on this website and webpage should not be construed as a substitute for therapy. Even if a survivor is certain that she or he is no longer in abuser contact, this material may exacerbate trauma-based fear, and should only be read with proper support. It is also important that this piece be read slowly, in small installments, taking time to cognitively and emotionally process the material, and to psychologically rest, even sleep, periodically. Finally, it is important to guard against quickly believing that all of the things discussed on this webpage apply to you. Each survivor’s experience is unique and ultimately, the truth of one’s life must be discovered from within.

This page represents my current opinions on mind-sets and measures that help survivors of ritual abuse and torture-based mind control to reduce and prevent re-contact with their abusers.

Most definitions of the term “ritual abuse” refer to ceremonial practices that involve physical and sexual abuse of children and adults, and human sacrifice, to appease, win favor with, or empower deities whom the abusers believe demand abuse and sacrifice, such as Satan and other polytheistic gods and goddesses.

Torture-based mind control programming can be defined as systematic torture that blocks the victim’s capacity for conscious processing (through pain, terror, drugs, illusion, sensory deprivation, sensory over-stimulation, oxygen deprivation, cold, heat, spinning, brain stimulation, and often, near-death), and then employs suggestion and/or conditioning to implant thoughts, directives, and perceptions in the unconscious mind, often in newly-formed trauma-induced dissociated identities, that force the victim to do, feel, think, or perceive things for the purposes of the programmer. The objective is for the victim to follow directives with no conscious awareness, including execution of acts in clear violation of the victim’s volition, moral principles, and spiritual convictions.

Torture-based mind control is practiced by individuals and groups who seek to maximally control and exploit others, usually beginning in childhood. Included are practitioners of abusive religious rituals (e.g., Satanism and abusive witchcraft), organized crimes against children (child pornography, prostitution, and trafficking), and groups with political, military, and espionage agendas.

My opinions are based on a synthesis of 17 years of experience in providing psychotherapy to victims and survivors of ritual abuse and mind control and extensive interviews of other survivors, including many survivor-therapists, and my ongoing communication with therapist and clergy colleagues working with survivors.
The two primary forms of re-contact with abusers include reporting back by phone or written correspondence, and physically returning to abusers to be abused again. Perpetrators of ritual abuse and mind control attempt to coerce their victims into submission and service to the abuser group for a lifetime. Abuser methods of exerting long-term contact and control vary in relation to the level of psychological sophistication of the abusers and the size of the abusers’s criminal network.

Some abuser groups rely primarily on threats to force their victims into compliance and to prevent their victims from escaping. For some of these groups, these are empty threats. The groups may be limited to one or two extended families or a relatively small abuser network. They make claims of having more power than they have, and may even claim responsibility for murders that they did not commit, much like political terrorists. Some abuser groups have larger criminal networks and thus, more power to carry out their threats. But, they too reliably overstate their power to maximally terrorize their victims. This is not to dismiss the reality that these abusers commit murder, but it is to say that they lie and exaggerate their power. Clearly, people who systematically abuse others lie to further their own interests. Words are just one more tool of manipulation to control their victims. Everything they say should be questioned and examined for underlying motives and feasibility. This holds particularly true for their claims of having the man power, technological power, and magical/spiritual power to carry out their surveillance and threats.

Many of these abusers also manipulate their victims’ attachment needs, that is, their basic survival needs and needs for security and love, usually beginning in early childhood. They also go to great lengths to try to make their victims believe that the victims are accomplices to the abuse, that they are as evil as their abusers themselves, and that they are unworthy and incapable of belonging anywhere but with the abusers.

Some abuser groups go a step further and manipulate their victims’ psychological capacity to form dissociated self-states in response to extreme pain and terror. I am using the term, “dissociated self-states,” here to refer to states of consciousness with some sense of self that exist out of the conscious awareness of the most-often conscious parts of the psyche, and that typify DSM-IV Dissociative Identity Disorder, and forms of Dissociative Disorder Not Otherwise Specified in which self-states exist internally, affecting the psyche from within, but never assume complete control of executive functions (e.g., purposive action).

These Machiavellian abusers systematically torture their victims for the intended purpose of coercing their victims’ psyches into forming new dissociated self-states that they then work to exploit. They “torture-hypno-condition” these self-states, that is, they use torture, hypnosis, and behavioral conditioning, to try to coerce these dissociated self-states into fulfilling functions that serve the abusers. (I thank Hans Ulrich Gresch, Ph.D., psychologist, mind control survivor, and respected colleague, for the term, “torture-hypno-conditioning,” the most succinct descriptive phrase that I have found that explains what occurs in most torture-based mind control programming; see: http://www.mind-control.psychoprobleme.de/). These abusers “program” some of these dissociated self-states to take on “reporter” and “re-contact” functions, that is, to report to the abusers on a regular basis from a distance, and to return to the abusers as directed.

In many cases, even though the survivor is working hard to break free of her or his abusers, these programmed self-states continue to report to, and return to, the abusers, often out of the conscious awareness of the most-often conscious parts of the psyche. Ongoing access allows the abusers to retaliate against their victims for attempting to break free and to escalate their abuse and programming in efforts to increase their control of their victims.

The purpose of this article is to help survivors, therapists, clergy, and other support people, to understand the tactics, briefly outlined above, used by ritually abusive and mind control abusers to attempt to trap their victims into life-long submission, and to use this knowledge to help survivors to overcome these abuser tactics of control, to break free of their abusers more easily and more quickly, and to prevent re-contact. ..... (cont.)

Please visit The Website of Ellen P. Lacter, Ph.D. for complete article

CDC: Majority of U.S. adults had troubled childhoods

2011-05-26T09:05:00.000-07:00

USA TODAY
Updated 12/17/2010 8:18 PM

By Steven Reinberg HealthDay

Almost 60% of American adults say they had difficult childhoods featuring abusive or troubled family members or parents who were absent due to separation or divorce, federal health officials report.

In fact, nearly 9% said that while growing up they underwent five or more "adverse childhood experiences" ranging from verbal, physical or sexual abuse to family dysfunction such as domestic violence, drug or alcohol abuse, or the absence of a parent, according to the U.S. Centers for Disease Control and Prevention (CDC).

"Adverse childhood experiences are common," said study coauthor Valerie J. Edwards, team lead for the Adverse Childhood Experiences Team at CDC's National Center for Chronic Disease Prevention and Health Promotion. "We need to do a lot more to protect children and help families," she said.

About a quarter of the more than 26,000 adults surveyed reported experiencing verbal abuse as children, nearly 15% had been physical abused, and more than 12% — more than one in 10 — had been sexually abused as a child.

Since the data are self-reported, Edwards believes that the real extent of child abuse may be still greater. "There is a tendency to under-report rather than over-report," she said.

The findings are published in the Dec. 17 issue of the CDC's journal Morbidity and Mortality Weekly Report.

For the report, researchers used data from the Behavioral Risk Factor Surveillance System, which surveyed 26,229 adults in Arkansas, Louisiana, New Mexico, Tennessee and Washington. Edwards is cautious about extrapolating these results, but based on other data they probably are about the same in other states, she said.

While there were few racial or ethnic differences in reports of abuse, the report confirmed that women were more likely than men to have been sexually abused as children. In addition, people 55 and older were less likely to report being abused as a child compared to younger adults.

One theory why older people did not report as much childhood abuse is that since these takes a toll on health in adulthood, many of these older abuse victims may have died early, Edwards said. The CDC report, for example, notes that adverse childhood experiences are associated with a higher risk of depression, heart disease, diabetes, cancer, substance abuse and premature death. "So (childhood abuse) may be associated with years of life lost," she said.

There was no difference in the number of people reporting childhood abuse in any other age group, Edwards added.

Adverse childhood experiences included in the report included verbal abuse, physical abuse, sexual abuse, incarceration of a family member, family mental illness, family substance abuse, domestic violence and divorce.

According to the report, about 7.2% had had a family member in prison during their childhood and 16.3% had witnessed domestic violence in the family home. In addition, about 29% grew up in a home where someone abused alcohol or drugs. "These cases occur across all racial groups and ethnicities," Edwards noted.

Almost one in five respondents (19.4 percent) had lived as a child with someone who was depressed, mentally ill or suicidal, the report noted.

Although the volume of abuse and dysfunction is significant, such traumatic experiences cannot be used to describe a person or determine what that person will be, the researchers cautioned. Instead, they said, keeping track of these abusive experiences is important to gain a better understanding of them and their effect on society.

In addition, it's crucial to work harder to prevent abuse and household stress as well as finding better ways to identify and treat children at risk, they said.

"For adults who have had these experiences and feel they are still causing them problems, they are not alone and there is help available," Edwards said.

Dr. Lee M. Sanders, an associate professor of pediatrics at the University of Miami Miller School of Medicine said that "one of the things we don't realize when we look around at our neighborhoods and communities is that these problems are so common."

"That's something to be concerned about. That's something to take communal action on," he added.

Identifying and treating abuse early can prevent many serious health consequences later in life. Programs that provide quality care for children, as well as home visitation programs in early infancy and parenting programs, are part of the solution to this problem, Sanders said.

