Subject: PSYCHIATRY 2

Topic: ABUSE AND NEGLECT

Lecturer: DR.UY
Shifting /Date: 4TH SHIFTING/ JAN 29, 2009
Trans group: kix, ces, pau, may

ABUSE AND NEGLECT

REPUBLIC ACT NO. 7610 ETIOLOGY

An act providing for stronger interference and special protection  “Perpetrator”: Parents (?)
against child abuse, exploitation and discrimination, and for other  Stressful Living /condition
purposes  Child characteristics

CHILDREN refers to: THE PERPETRATOR

 person below eighteen (18) years of age or  often known to the child
 those who are over but are unable to fully take care of  Mother (physical abuse)
themselves from abuse, neglect, cruelty, exploitation or  Men (sexual abuse)
discrimination because of a physical or mental disability or  Active baterrer and passive baterrer
condition;  Inappropriate expectations, treat as older
 Physically abused as a child
CHILD ABUSE
1. Psychological and physical abuse, neglect, cruelty, sexual PARENTS
abuse and emotional treatment  Parents as victims
2. Any act by deeds or words which debases, degrades or
 mental incapacity/ lack of coping mechanisms
demeans the intrinsic worth and dignity or a child as a
human being  substance abuse
3. Unreasonable deprivation of his basic needs for survival,
such as food and shelter ENVIRONMENT
 28% of children under age 5 are severely and moderately  overcrowding
underweight based on international standards (World  housing problems
Summit Goals for children, 1998)  poverty, unemployment
 49% of the total population of infants and 26% of the total  social isolation
population of the children with ages ranging from 1-6 years  conflict areas
old suffer from iron deficiency anemia
4. Failure to immediately give medical treatment to an injured CHILD FACTORS
child, resulting in serious impairment of his growth and  premature
development or on his permanent incapacity or death  mentally retarded
 Infant mortality rate is pegged at 42.73 per 1000 livebirths  physically disabled
(DOH)  difficult children
 there is one hospital for every113, 040 people
 there is only one doctor for every 24, 417 people; CLINICAL PICTURES OF CHILD ABUSE (ER)
 1 nurse for every 22, 3309  body trauma, bruises, abrasions, cuts, laceraions, burns,
 1 dentist for every 578, 124 and hematomas, soft tissue swelling
 1 midwife for every 722, 654 people  inability to move extremity
(Philipppine Textbook of Statistics)  abdominal injury
 hypernatremic dehydration
EPIDEMIOLOGY  neurological deficits, seizures, coma
 Research studies conducted in schools that for every 3
Filipino children, one child experiences abuse (Manila DIAGNOSIS OF PHYSICAL ABUSE
Bulletin, 11 February 1996)  multiple spinal fractures
 There were 2393 children who fell prey to rape, attempted  retinal hemorrhages
rape, incest, acts of lasciviousness and prostitution (DSWD  children repeatedly brought to the hospitals for treatment of
1st semester CY 1999) peculiar or puzzling problems by overly cooperative
 parents(Munchausen Syndrome by proxy)
CHILD ABUSE AS SERVICED BY DSWD:  bruises and injuries that are incompatible with history
 Sexually abused -4,129  symmetry or regular patterns
 Neglected – 2,549  shape of the instrument of abuse
 Physically abused – 1,440  immersion in water
 Victims of Child Labor – 358
 Sexually exploited-284 CHILD AND YOUTH WELFARE CODE OF THE PHILIPPINES
Article 59 of PD 603 1974
Criminal liability shall attach to any parent who:

MARY YVETTE ALLAIN TINA RALPH SHERYL BART HEINRICH PIPOY KC JAM CECILLE DENESE VINCE HOOPS CES XTIAN LAINEY RIZ KIX EZRA GOLDIE BUFF MONA AM MAAN ADI KC PENG
KARLA ALPHE AARON KYTH ANNE EISA KRING CANDY ISAY MARCO JOSHUA FARS RAIN JASSIE MIKA SHAR ERIKA MACKY VIKI JOAN PREI KATE BAM AMS HANNAH MEMAY PAU RACHE
ESTHER JOEL GLENN TONI
 Subject: psychiatry
Topic:abuse and neglect
Page 2 of 3
STATUTORY RAPE
1. Conceals or abandons the child with an intent tot make such - intercourse between a man over 16 years old and a woman
child lose his civil status under the age of consent

