Watch: The Impact of Psychological Abuse on Children

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Mental Abuse of Kids Leaves Lifelong Scars

HealthDay – 1 hr 4 mins ago MONDAY, July 30 (HealthDay News) -- Constantly belittling, threatening or ignoring children can be as damaging to their mental health as physical or sexual abuse, according to a new report from a pediatricians' group.

But, with no bruises to spot, pediatricians, teachers and family members may have trouble recognizing these and other forms of psychological abuse. Not only are there no obvious physical scars, there is no universally agreed-upon definition of what constitutes psychological maltreatment of children, and a fine line can exist between not-so-great parenting and outright abuse, experts say.

"The main message for child health clinicians and people working with children is that psychological maltreatment is just as harmful as other types of maltreatment," said report co-author Dr. Harriet MacMillan, a professor in the departments of psychiatry, behavioral neurosciences and pediatrics at McMaster University in Ontario, Canada.

"We know that exposure to other types of maltreatment like physical and sexual abuse can be associated with a broad range of types of impairment in physical and mental health, and cognitive and social development," she said. "Similarly, we see these types of impairments associated with psychological maltreatment."

The American Academy of Pediatrics' report is published online July 30 and in the August print issue of Pediatrics.

Estimating the prevalence of the problem is difficult, in part because of the lack of a universally accepted definition of psychological abuse, MacMillan said. Studies in Britain and the United States estimate that 8 percent to 9 percent of women and 4 percent of men report severe psychological abuse during childhood.

Psychological maltreatment of children can take many forms. It can include chronically belittling, humiliating or ridiculing a child for showing normal emotions. There is also neglect, such as leaving an infant alone in a crib all day, except for feeding or changing.

Other forms of psychological maltreatment can include withholding love and warmth from a child, putting children in dangerous or chaotic situations, having rigid or unrealistic expectations accompanied by threats if not met, or confining a child and restricting social interactions. Limiting a child's access to necessary health care for reasons other than affordability is another example, according to the report.

Sometimes, but not always, psychological abuse goes hand in hand with physical abuse.

"I once had a child who talked about being hit by his dad," MacMillan said. "The child said that the dad says things about me that make me feel badly, worse than the hitting."

One of the keys to spotting abuse is the pervasiveness of it, experts say.A single bad parenting day probably isn't abuse. But near-constant ridicule, telling a child he or she is unloved and unwanted, is abuse, MacMillan said.

Similarly, there is "suboptimal" parenting -- in other words, no one is going to nominate these moms or dads for parent of the year vs. parenting that is so damaging it rises to the level of abuse.

Telling the two apart can be difficult, experts say.

"Psychological abuse is so insidious, and is not as easily recognized by the victim or other family members," said Alec Miller, chief of child and adolescent psychology at Montefiore Medical Center, in New York City.

"If you see someone getting beaten, we all know it's against the law," Miller said. "It's demarcated as illegal and very unhealthy. Some of these other things are a little more slippery. If there is no bruising physically, it's harder to be convinced there is abuse."

Research shows the effects of psychological abuse and neglect can be profound and long-lasting, ranging from problems with brain development and a failure to grow properly, to problems with behavior and relating to others.

Some parents who are psychologically abusive aren't even aware that their words and actions are harming their child, experts said.

For example, consider parents going through a very difficult divorce. "The child is subjected to major conflict between the parents and told all sorts of things about the other parent and made to choose an allegiance," MacMillan said. "These sorts of things can be psychologically abusive to a child."

Suspected cases of psychological should be reported to child protective services, the authors say. They also urge pediatricians to look for signs of emotional maltreatment in their patients.

More information

The U.S. Department of Health and Human Services has information on recognizing the signs of child abuse.

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U.S. commander accused of stalling Afghan hospital abuse probe

Reuters – 22 mins ago WASHINGTON (Reuters) - A top U.S. general in Afghanistan sought to stall an investigation into waste, abuse and mismanagement at a U.S.-funded hospital in Kabul for political reasons, a former U.S. military official will tell Congress on Tuesday.

Retired Colonel Gerald Carozza, who served as an adviser to the U.S. campaign in Afghanistan, will accuse Lieutenant General William Caldwell, then head of U.S. and NATO efforts to train Afghan security forces, of delaying a military investigation into allegations of corruption and patient abuse at the Dawood National Military Hospital.

