Different Types Of Childhood Maltreatment Research Articles

Linking Healthcare and Social Service Databases to Study the Epidemiology of Child Maltreatment and Associated Health Problems: Hong Kong's Experience

To examine the incidence and trend of child maltreatment and its associated health problems in Hong Kong by linking healthcare and social service databases. Data on 4816 children under the age of 18 years registered with the Child Protection Registry and matching health records in public hospitals in Hong Kong from 2003 to 2010 were extracted. Associations were examined between different types of child maltreatment and child's medical diagnosis according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision codes including suicidal attempt (X60-X84), nonchild maltreatment related injuries (S00-S99; T00-T98, excluding T74 and T76 that are maltreatment related injuries), mental health problems (F00-F99), and congenital malformations/chromosomal abnormalities (Q00-Q99). Significant rising trends were found for child physical abuse, neglect, and sexual abuse during the period from 2003 to 2010. Psychological abuse remained stable. Risk of suicide attempt was higher among children suffering from sexual abuse, psychological abuse, and children experiencing multiple abuses; mental health diagnoses were more common in victims of psychological and multiple abuses. Congenital malformations and chromosomal abnormalities were more commonly found among neglected children. In contrast to the decreasing trend observed in the West during the study period, there has been an escalating trend in child maltreatment in Hong Kong and child maltreatment is strongly associated with major health problems. This is one of the first studies to demonstrate the power of linking healthcare and social service databases, which allows for both a better understanding of the impact of child maltreatment and as a guide future policy and service planning.

Childhood Maltreatment, Pathological Personality Dimensions, and Suicide Risk in Young Adults.

Several studies have demonstrated that child maltreatment (psychological, physical, and sexual abuse, and neglect) may be a significant factor in the development of pathological personality traits that increase the risk for suicidal ideation and behavior from adolescence to adulthood. Currently, the challenge is to understand how different forms of early negative experiences render an individual prone to develop specific personality traits and, in turn, be more vulnerable to suicide risk. To understand the relationship between childhood maltreatment and personality dimensions in suicide risk, our study aims to explore the role of self-criticism and dependency, two different pathological personality traits, as potential mediators of the link between different types of childhood maltreatment and suicide risk in young adults. For this purpose, 306 students from three Italian public universities were recruited. We used the Italian version of the Childhood Experience of Care and Abuse Questionnaire (CECA.Q) to assess experiences of lack of care by parents (i.e., antipathy and neglect) as well as psychological and physical abuse before the age of 17 years. The Depressive Experiences Questionnaire (DEQ) was used to assess the personality dimensions of self-criticism and dependency, and the Suicide History Self-Rating Screening Scale was administered to assess suicide risk. Results revealed that lack of care and psychological abuse were significantly associated with suicide risk and this association was partially mediated by the maladaptive personality dimension of self-criticism. These findings suggest that the combined effect of specific forms of dysfunctional parental behavior during childhood and the development of rigid and dysfunctional negative personality traits may increase the risk for suicidal ideation and behavior during adulthood.

Child and Family Factors Associated With Child Maltreatment in Vietnam.

This study aims to explore possible risk factors for child maltreatment in Vietnam by investigating the association of child and family factors with different types of child maltreatment (i.e., sexual abuse, physical abuse, emotional abuse, witnessing parental conflict, and neglect) and the occurrence of multiple types of child maltreatment. Cross-sectional data of 1,851 secondary and high school students aged 12 to 17 years (47.3% boys) in four provinces of Northern Vietnam were obtained using self-report questionnaires. Results indicated that the likelihood of emotional abuse, witnessing parental conflict, and experiencing multiple types of child maltreatment during lifetime increased with age. Boys had a higher risk than girls on lifetime sexual abuse, and past year and lifetime physical abuse. Living in a single parent family was the risk factor related to most types of child maltreatment including lifetime sexual abuse, neglect, and multiple types of child maltreatment, and both past year and lifetime witnessing parental conflict. Interestingly, low socioeconomic status (SES) and parental unemployment were associated with a decreased risk on experiencing emotional abuse in the past year and during lifetime, respectively. “Tiger parenting,” a parenting style observed frequently in East Asian parents, may be more common in families with high SES and might explain this finding. This study highlights the importance of prioritizing single parent families in parenting programs and implementing child maltreatment interventions early because of the risk on child maltreatment increased with age. More research on emotional abuse and “Tiger parenting” in Vietnam could clarify the association of emotional abuse with high SES and parental employment. Finally, the underlying mechanisms of the risk factors in Vietnam should be studied more to inform interventions.

