Actual Abuse Research Articles

Beyond the state: Conceptualizing protection in community settings

In the last two decades, the child welfare system has undergone a series of dramatic changes. We have moved from a broad concern for the social welfare of children and families to a restricted focus on detecting, investigating and assessing instances of child physical and sexual abuse and neglect. Spiraling reports of suspected or actual abuse and neglect, higher caseloads, reduced resources and lack of support for both families and workers, have all contributed to narrowing the focus of contemporary child welfare to one more aptly characterized as child protection. Child protection discourse is concerned with the nature and extent of state intervention into family life for the purpose of protecting children at risk of harm. While much attention has been given to boundaries and procedures for state intervention, it is less common to critically examine the actual activities involved in protection of children. An exception to this is the feminist scholarship on the topic, illustrating that protection is very much a gendered activity entailing the scrutiny of women's mothering practices and often associated with mother-blame. In this paper, another dimension to protection activity is explicated, namely that which occurs in a community setting. Drawing on a qualitative case study of a community agency that serves young mothers, we document its implications in 'child protection' processes and its markedly different approach to protection from formal child welfare agencies. Given the community agency's emphasis on supportive services to mothers, we turn a critical eye on usual conceptions of protection, where it occurs, and how it is accomplished.

M.D.s May Soon Be Free of Current E&M Guidelines

Back to table of contents Previous article Next article Government NewsFull AccessM.D.s May Soon Be Free of Current E&M GuidelinesMark MoranMark MoranSearch for more papers by this authorPublished Online:2 Aug 2002https://doi.org/10.1176/pn.37.15.0002Ten years of making—and remaking—the federal government’s guidelines for how physicians must document “evaluation and management” of patients for Medicare payment could be unmade entirely.That’s if the government heeds its own broad-based advisory committee on regulatory reform urging that the “E&M” documentation guidelines be scrapped.The Department of Health and Human Services (HHS) Advisory Committee on Regulatory Reform recommended dumping the guidelines at a recent meeting in Denver. The 21-member committee has five physicians, including Nancy Nielsen, M.D., vice speaker of the AMA’s House of Delegates, as well as administrators of the Centers for Medicare and Medicaid Services (formerly the Health Care Financing Administration).The recommendation awaits action by HHS Secretary Tommy G. Thompson.The guidelines for evaluation and management of patients are part of the government’s resource-based relative value scale for determining physician payment under the Medicare program and have been the object of heated controversy. Physician groups hailed the recommendation as long overdue.“The AMA has repeatedly informed HHS and the Regulatory Relief Advisory Committee that physicians identify E&M documentation guidelines as the single, largest paperwork burden imposed by the Medicare program,” the AMA said following the committee’s recommendation.Chester Schmidt, M.D., chair of APA’s Committee on RBRVS, Codes, and Reimbursement, echoed that view.“This is a very positive development,” he said. “The reason this panel is backing off is the very intense pressure that has been brought to bear to change the documentation requirements. Physicians believe that the guidelines are not clinically relevant and that they are merely a means for the government to do audits and to find fault, resulting either in civil or criminal actions [against doctors] because of documentation deficiencies.”Schmidt added, “The outcry from all specialties has consistently been that the E&M coding guidelines are not clinically relevant, are onerous, and impose on physicians extra paperwork for which there is no reimbursement.”Psychiatrists use the E&M codes for inpatient and partial hospitalization, consultation, nursing home visits, and some office visits. Especially controversial are the guidelines for determining the level of “medical decision making,” which is one of the three E&M components, along with history taking and examination. The guidelines for that component use a four-by-four grid designed to produce a numerical approximation of medical decision making.Schmidt has called the system so complex “it bears no resemblance to the actual practice of medicine.”Douglas L. Wood, M.D., chair of the advisory committee and a physician at the Mayo Clinic, summed up the view that the decade-long effort to revise or improve the guidelines has been exhausted.“The documentation guidelines that have been used are unworkable, and I think 10 years of effort to try to find one that works is a pretty strong statement that there is something fundamentally difficult or fundamentally impossible about trying to create documentation guidelines for evaluation and management services,” Wood said, according to transcripts of the advisory committee meeting in Denver.“The fact that no other commercial insurer uses them should be a pretty strong statement that they’re probably not applicable anyway,” Wood said. “And indeed, there is now and has been an adversarial environment that’s based on fraud and abuse actions and the actions of Medicare carrier medical directors.”The transcript of the Denver meeting is posted on the Web at www.regreform.hhs.gov/sacrr5_16.htm. ▪ ISSUES NewArchived