"These interventions are important not just because abuse is so common, but because of the lifelong health implications," Sanders said. "There is a connection of these events to lifelong implications, not just for mental health for adults, but also for physical health."

For example, a person who has several of these events is more likely to get cancer and heart disease, Edwards said. "This is serious and it's not just a quirk of statistics. It's a real relationship."

Deprivation and Neglect Found to Age Children's Chromosomes

2011-05-26T09:00:00.000-07:00

ScienceDaily (May 17, 2011) — Studies in institutionalized Romanian children have found that the length of time spent in conditions of social deprivation and neglect correlates with lower IQ and behavioral problems. A new study, led by researchers at Children's Hospital Boston and Tulane University, shows that early adversity even affects children's chromosomes -- prematurely shortening the chromosome tips, known as telomeres, and hastening how quickly their cells "age."

The study, published online this week in Molecular Psychiatry, is the first to find an association between adversity and telomere length in children. It is part of the Bucharest Early Intervention Project (BEIP), which is conducting a long-term clinical trial tracking two groups of institutionalized children: those who remained in the institution and those who were removed to high-quality foster care at varying ages.

Laboratory studies, conducted by Stacy Drury and colleagues at Tulane University, examined DNA samples collected from mouth swabs of the Romanian children (62 boys and 47 girls). The studies found that children exposed longer to institutional care before age 5 had significantly shorter relative telomere length (compared to that expected for their age) when they reached age 6-10.

"The telomere is designed to protect the chromosome, so accelerating how early in life telomeres lose length correlates with shortened life span," says Charles Nelson, PhD, director of the Laboratories of Cognitive Neuroscience at Children's and principal investigator of BEIP. "Children institutionalized early in life have shortened telomeres, which may lead to health consequences downstream, including premature aging."

The actual biological significance of these findings is unknown, but the researchers note that studies in adults have associated shorter telomere length with cognitive defects and with increased rates of cardiovascular disease and cancer.

The BEIP study contributes to a growing body of research linking early adversity with early shortening of telomeres. In 2004, Elizabeth Blackburn (who received a Nobel prize in 2009 for co-discovering telomeres) and Elisa Epel, both at the University of California at San Francisco, reported that women who took care of children with chronic illnesses had shorter telomeres -- the equivalent of having lost 9 to 17 years of life. Other studies have found shorter telomere length in adults who experienced adversity, abuse or serious illness in childhood.

The BEIP study also found a gender difference. In girls, the amount of time spent in the institution before the baseline assessment (done at an average of 22 months of age) was the strongest predictor of telomere shortening during middle childhood; in boys, the cumulative amount of institutional care at the 54-month assessment was the stronger predictor.

"One question we are currently studying is whether telomere length can recover as a child spends more time in foster care, or whether the shortening we observed reflects a permanent change," says Nelson.

The Romanian orphanages, which mostly house children who were abandoned, not orphaned, are infamous for severe child neglect. They are a legacy of the 1960s, when Romania's Communist dictator Nicolae Ceausescu taxed all families that had fewer than five children. When families began having children they could not afford, Ceausescu built child placement centers. By 1989, when Ceausescu's government fell, more than 170,000 Romanian children were living in state-run institutions.

By the time BEIP was begun in 2000, the Romanian government had begun reuniting children with their birth families, cutting Romania's institutionalized population in half. Spurred by BEIP findings, the government has banned institutionalization for children younger than 2, unless they are profoundly handicapped; they have also started a network of foster care families.

The study was supported by the Center for the Developing Child at Harvard University, the John D. and Catherine T. MacArthur Foundation, the Binder Family Foundation, Tulane University School of Medicine and The Brain and Behavior Research Foundation (formerly NARSAD).

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Children's Hospital Boston, via EurekAlert!, a service of AAAS.

Journal Reference:

S S Drury, K Theall, M M Gleason, A T Smyke, I De Vivo, J Y Y Wong, N A Fox, C H Zeanah, C A Nelson. Telomere length and early severe social deprivation: linking early adversity and cellular aging. Molecular Psychiatry, 2011; DOI: 10.1038/mp.2011.53

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Study blames culture of era for church’s abuse crisis

2011-05-26T08:56:00.000-07:00

Boston.com
May 18, 2011|By Lisa Wangsness, Globe Staff

WASHINGTON — The sexual abuse crisis in the Catholic Church was caused by the influence of sweeping social changes and increasing “deviant behavior’’ of the 1960s and 1970s on priests who were inadequately trained, emotionally unprepared, and isolated, according to a new report commissioned by the nation’s Roman Catholic bishops.

Researchers at John Jay College of Criminal Justice at the City University of New York, who spent five years conducting the most expensive and extensive study of sexual abuse in the Catholic church to date, concluded that homosexual priests were no more likely to abuse than heterosexual priests.

They also found that celibacy could not be blamed for the abuse epidemic. Nor could seminaries have done a better job screening for likely offenders because abusive priests had no common profile.

Wrote the authors: “The most significant conclusion drawn from this data is that no single psychological, developmental, or behavioral characteristic differentiated priests who abused minors from those who did not.’’
The report also states that poor training of priests, combined with social isolation, job stress, and few support mechanisms likely contributed to the abuse problem. The decline of sexual abuse in the mid-1980s coincided with better training for seminarians in human sexuality and relationships.

The report, titled “The Causes and Context of Sexual Abuse of Minors by Catholic Priests in the United States, 1950-2010,’’ appears to deflect most blame for the crisis away from the church. However, the study acknowledges that there was little evidence before 2002 “that diocesan leaders met directly with victims.’’ Instead, church leaders focused on the abusive priests rather than on their victims.

Abusive priests have often been branded pedophiles, but the report — in a declaration that appears destined to stir controversy — insists that fewer than 5 percent actually met that definition. In the process, however, the study’s authors seem to redefine what constitutes pedophilia.

Major associations of psychiatrists typically define pedophilia as interest in children 13 and younger, calling them “prepubescent.’’

But to reach their conclusion about the low incidence of the disorder among priests, the report authors seem to suggest that the prepubescent period ends at age 10.

“The majority of victims were pubescent or postpubescent,’’ the report states. “Thus,’’ they wrote, “it is inaccurate to refer to abusers as pedophile priests.’’

The researchers called the sexual abuse scandal, which began unfolding in Boston in 2002, a “historical problem.’’ They said reports of abuse rose sharply in the mid-1960s, peaked in the late 1970s, and declined in the 1980s, mirroring the trend in society generally.

The report also states that “the documented rise in cases of abuse in the 1960s and 1970s is similar to the rise in other types of “deviant’’ behavior in society, and coincides with social change during this time period.’’

The study, which cost about $2 million, about half of which was paid for by the church, was to be released today by the US Conference of Catholic Bishops, but the Religion News Service first reported its findings on its website last night. The Globe also obtained a copy of the report last night.

The study met with quick criticism, however.

“The study seems to focus on the offending priests in a way that minimizes the gravity of their crimes, and gives short shrift to the ‘other crime’ — the enabling, concealing, and fostering of abuse by the US bishops and the Vatican bureaucracy,’’ said Terence McKiernan of BishopAccountability.org, in a statement on news reports concerning the leaked study last night.

“The report also grotesquely emphasizes the ‘vulnerability’ of the priests who committed the crimes, and neglects the defenseless children who suffered them. In these respects, the first Causes and Context report — the Bennett Report of 2004 — was a better report than its successor.’’

Lisa Wangsness can be reached at lwangsness@globe.com.

Child Sexual Abuse Imapct - 23yo Study

2011-04-28T11:25:00.000-07:00

This is a new study about CSA cases by University of Southern California and Cincinnati Children’s Hospital Medical Center, University of Cincinnati College

of Medicine.

It is an amazing summary of a rigorous, 23 year prospective, longitudinal study of sexually abused girls, 
followed up through some of them having their own children.

ABSTRACT

This is a report on the research design and findings of a 23-year longitudinal 
study of the impact of intrafamilial sexual abuse on female development.
 The conceptual framework integrated concepts of psychological 
adjustment with theory regarding how psychobiological factors might 
impact development. Participants included 6- to 16-year-old females with
 substantiated sexual abuse and a demographically similar comparison 
group. A cross-sequential design was used and six assessments have taken
 place, with participants at median age 11 at the first assessment and 
median age 25 at the sixth assessment. Mothers of participants took part
 in the early assessments and offspring took part at the sixth 
assessment. Results of many analyses, both within circumscribed 
developmental stages and across development, indicated that sexually 
abused females (on average) showed deleterious sequelae across a host of
 biopsychosocial domains including: earlier onsets of puberty, cognitive
 deficits, depression, dissociative symptoms, maladaptive sexual 
development, hypothalamic–pituitary–adrenal attenuation, asymmetrical 
stress responses, high rates of obesity, more major illnesses and 
healthcare utilization, dropping out of high school, persistent 
posttraumatic stress disorder, self-mutilation, Diagnostic and 
Statistical Manual of Mental Disorders diagnoses, physical and sexual 
revictimization, premature deliveries, teen motherhood, drug and alcohol
 abuse, and domestic violence. Offspring born to abused mothers were at 
increased risk for child maltreatment and overall maldevelopment. There 
was also a pattern of considerable within group variability. Based on 
this complex network of findings, implications for optimal treatments 
are elucidated. Translational aspects of extending observational 
research into clinical practice are discussed in terms that will likely 
have a sustained impact on several major public health initiatives.