Assessing child physical abuse: An examination of the factor structure and validity of the Parent-Child Conflict Tactics Scale (CTSPC)

Child maltreatment (CM) is associated with negative outcomes for young children across several areas of functioning. Given limitations in measuring different types of CM using substantiated abuse reports, other assessments may be helpful to inform identification and intervention efforts, such as self-report measures. The Parent-Child Conflict Tactics Scale (CTSPC) is a parent-report measure that provides information regarding the presence and severity of parenting behaviors related to CM subtypes, including physical and psychological abuse. The current study examines the factor structure of the CTSPC as well as its convergent validity with a behavioral observation measure, the Dyadic Parent-Child Interaction Coding System (DPICS). Pre-treatment archival data for 110 parent-child dyads with a substantiated physical abuse incident who were court-mandated to receive treatment as part of a larger study were used. Results demonstrated that a four-factor model best described the structure of the CTSPC, contrary to the theoretically-proposed structure of the measure. Reports on the CTSPC scales were also associated with several parent behaviors measured by the DPICS. Possible areas of improvement for the scale were provided. The current study has implications for further psychometric development of the CTSPC as well as its future use as a measure of parenting behaviors related to abuse.

Dissociation fully mediates the relationship between childhood sexual and emotional abuse and DSM-5 PTSD in a sample of treatment-seeking adults

IntroductionChild abuse and neglect are associated with increased risk of adult PTSD and dissociation. Recent research suggests that dissociation mediates the relationship between child maltreatment and PTSD, however, there is a lack of clarity regarding the mediating role of dissociation for different types of child abuse. ObjectiveThe aim of the current study was to investigate dissociation as a mediator between 5 typologies of child maltreatment and posttraumatic stress severity. MethodIn a sample of highly symptomatic, treatment-seeking females (n=99), structural equation modelling was used to test 3 different models of mediation: direct effect, indirect effect, and direct and indirect effect. ResultsThe 5 typologies of child maltreatment were significantly related to dissociation and posttraumatic stress. Dissociation mediated the effect of childhood sexual abuse and childhood emotional abuse on posttraumatic stress severity. The indirect effect model fit the data best. ConclusionDissociation fully mediated the relationship between childhood sexual and emotional abuse and posttraumatic stress severity. The results are limited by the use of retrospective self-report measures and a small sample size.

Associations of childhood maltreatment with pre-pregnancy obesity and maternal postpartum mental health: a cross-sectional study

Pre-pregnancy obesity and postpartum mental disorders are prevalent health risks to both the mother and the offspring. The objective of our study was to examine whether a history of childhood maltreatment is associated with pre-pregnancy obesity and postpartum mental health and whether childhood maltreatment and pre-pregnancy BMI independently predict postpartum mental health. We obtained self-reported data from 741 postpartum women before 16 weeks after delivery (M = 8.1 weeks, SD = 3.2). Childhood sexual, physical, and emotional abuse and physical and emotional neglect were assessed with the Childhood Trauma Questionnaire. Depression and anxiety were assessed using the BDI and SCL-90-R. We conducted logistic regression models adjusted for demographic covariates and co-occurrence of different types of maltreatment. 7.6% of the included women entered pregnancy with obesity. Forty-six percent reported any type of childhood maltreatment. 6.4% displayed at least moderate postnatal depressive symptomatology and 20.5% scored above the 75th percentile for postpartum anxiety. Severe physical abuse, moderate emotional abuse and severe physical and emotional neglect were associated with pre-pregnancy obesity. After controlling for the presence of all other types of childhood maltreatment, only severe physical abuse was still predictive for pre-pregnancy obesity (adj.OR = 5.24, 95% CI = 1.15-23.75). Pre-pregnancy obesity was associated with an increased risk of postpartum depression (adj.OR = 2.55, 95% CI = 1.08-6.00) but not with elevated anxiety. Pre-pregnancy obesity and severe childhood sexual abuse independently predicted postpartum depression. After controlling for histories of different types of childhood maltreatment, the association between pre-pregnancy obesity and postpartum depression attenuated to non-significance. To our knowledge, this is the first study examining empirical relations between childhood maltreatment, pre-pregnancy BMI and postpartum mental health controlling for the co-occurrence of other maltreatment types. Childhood maltreatment has been found being associated with both pre-pregnancy obesity and impaired postpartum mental health and may at least partly account for the association between pre-pregnancy obesity and postpartum depression. Therefore childhood maltreatment is related to two common risk conditions during pregnancy and postpartum which bear several health risks for the mother and the child, and routine screening for histories of childhood maltreatment among pregnant women is warranted.