A Profile of The National Policy Summit on Elder Abuse: Perspective and Advice on Replication

ABSTRACTSocial change results from concerted and informed action by people who care about solving problems. However, the interest of concerned individuals must be focused on priority issues, and the experts, those who know the impact of the problem, those who can envision a preferred future, must be involved in defining the solutions. This article briefly describes The National Policy Summit on Elder Abuse where experts and visionaries came together in Washington, DC, in December 2001 to develop the first-ever national elder abuse action agenda. The article contains suggestions and advice for those interested to utilize the elder abuse summit approach for influencing policy change at the state and local levels.

Promoting Adaptive Self Care in Abuse Survivors

Abstract Turkus and Courtois (1996) have recommended a stage oriented approach to treatment of abuse survivors. The first stage of treatment emphasizes development of adaptive skills which the survivor can use to cope with her abuse experience. Their perpetrator's abusive actions devalue and dehumanize the abuse survivor. Focusing on survivors' capacity for adaptive self-care is particularly important the initial stage of treatment as survivors have often internalized this devalued sense of self. These perceptual remnants of abuse are frequently manifest as a diminished capacity for adaptive self-care. This article summarizes four activities designed to facilitate positive mechanisms for self-care. The over-riding goals of the interventions are to: (1) focus on the survivors' strengths, (2) empower survivors to be agents of change (3) normalize survivors post traumatic stress experiences, and (4) develop positive associational cues to counteract existing negative cues. The first activity uses the concept ...

Abuse History, World Assumptions, and Religious Problem Solving

At a Christian university, 167 subjects completed questionnaires measuring worldview assumptions, religious problem solving, physical and emotional abuse, and subjects' beliefs about whether they had been “abused.” Results indicated that worldview assumptions were not related to actual abuse histories. Instead, such assumptions were related to the subjects' beliefs that they had been abused. Subjects who believed that they had been abused had more negative views of the impersonal world, people, and themselves; they were also more likely to see events as random. Both actual abuse history and subjects' beliefs that they had been abused were related to religious problem‐solving styles. Finally, problem‐solving styles were related to various worldview assumptions. Results are discussed in terms of previous research on abuse and in the psychology of religion.

Assessing the abuse potential of methylphenidate in nonhuman and human subjects: a review

Methylphenidate (MPH) is widely used for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in children, adolescents, and adults. Methylphenidate is clearly effective for the treatment of ADHD, but there is controversy as to whether it has significant abuse potential like other psychostimulants (e.g., d-amphetamine and cocaine). In general, the drug is believed to be abused at rates much lower than those for other stimulants. The present review examines studies that investigated the behavioral pharmacological profile of methylphenidate and discusses how results from these studies address its abuse liability. Using MEDLINE search terms methylphenidate, drug discrimination, reinforcement, self-administration, subjective effects, subject-rated effects, abuse potential, and abuse liability, along with a review of the references from identified articles, 60 studies were located in which the reinforcing, discriminative-stimulus, or subjective effects of methylphenidate were directly assessed in nonhumans or humans. Forty-eight (80.0%) of the studies reviewed indicate that methylphenidate either functions in a manner similar to d-amphetamine or cocaine (e.g., functions as a reinforcer, substitutes fully in drug discrimination experiments), or produces a pattern of subjective effects suggestive of abuse potential. The results are discussed as they pertain to factors that may account for the apparent discrepancy in abuse rates between methylphenidate and other stimulants, including characterization of actual abuse rates, defining abuse and misuse, pharmacokinetic factors, and validity of abuse liability assays.

Referring abused women: does police assistance decrease abuse?

To evaluate if abused women's use of the police reduced further violence experienced, 90 abused women were interviewed at a large urban police department and followed for 6 months. Frequency and severity of violence as well as danger of homicide were measured before and at 3 and 6 months after women sought police help. Women seeking police help had significantly reduced threats of abuse (F = 124.62, df = 2,81; p < .0005), actual abuse (F = 90.11, df = 2,81; p < .0005), and danger of being killed (F = 188.69, df = 2,81; p < .0005) by her intimate partner. Bonferroni post hoc tests showed that significantly fewer threats of abuse, physical abusive acts, and risk indicators for homicide had occurred from prefiling to 3 months (p <.0005) and prefiling to 6 months (p <.0005). The data indicate that referring abused women to the police is an appropriate intervention.

