Transcript Children and Domestic Violence Dr Joanna Sales

Children and Domestic
Violence
Dr Joanna Sales
Consultant Child and Adolescent
Psychiatrist and Clinical Director
Oxleas NHS Trust
AIMS
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Understand context of domestic violence
Understand the impact upon women
Understand the repercussions for children
Adults: Definition
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“Intention or perceived intention of
physically injuring another person”
Includes actual and threatened violence,
psychological abuse and sexual assault
Repetitive and tends to escalate in
frequency and severity
Factors such as pregnancy and alcohol
abuse may potentiate
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“Violence between adult partners occurs in
all social classes, all ethnic groups and
cultures, all age groups, in disabled people
as well as able bodied, and in both
homosexual and heterosexual
relationships. It may involve abuse,
accusation, and innuendo; deprivation of
freedom; or physical or sexual assault.
Women are more likely to be injured than
men in domestic incidents, but men are not
necessarily the initial aggressors.” D. Hall, 1998
Adults: “Battered Woman
Syndrome” :1
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Higher rates of anxiety, depression, fear,
physical complaints and PTSD, eating
disorders
Women slide into helplessness, emotional
paralysis, coping strategies disappear and
they cannot act to change the situation
Adults: “Battered Woman
Syndrome” :2
Predictors of “battered woman syndrome”
include:
Battering in the home as a child; history of
sexual abuse; traditionality; health problems;
pathological jealousy; sexual assault; threats to
kill; psychological torture (isolation, induced
debility, verbal degradation, hypnosis, drugs,
occasional indulgences)
Adults: “Battered Woman
Syndrome”: 3
“Traumatic bonding” may develop Cannot leave; cannot be disloyal
 Adopt abusers belief system, believing
that they deserve punishment
 Not helped by lack of safe havens and lack
of faith in criminal justice system
The Cycle Of Violence
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Not inevitable, but requires certain factors to
interact along the way
Physical abuse as child factor for later
perpetrating of abuse
May be re-enactment of earlier experiences of
abuse-may be compulsion, re-experiencing of
trauma
May be defence against overwhelming feelings
of hopelessness and vulnerability
Post Traumatic Stress Disorder
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Recognised pattern of symptoms that
develop as a result of acute or chronic
stress
Traumatic incident at time
Re-experience of traumatic event in some
form, plus avoidance of situations, plus
hyper vigilance and arousal
Children: How Big Is The
Problem? :1
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3 million children in US at risk of witnessing
serious assault of one parent by the other
70% of domestic violence is witnessed by a child
in the home
70% of women seeking sanctuary take a child
with them
40-50 children a year lose a parent when one
kills the other; 30% will witness directly
Children: How Big Is The
Problem? :2
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Children in violent households are three to
nine times more likely to be injured and
abused, either directly or while trying to
protect their parent.
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Conversely, in 60% of cases where
children have been abused the mother will
also have been a victim.
Children: How Big Is The
Problem? :Associations
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Juvenile crime
Bullying
Educational Failure
Social Isolation
Developmental difficulties
Other disorders
Parental Relationships
Disordered attachment
Attacking father
Traumatised mother
Traumatised child
How Are Children Affected? :1
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Cardiff Study-148 children <16
Poor access to services
Developmental difficulties ( 3-4 on Denver
Scales)
49 % probable behavioural difficulties
76% mothers concerned about their
children
36 returned home to perpetrator
How Are Children Affected? :2
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The younger, the more vulnerable
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Note insecure attachment and PTSD
Boys are more vulnerable-effects on gender
identity formation, assume role of assailant,
irritability
Mothers assume irritability in boys is aggression
and label it accordingly
Girls show anxiety, depression and withdrawal
Example: Family A
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Mother-severely abused, poorly
functioning
Oldest child-severe PTSD, agoraphobic
and clingy, protective of mother
Second child (favoured by father)-conduct
disorder
Third child (stabbed by father)-emotional
and conduct disorder
Example: Family B
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Father-alcohol problems in conjunction
with physically abusive behaviour
Mother-PTSD, on top of fairly good
functioning
Children-PTSD
Prognosis-Good
Will Boys Become Violent in
Turn?
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In very violent homes, 1000 times more likely
than in non-violent homes
Violent men have often seen their mothers
subjected to violence
Victim women have often seen their mothers
subject to violence
Social learning theory-children copying the adults
they see
Attachment theory-insecure men lashing out,
identify with the men that they know
Emotional and Behavioural
Problems
Social Isolation
PTSD
Insecure
Attachment
CHILD
Rejection
Witnessing Violence
Abuse
Emotional and
behavioural
problems
Battered Women and Battered
Children
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Using conservative definitions of child
abuse, the co-occurrence rate is 40%
when there is domestic violence against
the mother
How severely mother is affected influences
what happens to children
Problems Seen
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Infants ( note need for attachment)
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Sleeping, feeding difficulties, excessive crying
Preschool children
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Separation anxiety, psychosomatic problems,
abdominal pain, whingeing, nightmares,
irritability, stuttering, regressive behaviours
Problems Seen
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Middle childhood
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Self-blame, psychosomatic behaviours,
regressive behaviours, aggressive behaviours
Adolescents
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Truancy, delinquency, substance abuse
early sexual activity
interpersonal problems
Other Factors Playing a Part
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Children’s lives are disrupted in many waysmoves of school, home, changes in socioeconomic position
Relative lack of parental supervision and
parental control
Greater likelihood of parental disagreement
Behavioural problems relate to the degree of
violence, mother’s mental state, and factors are
potentiating, not additive
What Protects?
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Not invariable that all children develop
problems-only 1/3 of boys and 1/5 of girls
Personality may protect
One good relationship protects
Good relationship with adult outside of family, or
with a sibling
School success
Higher cognitive ability and coping with previous
stresses
Women don’t tell
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Afraid the the children will be removed
Thought that the children would be OK
Don’t know who to tell or go to
Feel guilty themselves
References
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Hall D, Lynch MA. Violence begins at home. BMJ
1998; 316: 1551-1560
Webb, E. The health of children in refuges for women
victims of domestic violence: cross sectional
descriptive survey BMJ 2001;323 210-213
Abrahams C. The hidden victims, children and
domestic violence. London: NCH Action for
Children, 1994.