Doctors urged to screen women for domestic abuse

By Monte Morin, Los Angeles Times

January 21, 2013, 8:02 p.m.

 

Asking standard questions of female patients of childbearing age shows a 'moderate net benefit' and little risk, a federal advisory panel says.

Women of childbearing age should undergo screening for domestic violence and other forms of abuse while visiting their doctor or clinic, according to a recommendation published online Monday by an influential panel of medical experts that advises the federal government.

 

That recommendation, published in the Annals of Internal Medicine, marks a significant change from 2004 when the U.S. Preventive Services Task Force found insufficient evidence to support screenings for so-called intimate partner violence, or IPV.

 

Now, citing new evidence, the task force said that screening women for IPV with a list of standard questions showed a "moderate net benefit," while the risks associated with disclosing abuse were small.

"The bottom line is that more research is needed on how primary-care clinicians can effectively screen and protect all populations, including older and vulnerable adults, middle-aged women, men and children from abuse and violence," said Dr. David Grossman, a Seattle pediatrician and task force member.

The guidelines apply only to women aged 14 to 46 who do not show obvious signs of physical or sexual abuse that would otherwise prompt questions from healthcare providers. Though the report acknowledged that women of childbearing age were not the only people who suffered abuse at the hands of former or current intimate partners, evidence was still insufficient to recommend broader screenings, the authors said.If abuse is confirmed, physicians should provide patients with, or refer them to, intervention services, the panel said. Such services include counseling, home visits, information cards, community service referrals and mentor programs.

 

In a separate draft statement addressing child maltreatment, task force members said there wasn't enough evidence to recommend how clinicians could prevent abuse among children who lacked obvious symptoms.

 

Intimate partner violence includes physical violence, sexual abuse, psychological abuse, stalking and reproductive coercion — intimidation that increases the risk of unplanned pregnancy. The Centers for Disease Control and Preventionestimates that nearly 31% of women and 26% of men have experienced IPV in their lifetimes. Immediate health consequences include injury, death, sexually transmitted diseases, unintended pregnancy, psychological distress and premature births.

 

Screening for domestic violence is recommended by the American Congress of Obstetricians and Gynecologists for women of all ages. Other organizations, such as the American Medical Assn., encourage physicians to inquire about abuse in all patients as part of medical history, but do not recommend a specific screening format or list of questions.

 

Monday's recommendation by the task force could possibly steer organizations toward adopting a more standardized protocol, according to some healthcare providers.

 

"This is very significant," said Eric Ferrero, a Planned Parenthood spokesman who was not involved in the study. "It's just good practice to know a patient's health history, and we have been conducting screenings for a number of years. Hopefully, with this recommendation, it will be done more broadly."

In the case of Planned Parenthood, which treats about 3 million patients in 800 facilities, IPV screenings were sometimes the first time that patients spoke of or even acknowledged abuse, Ferrero said. "We know, at least anecdotally, that this first discussion has led some women to leave an abusive relationship."

 

The task force recommendation was based on a review of dozens of studies and interviews with more than 30,000 people. Screenings were conducted several ways. Some women were questioned face to face by their healthcare provider and others performed self-screenings, answering questions on either a computer or a printed questionnaire.

monte.morin@latimes.com

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

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.

Study links persistent depression to childhood abuse

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

(c) Copyright Thomson Reuters 2011

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

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

Mental Health Consequences of Intimate Partner Abuse

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....