Abuse Disorders
Child Abuse
- Physical, sexual, emotional maltreatment or neglect of a child
- High prevalence across socioeconomic classes; vigilance essential
- High priority for prevention
Clinical Presentation
- Unexplained or suspicious injuries (e.g., spiral fractures, stocking-glove pattern burns)
- Retinal hemorrhages (Shaken Baby Syndrome)
- Hyphema (blood in anterior chamber of eye)
- Behavioral indicators: anxiety, PTSD symptoms, depression, failure to thrive, substance abuse, suicidal ideation
Labs, Studies & Imaging
- Skeletal survey
- Head CT/MRI for suspected trauma
Treatment & Management
- Mandatory reporting
- Immediate hospitalization for severe injuries
- Multidisciplinary involvement: social services, child protective services
High-Yield Facts
- Fractures at various healing stages strongly indicate abuse
- Always prioritize child safety and mandatory reporting
Elder Abuse
- Abuse of elderly individuals, especially frail, isolated, cognitively impaired
- Approximately 4% prevalence annually
Clinical Presentation
- Unexplained injuries, signs of neglect (poor hygiene, malnutrition)
- Emotional withdrawal, fearfulness
Labs, Studies & Imaging
- Thorough documentation of all injuries and conditions
Treatment & Management
- Mandatory reporting
- Coordination with social services
- Supportive care
High-Yield Facts
- Isolation significantly raises risk
Intimate Partner Violence (Domestic Violence)
- Pattern of violence or abuse between partners
- Prevalent across demographics
- Heightened risk during pregnancy
Clinical Presentation
- Frequent healthcare visits with nonspecific complaints
- Injuries inconsistent with history or in various healing stages
- Partner exhibits controlling/aggressive behavior during visits
Labs, Studies & Imaging
- Private, careful screening and documentation of injuries
- Consider neuroimaging if head trauma suspected (MRI/CT)
Treatment & Management
- Mandatory reporting according to local regulations
- Safety planning, counseling, referral to community resources
High-Yield Facts
- Always perform private interviews to accurately screen for domestic violence
Physical and Psychological Abuse
Clinical Presentation
- Fearful behavior
- Anxiety
- Unexplained somatic complaints
- Low self-esteem
- Depression
Labs, Studies & Imaging
- Private patient interviews
- Thorough documentation
Treatment & Management
- Counseling
- Psychotherapy
- Safety planning
- Community resources
Sexual Abuse
Clinical Presentation
- Genital trauma
- STIs
- Pregnancy in minors
- Behavioral regression
Labs, Studies & Imaging
- Sexual assault forensic exam
