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Flashcards in Aggression and Abuse Deck (64):
1

Children at risk of showing aggressive behavior in adulthood?

1. Frequently moved and changed schools repeatedly.
2. Have been physically and/or sexually abused.
3. Mistreat animals and younger or weaker children.
4. Cannot defer gratification.
5. Their parents frequently display criminal behavior, and abuse drugs and alcohol.

2

Homicide occurs more often in ...?

In LOW socioeconomic populations and its incidence is INCREASING.

3

How many homicides result from guns?

At least half.

4

Biological determinants of aggression - Hormones:

1. Androgens are closely associated with aggression.
2. Homicides involving strangers is commited almost exclusively by MEN.

5

Androgenic or anabolic steroids, often taken by bodybuilders to increase muscle mass, can result in ...?

HIGH LEVELS OF AGGRESSION and evem psychosis.
--> SEVERE DEPRESSION frequently occurs in withdrawal from these hormones.

6

What is therefore useful in treating malee sex offenders?

Estrogen, progesterone, and antiandrogens.

7

Substances of abuse and their effects on aggression:

1. Low doses of alcohol + barbs --> INHIBIT AGGRESSION, while high doses facilitate it.
2. While intoxicated HEROIN users show LITTLE aggression, INCREASED aggression is associated with cocaine + amphetamines + PCP.

8

Neural bases of aggression - Serotonin and GABA?

INHIBIT aggression.
--> Low levels of serotonin metabolite (5-HIAA) are seen in people who show impulsive aggression.

9

Neural bases of aggression - Dopamine and NE:

FACILITATE AGGRESSION.

10

Neural bases of aggression - Drugs used to treat inappropriate aggressiveness include:

1. Antidepressants.
2. Benzos.
3. Antipsychotics (particularly atypical agents).
4. Mood stabilizers (eg Lithium).

11

Neural bases of aggression - Abnormalities of the brain:

1. Abnormal activity of the amygdala and prepiriform area.
2. Psychomotor + Temporal lobe epilepsy.
3. Lesions of the temporal lobes, frontal lobes, and HYPOTHALAMUS.

12

Violent people often have a history of ...?

HEAD INJURY or show abnormal EEG readings.

13

Abuse and neglect of childreen and the elderly - Types of child (65) abuse include:

1. Physical abuse.
2. Emotional or physical NEGLECT.
3. Sexual abuse.
--> The elderly may also be exploited for monetary gain.

14

Abuse-related injuries must be differentiated from injuries obtained during normal activity. Examples of accidental (ie non-abuse) injuries in children include ...?

1. Bruises.
2. Scrapes.
on BONY PROMINENCES (eg chin, forehead, kness, elbows) or, in the elderly, bruising on extensor surfaces of the limbs.

15

Physical abuse of children and elders - Annual occurrence - Child physical abuse:

At least 1 million cases are reported.
--> MOST CASES ARE NOT REPORTED.

16

Physical abuse of children and elders - Annual occurrence - Elder physical abuse:

Same as children.

17

Physical abuse of children and elders - Most likely abuse - Features of child physical abuse:

The closest family member (eg the mother).

18

Physical abuse of children and elders - Most likely abuser - Elder physical abuse:

The closest family member (eg spouse, daughter, sone, or other relative) with whom the person lives (and who is often supported financially by the elder).

19

Physical abuse of children and elders - Characteristics of the abused - Child?

1. Hyperactivity or mild physical handicap - Child is perceived as slow or different.
2. Premature, low-birth-weight infant.
3. Colicky or fussy infant.
4. Physical resemblance to the abuser's absent, rejecting, or abusive partner.
5. In 1/3 of cases victims are YOUNGER THAN 5yr of age.
6. In 1/4 of cases victims are 5-9yr of age.

20

Physical abuse of children and elders - Characteristics of the abused - Elder:

1. Some degree of worsening cognitive impairment (eg Alzheimer disease).
2. Physical dependence on others.
3. Incontinence.
4. Does NOT report the abuse, but instead says that he fell and injured himself.

21

Physical abuse of children and elders - Characteristics of the abuser - Child?

1. Substance abuse.
2. Poverty.
3. Social isolation.
4. Delays seeking treatment for the victim.
5. Personal history of abuse by caretaker or spouse.

22

Physical abuse of children and elders - Characteristics of the abuser - Elderly?

1. Substance abuse.
2. Poverty.
3. Social isolation.
4. Delays seeking treatment for the victim.

23

Physical abuse of children and elders - Signs of abuse - Neglect - Child?

1. Poor personal care and hygiene (eg diaper rash, dirty hair).
2. Lack of needed nutrition.

24

Physical abuse of children and elders - Signs of abuse - Neglect - Elder?