Click Here to read more about the study

Domestic Abuse Often Escapes Notice of ER Staff: Study

2011-04-16T12:39:00.000-07:00

Most not identified as victims when treated in emergency department
By Robert Preidt (* link will not be available after 06/16/2011)
Friday, March 18, 2011

Related MedlinePlus Pages

FRIDAY, March 18 (HealthDay News) -- Three of four domestic violence victims treated in hospital emergency departments are not identified as victims of abuse, a new study reveals.

Researchers at the University of Pennsylvania School of Medicine analyzed court, police and emergency department (ED) records from a semi-rural county in Michigan between 1999 and 2002, and found that 80 percent of women who reported domestic assaults to police came to an emergency department at least once during the four years after the reported assault.

Most of the women sought ED care frequently, an average of seven times each during the study period.
However, only 28 percent of the women were ever identified in EDs as victims of domestic violence. The study authors speculated that the reason for this is likely because most of their ED visits were for medical complaints, not injuries associated with abuse. Among these patients, only 3.8 percent of emergency visits were reported to be mainly due to an assault.

Victims of domestic violence were four times more likely to be identified if they went to the ED on the day of the assault. They were also more likely to be identified if they were transported to the hospital by police or if their chief complaints involved mental health issues such as suicidal behavior or substance abuse issues such as overdoses.

The study is to be published online this week in the Journal of General Internal Medicine.

The findings highlight the need for emergency department staff to screen women who don't appear to be at risk for domestic violence, said the study authors.

"Emergency departments are a safety net for women with health issues of all kinds, but our study shows we're not doing a good enough job of assessing our patients' entire situation," Dr. Karin V. Rhodes, director of the division of emergency care policy research in the emergency medicine department, said in a university news release.

"There is no reason in the age of information technology that we should not provide routine screening and referrals to the social services patients can use to protect themselves from future violence," she added.

SOURCE: University of Pennsylvania, news release, March 16, 2011

HealthDay

More Health News on:: Domestic Violence; Emergency Medical Services

Survey Finds Much Victimization of Children Goes Unreported

2011-04-16T12:21:00.000-07:00

Percentage of cases revealed to authorities has risen, experts say, but many remain hidden

URL of this page: http://www.nlm.nih.gov/medlineplus/news/fullstory_107309.html (*this news item will not be available after 04/04/2011)

By Randy Dotinga

Tuesday, January 4, 2011

TUESDAY, Jan. 4 (HealthDay News) -- Nearly 60 percent of 10-to-17-year-olds surveyed in a new study say they were victims of violence, abuse or crime in the past year. However, fewer than half said that authorities ever learned about what happened.
Researchers led by David Finkelhor of the University of New Hampshire surveyed youths 10 to 17 years old and parents of children up to 9 years old in 2008. More than 4,500 children were involved in the survey.

More than 58 percent of the kids said they'd been victimized in the past year, including reports of bullying. Of these, just shy of 46 percent said authorities knew of at least one of the incidents.

Authorities were more likely to know about incidents that were more serious, such as certain cases of sexual assault, kidnapping and gang or group assaults, the survey found.

"However, even emotional bullying (51.5 percent), neglect (47.8 percent) and theft (46.8 percent) were often known to authorities," the authors wrote. Kids were less likely to report assaults by peers and siblings, dating violence, sexual exposure (such as flashing) and statutory rape.

"Childhood/adolescent abuse is frequently described as a hidden problem, and victimization studies regularly have shown that much abuse goes undisclosed," the study authors wrote. "The hidden nature of childhood victimization has multiple sources. Clearly, children and adolescents are easily intimidated by offenders and fear retaliation."

The authors added that, in many cases, young people and their families choose to deal with incidents "informally," fearing the consequences of police and court involvement.

The study did find, though, that authorities are more aware of victimization than during an earlier survey, conducted in 1992.

"However, the study also shows that a considerable portion of childhood/adolescent exposure to victimization is still unknown to authorities," the authors wrote. "The study suggests that outreach needs to be particularly enhanced toward boys, Hispanics and higher-income groups. It also suggests that disclosure promotion should be directed toward episodes that involve family members and peer perpetrators."

The study is published in the January issue of Archives of Pediatrics & Adolescent Medicine.

SOURCE: Archives of Pediatrics & Adolescent Medicine, news release, Jan. 3, 2011

HealthDay

CDC Report: Adverse Childhood Experiences Reported by Adults

2011-04-16T12:20:00.000-07:00

Adverse childhood experiences (ACEs) include verbal, physical, or sexual abuse as well as family dysfunction (an incarcerated, mentally ill, or substance-abusing family member, domestic violence, and absence of a parent due to divorce or separation).

Adverse Childhood Experiences (ACEs) have been linked to a wide range of health outcomes in adulthood including substance abuse, depression, cardiovascular disease, diabetes, cancer, and premature mortality.

Using the 2009 ACE module of the Behavioral Risk Factor Surveillance System (BRFSS) to examine whether a history of ACEs was common, 26,229 adults were interviewed in 5 states- Arkansas, Louisiana, New Mexico, Tennessee, and Washington. The MMWR report on ACEs among U.S. adults summarizes the results of that analysis. The module consisted of 11 questions that yielded 8 categories of ACEs (verbal abuse, physical abuse, sexual abuse, household mental illness, household substance abuse, domestic violence, parental separation/divorce and incarcerated family members). Respondents were asked to refer to the time period before they were 18 years of age when answering questions.

Overall, 59.4% of respondents reported having had at least one ACE while 8.7% reported five or more ACEs. Given the high prevalence of ACEs, additional efforts are needed at the state and local level to reduce and prevent childhood maltreatment and associated family dysfunction in the US, and further the development and dissemination of trauma-focused services to treat stress-related health outcomes associated with ACEs.
The most common ACEs were:

Separated or divorced parents
Verbal abuse
Family member with depression or mental illness
Witness of domestic violence
Physical abuse
Sexual abuse

Differences by gender

Men and women reported similar prevalence for having grown up with a mentally ill household member (22.0% for women, 16.7% for men) and growing up with a substance-abusing family member (30.6% for women, 27.5% for men). A difference between men and women was observed in the ACE category of sexual abuse, where women reported more than twice as many experiences as men (17.2% for women, 6.7% for men).

Differences by race/ethnicity

Black, non-Hispanic respondents had the lowest prevalence of each ACE category among all racial-ethnic groups. However, compared to all racial-ethnic groups Black non-Hispanics reported higher prevalence of having had an incarcerated family member (12.9%) and experiencing parental divorce (37.9%). Compared to Whites, Hispanics more frequently reported physical abuse (14.6% for Whites, 19.8% for Hispanics), witnessing domestic violence (15.1% for Whites, 21.7% for Hispanics), and having an incarcerated family member (6.2% for Whites, 9.5% for Hispanics).

These findings reinforce that adverse childhood experiences are common across racial/ethnic groups and states, further reinforcing the need to expand evidence-based child abuse prevention programs such as home visiting and parent education.

Data Source

CDC. Adverse Childhood Experiences Reported by Adults — Five States, 2009. MMWR 59(49);1609-1613.

More Information

STRYVE to Prevent Youth Violence

2011-04-16T12:15:00.000-07:00

From: CDC's National Center for Injury Prevention and Control.

Youth violence is preventable. Learn how STRYVE helps communities build comprehensive strategies that are based on the best available evidence and implemented through multisector action.

STRYVE, or Striving To Reduce Youth Violence Everywhere, is a national initiative led by the Centers for Disease Control and Prevention (CDC) to prevent youth violence before it starts.

STRYVE provides community tools through mechanisms such as STRYVE Online. STRYVE Online offers community leaders and others working to prevent youth violence

Effective strategies based upon the best available evidence;

Training and technical assistance;

Online community workspaces; and

Connections to other communities.

More Information

Moms With Tough Childhoods More Likely to Have Smaller Babies: Study

2011-04-16T12:12:00.000-07:00

Abuse, poverty during a mother's youth is associated with heightened health risks for the next generation

By Robert Preidt (*this news item will not be available after 06/29/2011)

Thursday, March 31, 2011

THURSDAY, March 31 (HealthDay News) -- Women who suffered abuse in childhood are at increased risk of having low birth weight babies, a new study indicates.

It also found that poverty during childhood and substance use during adolescence and pregnancy boosts the chances of having low birth weight babies, who are at increased risk for death before their first birthday and chronic health problems.

About 8 percent of babies born in the United States each year have a low birth weight -- less than 5 pounds, 8 ounces (2,500 grams).