Smoke and Mirrors: The Devastating Effect of False Sexual Abuse Claims

Back to table of contents Previous article Next article Book Forum: Abuse During ChildhoodFull AccessSmoke and Mirrors: The Devastating Effect of False Sexual Abuse ClaimsKARI LOCKWOOD, R.N., and SANJAY GUPTA, M.D., KARI LOCKWOODSearch for more papers by this author, R.N., and SANJAY GUPTASearch for more papers by this author, M.D., Olean, N.Y.Published Online:1 Oct 2000https://doi.org/10.1176/appi.ajp.157.10.1713-aAboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail This is a must-read book for the public as well as mental health professionals. Terence W. Campbell demonstrates how false sexual abuse claims can mark innocent people as well as families for life. He illustrates his point by recounting numerous cases where he has testified as a consultant.The first section of the book describes the origins and misinterpretations that lead to false sexual abuse claims. Campbell demonstrates how this horrible experience can happen anywhere and to anyone and states that the frequency of false allegations of child sexual abuse likely exceeds that of reports of actual abuse. He discusses how these false allegations are detrimental to those who are victims of actual abuse. The descriptions of the allegations are very explicit, detailed, and substantiated by real-life examples. Campbell demonstrates how children respond to therapists in a way that the therapists want. He explains how a child will tell the interviewer what the interviewer may want to hear because the child may think that is the correct answer. The stories become so entangled that the alleged victims and their families begin to believe their own fabricated stories. The accused then becomes the actual victim. Innocent people spend time in prison and are scarred for life. Campbell gives examples of numerous tools that have been developed to screen children for sexual abuse, such as the Sexual Abuse Legitimacy Scale developed by Dr. Richard Gardner. These scales are often used incorrectly, and the procedural recommendations are often ignored. Some interviewers have already made up their mind that the child has been sexually abused before using the scales.In the second part of the book, Campbell hones in on the role of psychotherapists in bringing out memories that are not real. He demonstrates how clients are convinced after a session with the therapist that they were sexually abused as children in horrible ways and that they need further sessions to remember and to deal with the past. Campbell demonstrates how some clients are treated by poorly trained therapists who can destroy relationships among family members by contaminating what the clients think and remember. There definitely needs to be a change in the way some aspects of mental health practice are overseen. The stigma regarding the field of mental health thrives because of the few who practice poorly.This book is easy to read and understand. Typographical errors and misspellings are rare, and the editing is of high quality. Overall, Smoke and Mirrors is a must read for any professional who deals with the public, especially anyone in the health and judicial system.By Terence W. Campbell, Ph.D. New York, Perseus, 1998, 325 pp., $28.95. FiguresReferencesCited byDetailsCited ByNone Volume 157Issue 10 October 2000Pages 1713-a-1714 Metrics History Published online 1 October 2000 Published in print 1 October 2000