1. Poor personal care and hygiene (eg urine odor in incontinent person).
2. Lack of medication or health aids such as eyeglasses, or dentures.
3. Lack of needed nutrition.

25

Physical abuse of children and elders - Signs of abuse - Bruises - Child:

1. Particularly in the areas not likely to be injured during normal play, such as buttocks or lower back, or not over bony prominences.
2. Belt or belt-buckle marks.

26

Physical abuse of children and elders - Signs of abuse - Bruises - Elder?

Often on the inner (flexor) surfaces of arms from being grabbed.

27

Physical abuse of children and elders - Signs of abuse - Fractures and burns - Child?

1. Fractures at different stages of healing.
2. Spiral fractures at different stages of healing.
3. Cigarette and other burns.
4. Wrist or ankle rope burns caused by tying to a bed or chair.
5. Burns on the feet or buttocks caused by immersion in hot water.

28

Physical abuse of children and elders - Signs of abuse - Fractures and burns - Elder?

1. Fractures at different stages of healing.
2. Spiral fractures caused by twisting the limbs.
3. Cigarette and other burns.
4. Wrist or ankle rope burns caused by tying to a bed or chair.

29

Physical abuse of children and elders - Other signs - Child:

1. Internal abdominal injuries (eg ruptured spleen).
2. "Shaken baby" syndrome (ie retinal detachment or hemorrhage, and subdural hematoma caused by shaking the infant to stop it from crying).
3. Injuries of the mouth caused by forced feeding.

30

Physical abuse of children and elders - Other signs - Elderly?

1. Internal abdominal injuries (eg ruptured spleen).
2. Evidence of depleted personal finances (the elder's money was spent by the abuser and other family members).
3. Injuries of the mouth caused by forced feeding.

31

Sequela of child abuse:

1. Children often seem sad.
2. Show behavioral changes (eg are no longer outgoing and friendly).
3. Do poorly in school.

32

Adults who WERE ABUSED as children are more likely to:

1. Have dissociative disorders (eg dissociative identity disorder) and borderline personality disorder.
2. Have posttraumatic stress disorder and other anxiety disorders.
3. Have depression and substance abuse disorders.
4. Abuse their own children.

33

SEXUAL abuse of children - Signs:

1. STDs in children.
2. Genital or anal trauma.
3. Young children often have vague knowledge about sexual activities; specific knowledge about sexual acts (eg fellation) in a young child often indicates that the child has been sexually abused.
4. Recurrent UTI + Excessive initiation of sexual activity with friends or with younger children.

34

Sexual abuse of children - Occurrence:

Estimated 500.000 American children are SEXUALLY ABUSED PER YEAR.

35

Most sexually abused children are ...-... yr of age.

8-13 (25% are

36

Approx. ...% of women and ...-...% of men report sexual abuse at some time during their childhood and adolescence.

20% and 5-10%.

37

Characteristic of the sexual abuser?

1. 70-90% of sexual abusers are KNOWN TO THE CHILD (90% are men).
2. About 50% of these men are relatives (eg uncle, father, stepfather).
3. 50% family acquintances (eg mother's boyfriend, neighbor).
4. Alcohol and drugs are commonly used by the abuser.
5. The abuser typically has marital problems and no appropriate alternate sexual partner; ie he prefers children to appropriate sexual partners.

38

Physical and sexual abuse of domestic partners - Domestic partners are ...?

Couples who live together and share living expenses and household responsibilities.

39

Domestic partners - Abuse occurs when ...?

One partner has POWER (physical, financial, psychological) over the other.

40

Domestic abuse occurs between ...?

1. Married couples (spouse abuse).
2. Unmarried heterosexual or homosexual couples.
3. Adult siblings.
4. Couples with other domestic arrangements.

41

A common reason women come to a hospital ER?

Domestic abuse.
--> May be physical or sexual and the abuser is almost always male.

42

Evidence of domestic abuse?

1. The victim commonly has bruises (eg blackened eyes) and broken bones.
2. In pregnant women (who HAVE a higher risk of being abused), the injuries are often in the "baby zone" (ie, the breasts and abdomen).
3. An irrational explanation of how the injury occurred, delay in seeking treatment, and appearance of sadness in the victim are other indications of domestic abuse.

43

The cycle of abuse includes 3 phases:

1. Buildup of tension in the abuser.
2. Abusive behavior (battering).
3. Apologetic and loving behavior by the abuser toward the victim.

44

Physical and sexual abuse of domestic partners - Characteristics of the abuser:

1. Almost always male.
2. Often uses alcohol or drugs.
3. Impulsive and angry.
4. Low tolerance for frustration.
5. Threatened to harm the abused if he or she reports or leaves him.
6. Shows apologetic and loving behavior after the abuse.
7. Has low self-esteem.

45

Physical and sexual abuse of domestic partners - Characteristics of the abused?