Researchers at the University of Washington in Seattle examined data from 136 mothers who had been part of a study since childhood. They found that women who suffered emotional, physical or sexual abuse or poverty in childhood were more likely to smoke, drink or use drugs during pregnancy, which increases the risk of having a low birth weight baby.

"Our findings suggest that a mother's economic position in childhood and her experience of maltreatment during childhood have implications for her children born years later," study author Amelia Gavin, an assistant professor in the School of Social Work, said in a university news release.

"What is important about this study is that it was the mother's experience of poverty and maltreatment in childhood, not her poverty or depression or obesity in adulthood, that contributed to her infant's low birth weight," she added.

Doctors should ask prospective mothers about any childhood maltreatment and offer help to those at risk for substance abuse during pregnancy, Gavin suggested.

The study was published online recently in the Journal of Adolescent Health.

SOURCE: University of Washington, news release, March 29, 2011

PTSD Risk in Women Tied to Genetics

2011-03-15T12:03:00.000-07:00

By John Gever, Senior Editor, MedPage Today
Published: February 23, 2011
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

A common gene variant was associated with a nearly doubled likelihood of posttraumatic stress disorder (PTSD) in at-risk urban women -- but not in otherwise similar men, researchers said.

The affected gene encodes a receptor protein believed to mediate stress responses, and is also modulated by estrogen signaling, according to Kerry Ressler, MD, PhD, of Emory University in Atlanta, reporting in the Feb. 24 issue of Nature.

Heavily traumatized civilian women with two copies of a specific single nucleotide polymorphism (SNP) in the ADCYAP1R1 gene were more likely to show PTSD with an odds ratio of 1.66 (95% CI 1.32 to 2.09) relative to similar women without the condition, Kessler and colleagues found.

The same SNP -- called rs2267735, substituting a cytosine base for a guanine -- in men exposed to fearful situations showed no association with PTSD, the researchers also found (OR 0.95, 95% CI 0.71 to 1.27).
The authors did point out, however, that women are more likely to develop PTSD than men, and this discrepancy may relate to the modulation of the receptor pathway by estrogen.

Nearly 40% of women in the study had the CC genotype, carrying two copies of the risk-associated SNP.
In that group, an average of 15 PTSD symptoms were identified clinically, compared with 11 in individuals with the CG or GG genotypes (P<0.05).

About one-third of the 763 women in the study were diagnosed with PTSD.

Other researchers contacted by MedPage Today and ABC News said the results were promising but needed replication in larger and different samples.

"This study was done on chronically ill patients, those with both chronic medical and chronic psychological comorbidities, so it's difficult to know if the signaling is from PTSD or from their comorbidities," said Charles Marmar, MD, of NYU Langone Medical Center in New York City, in an e-mail. "There's a need for replication in a younger, healthier population with more recent trauma exposure."

Judith A. Myers-Walls, PhD, of Purdue University in West Lafayette, Ind., also noted that the methodology left some questions unanswered.

"The data were collected after the PTSD symptoms were identified, so it is not clear whether the stress reaction itself created the changes in physiology or they existed before the exposure to the stressful situation," she said in an e-mail.

Among the individual PTSD symptoms, hyperarousal was the one most strongly associated with the CC genotype. After controlling for trauma history, age, and race, women with the CC genotype had mean hyperarousal scores of about 5.2, compared with 3.9 among women with at least one G allele (P=0.0008).
Women with the CC genotype also showed exaggerated startle responses.

All these effects were completely confined to women in the study. For the genetic research, Ressler and colleagues initially analyzed a group of 503 women and 295 men. They then confirmed the findings in a replication set of 260 women and 179 men -- also drawn from the same population of trauma-exposed city dwellers but enrolled later and interviewed by different staff.

Most of the associations reported in the Nature paper were calculated from both samples combined.
Ressler and colleagues actually started out investigating the role of a protein called PACAP, the pituitary adenylate cyclase-activating polypeptide, which earlier studies had linked to cellular stress responses. PACAP is the natural ligand for the receptor encoded by ADCYAP1R1.

Blood levels of the peptide were significantly associated with PTSD symptom counts, startle reflexes, and other measures of fear physiology, the researchers found -- but again only in women.

Ressler and colleagues also found that expression of an ADCYAP1R1 homologue in rodents was increased with estrogen replacement and with fear conditioning -- supporting a role for the gene and its protein product, the PAC1 receptor, in handling stress.

The researchers suggested that PACAP had potential clinical application as a biomarker of active PTSD, whereas ADCYAP1R1 genotype might be used to identify individuals most at risk for PTSD following trauma.
More study of the pathway may also reveal therapeutic targets for PTSD treatments, Ressler and colleagues indicated.

In an accompanying commentary published in Nature, Murray B. Stein, MD, of the University of California San Diego, suggested it would be premature to put the study's findings into clinical use immediately.
In addition to replicating the findings, he wrote, "more must be learned about the relationship between PACAP levels in peripheral blood and cerebrospinal fluid, and, particularly, in the regions of the brain that modulate the fear response."

Stein also called for studies of other genetic factors previously linked to PTSD and how they may be related to ADCYAP1R1.

Steven P. Hamilton, MD, PhD, of the University of California San Francisco, told MedPage Today and ABC News in an e-mail that the study's genetic findings were clearly important, at least as a starting point.
"So far, we have only a minimal understanding of the genetic factors influencing PTSD, so this finding is a promising advance, and suggests that more genetic research into anxiety disorders is warranted," said Hamilton.

The study was funded primarily by the National Institutes of Health. Some authors also received salary support from other government and foundation sources.
Study authors and Stein declared they had no relevant financial interests.

This article was developed in collaboration with ABC News.

Primary source: Nature
Source reference:
Ressler K, et al "Post-traumatic stress disorder is associated with PACAP and the PAC1 receptor" Nature 2011; 470: 492-497.

Additional source: Nature
Source reference:
Stein M, "A molecular shield from trauma" Nature 2011; 470: 468-469.

Cost of Injury and Violence in the United States

2011-03-15T11:57:00.000-07:00

from CDC's National Center for Injury Prevention and Control.

CDC's Injury Center is pleased to announce the release of the new WISQARS^TM (Web-based Injury Statistics Query and Reporting System) Cost of Injury Reports.*

WISQARS™ data can be used to learn more about the public health and economic burden associated with unintentional injury and violence-related injury in the United States.

The Cost of Injury Reports module provides cost estimates for injury deaths, hospitalizations, and emergency department visits where the patient was treated and released.

The new module allows users to create reports of: medical costs (e.g., treatment and rehabilitation), work loss costs (e.g., lost wages, fringe benefits, and self-reported household services), and combined costs (medical plus work loss) based on a number of variables including: intent and mechanism (cause) of injury, body region and diagnosis of injury, geographic location (for deaths only), sex, and age.

Learn More

* WISQARS^TMCost of Injury Reports are based on lifetime medical and lifetime work loss costs in 2005. This was the most recent year of unit cost data available at the time the module was developed. NCIPC plans to update these estimates to more recent years in the future.

Video Series on: The A.C.E. Study - Adverse Childhood Experiences

2011-03-09T11:16:00.000-08:00

ACE Study -

Vincent Felitti, MD

"We saw that things like intractable smoking, things like promiscuity, use of street drugs, heavy alcohol consumption, etc., these were fairly common in the backgrounds of many of the patients...These were merely techniques they were using, these were merely coping mechanisms that had gone into place."– Vincent Felitti, MD

When Dr. Vincent Felitti, head of the Department of Preventive Medicine at Kaiser Permanente in San Diego, began to delve into the reasons for the high dropout rate of patients who'd been successfully losing weight in Kaiser’s obesity program, he found to his surprise that a high proportion of those dropping out had histories of childhood abuse or neglect. Dr. Robert Anda, who had been doing research with the Centers for Disease Control and Prevention on the psychosocial origins of health-risk behaviors in patients at VA hospitals, heard Felitti speak about his findings, and in 1992 the two began to collaborate on the largest-scale study to date of the incidence and effects of childhood trauma, known as the Adverse Childhood Experiences (ACE) Study.

According to data collected from the over 17,000 Kaiser patients in this ongoing retrospective and prospective study, adverse childhood experiences, though well concealed, are unexpectedly common, have a profound negative effect on adult health and well-being a half century later, and are a prime determinant of adult health status in the United States.

The Origins of Addiction: Evidence from the Adverse Childhood Experiences Study

Vincent J. Felitti, MD - Department of Preventive Medicine - Kaiser Permanente Medical Care Program

ABSTRACT:
A population-based analysis of over 17,000 middle-class American adults undergoing comprehensive, biopsychosocial medical evaluation indicates that three common categories of addiction are strongly related in a proportionate manner to several specific categories of adverse experiences during childhood. This, coupled with related information, suggests that the basic cause of addiction is predominantly experience-dependent during childhood and not substance-dependent. This challenge to the usual concept of the cause of addictions has significant implications for medical practice and for treatment programs....

