Abuse: 
              Physical Abuse, Sexual Abuse, Emotional Abuse,
              Child Abuse, Spousal Abuse, & Rape


       Abuse of any type takes its toll in many ways on different individuals. While this remains a “hush – hush” topic for most people, bringing the abuse out into the open is often a way to begin the healing process. The next step is to help the abused individual to get to a safe place to avoid further abuse and to receive proper psychiatric evaluation and treatment. A variety of disorders, some with similar symptoms, frequently are found after abuse has been experienced. Depression and suicidal thoughts are common, as are homicidal thoughts or other wishes to harm or escape the abuser. Frequently the abuser is in a position of power and responsibility with respect to the abused individual or may make the victim feel he or she is responsible for the abuse. The abuser can be a parent or guardian, teacher, minister, caretaker, employer or spouse. 
       Most states (including Maryland) now require a licensed health care giver to report suspected abuse to the Department of Social Services(DSS). DSS may initiate an investigation into the abuse; this may lead to recommendations regarding how to maintain the person’s safety. DSS may also choose to decline the case if they feel no action is appropriate. The purpose of the required reporting is to help prevent further abuse of others as well as to help the victim. Other than if a therapist feels that someone is in imminent danger, this is the only time a patient’s confidentiality would be waived without the patient’s consent.
       Flashbacks of the abuse, nightmares, anxiety, fearfulness, and brief periods of loss of normal orientation may indicate PTSD (Post Traumatic Stress Disorder). Irritability, loss of interest of pleasure in normal activities, weight gain or loss and sleep disturbance are common signs of depression after abuse or rape. A full psychiatric evaluation can help determine the best course of treatment. Rape victims should go immediately to an Emergency Room or Rape Crisis and Evaluation Center for medical examination, counseling, legal advice and to determine if they wish the center to attempt to obtain any physical evidence for possible prosecution of the offender. 

        Whenever there is any concern about suicide risk, emergency psychiatric evaluation is appropriate. The Sheppard Pratt Health System offers 24 hour evaluation and admission if appropriate; call 410-938-3800.

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Depression
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PTSD
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