Dick Allen, the Phillies, and Racism

Dick Allen, the Phillies, and Racism William C. Kashatus (bio) From the days of the Negro Leagues up to the present battles over merit-based excuses for the absence of blacks in management positions, baseball has long served as a barometer of the nation's racial climate. Nowhere is this more true than in Philadelphia, where the Phillies have suffered for their reputation as a racially segregated team in a racially segregated city. The case of Dick Allen is most often cited as the prime example of this inglorious history of race relations. Allen, the first African-American superstar to don the red pinstripes, was at the center of controversy in the 1960s and mid-1970s when he played in Philadelphia. He exploded onto the scene in 1964, winning the Rookie of the Year Award for his .318 average, 29 homers, and 94 RBI. It was a performance that kept the Phillies in the pennant race for most of the summer until their infamous collapse in the final two weeks of the season. Over the next seven years Allen established himself among the ranks of the game's superstars, becoming a consistent .300 hitter and averaging 30 homers and 90 RBI a season. Those statistics, along with a 1972 MVP performance with the Chicago White Sox, earned him a hero's welcome when Allen returned to Philadelphia in 1975. Phillies management and the fans were convinced that his time away from the city had given him the maturity and experience needed to win the pennant for a budding contender. They were wrong. While Allen's tape-measure home runs and exceptional speed gained for him the tremendous admiration of fellow players, his unexcused absences, candid opinions, and pregame beer drinking earned him some of the harshest press in the city's sports history. Through it all the specter of racial prejudice hung over Allen's relationship with the owners, the team, the press, and the city's fans. For some he was the quintessential rebel who did as he pleased when he pleased, with little regard for team rules or his teammates. For others he exemplified the emerging independence of Major League baseball players as well as growing black consciousness in the game. [End Page 151] The controversy has made Dick Allen the greatest player not enshrined in the National Baseball Hall of Fame. Although he became eligible in 1982, his candidacy has been tainted by the scathing opinions of baseball writers like Bill James, who claims that Allen "used racism as an explosive to blow his own teams apart." James specifically cites Allen's 1965 fight with Frank Thomas, a popular white veteran who was subsequently traded, and the slugger's threat not to play in the 1976 post season if the Phillies didn't make room on the roster for Tony Taylor, an aging Hispanic player, as examples of Allen's manipulative nature. James dismisses Allen's eligibility for the Hall on the grounds that he "did more to keep his teams from winning than anybody else who ever played major league baseball."1 This essay argues that Dick Allen was both a victim and a manipulator of racism on a team that had a poor history of race relations, but a team that was making an earnest effort to distance itself from that inglorious reputation during the 1960s. The tragedy of Dick Allen's relationship with the Philadelphia Phillies is that there always existed a fundamental level of distrust between the two that inevitably expressed-itself sometimes willingly, at other times quite unwittingly-in racial terms. That distrust has cost Allen a place in the Hall of Fame and the Phillies the opportunity to acquit themselves of an infamous reputation as a racist organization. Defining Racism At the root of the Allen controversy is a basic misunderstanding of racism. Too often society confuses racism with prejudice. Racial prejudice refers to individual beliefs and attitudes that frequently manifest themselves in psychologically or physically abusive actions toward people of color. Racism, on the other hand, cannot be fully explained as an expression of prejudice alone. It is a much broader cultural phenomenon, encompassing institutions as well as individuals and...

Preventing abuse of vulnerable adults

Ensuring that social and health care professionals have a clear understanding and acceptance of what constitutes adult abuse and how they should respond when faced by suspected or actual abuse is a key responsibility for all professional associations. Here an account is given how one organisation ‐ UKCC, the regulatory body for nursing, midwifery and health visiting, has approached this task.

The Relative Extent of Physical Punishment and Abuse by Mothers and Fathers

This article reviews the literature that compares the extent to which mothers and fathers administer physical punishment and perpetrate physical abuse. Studies that used similar methods usually show fair agreement, but some significant inconsistencies occur when different sources of information have been used. There is general agreement that mothers and fathers physically punish their children to similar extents. The picture regarding severe or abusive actions is less clear. Most parental self-report studies indicate that mothers are at least as likely as fathers to be responsible. However, according to most studies based on victims' reports, and on official or clinical records that take father absence into account, fathers are more often implicated. Possible reasons for these discrepancies include differences between definitions, biases in samples, and inaccurate reporting. Despite this lack of agreement, the evidence shows that fathers are responsible for a considerable proportion of violence to children.

10.1023/A:1005726012007

Most people are familiar with Justice Stewart's now classic statement that while he cannot describe pornography, he certainly knows it when he sees it. We instantly identify with Justice Stewart. Pornography is not difficult to recognize, but it does elude description. This is because traditional attempts at description are attempts that seek to explain at either an abstract or empirical level rather than at the level that accounts for experience in its totality. Justice Stewart's lament represents the need to understand the subjective experience of pornography and cease trying to explain it in purely objective terms. Much feminist literature in general and Catharine MacKinnon's work in particular seeks to do just this. MacKinnon argues that pornography should not be explained in familiar First Amendment freedom-of-expression terms, but rather in terms of the actual sexual abuse it constitutes in experience. Then, and only then, are we able to select the appropriate legal remedy. This essay suggests that MacKinnon's position not only needs the support of a non-traditional philosophical approach, but has one readily available in the phenomenology of philosopher Edmund Husserl.