1. Has been raised in a home in which there was domestic abuse.
2. Is financially or emotionally dependent on the abuser.
3. Can be male or female.
4. Blames him- or herself for the abuse.
5. May neither report to the polic nor leave the abuser.
6. Has low self-esteem.

46

The role of the physician in suspected child, elder, and domestic partner abuse - Child and elder abuse - According to the law of every state ...?

Physicians MUST REPORT suspected physical or sexual abuse of a child or elderly person, or of an adult who appears to be physically or mentally impaired, to the appropriate family social service agency (eg state child-protective service or state adult-protective service) BEFORE or IN CONJUNCTION WITH TREATMENT of the patient.

47

The physician is NOT REQUIRED TO ...?

Tell the suspected abuser of the child or impaired elder that he or she suspects abuse.

48

The physician DOES NOT NEED ...?

FAMILY CONSENT to hospitalize the abused child or elderly person for protection or treatment.

49

Even if there was NO INTENTION TO INJURE, if a cultural remedy such as "coining" injures a child or elderly person, such injury ALSO MUST ...?

BE REPORTED TO THE APPROPRIATE AGENCY.

50

Domestic partner abuse - Direct reporting by the physician of domestic partner abuse is ...?

NOT APPROPRIATE because the victim is usually A COMPETENT ADULT between the ages 18-64.

51

A physician who suspects domestic partner abuse should:

1. Document the abuse.
2. Ensure the safety of the abused person.
3. Provide emotional support to the abused person.
4. Develop an emergency escape plan for the abused person.
5. Refer the abused person to an appropriate shelter or program.
6. Encourage the abused person to report the case to law-enforcement officials.

52

Sexual aggression - Rape - Definition:

A crime of violence, not of passion, and is known legally as "sexual assault", or "aggravated sexual assault".

53

Sodomy is defined as ...?

The insertion of the penis into the oral or anal orifice.
--> The victim may be male or female.

54

Sexual aggression - Rape and related crimes - Legal considerations - Rapists may use condoms to avoid ...?

Contracting HIV or to avoid DNA identification, or because they may have difficulty with erection or ejaculation --> SEMEN MAY NOT BE PRESENT IN THE VAGINA OF THE RAPE VICTIM.

55

A victim is NOT REQUIRED to prove that she ...?

Resisted the rapist for him to be convicted.
--> A rapist can be convicted even though the victim asks him to use a condom or other form of sexual protection.

56

Certain info about the victim (eg previous sexual activity, "seductive" clothing worn at the time of the attack) is generally ...?

NOT ADMISSABLE as evidence in rape trials.

57

Husbands can be prosecuted for forcing ...?

Their wives to have intercourse.
--> It is ILLEGAL to force anyone to engage in sexual activity.

58

"Date rape"?

EVEN IF a woman consents to go on a date with a man and consents to sexual activity NOT INVOLVING INTERCOURSE, a man can be prosecuted for rape.

59

Characteristics of the rapist and victim - The rapist:

1. Rapists are usually younger than 25 yr.
2. Usually the SAME RACE as the victim.
3. Usually known to the victim.
4. Often use alcohol.

60

Characteristics of the rapist and victim - The victim:

1. Rape victims are most typically between 16-24yr of age.
2. Rape MC occurs inside the victim's home.
3. Vaginal injuries MAY BE ABSENT, particularly in parous women (those who have had children).

61

The sequela of rape:

1. For a variety of reasons, including shame, fear of retaliation, and the difficulties involved in substantiating rape charges, only 25% of all rapes are reported to the police.
2. Others may commonly blame the victim in rape cases.
3. The length of the emotional recovery period after rape varies, but is commonly at least 1yr.
4. Posttraumatic stress disorder sometimes occurs after rape.
5. The most effective type of counseling is group therapy with other rape victims.

62

The role of the physician in rape cases - Immediately after the rape, the physician should:

1. Take the patient's history in a supportive manner, and not question the patient's veracity or judgement.
2. Perform a general physical exam and conduct lab tests (eg cultures for STDs from the vagina, anus, and pharynx; test for presence of semen).
3. Prescribe prophylactic antibiotics and postcoital contraceptive measures (eg levonorgestrel) if appropriate).
4. Encourage the patient to notify the police. The doctor is NOT required to notify the police if the woman is a competent adult.

63

The role of the physician in rape cases - Up to 6wks after the rape:

1. Discuss with the patient the emotional and physical sequelae of the rape (eg suicidal thoughts, vaginal bleeding) and, if needed, refer her for long-term counseling or a support group.
2. Do A PREGNANCY TEST and repeat other lab tests if appropriate.

64

Aggression - Social determinants of aggression - Factors associated with aggression?

1. Poverty.
2. Frustration.
3. Physical pain.
4. Exposure to aggression in the media (eg violence on television).