Our overall findings, presented extensively in the American literature, demonstrate that:
• Adverse childhood experiences are surprisingly common, although typically concealed and unrecognized.
• ACEs still have a profound effect 50 years later, although now transformed from psychosocial experience into organic disease, social malfunction, and mental illness.
• Adverse childhood experiences are the main determinant of the health and social well-being of the nation....

Conclusion:
The current concept of addiction is ill founded. Our study of the relationship of adverse childhood experiences to adult health status in over 17,000 persons shows addiction to be a readily understandable although largely unconscious attempt to gain relief from well-concealed prior life traumas by using psychoactive materials

The Relation Between Adverse Childhood Experiences and Adult Health: Turning Gold into Lead

By Vincent J Felitti, MD

The ACE Study reveals a powerful relation between our emotional experiences as children and our adult emotional health, physical health, and major causes of mortality in the United States. Moreover, the time factors in the study make it clear that time does not heal some of the adverse experiences we found so common in the childhoods of a large population of middle-aged, middle-class Americans. One doesn't "just get over" some things.

Strong Link Found Between Victimization, Substance Abuse

2011-03-09T11:07:00.000-08:00

ScienceDaily (Feb. 24, 2011) — A strong link between victimization experiences and substance abuse has been discovered by researchers at the University of Illinois at Chicago.

See Also:

Health & Medicine

Mind & Brain

Reference

The correlation is especially prevalent among gays, lesbians and bisexuals -- more so than in heterosexuals, says Tonda Hughes, professor and interim head of health systems science in the UIC College of Nursing. Hughes is lead author of the study, published in the journal Addiction.

Researchers compared victimization experiences of unwanted sexual activity, neglect, physical violence, and assault with a weapon, across four sexual-identity subgroups -- heterosexual, gay or lesbian, bisexual, or "not sure." The study used data collected nationally from 34,635 adults from the National Epidemiologic Survey on Alcohol and Related Conditions.

Hughes and her research team wondered if sexual-minority women and men are at a heightened risk for victimization. The results, Hughes said, showed that they are.

Lesbian and bisexual women were more than twice as likely as heterosexual women to report any victimization over their lifetime. Lesbians, gay men and bisexual women also reported a greater number of victimization experiences than did heterosexuals. Three times as many lesbians as heterosexual women reported childhood sexual abuse.

One possible explanation for this disproportionality, Hughes said, is that lesbians are more willing to acknowledge and report this experience.

"Gays and lesbians tend to be more self-reflective," she said. "This means they are more likely to think about and report negative or stigmatizing life experiences. Heterosexuals may not be inclined to do so."

Gay men also had high rates of victimization, with about half of them reporting any lifetime victimization. They reported significantly higher rates of childhood sexual abuse, childhood neglect, partner violence and assault with a weapon than heterosexual men.

Not only are there higher rates of violence and victimization among sexual minorities, but there is also a higher rate of substance abuse, Hughes said.

Regardless of sexual identity, women who reported two or more victimization experiences had two to four times the prevalence of alcohol dependence, drug abuse or drug dependence as women who reported no victimization, she said.

The research also concluded that gay, lesbian and bisexual youth may use substances to cope with adverse psychological and interpersonal effects of victimization, increasing the risk for further victimization from others, she said.

The study was funded through grants from the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, two of the National Institutes of Health.

Other authors on the Addiction paper were Sean Esteban McCabe, Brady West and Carol Boyd of the University of Michigan and Sharon Wilsnack of the University of North Dakota.

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The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Illinois at Chicago.

Chronically Ill Children Are 88% More Likely to Suffer Physical Abuse, Swedish Researchers Find

2011-02-25T11:20:00.000-08:00

ScienceDaily (Feb. 18, 2011) — Children with chronic health conditions are 88% more likely to suffer physical abuse than healthy children, according to research in the March issue of Acta Paediatrica. They are also 154% more likely to suffer a combination of physical abuse and exposure to intimate partner violence than their healthy school friends.

Researchers from Karlstad University, Sweden, analysed 2,510 questionnaires completed anonymously by children aged ten, 12 and 15 from 44 schools. Nearly one in four had at least one chronic health condition, including visual, hearing or speech problems, diabetes, mental illness, physical disabilities, allergies, weight issues, epilepsy or Attention Deficit Hyperactivity Disorder.

"Twelve per cent of all the children who took part in the survey said they had been physically abused, 7% had witnessed intimate partner violence and 3% had experienced both" says lead author Birgitta Svensson from the Department of Health and Environmental Sciences at the University. "But when we looked at children with chronic illness, the figures were significantly higher for physical abuse and for physical abuse combined with intimate partner violence."

Child physical abuse ranged from severe shaking, ear boxing and hair pulling by an adult to being severely beaten with a hand or device. Intimate partner violence was defined as a child seeing adults in their family hit each other.

"It is clear from our study that children with chronic health conditions face an increased risk of child physical abuse and intimate partner violence and that certain factors may unite this group, regardless of the nature or severity of their health problem" says Svensson.

"Further analysis showed that children with chronic health conditions faced an even higher risk of physical abuse when they were also born outside Sweden or lived in a low income family. The most vulnerable children were those that fell into all three categories."

Key findings of the study include:

Chronic health problems:

39% of the children reported chronic health problems -- 25% reported one, 10% reported two and 4% reported three or more. Children aged 15 reported significantly more chronic health problems than younger children.

All child physical abuse (with or without intimate partner violence):

Having a chronic health condition raised the risk of physical abuse by 88%, as did being 15-years-old (+77%), male (+30%), born outside Sweden (+113%) and not living with both biological parents (+90%).

Child physical abuse only:

7% of the healthy children and 12% of the children with chronic health problems had suffered physical abuse only.
Chronic health raised the risk of physical abuse only (+ 67%) as did being 15 (+37%) male (+49%) and born outside Sweden (+89%).
Abuse rates increased with the number of chronic health conditions, from 10% for children with one to 16% for children with three or more.

Child physical abuse plus intimate partner violence:

2% of the healthy children and 5% of the children with chronic heath had suffered physical abuse and witnessed intimate partner violence.
Chronic health raised the risk of experiencing both (+154%) as did being 15 (+192%), born outside Sweden (+128%) and not living with both biological parents (+314%).
The chance of experiencing both increased with the number of chronic conditions, from 3.5% for children with one to 12% for children with three or more.

"This information, and the other trends identified by this study, will be very useful to anyone who works with children" concludes Svensson. "We are now taking our research a stage further to look at how families handle this internal conflict and at the professional support they need and receive."

Science Daily Link

MEDICAL NEWS: Domestic Abuse May Affect Reproductive Freedom

2011-01-05T12:11:00.000-08:00

MedPage Today
By Kristina Fiore, Staff Writer, MedPage Today
Published: January 25, 2010
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

In some abusive relationships, men may use strategies to force women to become pregnant, including sabotaging their birth control, researchers reported.

In a cross-sectional study of women treated at five family clinics across northern California, about 20% of women said that their partner tried to coerce them into having a child, Elizabeth Miller, MD, of the University of California Davis, and colleagues reported online in the journal Contraception.

Beyond outright coercion, abusive partners also engaged in birth control sabotage, for example, poking holes in condoms and flushing birth control pills down the toilet.

"It was stunning to have this many women seeking reproductive health services saying, 'this has happened to me,'" Miller said.

To investigate a possible link between domestic violence and forced pregnancy, the researchers conducted a survey of 1,278 women ages 16 to 29 who sought care at the five family planning clinics in northern California.

More than half of the women surveyed -- 53% -- reported physical or sexual partner violence.

Approximately a third of the women who reported partner violence also reported pregnancy coercion or birth control sabotage.

Altogether, the effect of both partner violence and reproductive control nearly doubled a woman's odds of unintended pregnancy (OR 1.99, 95% CI 1.11 to 3.58).

Both pregnancy coercion and birth control sabotage were separately associated with unintended pregnancy as well (OR 1.83, 95% CI 1.36 to 2.46 and OR 1.58, 95% CI 1.14 to 2.20, respectively).

"The findings suggest that pregnancy coercion and birth control sabotage may be an aspect of partner violence that, given its relevance to reproductive health, should be identified by providers in clinical settings," the authors wrote.

Among the reasons men would want their partners to bear children: "It ranges from things like wanting to leave a legacy, to a straightforward desire for attachment, to having absolute control over her body," Miller said. "There are all of these elements to it."

Aisha Mays, MD, director of the Teen and Young Adult Clinic at San Francisco General Hospital who was not involved in the study, said pregnancy coercion is a growing problem that has been around for "quite some time" but is just now being recognized as a major health issue.
"It's about power and control," Mays said. "It's another way of saying, 'this girl's taken, this girl's mine.'"

Mays said she has seen cases in which a young mother who has a child with another partner will be forced by her new boyfriend to have another baby with him.

It's also a way for males to make their partners more dependent on them, according to Amy Bonomi, PhD, MPH, of Ohio State University.
"Women in abusive relationships are sometimes forced to bear children as a means to keep them dependent on their partner and sometimes as a means to justify additional -- and sometimes more severe -- abuse," Bonomi said.

