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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
- STI and pregnancy screening
Treatment & Management
- Mandatory reporting
- Psychological counseling and support
- Empiric STI prophylaxis:
- Ceftriaxone IM (single dose) – Gonorrhea
- Doxycycline orally (7 days) – Chlamydia
- Metronidazole orally (single dose) – Trichomoniasis
- Emergency contraception as needed
- HIV prophylaxis (PEP) within 72 hours if high risk
- Hepatitis B vaccination/immunoglobulin if indicated
Trauma and Stressor-Related Disorders
Adjustment Disorders
- Emotional or behavioral response to an identifiable stressor
- Resolves within 6 months
Clinical Presentation
- Disproportionate emotional distress
- Temporary functional impairment
Treatment & Management
- Supportive counseling
- Psychotherapy
- Short-term anxiety-focused medication
Bereavement (Normal vs. Complicated Grief)
Normal Grief
- Gradual improvement
- Sadness diminishes
Complicated Grief
- Persistent >12 months
- Marked functional impairment
Clinical Presentation
- Intense sorrow
- Prolonged emotional distress
- Potential hallucinations (auditory or visual)
Treatment & Management
- Grief counseling
- Psychotherapy
Post-Traumatic Stress Disorder (PTSD)
- Disorder resulting from exposure to actual or threatened death, serious injury, or sexual violence
- Symptoms persist for more than 1 month after the traumatic event
Clinical Presentation
- Re-experiencing Symptoms:
- Intrusive memories, flashbacks, nightmares
- Psychological distress or physiological reactions triggered by reminders
- Avoidance Symptoms:
- Avoidance of memories, people, places, or activities associated with trauma
- Emotional numbness, detachment, reduced interest
- Hyperarousal Symptoms:
- Irritability, anger outbursts
- Hypervigilance, exaggerated startle response
- Sleep disturbances, difficulty concentrating
Diagnosis
- DSM-5 Criteria:
- Exposure to trauma
- Symptoms in each category (re-experiencing, avoidance, hyperarousal) lasting >1 month
- Symptoms cause significant distress or functional impairment
Treatment & Management
- First-line: Trauma-focused psychotherapy
- Cognitive Behavioral Therapy (CBT) with trauma exposure
- Eye Movement Desensitization and Reprocessing (EMDR)
- Medications:
- SSRIs (e.g., sertraline, paroxetine) – first-line pharmacotherapy
- Prazosin – effective for nightmares/hyperarousal
- Benzodiazepines – short-term use for severe anxiety/agitation (use with caution)
