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Concept: Psychological abuse

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Abstract Background: While intimate partner violence (IPV) affects 25% of women and impairs health, current societal conditions-including the normalization of abuse in popular culture such as novels, film, and music-create the context to support such violence. Fifty Shades of Grey, a best-selling novel, depicts a “romantic” and “erotic” relationship involving 28-year-old megamillionaire, Christian Grey, and a 22-year-old college student, Anastasia Steele. We argue that the relationship is characterized by IPV, which is harmful to Anastasia. Methods: All authors engaged in iterative readings of the text, and wrote narrative summaries to elucidate themes. Validity checks included double review of the first eight chapters of the novel to establish consistency in our analysis approach, iterative discussions in-person and electronically to arbitrate discrepancies, and review of our analysis with other abuse and sexual practice experts. To characterize IPV, we used the U.S. Centers for Disease Control and Prevention’s definitions of emotional abuse (intimidation/threats; isolation; stalking; and humiliation) and sexual violence (forced sex acts/contact against a person’s will, including using alcohol/drugs or intimidation/pressure). To characterize harm, we used Smith’s conceptualizations of perceived threat, managing, altered identity, yearning, entrapment, and disempowerment experienced by abused women. Results: Emotional abuse is present in nearly every interaction, including: stalking (Christian deliberately follows Anastasia and appears in unusual places, uses a phone and computer to track Anastasia’s whereabouts, and delivers expensive gifts); intimidation (Christian uses intimidating verbal and nonverbal behaviors, such as routinely commanding Anastasia to eat and threatening to punish her); and isolation (Christian limits Anastasia’s social contact). Sexual violence is pervasive-including using alcohol to compromise Anastasia’s consent, as well as intimidation (Christian initiates sexual encounters when genuinely angry, dismisses Anastasia’s requests for boundaries, and threatens her). Anastasia experiences reactions typical of abused women, including: constant perceived threat (“my stomach churns from his threats”); altered identity (describes herself as a “pale, haunted ghost”); and stressful managing (engages in behaviors to “keep the peace,” such as withholding information about her social whereabouts to avoid Christian’s anger). Anastasia becomes disempowered and entrapped in the relationship as her behaviors become mechanized in response to Christian’s abuse. Conclusions: Our analysis identified patterns in Fifty Shades that reflect pervasive intimate partner violence-one of the biggest problems of our time. Further, our analysis adds to a growing body of literature noting dangerous violence standards being perpetuated in popular culture.

Concepts: Sexual intercourse, Domestic violence, Child abuse, Abuse, Psychological abuse, Bullying, Psychological manipulation, Intimidation

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This article explores the repercussions of workplace bullying on nurses and the health-care profession as a whole. I discuss the nature of workplace bullying and draw upon prior studies to explore some of the barriers that prevent witnesses to bullying from intervening, as well as barriers faced by targets in taking action to stop the bullying. As overt forms of resistance are often not feasible in situations where nurses occupy subordinate positions to their bullies, I propose that cognitive reappraisal can be an effective coping strategy, and situate this perspective within the research on humour, hope and optimism.

Concepts: Positive psychology, Strategy, Abuse, Psychological abuse, Workplace bullying, Bullying, Sexual harassment, Mobbing