Miller said the findings emphasize the need for family planning clinics to provide intervention programs to combat both reproductive control and partner violence.

Key strategies include advising women about "invisible" forms of birth control such as injectable and intrauterine contraceptives, as well as easy access to emergency contraception.

"If we can identify that reproductive control is going on," Miller said, "we can offer the woman methods for birth control that the partner can't mess with."
Mays added that physicians and counselors should talk about women's empowerment with regard to reproduction during reproductive health visits.
"It tends to be left out," Mays said. "We talk about getting the prescription [for birth control] and its side effects. But we really need to have a discussion around whether the girl is feeling ready for sex."

The study was limited by its cross-sectional design, which "precludes conclusions concerning temporality regarding associations observed among pregnancy coercion, birth control sabotage, and intimate partner violence with unintended pregnancy." Miller et al said additional studies are needed to clarify the chronology of reproductive control and partner violence, and how those factors might combine to affect risk for unintended pregnancy.

The study was supported by grants from the National Institute of Child Health and Human Development, a UC Davis Health System Research Award, and a Building Interdisciplinary Research Centers in Women's Health award.
The researchers reported no conflicts of interest.

This article was developed in collaboration with ABC News.

Primary source: Contraception
Source reference: Miller E, et al "Pregnancy coercion, intimate partner violence and unintended pregnancy" Contraception 2010; DOI: 10.1016/j.contraception.2009.12.004.

MEDICAL NEWS: No Benefit Seen in Routine Screening for Domestic Abuse

2010-12-13T12:07:00.001-08:00

MedPage Today
No Benefit Seen in Routine Screening for Domestic Abuse

By John Gever, Senior Editor, MedPage Today
Published: August 04, 2009
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

Screening all women in medical clinics for intimate partner violence in a randomized trial did not reduce rates of abuse or improve their quality of life, researchers said.

Among those for whom the screening revealed a history of abuse, recurrence of partner violence during 18 months of follow-up was reduced by a nonsignificant 18% (odds ratio 0.82, 95% CI 0.32 to 2.12) compared with control participants, according to Harriet L. MacMillan, MD, of McMaster University in Hamilton, Ontario, and colleagues.

The study randomized more than 6,700 eligible and consenting women at 26 Ontario medical clinics to either screening before their medical evaluation, so that interventions could be recommended to women exposed to partner violence, or to completing the screening questionnaires after the clinic visit.

Writing in the Aug. 5 Journal of the American Medical Association, the researchers found that quality of life scores improved somewhat more at the 18-month follow-up in the screened group -- from 52.1 to 58.5, compared with an increase from 50.6 to 52.7 in the control group (P<0.05). Depression scores were also modestly reduced.

But when MacMillan and colleagues imputted outcomes for the more than 40% of participants in both groups who dropped out of the study during follow-up, these differences shrank to insignificance.

The screened women also showed no reduction in after-effects of domestic violence, such as post-traumatic stress disorder and drug and alcohol problems, compared with the unscreened group.

"These results do not provide sufficient evidence to support universal IPV screening in healthcare settings in the absence of an effective intervention to prevent or reduce intimate partner violence," the researchers concluded.

The trial did not employ a specific intervention for those with positive screening results. Clinicians were informed of available local services for victimized women, but they provided referrals at their own discretion.

In fact, the researchers said, "fewer than half [44%] of the screened-positive women reported having a discussion about violence with their clinician during their visit."
MacMillan and colleagues said it may be argued that even small improvements in outcomes justify screening, particularly as the trial did not identify any specific harms to participants from the screening.

For example, other researchers suggested last year that performing such screens on mothers bringing their children to pediatric clinics would be beneficial. (See Pediatricians Should Screen Moms for Domestic Violence)

But the researchers pointed out that 87% of participants were not exposed to partner violence, suggesting a significant amount of wasted effort in the screening.

They also noted that the screening had a false-positive rate of 11%, requiring additional clinical effort and opportunity costs to identify those with positive results who actually needed no intervention.

In an accompanying editorial, Kathryn E. Moracco, PhD, MPH, of the University of North Carolina in Chapel Hill, N.C., and Thomas B. Cole, MD, MPH, a contributing editor at JAMA, suggested that the effectiveness of medical screening for partner violence can't be properly evaluated until there are clinic-based interventions with proven efficacy.
"Specific interventions to prevent the recurrence of abuse for women at risk of violence should be implemented and rigorously tested, preferably in randomized trials, without further delay," they wrote.

"The results of the [current study] should dispel any illusions that universal screening with passive referrals to community services is an adequate response to violence in intimate relationships," they contended.

In the study, women presenting at 11 emergency departments, 12 family practice centers, and three ob/gyn clinics during an 18-month period beginning in July 2005 were nominally eligible to participate.

Those younger than 18 or older than 64 were excluded, as were women who did not make their own appointments or who did not have a male partner in the past year. Participation was also limited to those who spoke English, were able to be alone, and were not seriously ill.
These exclusions meant that, of more than 120,000 women presenting at these clinics, about 87,000 were ineligible. Another 13,000 either refused to provide information to determine eligibility or were missed by the investigators. About 1,500 more who were eligible declined to participate.

That left about 6,700 to be randomized. The investigators designated certain days as "screening days" during which all eligible and consenting female patients were asked to complete the screening questionnaire before they saw clinicians. An equal number of days provided the nonscreened control, with participants completing the questionnaire after the clinic visit.

The screening instrument was the Woman Abuse Screening Tool, with the Composite Abuse Scale used to determine exposure to violence during follow-up. Other outcomes such as PTSD, depression, and substance abuse were measured with standard instruments such as the Short Form-12 and Short Form-36. Quality of life was evaluated with the World Health Organization Quality of Life (WHOQOL)–Bref questionnaire.

Of 2,733 screened patients, 347 had positive results. A similar proportion of the 2,948 patients in the control group who completed the questionnaires also had positive results.

Those in the unscreened group could also be asked about domestic violence if the clinician chose.
Participants were interviewed every six months afterward through the 18-month follow-up period. Attrition was steady, reaching 43% in the screened group and 41% in the control patients at the end of follow-up.

Growth trajectories were calculated with a logistic model for abuse recurrence and with a linear model for quality of life. A secondary analysis used imputed observations based on partial follow-up data to compensate for the high attrition.

The researchers found that, among the screened-positive women still in the study at 18 months, 8% had called a crisis hotline, while 9% had contacted a counseling or advocacy center for abused women, and 4% had sought refuge at a shelter during the follow-up period. Some 26% had talked with a psychologist or social worker.

These figures were very similar to those in the control group whose screening results were positive.

MacMillan and colleagues said it was notable that absolute improvements in most outcomes were seen in both groups relative to baseline.

They speculated that participation in the study -- being asked about intimate partner violence and its effects -- may have been beneficial in itself. Every participant was given an information card with details on services for abused women in their communities.

The authors also noted that the study began during a period when crime statistics indicated violence was at a high point, and "was likely to decrease over time regardless of any intervention."

Besides the high loss to follow-up, limitations to the study included the reliance on participant self-report for baseline and follow-up data, as well as the carefully controlled trial conditions that would probably not occur in ordinary medical practice.

They also noted that significant costs were involved to support the highly trained research assistants who ensured that women filled out the written screen and that positive results were delivered immediately to the clinicians. In addition, each clinician received specific training.
Also, the study was conducted in Canada where women have universal access to most healthcare services.

The study was funded by a grant from the former Ontario Women's Health Council (Ontario Ministry of Health and Long-Term Care).

MacMillan reported holding a Canadian Institutes of Health Research (CIHR) New Emerging Team grant from the Institutes of Gender and Health.

Primary source: Journal of the American Medical Association
Source reference:
MacMillan H, et al "Screening for intimate partner violence in health care settings: a randomized trial" JAMA 2009; 302: 493-501.

Additional source: Journal of the American Medical Association
Source reference:
Moracco K, et al., "Preventing intimate partner violence: screening is not enough" JAMA 2009; 302: 568-69.

Teen Dating Violence is Common, Study Finds

2010-12-12T09:47:00.000-08:00

URL of this page: Medline Plus (*this news item will not be available after 03/06/2011) Monday, December 6, 2010

It occurs in almost 1 in 5 couples, and perpetrators also often assault family, friends

MONDAY, Dec. 6 (HealthDay News) -- Almost one-fifth of high-school students admit they physically abused someone they were dating, and those same students were likely to have abused other students and their siblings, a new study finds.

The study provides new details about the links between various types of violence, said study lead author Emily F. Rothman, an associate professor at the Boston University School of Public Health.

"There's a huge overall connection between perpetration of dating violence and the perpetration of other forms of youth violence," she said. "The majority of students who were being violent with their dating partners were generally violent. They weren't selecting their dating partners specifically for violence."

For the study, published in the December issue of the journal Archives of Pediatrics and Adolescent Medicine, the researchers surveyed 1,398 urban high school students at 22 schools in Boston in 2008 and asked if they had physically hurt a girlfriend or boyfriend, sibling or peer within the previous month.
The authors define physical abuse as "pushing, shoving, slapping, hitting, punching, kicking, or choking." Playful aggression was excluded.