Physical Child Abuse by Parents and Teachers in Saudi Arabia: a Systematic Literature Review.

A systematic review was conducted to find out what is known about the prevalence and nature of physical child abuse in Saudi. The review identified 15 abuse prevalence studies carried out in Saudi Arabia between 1998 and 2016, written in English or Arabic. An analysis of these revealed the known prevalence of different types of child abuse, the relationship of the abuser to the victim, and the level of awareness among school professionals of procedures and programs in Saudi to protect children from abuse. The review revealed many shortcomings of existing literature, including a paucity of published studies, lack of rigor in research design, an absence of data from many parts of the country, and an emphasis on hospital reports rather than data collected directly from victims. Studies conducted to date suggest that physical abuse of children is more widespread and severe in the Kingdom than previously acknowledged.

The association between child maltreatment and emotional, cognitive, and physical health functioning in Vietnam

BackgroundThere is a paucity of research on correlates of child maltreatment in limited-resource countries with a relatively high tolerance of harsh discipline. This Vietnamese study aimed to investigate associations between different types of child maltreatment and child emotional, cognitive, and physical health functioning as well as moderation effects of gender and ethnicity.MethodsThis cross-sectional study was conducted with 1851 randomly selected students aged 12–17 years. Both self-report and more objective measures (weight, height, study ranking, and a memory test) were used.ResultsAll types of child maltreatment were associated with emotional dysfunctioning. Life time and past year experiences of physical abuse and life time experiences of sexual abuse and neglect were related to poorer perceived physical health. The study did not find associations between any type of child maltreatment and overweight or underweight status. Regarding cognitive functioning, life time experience of sexual abuse and neglect were related to poorer working memory performance. Noticeably, emotional abuse was related to better academic performance, which might be an indication of “tiger parenting” practice in Vietnam, implying academic performance stimulation at the expense of emotional security. No significant moderation effects by gender and ethnicity were found.ConclusionEven in a culture in which harsh discipline is normative, child maltreatment was related to negative aspects of child wellbeing including emotional, cognitive, and physical health functioning. Efficient and low-cost interventions on child maltreatment should be developed and conducted in Vietnam as well as other countries with similar contexts.

Emotional Abuse in Childhood and Attachment Anxiety in Adult Romantic Relationships as Predictors of Personality Disorders

ABSTRACTPersonality disorders are characterized by interpersonal problems. These problems might arise not only in current, but also in past relationships. To test this hypothesis, recollections of abuse and neglect in childhood and representations of adult attachment to the romantic partner were related to dimensional ratings of the 10 DSM-5 personality disorders. Ultimately, 110 patients of a psychosomatic clinic took part in the study. All data were collected with self-report measures. Among the different types of child abuse and neglect, emotional abuse was shown to be most frequently correlated with personality disorders. Attachment dimensions avoidance and anxiety were both associated with personality disorders; anxiety, however, showed stronger correlations. The results reveal that personality disorders come along with enduring adversities in close relationships, mainly experiences of emotional abuse and attachment anxiety, starting in the family of origin and continuing in adult attachment bonds.

Cognitive Empathy Partially Mediates the Relationship between Childhood Physical Abuse and Borderline Personality Disorder Features in College Students

Among college students, Borderline Personality Disorder (BPD) features are prevalent and impairing. Different types of childhood maltreatment (CM) are associated with BPD features, though the type(s) of CM that is most robustly associated with BPD features and the mechanism by which CM leads to BPD features are not well-studied. Thus, the purpose of this study was to investigate which type(s) of CM was most robustly associated with BPD features and to test whether empathy, which is negatively correlated with CM, mediated the relationship between CM and BPD features in college students. Two thousand five hundred fifty-one undergraduate college students completed online self-report questionnaires measuring CM, empathy, and BPD features. A series of regression models were tested to explore relationships between types of CM and BPD features and CM, empathy and BPD features. Childhood physical abuse, but neither sexual abuse nor neglect, significantly predicted BPD features. Cognitive empathy partially mediated the relationship between childhood physical abuse and BPD features. These findings suggest childhood physical abuse is negatively associated with cognitive empathy, which in turn, is negatively associated with BPD features. Implications for treating BPD features in college students based on these findings are discussed.