"The evidence is clear to me that General Caldwell had the request (for a probe into the hospital) withdrawn and postponed until after the (November 2010 U.S. congressional) election and then, after the election, tried to intimidate his subordinates into a consensus that it need not move forward at all," Carozza said in testimony submitted ahead of Tuesday's hearing.

Carozza and others who say they sought to bring problems at the U.S.-funded hospital to light will testify before a subcommittee of the House of Representatives Oversight and Government Reform Committee, which will examine allegations that military officials blocked or delayed the hospital probe.

Colonel Wayne Shanks, a military spokesman, said Caldwell "would welcome the opportunity to respond to any inquiry and I'm confident that once the facts are presented and examined, all allegations will be proven false."

Last month, Republican Representative Jason Chaffetz sent Defense Secretary Leon Panetta a letter on behalf of the Oversight Committee and asked the Defense Department to examine whether military leaders had sought to cover up reports of abuse at the hospital in 2010.

U.S. lawmakers began looking into the hospital last year after The Wall Street Journal reported abuse and neglect of Afghans receiving medical treatment there.

Lawmakers have voiced concerned not only by the allegations that a probe may have been blocked but that mismanagement and fraud were widespread at the hospital, just the latest case raising questions about the U.S. effort to rebuild Afghanistan and ensure stability as most foreign forces withdraw in coming years.

The Pentagon has acknowledged problems at the hospital and has said that "investigations and corrective action" were underway.

Caldwell, who is now a senior Army official in the United States, was not invited to testify at Tuesday's hearing.

Schuyler Geller, another retired colonel who served in Afghanistan, accused the U.S. leadership in his prepared testimony of "providing half-truths" in the hospital case, including about widespread corruption in the Afghan government.

After over a decade of Western aid efforts in Afghanistan, which have cost tens of billions of dollars, rampant corruption remains a major concern.

(Reporting By Missy Ryan; Editing by Eric Beech)

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Childhood Abuse Linked to Diabetes, Heart Disease in Middle-Aged Women

HealthDay – 1 hr 23 mins ago FRIDAY, July 20 (HealthDay News) -- Middle-aged women who suffered physical abuse as children may be at increased risk for diabetes and heart disease, a new study suggests.

Researchers examined nearly 350 black and white women in the Pittsburgh area who were between 42 to 52 years old at the start of the study. About 34 percent of the women said they had been victims of some form of childhood abuse.

Compared to other women in the study, which was published online in the journal Health Psychology, those with a history of childhood physical abuse were about twice as likely to have high blood pressure, high blood sugar, a larger waistline and poor cholesterol levels.

Collectively, these health issues are known as metabolic syndrome. Previous research suggests that people with metabolic syndrome are at increased risk for heart disease and type 2 diabetes.

The link between childhood physical abuse and metabolic syndrome was separate from traditional risk factors for the syndrome, such as smoking, lack of physical activity, menopause, alcohol use and depression. This persistent association suggests that abuse plays a unique role in women's cardiovascular health, the researchers said.

"Our research shows us that childhood abuse can have long-lasting consequences -- even decades later -- on women's health, and is related to more health problems down the road," study co-author Aimee Midei, a graduate student in psychology at the University of Pittsburgh, said in a journal news release.

"It's possible that women with histories of physical abuse engage in unhealthy eating behaviors or have poor stress regulation," Midei said. "It appears that psychology plays a role in physical health even when we're talking about traumatic incidents that happened when these women were children."

Although the study found an association between childhood physical abuse and an increased occurrence of metabolic syndrome later in life, it did not prove a cause-and-effect relationship. The study also found no association between childhood sexual and emotional abuse and metabolic syndrome.

More information

The American Academy of Family Physicians has more about metabolic syndrome.

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Abuse during childhood may contribute to obesity in adulthood

ScienceDaily (July 2, 2012) — Investigators from Boston University School of Medicine (BUSM) and Boston University's Slone Epidemiology Center report research findings that may shed light on influences on obesity during adulthood. Appearing in the journal Pediatrics, the study found an association of severity of sexual and physical abuse during childhood and adolescence with obesity during adulthood.

See Also:Health & MedicineObesityDiet and Weight LossFitnessMind & BrainDieting and Weight ControlCrystal MethIllegal DrugsReferenceSubstance abuseStretch marksChild abuseAdult attention-deficit disorder

The findings were based on the ongoing Black Women's Health Study, which has followed a large cohort of African-American women since 1995. Information provided in 2005 by more than 33,000 participants on early life experiences of abuse was assessed in relation to two measures of obesity: body mass index of 30 kg/m2 or more as a measure of overall obesity and waist circumference greater than 35 inches as a measure of central obesity.

