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M09.03.016 Abuse
Abuse involves acts that cause physical harm, neglect, sexual exploitation, or mental cruelty. It is a significant concern in healthcare, especially when it involves children, the elderly, or domestic partners. Here’s a breakdown of key information and physician responsibilities when abuse is suspected.
Types of Abuse and Reporting Requirements
Abuse is divided into three main categories: Child Abuse, Elder Abuse, and Domestic Abuse. Each category has distinct characteristics, reporting requirements, and physician responsibilities.
Child Abuse
- Definition: Abuse resulting in physical injury, neglect, or sexual exploitation in individuals under 18 years.
- Reporting: Mandatory to report any suspected abuse for individuals under 18. Failure to report is a criminal offense.
- Physician’s Responsibility: Protect the child first (e.g., by separating from the caregiver if necessary) and then report the case. If reported in error, physicians are legally protected.
Elder Abuse
- Definition: Abuse, neglect, or exploitation of individuals typically over the age of 65.
- Reporting: Mandatory reporting in cases of suspected elder abuse.
- Physician’s Responsibility: Protect and report suspected abuse cases.
Domestic Abuse
- Definition: Physical, psychological, or financial abuse of an intimate partner.
- Reporting: Not mandatory for physicians.
- Physician’s Responsibility: Offer counseling, information, and resources (e.g., local shelters). Educate the victim about the available support systems as they may often blame themselves or identify with the aggressor.
Signs and Symptoms of Abuse
- Physical Abuse:
- Common indicators: Bruises, burns, lacerations, especially in soft tissues (arms, legs, trunk).
- Red flags: Injuries that do not match the caregiver’s explanation or unusual injury locations.
- Specifics:
- Child Abuse: Broken bones within the first year, STDs, bruises in hidden areas.
- Shaken Baby Syndrome: Retinal hemorrhages (broken blood vessels in the eyes).
- Non-accidental Burns:
- Associated with poor prognosis.
- Types: Intentional burns often present distinct patterns (e.g., immersion burns).
- Cultural Considerations:
- Certain practices like coining or moxibustion may mimic abuse. Recognize these as cultural but treat practices like female circumcision as abuse.
Summary Table of Abuse Types
| Type of Abuse | Child Abuse | Elder Abuse | Domestic Abuse |
|---|---|---|---|
| Annual Cases | >2 million | Caregivers, often spouses | >4 million |
| Most Common Type | Physical battery/neglect | Neglect, psychological, physical | Physical battery |
| Likely Victim Age | <5: Female, >5: Male | Older adults, primarily female | Primarily female |
| Perpetrator | Typically female | Sexual abuse involves an age gap of 5 years between victim <18 and perpetrator; 50% family members involved; underreported | Primarily male |
| Mandatory Report | Yes | Yes | No |
| Physician Response | Protect and report | Protect and report | Counseling, information |
| Additional Notes | Sexual abuse involves an age gap of 5 years between victim <18 and perpetrator; 50% of family members involved; underreported | Elder neglect is common | Victims may blame themselves or defend the abuser |
Points to Remember
- Child abuse must be reported up to age 18; legal immunity applies if reported in error.
- Look for inconsistencies between reported history and injury type/location.
- Recognize intentional burns and shaken baby syndrome for appropriate intervention.
- Cultural practices can resemble abuse but require careful assessment.