Childhood Maltreatment and Young Adulthood Hallucinations, Delusional Experiences, and Psychosis: A Longitudinal Study.

Child maltreatment is a widespread public health problem associated with a range of mental health disorders later in life. In order to effectively address these disorders, there is a need to understand more about the mental health consequences of different types of child maltreatment. This study examines the associations between prospectively substantiated child maltreatment (ages 0-14 y) and reports of hallucinations and delusional experiences at 21 years after birth. As well, we examined 12-month and lifetime psychotic disorders using data from a longitudinal birth cohort. The study comprised 3752 participants from the Mater-University of Queensland Study of Pregnancy, a prospective Australian prebirth cohort study. Psychotic experiences and 12-month and lifetime psychosis were measured using the Achenbach Young Adults Self-Report, the Peter's Delusions Inventory, and Composite International Diagnostic Interview at the 21-year follow-up. In adjusted analyses, those children who had experienced any maltreatment and who were emotionally abused and neglected were more likely to report (1) hallucinations and lifetime delusional experiences and (2) more likely to experience lifetime psychosis than their nonabused counterparts. In expanded models, those exposed to multiple forms of maltreatment, in particular with emotional abuse and neglect, had an increased likelihood of hallucinations and delusional experiences. There is an association between child maltreatment, especially emotional abuse and neglect, and later hallucinations, delusional experiences, and psychosis. It is, however, relevant to note that the vast majority of children experiencing childhood maltreatment do not appear to develop psychotic experiences or psychotic disorder. Further research to determine the reasons for highly variable outcomes of child maltreatment is warranted.

Childhood Maltreatment and School Problems: A Danish National Study

ABSTRACTThe association between child maltreatment (CM) and educational outcomes have been well documented. However, there is a paucity of research that explores the association between different types of maltreatment and other school problems that may affect the educational outcomes of maltreated children. This study examined the association between different types of CM and school changes, concentration problems, and special educational needs. Gender differences were also examined. Structured interviews were conducted with 2,980 participants. Significant associations emerged between CM, in particular, multiple maltreatment experiences and school problems. Males had higher concentration difficulties and special educational needs. More research attention is needed into optimal learning environments and interventions that support maltreated children more effectively.

Factorial validity of the Childhood Trauma Questionnaire in Italian psychiatric patients.

Early adverse experiences are associated with neurobiological changes and these may underlie the increased risk of psychopathology. The Childhood Trauma Questionnaire (CTQ-SF) is the most commonly used instrument for assessing childhood maltreatment. Thus, the aim of our study was to investigate the factorial validity of an Italian version of the CTQ-SF in a sample of psychiatric inpatients by means of confirmatory and exploratory factor analyses. The sample was composed of 471 psychiatric in-patients and out-patients (206 males and 265 females) aged 16-80 years (mean age=34.4 years [SD=16.3]) consecutively admitted to two psychiatric departments. All patients were administered the Italian version of the CTQ-SF. We tested five different factor models which lacked good fit, while the exploratory factor analysis supported the adequacy of a solution with three factors (Emotional Neglect/Abuse, Sexual Abuse, Physical Neglect/Abuse). The three factors had satisfactory internal consistency (ordinal Cronbach alphas >0.90). Our study supports results from previous research indicating the lack of structural invariance of the CTQ-SF in cross-cultural adaptations of the test, and the fact that, when measuring different types of childhood maltreatment, the difference between abuse and neglect may be not valid.

Investigating the relationship between childhood maltreatment and alcohol misuse in a sample of Danish young adults: Exploring gender differences