Estudio de 43 ciclos de tratamiento con anabolizantes esteroideos en deportistas: usos y efectos secundarios

To know the actual abuse of anabolic steroids by amateur athletes in our environment as well as actions and secondary effects resulting from such abuse. Analytical observational study from May 1997 to November 1998. Forty-three therapy courses with anabolic steroids among 39 male athletes were studied. Diet and training were standardized for all participants. A verification was made that the test group started from a basal state. Duration of therapy was 6 weeks and the mean total dose was 2,928 mg. Significant differences were found in the test group regarding basal and post-therapy values for: transaminases (AST: 29.8 vs 45.0 IU/l, p < 0.001. ALT: 32.9 vs 51.4 IU/l, p < 0.01), cholesterol, HDL-cholesterol (31.4 vs 19.7 mg/dl, p < 0.01), LDL-cholesterol (145.9 vs 173.5 mg/dl, p < 0.01), LH (2.1 vs 0.2 U/l, p < 0.001), FSH (3.3 vs 0.4 U/l, p < 0.001), free testosterone (14.4 vs 34.0 pg/ml, p < 0.001), 17-beta-estradiol and arm muscular section (98.8 vs 103.7 cm2, p < 0.001). The inclusion of testosterone in therapy introduced a significant difference with respect to the use of synthetic anabolic agents alone, in total testosterone (4.5 vs 0.9 ng/ml, p < 0.001) and 17-beta-oestradiol, but neither with respect to free testosterone nor arm muscular section. An 84.6% of individuals in the problem group stated to complete two therapy courses in a year. The use of anabolic steroids increases the lean muscular mass. The most relevant secondary effects included: increased transaminase serum levels, change in the lipid profile and suppression of the hypothalamus-pituitary gland-gonad axis. The inclusion of testosterone did not increase the lean muscular mass.

Governance and Legitimacy in the Law of Class Actions

The law of class actions has emerged prominently in the Supreme Court?s docket in the past few Terms through repeated confrontations with the relatively recent emergence of the settlement class action. In the three leading cases, Matsushita v. Epstein, Amchem v. Windsor Products, and Ortiz v. Fibreboard, the Court has traced an uncertain line between the efficiency mandates of aggregate dispute resolution and the fairness concerns of the absent class members. Because each arose in the settlement context there is a blurring of what should be two distinct questions in the class certification context: the necessity of class treatment to overcome collective action barriers to the prosecution of perceived group harms, and the question of who should control the class action and under what terms. Because these two questions are addressed jointly as part of the certification inquiry, courts have had great difficulty separating out their particular attributes. This article argues that a specific focus on the governance of the class action brings into sharper relief the core difficulty in the functional analysis developed by the Court in Amchem and Ortiz. In attempting to control abusive class action practice from within the loose standards of Rule 23 of the Federal Rules of Civil Procedure, the Court identifies rather than fully explains the potential mischief in the class action settlements it condemns. By focusing more clearly on these cases as governance problems, the Court?s analysis may be reconceptualized as a classic principal-agent problem in which there are insufficient checks on opportunistic or self-serving behavior by the agents. This approach rejects the Court?s retreat in both Amchem and Ortiz to rule-based formalism focusing on the technical requirements and the amendment process for Rule 23. Instead, Amchem and particularly Ortiz are analyzed as extremely positive developments of a due process based analysis for the law of representative actions. This due process approach rests the propriety of class certification on the guarantees of loyalty of the agents for the absent class members (first and foremost class counsel) to those whose rights must ultimately be adjudicated in absentia. By contrast to the rule formalism evident in both Amchem, with regard to the technical requirement of manageability for certification under Rule 23(b)(3), and Ortiz, concerning the requirement of a truly limited fund for certification under Rule 23(b)(1), both opinions also apply a highly functional analysis to the adequacy of representation determination of whether the absent principals were loyally served by their agents. In turn, while adequacy of representation is part of the rule-based certification inquiry under 23(a)(4), this article suggests that once the governance issue is examined independently, it forms part of a robust due process tradition linking the current class action cases to more distant predecessors such as Hansberry v. Lee and Martin v. Wilks.