The risk of obesity in 2005 by either measure was estimated to be approximately 30 percent greater among women in the highest category of physical and sexual abuse than in women who reported no abuse. The association was dampened but not fully explained by allowance for reproductive history, diet, physical activity and depressive symptoms, which might have been intermediates between abuse and weight gain.

According to the researchers, the findings add to growing evidence that experiences during childhood may have long-term health consequences. "Abuse during childhood may adversely shape health behaviors and coping strategies, which could lead to greater weight gain in later life," explained Renee Boynton-Jarrett, MD, the lead investigator of the study and a pediatric primary care physician at Boston Medical Center. She also noted that metabolic and hormonal disruptions resulting from abuse could have that effect and that childhood abuse could be a marker for other adversities. "Ultimately, greater understanding of pathways between early life abuse and adult weight status may inform obesity prevention and treatment approaches." Boynton-Jarrett cautioned that further studies are needed to clarify just which factors are responsible for the association of abuse with obesity and noted there is a consensus that pediatric providers should screen for abuse.

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Shrinking stomach may boost risk for booze abuse

The most common type of obesity surgery may increase patients' chances for alcohol abuse, according to the largest study to demonstrate a potential link.

Patients who had gastric bypass surgery faced double the risk for excessive drinking, compared with those who had a less drastic weight-loss operation.

Gastric bypass surgery shrinks the stomach's size and attaches it to a lower portion of the intestine. That limits food intake and the body's ability to absorb calories. Researchers believe it also changes how the body digests and metabolizes alcohol; some people who've had the surgery say they feel alcohol's effects much more quickly, after drinking less, than before the operation. The study suggests that may lead to problem drinking.

The researchers asked nearly 2,000 women and men who had various kinds of obesity surgery at 10 centers nationwide about their drinking habits one year before their operations, versus one and two years afterward. Most didn't drink excessively before or after surgery, and increases in drinking didn't occur until two years post-surgery.

More than two-thirds had gastric bypass surgery and were most at risk. Two years after the surgery, almost 11 percent, or 103 of 996 bypass patients, had drinking problems, a 50 percent increase from before surgery.

By contrast, about 5 percent of patients who had stomach-banding obesity surgery drank excessively two years later, similar to the pre-surgery numbers. Too few patients had other types of weight-loss surgery to make strong comparisons.

The study was released online Monday in the Journal of the American Medical Association.

About 8 percent of U.S. adults abuse alcohol by drinking excessively. The study authors say their results suggest that an additional 2,000 people each year will develop drinking problems because of obesity surgery.

More than 200,000 stomach-reducing surgeries are performed each year. Gastric bypass, also called stomach-stapling, is the most common and generally results in more weight loss than other methods. The benefits of gastric bypass surgery include sometimes reducing diabetes and heart disease risks.

Patients should be screened for alcohol problems before and after surgery and told about the risks, said lead author Wendy King, an assistant professor at the University of Pittsburgh's graduate school of public health.

Dr. Robin Blackstone, president of the American Society for Metabolic and Bariatric Surgery, said the results echo findings in smaller studies and clearly show an alcohol-related risk from gastric bypass surgery.

"We in the medical community are going to take that seriously," said Blackstone, an obesity surgeon in Scottsdale, Ariz. The findings are being presented at the medical group's meeting in San Diego this week.

She noted that obese people are often socially isolated because of their weight, and that drinking often increases when patients have slimmed down and pursue a more active social life. Blackstone said she and many other doctors routinely warn patients that they may be more sensitive to alcohol, and that the study reinforces that advice.

Patients seeking obesity surgery often undergo psychological evaluations to make sure they are stable enough to handle the operation and life changes afterward. Guidelines recommend against the surgery for people with substance abuse problems including excessive drinking, said psychologist Leslie Heinberg, director of behavioral services for Cleveland Clinic's bariatric and metabolic institute.

Study results were based on patients' responses on questionnaires about alcohol use.

Problems included frequently having at least three drinks or at least six drinks on one occasion; needing to drink in the morning; and forgetting events because of alcohol use.

Two years after surgery, these problems were more common in gastric bypass patients, and in men, young adults and smokers after either type of surgery.