Background This study examined the relationship between alcohol misuse and different types of childhood maltreatment in a sample of young adults while controlling for posttraumatic stress disorder (PTSD) symptoms and current mental disorders. This study further examined if these associations were different for males and females. Methods Data were collected from a Danish national study conducted by The Danish National Centre for Social Research in 2008 and 2009. A sample of 4718 young adults (24 years of age) was randomly selected using the total birth cohort of children born in 1984. Structured interviews were conducted with a response rate of 63%, equating to a total sample size of 2980 participants. Results Three types of child maltreatment were assessed; emotional abuse (N =263), sexual abuse (N=59), and multiple abuse (N=64) alongside a non-abused (N=2595) control group. Findings indicated the three maltreatment groups were all related to alcohol misuse. Maltreated women in particular had a 16-to-25-fold increased risk of alcohol misuse. For males these associations were attenuated with odds ratios (OR) ranging between 3 and 5 for emotional and multiple abuse groups. PTSD symptoms were associated with alcohol misuse for both genders, whilst current mental health disorder was non-significant for both males and females. Conclusion A significant relationship was found between the child maltreatment and alcohol misuse. This relationship was significantly stronger for maltreated women, which identifies a gap in the literature. High associations between maltreatment and alcohol misuse in females may suggest alcohol is used as a coping strategy following childhood maltreatment.

Patterns of Childhood Abuse and Neglect in a Representative German Population Sample

BackgroundDifferent types of childhood maltreatment, like emotional abuse, emotional neglect, physical abuse, physical neglect and sexual abuse are interrelated because of their co-occurrence. Different patterns of childhood abuse and neglect are associated with the degree of severity of mental disorders in adulthood. The purpose of this study was (a) to identify different patterns of childhood maltreatment in a representative German community sample, (b) to replicate the patterns of childhood neglect and abuse recently found in a clinical German sample, (c) to examine whether participants reporting exposure to specific patterns of child maltreatment would report different levels of psychological distress, and (d) to compare the results of the typological approach and the results of a cumulative risk model based on our data set.MethodsIn a cross-sectional survey conducted in 2010, a representative random sample of 2504 German participants aged between 14 and 92 years completed the Childhood Trauma Questionnaire (CTQ). General anxiety and depression were assessed by standardized questionnaires (GAD-2, PHQ-2). Cluster analysis was conducted with the CTQ-subscales to identify different patterns of childhood maltreatment.ResultsThree different patterns of childhood abuse and neglect could be identified by cluster analysis. Cluster one showed low values on all CTQ-scales. Cluster two showed high values in emotional and physical neglect. Only cluster three showed high values in physical and sexual abuse. The three patterns of childhood maltreatment showed different degrees of depression (PHQ-2) and anxiety (GAD-2). Cluster one showed lowest levels of psychological distress, cluster three showed highest levels of mental distress.ConclusionThe results show that different types of childhood maltreatment are interrelated and can be grouped into specific patterns of childhood abuse and neglect, which are associated with differing severity of psychological distress in adulthood. The results correspond to those recently found in a German clinical sample and support a typological approach in the research of maltreatment. While cumulative risk models focus on the number of maltreatment types, the typological approach takes the number as well as the severity of the maltreatment types into account. Thus, specific patterns of maltreatment can be examined with regard to specific long-term psychological consequences.

Predicting Response Trajectories during Cognitive-Behavioural Therapy for Panic Disorder: No Association with the BDNF Gene or Childhood Maltreatment.

BackgroundAnxiety disorders are highly prevalent and result in low quality of life and a high social and economic cost. The efficacy of cognitive-behavioural therapy (CBT) for anxiety disorders is well established, but a substantial proportion of patients do not respond to this treatment. Understanding which genetic and environmental factors are responsible for this differential response to treatment is a key step towards “personalized medicine”. Based on previous research, our objective was to test whether the BDNF Val66Met polymorphism and/or childhood maltreatment are associated with response trajectories during exposure-based CBT for panic disorder (PD).MethodWe used Growth Mixture Modeling to identify latent classes of change (response trajectories) in patients with PD (N = 97) who underwent group manualized exposure-based CBT. We conducted logistic regression to investigate the effect on these trajectories of the BDNF Val66Met polymorphism and two different types of childhood maltreatment, abuse and neglect.ResultsWe identified two response trajectories (“high response” and “low response”), and found that they were not significantly associated with either the genetic (BDNF Val66Met polymorphism) or childhood trauma-related variables of interest, nor with an interaction between these variables.ConclusionsWe found no evidence to support an effect of the BDNF gene or childhood trauma-related variables on CBT outcome in PD. Future studies in this field may benefit from looking at other genotypes or using different (e.g. whole-genome) approaches.