2. Abandons the child under such circumstances as to deprive RESULTANT PSYCHOLOGICAL EFFECTS
him of love, care and protection she needs  there are 1.5 M •Vulnerability depends on….
street children. DSWD estimates that this number increases -type of abuse
annually by 6,365 -its chronicity
-age of the child
3. Sells or abandons the child to another person for a valuable -overall relationship of the victim and abuser
consideration  anxious, hyperalert, depressed
 of the 1.5 M streetchildren 60,000 are prostituted (ECPAT  PTSD, dissociative personality disorder
1996)  substance abuse
 the DSWD claims that the annual average increase of the
prostituted children 3,266. DIFFERENTIAL DIAGNOSIS:
 the Philippines is the fourth country with the most number of  Parental feuding and custody disputes
prostituted children (Intersect, December 1995)
TREATMENT OF CHILD ABUSE
4. Neglects the child by not giving him the education which the  Ensure safety and well-being
family’s station in life and financial conditions permit  Treat emergent conditions
 only 19% of children aged 4 to 6 years old are able to go to  Counseling
public schools and private preschools  Reporting
 60% of the children drop out of the school when they reach  Prevention – education, identification
grade 2 (PDI, 18 May 1997)
 62 towns in the country do not have a high school PHYSICAL ABUSE OF ADULT
 Spouse abuse
CLINICAL FEATURES OF A NEGLECTED CHILD
 Husband’s aggression is bullying behavior to humiliate their
 overt failure to thrive less than 1 yr old wives and build their own self- esteem
 malnutrition -threatened or frustrated at home, work and peers
 poor skin hygiene
 inappropriate dress DYNAMICS:
 physical and developmentally depressed  Identifying with the aggressor
PHYSIOSOCIAL DWARFISM  Testing behavior
 distorted desires to express manhood
PSYCHOLOGICAL FEATURES  Dehumanization of women
 Behavior: withdrawn and frightened
 aggressive and labile mood FEATURES OF SPOUSE ABUSE:
 depression, low self- esteem anxiety -Pregnant
 delay in developmental milestones -Broken limbs and ribs
-Internal Bleeding
LABORATORY EXAMS -Brain damage
 physical exam - Emotional drama
 endocrinological exam -Dependence
-Lack of self-esteem
 external genital examination
-Fear of life
 radiologic exam: fractures at different stages of healing
HISTORY AND PHYSICAL EXAM
SEXUAL ABUSE
 Interview alone, without partner present
 Simple and direct questions
ABUSER: adults within the immediate or extended family
 Confidential setting
 History is difficult to obtain
If yes....
Clinical Features:
1. encourage her to talk about it
-most often, no definitive physical evidence unless profound
2. listen non-judgmentally
injury
3. validate
-Genital injury
4. document
- STD in child
5. assess the danger to your patient
-no specific behavioral manifestations prove that sexual abuse
6. provide treatment, referral and support
has taken place
-young children with detailed knowledge
If no....
-play and may initiate with peers
-extremely fearful of adults  beware of the clinical findings that may indicate abuse:
- injury to the head, neck, torso, breast, abdomen, ang
genitals
 Subject: psychiatry
Topic:abuse and neglect
Page 3 of 3
-bilateral or multiple injuries  Requires only slight penile penetration of the victim’s outer
-delay between onset of injury and seeking treatment vulva
-explanation of patient inconsistent with the type f injury  an average of seven women were raped daily in the
-any injury during the pregnancy Philippines
-chronic pain symptom s
-psycological distress, sleep disorders, suiciadal ideation
-prior history of trauma
-partner who seem overly protective or will not leave her side

SEXUAL COERCION
-one person predominates the other by force or compels the
other person to perform a sexual act RAPE OF WOMEN
 Male Rapists
STALKING -Sexual sadists (arouse by pain or their victims)
 A pattern of harassing or menacing the behavior coupled with a -Exploitive predators (victims as objects of gratification)
threat to do harm -Inadequate men
 Most are men but women who stalk are just likely as men to -Men who rape because of anger and rage
attack their victims violently  often accompanies another crime
 Women can be raped at any age
SEXUAL HARASSSMENT  Commonly occurs in own neighborhood or frequently inside
 Sexual advances, request for sexual favors, verbal or physical or near her home
conduct of sexual nature- all of which are unwelcomed by the  most are premeditated
victim  half by strangers
 if a man is being harassed usually by another man  10% involve more than one attacker
 Behavioral Types: abusive language, request for special DATE RAPE
favors, sexual jokes, staring, ogling, and giving messages. -Aquaintance rape
 Victims: don’t come forward due to fear -rapist is known to the victim
RAPE In addition to the same symptoms of rape
Conventional definition: perpetration of an act of sexual -berate themselves for poor judgment in choice of male
intercourse with a woman against her will and consent friends
Whether her will is overcome by a force or fear or by -more likely to blame themselves
drug or toxicants
She is incapable of exercising rational judgment CLINICAL EFFECTS
Below arbitrary age of consent  During the rape- shock, fright, and panic
- But can occur between married partners, or persons of the  Primary Motivation- to stay alive
same sex
 After the rape- shame, humiliation, confusion, fear and
rage
RAPE IS COMMITTED:
1. By a man who shall have carnal knowledge of a woman
The type, reaction and degree of damage vary:
under any of the following circumstances:
-violence of attack itself
a. through force, threat or intimidation;
-vulnerability of the woman
b. when the woman is deprived of reason or otherwise
-support system available to her immediately after the attack
unconscious
c. by means of fraudulent machination or grave abuse of
MANAGING A RAPE VICTIM
authority; and
Best if immediate support is received and she can ventilate her
d. when the offended party is under 12 years of age or is
emotions
demented, even though none of the circumstances
Supportive therapy to restore her sense of adequacy and control
mentioned above be present
over her life
2. by any person who, under any of the circumstances
mentioned in the paragraph 1 hereof, shall commit an
act of sexual assault by inserting his penis into another
person’s mouth or anal orifice, or any instrument, or
object, or any other part of the body such as fingers or
toes, into the genital or anal orifice of another person.

Source: (The Anti-Rape Law of 1997)

CRIME OF RAPE
 An act of violence and humiliation that is expressed through
sexual means
 expresses power or anger not sexuality