Stomach banding involves surgically putting an adjustable band around the stomach to decrease the amount of food it can hold. It is reversible but less common than gastric bypass in the United States.

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Online:

JAMA: http://jama.ama-assn.org

Gastric bypass surgery: http://1.usa.gov/KMZQkH

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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner

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Depressed Teens Who Respond to Treatment Less Likely to Abuse Drugs

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Screening Women for Domestic Violence Could Help Prevent Abuse

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Sexual Abuse May Put Boys at Risk for Unsafe Sex

HealthDay – 1 hr 22 mins ago TUESDAY, April 10 (HealthDay News) -- Male teens who were sexually abused are more likely to have unsafe sex, a new study finds.

University of British Columbia researchers analyzed data from more than 40,000 American and Canadian male high school students who were surveyed between 1986 and 2011.

Compared to those with no history of sexual abuse, young males who were sexually abused were five times more likely to cause teen pregnancy, three times more likely to have multiple sexual partners and two times more likely to have unprotected sex, according to the study published online and in the June print issue of the Journal of Adolescent Health.

"As far as we know, this is the first study to explore the strength of the effects of sexual abuse on boys' sexual behavior," lead author Yuko Homma, a recent Ph.D. graduate from the University of British Columbia's School of Nursing, said in a university news release. "Our findings show that boys are also vulnerable to the traumatic effects of sexual abuse, which can lead to sexually transmitted infections or teen pregnancy."

About 8 percent of males and 20 percent of females in North America report that they've been sexually abused.

"Boys are far less likely to tell someone when they have been sexually abused," study co-author Elizabeth Saewyc, a UBC professor of nursing and adolescent medicine, said in the news release. "Yet it's clear they too need support and care to cope with the trauma from sexual violence."

Homma agreed. "Parents need to speak to their sons about sexual abuse awareness and prevention, as parents of girls do. Boys may hesitate to tell parents about an incident if parents have misconceptions about sexual abuse -- that it can't happen to males."

The researchers also suggested that schools should include sexual abuse prevention in health education, and health care agencies should screen boys and girls for a history of sexual abuse.

More information

The American Academy of Pediatrics has more about sexual abuse.

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Drug, Alcohol Abuse Common Among U.S. Teens, Study Finds

HealthDay – 21 mins ago MONDAY, April 2 (HealthDay News) -- Alcohol and drug use is common among American teens and more than 15 percent of them meet the criteria for substance abuse, a new study finds.

"Once again, we are reminded that in most instances experimentation with alcohol and drugs begins during adolescence," said Bruce Goldman, director of Substance Abuse Services at The Zucker Hillside Hospital in Glen Oaks, N.Y.

"Unfortunately, many youth are at risk of developing abuse and dependency problems due to factors including genetic predisposition, environmental availability, school difficulties, social/family problems and co-occurring psychiatric or behavioral disorders," added Goldman, who was not involved in the new study.

In the study, Joel Swendsen, of the University of Bordeaux in France, and colleagues analyzed data from a U.S. survey of more than 10,000 teens between the ages of 13 and 18. They found that more than 78 percent of the oldest teens had consumed alcohol, about 47 percent consumed at least 12 drinks a year, and about 15 percent met the criteria for alcohol abuse.

The study also found that 81.4 percent of the oldest teens reported the opportunity to use illicit drugs, 42.5 percent used drugs, and 16.4 percent were drug abusers.

The median age when teens started substance use was 14 for regular alcohol use or abuse with or without dependence, 14 for drug abuse with dependence, and 15 for drug abuse without dependence.

"Because the early onset of substance use is a significant predictor of substance use behavior and disorders in a lifespan, the public health implications of the current findings are far-reaching," the team wrote in the April issue of the journal Archives of General Psychiatry.

More must be done to make sure youth don't start out early on the road to substance abuse, Goldman said.

"It is imperative that families, schools, police, youth groups, and communities all join together to prevent or delay the onset of substance use as long as possible," he said. "Social norms have a very powerful impact on drug-use patterns. We need to create norms where substance use and availability, especially for young people, is not acceptable."

That means giving young people the resources to fight back, Goldman added. "Effective early intervention needs to be universally available to youth that are found to be using substance," he said.

More information

The U.S. National Institute on Alcohol Abuse and Alcoholism offers advice on parenting to prevent childhood alcohol use.

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