Child maltreatment and ADHD symptoms in a sample of young adults

ObjectiveThe present study investigated the relationship between different types of childhood maltreatment (emotional, sexual, overall abuse, and no abuse) and the symptoms of attention deficit hyperactivity disorder (ADHD) in young adulthood.MethodData were collected from a Danish national study conducted by The Danish National Centre for Social Research in 2008 and 2009. A sample of 4,718 young adults (24 years of age) were randomly selected using the total birth cohort of children born in 1984. Structured interviews were conducted with a response rate of 63%, equating to a total sample size of 2,980 participants.ResultsChi-square analyses revealed significant relationships between child maltreatment groups and a probable diagnosis of ADHD using the Adult ADHD Self-Report Scale (ASRS). Binary logistic regression analysis showed that the overall abuse class was more strongly associated with probable ADHD (OR=5.08), followed by emotional abuse (OR=3.09) and sexual abuse (OR=2.07).ConclusionsThe results showed that childhood maltreatment was associated with increased risk of ADHD symptoms in young adulthood. The findings of this study are discussed within the existing literature and suggestions for future research are outlined in order to replicate these findings in other adult populations.Highlights of the articleChild maltreatment is associated with higher levels of ADHD symptoms in a nationally representative sample of young Danish adults.Co-occurring (multiple) types of maltreatment display stronger associations with ADHD symptoms with attenuated effects for sexual abuse.Males confer stronger associations with ADHD symptoms than females.Findings underscore the importance of exploring the role of childhood trauma in young adults with ADHD symptoms.

Adverse childhood experiences, gender, and HIV risk behaviors: Results from a population-based sample.

Recent HIV research suggested assessing adverse childhood experiences (ACEs) as contributing factors of HIV risk behaviors. However, studies often focused on a single type of adverse experience and very few utilized population-based data. This population study examined the associations between ACE (individual and cumulative ACE score) and HIV risk behaviors. We analyzed the 2012 Behavioral Risk Factor Surveillance Survey (BRFSS) from 5 states. The sample consisted of 39,434 adults. Eight types of ACEs that included different types of child abuse and household dysfunctions before the age of 18 were measured. A cumulative score of ACEs was also computed. Logistic regression estimated of the association between ACEs and HIV risk behaviors using odds ratio (OR) with 95% confidence intervals (CIs) for males and females separately. We found that ACEs were positively associated with HIV risk behaviors overall, but the associations differed between males and females in a few instances. While the cumulative ACE score was associated with HIV risk behaviors in a stepwise manner, the pattern varied by gender. For males, the odds of HIV risk increased at a significant level as long as they experienced one ACE, whereas for females, the odds did not increase until they experienced three or more ACEs. Future research should further investigate the gender-specific associations between ACEs and HIV risk behaviors. As childhood adversities are prevalent among general population, and such experiences are associated with increased risk behaviors for HIV transmission, service providers can benefit from the principles of trauma-informed practice.

The relationship between child maltreatment and exposure to traumatic events during later adolescence and young adulthood

Abstract Objective The present study investigated the relationship between different types of childhood maltreatment (emotional abuse, sexual abuse, multiple abuse types, and no abuse) and the occurrence of later traumatic events during later adolescence and young adulthood. Method Data were collected from a Danish national study conducted by The Danish National Centre for Social Research in 2008 and 2009. A sample of 4718 young adults who were 24 years old was randomly selected using the total birth cohort of children born in 1984. A structured interview was conducted during which participants were asked about a range of traumatic and abusive experiences. Results A response rate of 63% was achieved for a total sample size of 2980. Chi-squared analyses revealed significant relationships between all child maltreatment groups and direct exposure to 10 of the 13 traumatic events; there were also significant relationships between all child maltreatment groups and indirect exposure to 12 of the 13 traumatic events. Conclusions The results showed that childhood maltreatment was associated with increased risk of exposure to traumatic events, both directly and indirectly, during adolescence and young adulthood. The findings of this study suggest there is an increased risk of being exposed to both direct and indirect traumas during later adolescence and young adulthood after any form of child maltreatment.

Transtorno factício imposto a outro (síndrome de munchausen por procuração) e maus-tratos infantis

Violence is recognized worldwide as a public health problem. In 2002, the World Health Organization (WHO) highlighted abuse and neglect due to their chronic nature and the psychological and social harm that they cause, in addition to physical injury, often victimizing children. This article describes different types of child abuse, with a main focus on Munchausen syndrome by proxy, due to the peculiarity of involving three entities, even if inadvertently: the doctor, the caregiver/perpetrator, and the child/victim.