MANDATORY REPORTING OF ABUSE: PRACTICAL, MORAL, AND LEGAL ISSUES FOR PSYCHIATRIC HOME HEALTHCARE NURSES

Psychiatric home healthcare nurses (PHHNs) work directly with clients and their families in the community and serve as consultants to other home health nurses when concerns of mental health arise. They must be able to identify areas of possible or actual family violence or abuse and intervene appropriately. They must be cognizant of the laws regarding abuse reporting in their states. Decisions to report abuse are practical and moral and, when combined with legal imperatives, create ethical dilemmas for healthcare professionals. Guidelines are presented to help PHHNs understand the complex issues associated with mandatory reporting of abuse.

Parenthood, Childhood and Injury: Some Dilemmas for the Law of Torts

This paper looks at some recent developments in the law of torts. It looks in particular at the emergence of civil claims with respect to child abuse and the confinements effected by traditional limitation periods in relation to those claims. It examines in particular in the first section the House of Lords decision in Stubbings v. Webb to the effect that civil claims over child sex abuse were time barred, and the subsequent unsuccessful appeal to the European Court of Human Rights which ruled by seven votes to two that there had been no violation of articles 6 of the European Convention on Human Rights. It is also noted that the Court ruled unanimously that there had been no violation of article 8; and by eight votes to one that there had been no violation of article 14. The paper turns in the second section to what have been called actions for ‘wrongful birth’, arguing that here we see the law of torts taking a more protective role, one which must be set side by side with the child abuse actions examined in the first part of the paper. Throughout the paper, both English and Australian law is canvassed. The major claims in this paper relate to what the author terms a singularly adult picture or rights and wrongs reflected in the law of torts.

The Problematic Use of the Concepts of Empowerment, Responsibility and Innocence in Child Protection Programs

Abstract The academic literature on child sexual abuse reveals that since the 1980's there has been a focus upon studies of prevention programmes such as the protective behaviours programmes. These programmes are aimed at children and advocate the importance of teaching them appropriate responses to threatening situations such as sexual, emotional, physical abuse and domestic violence. Sexual abuse is one among several forms of abuse that children are being schooled in self protection. Taught at primary schools the programs are presented as plays, storytelling, role playing and games which seek to emphasise the sexual abuse component of the protective behaviour. In particular they aim to inform children how to identify inappropriate sexual behaviour by adults, to recognise ‘good’ and ‘bad’ touching. They also aim to encourage children to respond to the behaviour by saying ‘no’ and finally to confide in a ‘trusted’ adult of any attempted or actual abuse.

Should smart operators mix business and surgery?

Should smart operators mix business and surgery?

Mothers' potential for child abuse: the roles of childhood abuse and social resources.

The mechanism by which some victims of childhood abuse become abusive parents, whereas others do not, is not well understood. Previous empirical evidence indicates that social resources may modify the cycle of abuse or maladaptive parenting; however, the effects of different dimensions of social resources have not been compared. To determine whether a measure of mothers' potential for physical child abuse was related to their retrospective reports of physical and sexual abuse before 18 years of age and to investigate the potential buffering effects of multiple dimensions of social resources on the relationship between childhood abuse and mothers' potential for physical child abuse. The potential role of social resources as a moderator of the relationship between a history of childhood abuse and potential for physical child abuse was investigated in 206 low-income single mothers of young children. The levels of physical and sexual abuse in childhood were positively associated with the mothers' child abuse potential; sexual abuse displayed the strongest association. Compared with mothers who were not sexually abused in childhood, those reporting violent sexual abuse as children were almost six times more likely to have high potential for physically abusing their children. There was no evidence that any of the social resources modified the relationship of either type of childhood abuse with the mothers' potential for abuse. However, all four dimensions of social resources demonstrated significant main effects on child abuse potential. Low-income mothers face many stressors because of their lack of economic resources. This, coupled with a lack of social resources and a history of childhood abuse, makes low-income, single mothers particularly at risk for abusive parenting. The lives of these women and their children may be enhanced by assisting the women to improve their social resources which, ultimately, may reduce their potential for child abuse. Future research should focus on identifying factors that predict and/or modify the potential for abusive parenting as well as actual abuse.

Group therapy for victims and perpetrators of incest

Abuse is an inter-generational problem. Abusers have been damaged in childhood by abusive action perpetrated on them, usually by their parents but sometimes by other significant adults. At times, in becoming adults, the early emotional damage can manifest into psychopathological features, including perversions or paraphilias and perpetration of abuse against children.