19

Childhood maltreatment increases the risk of subsequent depression, anxiety and alcohol abuse, but the rate of resilient victims is unknown. Here, we investigated the rate of victims that do not suffer from clinical levels of these problems after severe maltreatment in a population-based sample of 10980 adult participants. Compared to men, women reported more severe emotional and sexual abuse, as well as more severe emotional neglect. For both genders, severe emotional abuse (OR = 3.80 [2.22, 6.52]); severe physical abuse (OR = 3.97 [1.72, 9.16]); severe emotional neglect (OR = 3.36 [1.73, 6.54]); and severe physical neglect (OR = 11.90 [2.66, 53.22]) were associated with depression and anxiety while only severe physical abuse (OR = 3.40 [1.28, 9.03]) was associated with alcohol abuse. Looking at men and women separately, severe emotional abuse (OR = 6.05 [1.62, 22.60] in men; OR = 3.74 [2.06, 6.81] in women) and severe physical abuse (OR = 6.05 [1.62, 22.60] in men; OR = 3.03 [0.99, 9.33] in women) were associated with clinical levels of depression and anxiety. In addition, in women, severe sexual abuse (OR = 2.40 [1.10, 5.21]), emotional neglect (OR = 4.78 [2.40, 9.56]), and severe physical neglect (OR = 9.86 [1.99, 48.93]) were associated with clinical levels of depression and anxiety. Severe emotional abuse in men (OR = 3.86 [0.96, 15.48]) and severe physical abuse in women (OR = 5.18 [1.48, 18.12]) were associated with alcohol abuse. Concerning resilience, the majority of severely maltreated participants did not report clinically significant levels of depression or anxiety (72%), or alcohol abuse (93%) in adulthood. Although the majority of severely abused or neglected individuals did not show clinical levels of depression, anxiety or alcohol use, severe childhood maltreatment increased the risk for showing clinical levels of psychopathology in adulthood.

Concepts: Domestic violence, Child abuse, Suffering, Abuse, Psychological abuse, Physical abuse, Neglect, Bullying

19

OBJECTIVE:The social vulnerability that is associated with food allergy (FA) might predispose children with FA to bullying and harassment. This study sought to quantify the extent, methods, and correlates of bullying in a cohort of food-allergic children.METHODS:Patient and parent (83.6% mothers) pairs were consecutively recruited during allergy clinic visits to independently answer questionnaires. Bullying due to FA or for any cause, quality of life (QoL), and distress in both the child and parent were evaluated via questionnaires.RESULTS:Of 251 families who completed the surveys, 45.4% of the children and 36.3% of their parents indicated that the child had been bullied or harassed for any reason, and 31.5% of the children and 24.7% of the parents reported bullying specifically due to FA, frequently including threats with foods, primarily by classmates. Bullying was significantly associated with decreased QoL and increased distress in parents and children, independent of the reported severity of the allergy. A greater frequency of bullying was related to poorer QoL. Parents knew about the child-reported bullying in only 52.1% of the cases. Parental knowledge of bullying was associated with better QoL and less distress in the bullied children.CONCLUSIONS:Bullying is common in food-allergic children. It is associated with lower QoL and distress in children and their parents. Half of the bullying cases remain unknown to parents. When parents are aware of the bullying, the child’s QoL is better. It is important to proactively identify and address cases in this population.

Concepts: Parent, Food, Mother, Father, Abuse, Psychological abuse, Bullying, Sexual harassment

9

Digital dating abuse (DDA) behaviors include the use of digital media to monitor, control, threaten, harass, pressure, or coerce a dating partner. In this study, 703 high school students reported on the frequency of DDA victimization, whether they were upset by these incidents, and how they responded. Results suggest that although both girls and boys experienced DDA at similar rates of frequency (with the exception of sexual coercion), girls reported that they were more upset by these behaviors. Girls also expressed more negative emotional responses to DDA victimization than boys. Although DDA is potentially harmful for all youth, gender matters. These findings suggest that the experience and consequences of DDA may be particularly detrimental for girls.

Concepts: Childhood, Experience, Control theory, High school, Abuse, Psychological abuse, Bullying, Intimidation

7

The role of empathy and perspective-taking in preventing aggressive behaviors has been highlighted in several theoretical models. In this study, we used immersive virtual reality to induce a full body ownership illusion that allows offenders to be in the body of a victim of domestic abuse. A group of male domestic violence offenders and a control group without a history of violence experienced a virtual scene of abuse in first-person perspective. During the virtual encounter, the participants' real bodies were replaced with a life-sized virtual female body that moved synchronously with their own real movements. Participants' emotion recognition skills were assessed before and after the virtual experience. Our results revealed that offenders have a significantly lower ability to recognize fear in female faces compared to controls, with a bias towards classifying fearful faces as happy. After being embodied in a female victim, offenders improved their ability to recognize fearful female faces and reduced their bias towards recognizing fearful faces as happy. For the first time, we demonstrate that changing the perspective of an aggressive population through immersive virtual reality can modify socio-perceptual processes such as emotion recognition, thought to underlie this specific form of aggressive behaviors.

