Episode 133: Abuse, Violence, and Trauma Disorders

• 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

• 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

• 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

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

Clinical Presentation

• Genital trauma



• STIs



• Pregnancy in minors



• Behavioral regression

Labs, Studies & Imaging

• Sexual assault forensic exam