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Sexual and Physical Abuse: A Public Health Challenge in Neurology

The relationship between abuse and violence and the care of neurological patients is an important topic not often addressed. The incidence of abuse and violence has reached epidemic proportions affecting all individuals regardless of age or socioeconomic status.  Twenty-two percent of women and seven percent of men surveyed reported being physically assaulted by a current or former partner in their lifetime. Abuse is generally divided into four categories: physical abuse, sexual abuse, emotional abuse, and financial abuse. Physical abuse is the intentional use of physical force causing injury, or harm whereas sexual abuse forces a person to engage in a sexual act against his or her will.  Emotional abuse involves trauma to the victim caused by threats of acts or coercive tactics.  The physical and emotional consequences of abuse can be serious and sometimes fatal leading to direct physical injury and psychological trauma as well as long-term health consequences, such as mental illness and chronic medical problems. The long-term effects of abuse and violence can be observed in either those who experience abuse and violence, or indirectly witness it.

There is an intriguing association between abuse and the later development of neurological conditions such as higher rates of headache, and neck and back pain than those who have never experienced abuse. Maltreatment in childhood is associated with a significant increase in the likelihood of recurrent migraines, chronic daily headaches, and non-epileptic seizures in later adulthood. The likelihood of abuse is greater in patients with chronic neurological conditions such as those with severe cognitive or physical impairment by single caregivers who suffer burnout and others who are poorly supervised by family members or professional staff.  Yet despite the relationship between abuse and neurological patients, surveys demonstrate that neurologists do not routinely inquire about abuse and violence. Despite recommendations of the American Medical Association that all patients be screened for abuse and neglect, most physicians do not routinely screen patients. One simple effective strategy used by investigators to screened outpatients in a neurology clinic to determine the prevalence of abuse employed six yes/no questions asking if they witnessed or experienced direct physical harm, acts of threats or intimidation, sexual encounters, limitation or control of finances, or felt unsafe in their relationships.

Their findings reported in the journal Neurologist found that among 103 patients of mean age 51 years, 21% overall reported experiencing or witnessing abuse or violence. Being a witness to abuse or violence was the most commonly reported exposure seen in two-thirds, followed by physical abuse in 41%, sexual and emotional abuse each in a third, and financial abuse in 23% of patients so screened.  The take home message is clear, sexual and physical abuse is a silent public health problem that is preventable. If you or someone you know is a victim, you have an obligation to report it to avert later consequences.