More than forty-one percent said they'd physically hurt another kid on at least one occasion the previous month; 31.2 percent reported that they'd physically abused their siblings, and nearly 19 percent said they'd abused their boyfriend, girlfriend, someone they were dating or someone they were simply having sex with.
Among those admitted to dating violence, 9.9 percent reported kicking, hitting, or choking a partner; 17.6 percent said they had shoved or slapped a partner, and 42.8 percent had cursed at or called him or her "fat," "ugly," "stupid" or a similar insult.

Proportionately more girls than boys (27 percent versus 10 percent) reported they'd abused dating partners.
After adjusting for factors including age and specific schools, the researchers found that abuse of dating partners was strongly linked to abuse of other students, especially among boys.

Students who used drugs, carried knives or had been in trouble with the law were also more likely to abuse their dating partners. And those who had witnessed community violence were also more likely to engage in violence.

These findings are consistent with research on adult male batterers, which has shown that domestic violence often accompanies other violent and criminal behavior, the authors said.

The study has some caveats, however. The students -- nearly 80 percent of whom were black or Hispanic -- only came from public high schools. Those who weren't recently dating were excluded, and the findings were self-reported. Also, motives were not examined, so it's unknown if any teens acted in self-defense.

Still, the results can help people who work with teenagers detect dating violence, Rothman said. "This study supports the idea that we should go to those kids who are being violent with siblings and peers and address their violent behavior in general," she said.

Monica Swahn, an associate professor at Georgia State University's Institute of Public Health whose research includes violence and injury epidemiology, said the study findings give researchers insight into how they may reduce teens' abusive behavior by targeting more than one type of violence.

However, few anti-violence programs for school children have been shown to be effective, she said.

SOURCES: Emily F. Rothman, Sc.D., associate professor, Boston University School of Public Health; Monica Swahn, Ph.D., associate professor, Institute of Public Health, Georgia State University, Atlanta; December 2010 Archives of Pediatrics and Adolescent Medicine
HealthDay
Copyright (c) 2010 HealthDay. All rights reserved.

Fibroids more common after child abuse

2010-12-12T09:38:00.000-08:00

Medline Plus
Monday, November 29, 2010
By Alison McCook

NEW YORK (Reuters Health) - Women who were abused as children are more likely to develop uterine fibroids as adults, a new study finds.

The results suggest that the consequences of child abuse can last way beyond childhood, study author Dr. Renee Boynton-Jarrett of the Boston University School of Medicine told Reuters Health.

"Childhood abuse is something that happens in childhood, but this experience could jeopardize your health in adulthood, as well."

The report, published in the journal Epidemiology, also showed that the more abuse women said they suffered as children, the more likely they were to be diagnosed in adulthood with fibroids, which can cause pain, abnormal bleeding and infertility.

The study cannot prove that child abuse caused women's fibroids, but there are several reasons why early abuse might increase fibroid risk, Boynton-Jarrett explained. "One possibility is that childhood abuse is associated with health behaviors such as eating and activity patterns, which elevates your risk of obesity," a known risk factor for fibroids.

Alternatively, chronic stress resulting from the abuse may disrupt how the body regulates hormones, which can also raise the risk of fibroids, Boynton-Jarrett added.

Encouragingly, among women who were abused, those who received more emotional support as children were somewhat less likely to develop fibroids, suggesting that it's possible to mitigate the negative effects of abuse. "We might not be able to prevent every episode of child abuse," Boynton-Jarrett said, but "we can support those children differently," by providing them with extra social support, a step that "might have long-term benefits."

According to Childhelp, every 10 seconds, a person reports a case of child abuse. Previous research has shown that people abused as children tend to have more health problems as adults.

Uterine fibroids are generally benign tumors that grow in the walls of the uterus. They can be removed by minimally invasive surgery.

Up to 1 in 4 women will develop symptoms from fibroids at some point in their lives.

To investigate whether the condition is more common among women with a history of abuse, Boynton-Jarrett and her team reviewed data collected from 60,615 women about their exposure to violence, and followed them for 16 years, noting who developed fibroids.

Sixty-five percent of participants said they had been physically or sexually abused as children or teenagers, and nearly 10,000 were eventually diagnosed with fibroids.

Among those who developed fibroids, nearly 70 percent reported some history of abuse. Relative to women with no history of abuse, women who said they had been abused as children were between 8 and 36 percent more likely to develop fibroids, with the risk of fibroids increasing the greater a woman's exposure to severe, chronic or multiple types of abuse.

The study is "very well done," Dr. Jackie Campbell at Johns Hopkins University School of Nursing, who did not participate in the research, told Reuters Health. "It gives us important direction for future research."
Campbell herself has found that African-American women who were abused by an intimate partner were also at higher risk of fibroids, and for that reason, she said she wishes the study had looked separately at the effect of intimate partner violence on adults.

Based on these findings, it makes sense for gynecologists to "routinely" screen women for a history of abuse, or the presence of abuse by an intimate partner, given the potential long-term effects on their health, Campbell concluded.

SOURCE: http://link.reuters.com/huz57q Epidemiology, online November 9, 2010.
Reuters Health
(c) Copyright Thomson Reuters 2010. Check for restrictions at: http://about.reuters.com/fulllegal.asp

Volunteers Wanted for Local Domestic Violence Group

2010-12-10T21:11:00.001-08:00

We started out as a group of parents who were also victims of abuse who banded together. We have now come to a cross roads and in need of help of to get what we been working on over the past few years to the next level and make it run more efficient.

So we are in need of volunteers to help us get there and partner with us. This is grass roots so those wanting leadership opportunities or needing internship requirements could benefit as well as those who have a passion helping victims of abuse.

Goals of group:

Provide healing services and holistic care for victims such as coaching, reiki, referral sources and meditation
Advocate for change in current state laws. Use CAPPA as example.
Build a collaborative of health, wellness and legal professionals w DV experience for referrals and advocacy.

Ideal skills wanted:

Writing skills
Administrative
Grant writing
Fundraising
Compassion
Organizational
Above all - a Positive attitude

If interested, please email us. We are seeking volunteers and advocates to help us for a project involving domestic violence. Right now, you must be located in the Boston area and will benefit local survivors of abuse.

Please help us get the word out.

If you are unable to volunteer, but would like to make a donation to support our cause, you may do so safely through paypal by going to the right margin of this blog for the donation link. Donations will be used to help us with the escalating administrative costs, advocacy, and legal consultations.

Mecklenburg Family Court III

2010-09-29T14:10:00.000-07:00

Drugging Kids a Form of Abuse

2010-07-23T15:19:00.000-07:00

By Todd Neale, Staff Writer, MedPage Today
Published: July 22, 2010
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

Giving children pharmaceuticals for nontherapeutic reasons may be an under-recognized form of abuse, a retrospective study showed.

Data from U.S. poison control centers revealed an average of 160 cases of "malicious" use of pharmaceuticals in children younger than 7 annually over a nine-year period, Shan Yin, MD, MPH, of Rocky Mountain Poison and Drug Center in Denver, reported online in the Journal of Pediatrics.

The most commonly used drugs were analgesics, stimulants/street drugs, sedatives/hypnotics/antipsychotics, and cough and cold preparations.

About half of the cases (51.1%) involved a sedating agent.

Moderate or major outcomes -- or death -- occurred in 13.8% of cases.

Mark Riddle, MD, a psychiatrist at Johns Hopkins Hospital, said in an e-mail that it can be difficult to differentiate between accidental and malicious misuse of a drug, and that looking at a pattern of previous behaviors might help decide.

"A malicious act directed at a child is unlikely to be a stand-alone event," said Riddle, who noted that mental illness or substance abuse in a parent may impair his or her judgment.

Although the study could not determine the reasons for the inappropriate use of drugs in children, Yin speculated in his paper that parents might be trying to get a baby to stop crying, calm a child after being physically abused, or take a break from caring for a child.

Aside from sedation, he added, other reasons might include homicide, punishment, Munchausen by proxy, or amusement.

Regardless of the reason, according to Paul Miller, PhD, a psychologist at Arizona State University, "parents first need to be directly informed about the consequences of misusing such agents for their children."

"Evidence of malicious drugging should be considered child abuse," he said in an e-mail. "This may well be hard to determine, but if there is evidence that the behavior is actually malicious, children need to be protected from their parents just the same as if the parents were physically attacking them."

According to Yin, the nontherapeutic use of pharmaceuticals does not fit well in the four traditional categories of child maltreatment -- physical abuse, sexual abuse, emotional abuse, and neglect.

But on the basis of reports of Munchausen by proxy syndrome via poisoning, malicious use of over-the-counter cough and cold medicines, and sexual abuse of children facilitated by drugs, it is reasonable to consider such an act a form of child abuse, he wrote in his paper.

To quantify the problem, Yin reviewed information reported to the U.S. National Poison Data System regarding all exposures to pharmaceuticals and alcohol coded as "malicious" -- meaning someone intentionally meant harm -- from 2000 to 2008.

