1. Dr. Hassan Sarsak, PhD, OT

2.  Abuse: maltreatment of one person by another (physical or psychological).  Abuse is a cyclical phenomenon; many abusers were themselves victims of abuse as children.  Most common forms of abuse include: spouse abuse (mostly women), child abuse or neglect (physically or emotionally), and sexual assault.

3. 3 Biological theories: neurological defects in temporal lope and limbic system as well as norepinephrine, serotonin, and dopamine imbalances facilitate or inhibit aggressive impulses. Genetic components and brain tumors. Psychological theories: underdeveloped ego, weak superego. Imitation and modeling. Sociocultural theories: aggressive behavior is primarily a product of culture and social structure. Some societal influences contribute to violence.

4. 4  Spouse abuse (domestic violence) is the mistreatment or misuse of one spouse by the other. Ranging from shoving (hatred) and pushing to choking and severe battering.  95% of the victims are women.  Battered women usually have low self- esteem, adhere to feminine sex-role stereotypes, isolated, have a weak or no support system, express anger, guilt, fear, and shame. They grew up in abusive environment. Learned helplessness (in ability to act on her own behalf) is common (mostly dependent on their spouse*).

5. 5  The victimizer usually has low self-esteem, pathological jealous, has limited coping abilities, possessive, and they strive to keep the women isolated from others and totally dependent on them.  Battering is viewed as a cycle that is repeated overtime. Battering includes three distinct phases that vary in time and intensity among the same or different couples.

6. 6 1. The tension-building phase: he/she becomes angry with little provocation, minor battering may occur, his/her jealousy and possessiveness increase. 2. The acute battering incident: most violent and shortest phase. 3. Calm, loving, and respite phase: loving, kind, and contrite.

7.  Why she stay? 1. Lack of support network. 2. Religious beliefs. 3. Lack of financial independence. 4. Live for their children. 5. Cultural values.

8. 8  Erikson stated that “the worst sin is the mutilation of a child’s abuse”.  Children are vulnerable and relatively powerless, and the effects of maltreatment are infinitely deep and long-lasting.  Child abuse (maltreatment) typically includes: physical injury, emotional injury, physical neglect, emotional neglect, and sexual abuse.

9. 9  Physical injury includes any none accidental physical injury as a result of punching, beating, kicking, biting, burning, and shaking. Or physical injury resulted from over discipline or physical punishment.  Physical signs: bruises, marks, skin welts, fractures, lacerations..  Behavioral signs: behavioral extremes, fear of caretaker, passivity, withdrawal, cheating, lying, inability to form relationships, age-inappropriate behavior.

10. 10  Behaviors from the part of caretaker that results in serious impairment of the child’s social, emotional, or intellectual functioning. Such as belittling, rejecting, ignoring, blaming and isolating the child, using harsh and inconsistent discipline.  Sign: age-inappropriate behavior, anxiety and unrealistic fear, sleep problems and nightmares, behavioral extremes, social isolation, self- destructive behavior, vandalism, stealing, cheating, thumb sucking, rocking, enuresis.

11. 11  Physical neglect includes refusal of or delay in seeking healthcare, abandonment, expulsion طرد from the home, or inadequate supervision.  Characteristics: soiled clothing, steals food, hungry, poor hygiene, medical problems, poor school performance, malnutrition, and poor relationships.

12. 12  Emotional neglect refers to a chronic failure by the parent or caretaker to provide the child with the hope, love, and support necessary for the development of healthy personality.  Characteristics: ignoring child presence, rebuffing attempts by the child to establish meaningful interaction, ignoring the child’s social, educational, recreational, and developmental needs, denying the child opportunity to receive positive feedback.

13. 13  Child sexual abuse: employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or assist any other person to engage in, any sexually explicit conduct or any simulation of such a conduct for the purpose of producing visual deception of such a conduct or rape, molestation, prostitution, or any other form of sexual exploitation of children, or incest (sexual activity with close relatives) with children.

14. 14 Physical indicators of child sexual abuse 1. Frequent urinary infection 2. Sexually transmitted disease 3. Difficulty or pain in sitting or walking 4. Foreign matters in rectum, bladder, urethra. 5. Sleep problems. 6. Rashes, itching, bruises, or pain in the genital area. 7. Genital or rectal bleeding, vaginal discharge.

15. 15 Behavioral indicators of child sexual abuse 1. Seductive مغري behavior (inappropriate sexual behaviors such as putting tongue in other’s mouth when kissing), promiscuity 2. Reluctance or refusal to let caregiver wash parts of the body 3. Sexual play 4. Expressing fear of particular places or persons. 5. Sexually abusing another child. 6. Excessive anxiety, excessive bathing, running away from home. 7. Drop in school performance. 8. Expression of low self-worth. 9. Suicidal attempts

16. 16 Characteristics of adults who abuse or neglect the/their children 1. Experiencing stressful life situation 2. Having few, if any, support systems. 3. Being commonly isolated from others. 4. Lack understanding of child development or care needs. 5. Lacking adaptive coping strategies, angers easily, have difficulty trusting others. 6. Expecting the child to be perfect.

17.  The ancestral relationship: sexual activity between two people who are considered, for moral or genetic reasons, too closely related to have such a relationship. Incest is regarded as a serious taboo in almost every society, although cultures differ as to the extent to which marriages are allowed between relatives. Some etiological implications include: impaired sexual relationship between parents, ineffective communication between parents concerning their problems, typically the father is domineering, impulsive, and physically abusing whereas mother is passive and submissive

18. Onset of incestual relationship typically occurs when daughter is 8-10 years, generally begin with genital touching and fondling Oldest daughter is the most vulnerable to father- daughter incest.

19. 19 The adult survivor of incestual relationship 1. Lack of trust, low self-esteem, and poor sense of identity. 2. Self-doubt, inability to trust own feelings. 3. Avoid all interpersonal relationships 4. Distortion of the normal pleasure with sexual activity. 5. Feeling of guilt, despair, prostitution, depression, suicide.

20. 20 Sexual assault: is the expression of power and dominance by means of sexual violence. Most commonly by men over women. Sexual assault is viewed as any type of sexual act that an individual is threatened, coerced, or forced to submit to against his or her will.

21. 21 Rape is a type of sexual assault. There are three kinds of rape: 1. Date rape: the rapist is known to the victim. 2. Marital rape: marital partner against will. 3. Statutory rape: unlawful intercourse between a man of older than 16 years and a woman under the age of CONSENT. High risk group for rape aged between 16-24 years