Physical and sexual abuse occurs in girls and boys of all ages, in all ethnic groups, and at all socioeconomic levels. The abuses vary widely with respect to their severity and duration, but any form of continued abuse constitutes an emergency situation for the child. Fear, guilt, anxiety, depression, and ambivalence regarding disclosure commonly surround children who have been abused.

In child neglect, a child’s physical, mental, or emotional condition has been impaired because of a parent’s or caretaker’s inability to provide adequate food, shelter, education, or supervision. In its extreme form, neglect can contribute to failure to thrive. Failure to thrive typically occurs under circumstances in which adequate nourishment is available yet a disturbance within the relationship between the caretaker and the child results in a child who does not eat enough to grow and develop. More than 50 percent of abused or neglected children were born prematurely or had low birth weight. Many abused children are perceived by their parents as difficult, slow in development or mentally retarded, bad, selfish, or hard to discipline. More than 80 percent of abused children are living with married parents at the time of the abuse, and 90 percent of abusing parents were abused by their own parents.

The only sure way of proving infant abuse or neglect, other than catching the perpetrator in the act, is to show that significant recovery occurs when the caretaking is altered. All markedly deprived infants should warrant an investigation of the social and environmental conditions of the family and the psychological status of the parent to determine the factors responsible for inadequate and destructive treatment. Parents who abuse substances, who have psychotic or pronounced mood disorders, or who have severe personality disorders are at higher risk for impaired judgment and potentially abusive behavior.

Child abuse and neglect may be suspected when a child appears unduly afraid (especially of the parents); is kept confined for overly long periods of time; shows evidence of repeated skin or other injuries; is undernourished; is dressed inappropriately for the weather; cries often; or has bruising, pain, or itching in the genital or anal region or repeated urinary tract infections and vaginal discharge. Unusually precocious knowledge of sexual acts may indicate sexual abuse. Clinicians are required to report suspected cases of child abuse or neglect and must be familiar with the current laws and regulations in their individual states.

Sexual or physical abuse of adults, including elderly adults, is also a major problem in the United States. Spouse abuse, for example, is thought to occur in as many as 12 million families in this country, and there are estimated to be almost 2 million battered wives. About 10 percent of rapes are perpetrated by close relatives, and 50 percent are committed by men known to varying degrees by the victims. Elder abuse is seen in nursing homes and other institutions, as well as in some private households where the demands of caring for a frail, helpless, or demented person can lead individuals to commit acts of physical or sexual abuse.

Students should study the questions and answers below for a useful review of these problems.