Children and Domestic Violence Dr Joanna Sales

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Children and Domestic Violence Dr Joanna Sales

• Consultant Child and Adolescent Psychiatrist and
  Clinical Director
• Oxleas NHS Trust

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AIMS

• Understand context of domestic violence
• Understand the impact upon women
• Understand the repercussions for children

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Adults Definition

• 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

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Adults Battered Woman Syndrome 1

• 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

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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)

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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

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The Cycle Of Violence

• 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

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Post Traumatic Stress Disorder

• 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

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Children How Big Is The Problem? 1

• 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

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Children How Big Is The Problem? 2

• 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.
• Conversely, in 60 of cases where children have
  been abused the mother will also have been a
  victim.

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Children How Big Is The Problem? Associations

• Juvenile crime
• Bullying
• Educational Failure
• Social Isolation
• Developmental difficulties
• Other disorders

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Parental Relationships

• Disordered attachment

Attacking father
Traumatised mother
Traumatised child
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How Are Children Affected? 1

• Cardiff Study-148 children lt16
• 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

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How Are Children Affected? 2

• The younger, the more vulnerable
• 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

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Example Family A

• 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

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Example Family B

• Father-alcohol problems in conjunction with
  physically abusive behaviour
• Mother-PTSD, on top of fairly good functioning
• Children-PTSD
• Prognosis-Good

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Will Boys Become Violent in Turn?

• 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

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Emotional and Behavioural Problems
PTSD
Social Isolation
Insecure Attachment
CHILD
Rejection
Abuse
Witnessing Violence
Emotional and behavioural problems
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Battered Women and Battered Children

• 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

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Problems Seen

• Infants ( note need for attachment)
• Sleeping, feeding difficulties, excessive crying
• Preschool children
• Separation anxiety, psychosomatic problems,
  abdominal pain, whingeing, nightmares,
  irritability, stuttering, regressive behaviours

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Problems Seen

• Middle childhood
• Self-blame, psychosomatic behaviours, regressive
  behaviours, aggressive behaviours
• Adolescents
• Truancy, delinquency, substance abuse
• early sexual activity
• interpersonal problems

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Other Factors Playing a Part

• Childrens lives are disrupted in many ways-moves
  of school, home, changes in socio-economic
  position
• Relative lack of parental supervision and
  parental control
• Greater likelihood of parental disagreement
• Behavioural problems relate to the degree of
  violence, mothers mental state, and factors are
  potentiating, not additive

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What Protects?

• 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

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Women dont tell

• Afraid the the children will be removed
• Thought that the children would be OK
• Dont know who to tell or go to
• Feel guilty themselves

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References

• 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 2001323 210-213
  
• Abrahams C. The hidden victims, children and
  domestic violence. London NCH Action for
  Children, 1994.