Concepts: Domestic violence, Violence, Child abuse, Virtual reality, Abuse, Psychological abuse, Violence against women, Intimidation

5

Despite the well-recognised benefits of sport, there are also negative influences on athlete health, well-being and integrity caused by non-accidental violence through harassment and abuse. All athletes have a right to engage in ‘safe sport’, defined as an athletic environment that is respectful, equitable and free from all forms of non-accidental violence to athletes. Yet, these issues represent a blind spot for many sport organisations through fear of reputational damage, ignorance, silence or collusion. This Consensus Statement extends the 2007 IOC Consensus Statement on Sexual Harassment and Abuse in Sport, presenting additional evidence of several other types of harassment and abuse-psychological, physical and neglect. All ages and types of athletes are susceptible to these problems but science confirms that elite, disabled, child and lesbian/gay/bisexual/trans-sexual (LGBT) athletes are at highest risk, that psychological abuse is at the core of all other forms and that athletes can also be perpetrators. Harassment and abuse arise from prejudices expressed through power differences. Perpetrators use a range of interpersonal mechanisms including contact, non-contact/verbal, cyber-based, negligence, bullying and hazing. Attention is paid to the particular risks facing child athletes, athletes with a disability and LGBT athletes. Impacts on the individual athlete and the organisation are discussed. Sport stakeholders are encouraged to consider the wider social parameters of these issues, including cultures of secrecy and deference that too often facilitate abuse, rather than focusing simply on psychopathological causes. The promotion of safe sport is an urgent task and part of the broader international imperative for good governance in sport. A systematic multiagency approach to prevention is most effective, involving athletes, entourage members, sport managers, medical and therapeutic practitioners, educators and criminal justice agencies. Structural and cultural remedies, as well as practical recommendations, are suggested for sport organisations, athletes, sports medicine and allied disciplines, sport scientists and researchers. The successful prevention and eradication of abuse and harassment against athletes rests on the effectiveness of leadership by the major international and national sport organisations.

Concepts: Child abuse, Abuse, Psychological abuse, Workplace bullying, Bullying, Sport, Harassment, Sexual harassment

5

To determine the extent to which undergraduate medical students experience (and/or witness) bullying and harassment during their first year on full-time placements and to compare with new General Medical Council (GMC) evidence on bullying and harassment of doctors in training.

Concepts: Avicenna, Physician, United Kingdom, Alternative medicine, Abuse, Psychological abuse, Bullying

4

The detection of elder mistreatment is emerging as a public health priority; however, abusive behaviors exercised by caregivers are little known and rarely detected among primary health care professionals. This study aims to estimate the prevalence of risk of abuse against community-residing elderly with moderate to severe dependency whose caregivers are relatives. In addition, we aim to describe the association between such a risk and socio-demographic variables, cognitive and dependency state of the victim, and the scale of the caregiver’s anxiety, depression, and burden.

Concepts: Family, Health care, Psychology, Abuse, Psychological abuse, Bullying, Victimisation, Victim blaming

4

Guns figure prominently in the homicide of women by an intimate partner. Less is known, however, about their nonfatal use against an intimate partner. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched eight electronic databases and identified 10 original research articles that reported the prevalence of the nonfatal use of firearms against an intimate partner. Results indicate that (1) there is relatively little research on the subject of intimate partners' nonfatal gun use against women. (2) The number of U.S. women alive today who have had an intimate partner use a gun against them is substantial: About 4.5 million have had an intimate partner threaten them with a gun and nearly 1 million have been shot or shot at by an intimate partner. Whether nonfatal gun use is limited to the extreme form of abuse (battering) or whether it occurs in the context of situational violence remains to be seen. Regardless, when it comes to the likely psychological impact, it may be a distinction without a difference; because guns can be lethal quickly and with relatively little effort, displaying or threatening with a gun can create a context known as coercive control, which facilitates chronic and escalating abuse. Implications for policy, practice, and research are discussed, all of which include expanding an implicit focus on homicide to include an intimate partner’s nonfatal use of a gun.

Concepts: Domestic violence, Violence, Meta-analysis, Child abuse, Psychological abuse, Firearm, Gun, Intimidation