Over that time, there were 1,439 cases, ranging from 124 to 189 per year. There was a steady increase over time (P=0.006).

Eleven categories of pharmaceuticals or alcohol accounted for 82.3% of the cases -- analgesics, stimulants/street drugs, sedatives/hypnotics/antipsychotics, cough and cold preparations, unknown, ethanol, topical preparations, gastrointestinal preparations, antihistamines, antidepressants, and cardiovascular drugs.

About one in every 10 (9.7%) of cases involved more than one substance.

Among those cases with outcome data, 13.8% resulted in moderate or major outcomes or death; 18 children died, 17 of whom were given sedating agents such as antihistamines and opioids.

The occurrence of death or major outcomes was associated with exposure to multiple agents (OR 3.0, 95% CI 1.6 to 6.0), exposure to a sedating agent (OR 3.6, 95% CI 1.7 to 7.7), and age younger than 3 (OR 1.9, 95% CI 1.02 to 3.6).

But even though the majority of children did not have serious immediate consequences from the exposures, there could be long-term effects, according to Alan Kazdin, PhD, a psychologist at Yale University.

"The impact of abuse of drugs in this way is likely to have cascading effects on the developing biology of children and even potentially long-term effects on morbidity and mortality," he said in an e-mail.

Yin acknowledged some limitations of his study, including the possibility that some cases were mistakenly coded as malicious; the lack of information on the exact circumstances of each case; the reliance on voluntary and self-reported data, which may underestimate the problem; and the lack of data confirming exposures with drug levels except for the fatalities.

Yin reported that he had no conflicts of interest.

This article was developed in collaboration with ABC News.

Primary source: Journal of Pediatrics
Source reference:
Yin S "Malicious use of pharmaceuticals in children" J Pediatr 2010; DOI: 10.1016/j.jpeds.2010.05.040.

Spouse Abuse Increases Risk of Miscarriage

2010-07-18T08:09:00.000-07:00

By Crystal Phend, Staff Writer, MedPage Today
Published: January 22, 2009
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco .

TAMPA, Jan. 22 -- Women victimized by spousal abuse are at a substantially increased risk of losing at least one pregnancy, researchers found.

Women who had ever experienced domestic abuse of any kind were 50% more likely to have had a single or repeated stillbirth or spontaneous abortion, Amina Alio, Ph.D., of the University of South Florida here, and colleagues reported in the Jan. 24 issue of The Lancet.

Notably, sexual abuse had the strongest effect on fetal loss overall (OR 1.7, 95% confidence interval 1.3 to 2.2) whereas emotional abuse had the strongest association with multiple stillbirths or miscarriages (OR 1.7, 95% CI 1.2 to 2.3).

The effect of these kinds of nonphysical abuse is often underestimated across cultures, Dr. Alio said.

These findings from a population-based study in Africa, which has the world's highest fetal loss rates, supported prenatal screening for spousal violence, Dr. Alio said.

"Unfortunately, even in the U.S. we don't always screen for domestic violence," she said, adding that the effect would likely be generalizable to the developed world despite lower occurrence.

Claudia Garcia-Moreno, M.D., of the World Health Organization in Geneva, agreed that antenatal screening is appropriate. However, she noted in an accompanying editorial, few interventions have had a demonstrable impact on health outcomes.

Prior studies have linked spousal abuse to fetal demise but rarely distinguished between induced abortion and miscarriage.

So, Dr. Alio's group analyzed findings from a demographic health survey of women in the sub-Saharan nation of Cameroon that differentiated between voluntary and involuntary fetal deaths.

Among the 2,562 women who responded to specific questions regarding abuse under private, anonymous conditions, 51% reported at least one type of abuse from their husband or spouse.

Physical violence was most common (39%), followed closely by emotional abuse, defined as verbal or physical public humiliation or verbal threatening of the woman or her family (31%). Another 15% reported being forced to have sex or perform sexual acts.

Overall, women exposed to any form of domestic violence were at significantly elevated risk of at least one episode of fetal loss compared with women not exposed to abuse (28.8% versus 20.7%, odds ratio 1.5, P<0.0001).

This risk further increased for women exposed to more than one type of abuse by their spouse (31.5% versus 26.0% for one type, P<0.0001).

Recurrent fetal mortality was also more common with any type of spousal abuse than among women not reporting (9.8% versus 6.5%, P=0.002) and rose with multiple types of abuse (11% versus 9%, P=0.002).

Many times women don't consider sexual or emotional abuse to be violence, which screening needs to take into account, she added. "We need to ask the right questions and be a little more specific."

The findings also suggest that screening women who've unintentionally lost a pregnancy is important to potentially prevent recurrence, Dr. Alio's group wrote.

An intervention that could entirely eliminate spousal abuse was estimated to prevent 33% of recurrent fetal losses while reducing the prevalence of spousal abuse by even half would prevent 17% of these losses.

The researchers cautioned, though, that the study was limited by lack of temporal data to indicate whether spousal violence preceded fetal loss.

The researchers reported no conflicts of interest. Dr. Garcia-Moreno reported no conflicts of interest.

Primary source: The Lancet
Source reference: Alio AP, et al "Spousal violence and potentially preventable single and recurrent spontaneous fetal loss in an African setting: cross-sectional study" Lancet 2009; 373: 318-24.

Additional source: The Lancet
Source reference: Garcia-Moreno C "Intimate-partner violence and fetal loss" Lancet 2009; 373: 278-79.

Impact of Exposure to Domestic VIolence on Children and young people

2010-07-18T08:06:00.000-07:00

Stephanie Holt; Helen Buckley; Sadhbh Whelan;

Children's Research Centre, University of Dublin, Trinity College, Dublin, Ireland.

OBJECTIVE: This article reviews the literature concerning the impact of exposure to domestic violence on the health and developmental well-being of children and young people. Impact is explored across four separate yet inter-related domains (domestic violence exposure and child abuse; impact on parental capacity; impact on child and adolescent development; and exposure to additional adversities), with potential outcomes and key messages concerning best practice responses to children's needs highlighted.

METHOD: A comprehensive search of identified databases was conducted within an 11-year framework (1995-2006). This yielded a vast literature which was selectively organized and analyzed according to the four domains identified above.

RESULTS: This review finds that children and adolescents living with domestic violence are at increased risk of experiencing emotional, physical and sexual abuse, of developing emotional and behavioral problems and of increased exposure to the presence of other adversities in their lives. It also highlights a range of protective factors that can mitigate against this impact, in particular a strong relationship with and attachment to a caring adult, usually the mother.

CONCLUSION: Children and young people may be significantly affected by living with domestic violence, and impact can endure even after measures have been taken to secure their safety. It also concludes that there is rarely a direct causal pathway leading to a particular outcome and that children are active in constructing their own social world. Implications for interventions suggest that timely, appropriate and individually tailored responses need to build on the resilient blocks in the child's life. PRACTICE

IMPLICATIONS: This study illustrate the links between exposure to domestic violence, various forms of child abuse and other related adversities, concluding that such exposure may have a differential yet potentially deleterious impact for children and young people. From a resilient perspective this review also highlights range of protective factors that influence the extent of the impact of exposure and the subsequent outcomes for the child. This review advocates for a holistic and child-centered approach to service delivery, derived from an informed assessment, designed to capture a picture of the individual child's experience, and responsive to their individual needs.

PMID: 18752848 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/18752848?ordinalpos=7&itool=EntrezSystem2.PEntrez.P...

Mental Health Consequences of Intimate Partner Abuse

2010-07-18T08:00:00.001-07:00

Mindy B Mechanic; Terri L Weaver; Patricia A Resick;

California State University, Fullerton, CA, USA.

Battered women are exposed to multiple forms of intimate partner abuse. This article explores the independent contributions of physical violence, sexual coercion, psychological abuse, and stalking on symptoms of posttraumatic stress disorder (PTSD) and depression among a sample of 413 severely battered, help-seeking women. The authors test the unique effects of psychological abuse and stalking on mental health outcomes, after controlling for physical violence, injuries, and sexual coercion. Mean scores for the sample fall into the moderate to severe range for PTSD and within the moderate category for depression scores. Hierarchical regressions test the unique effects of stalking and psychological abuse, after controlling for physical violence, injuries, and sexual coercion. Psychological abuse and stalking contribute uniquely to the prediction of PTSD and depression symptoms, even after controlling for the effects of physical violence, injuries, and sexual coercion. Results highlight the importance of examining multiple dimensions of intimate partner abuse.

PMID: 18535306 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/18535306?ordinalpos=76&itool=EntrezSystem2.PEntrez....

Controling & Obsessed People Blurb

2010-07-11T10:45:00.000-07:00

It is sad that people who can't be satisfied with their own lives, have to resort to abuse, stalking, harassment, and malicious tactics. Prayers & healing being sent to all those very sad lives.

Happy we are transitioning out of retrograde. All these negative events thrown at you only makes one stronger and better equipped to stand tall and strong with your feet firmly planted on the ground. - Oct 2009