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Kekerasan Pada Anak

Eri Achmad
Psikiater
•RSUD Arjawinangun
•RS Sumber Waras
•RS Mitra Plumbon
eriachmad@yahoo.co.id
Materi pembelajaran
• Macam-macam kekerasan pada anak
• Faktor penyebab terjadinya kekerasan pada
anak
• Dampak kekerasan secara biopsikososial pada
anak
Masalah-masalah khusus pada anak
• Isu forensik pada psikiatri anak
• Yatim piatu dan adopsi
• Child maltreatment and abuse
• Impact of terrorism on children
Kekerasan pada anak
• Child maltreatment and abuse
• Impact of Terrorism on children
Child maltreatment and abuse
• USA
▫ Korban maltreatment hingga 1 juta per tahun
▫ Korban meninggal akibat abuse and neglect
hingga 1500
• Bentuk maltreatment
▫ Left home alone 41.5 %
▫ Physical asault 28.4 %
▫ Physical neglect 11.8 %
▫ Sexual abuse 4.5 %
Batasan menurut PPDGJ-III
• Kondisi lain yang menjadi fokus perhatian klinis
▫ Z63.8
 masalah hubungan orangtua anak
▫ T74
 masalah yang berhubungan abuse atau neglect
 T74.0 neglect of child
 T74.1 physical abuse of child or adult
 T74.2 sexual abuse of child or adult
Definisi
• USA Federal law
▫ Child abuse and neglect
 As a minimum, any recent act or failure to act on the
part of a parent or caretaker that results in death,
serious physical or emotional harm, or sexual abuse
or exploitation. It also includes an act or failure to
act that presents an imminent risk of serious harm.
▫ Sexual abuse
 The employment, use persuasion, inducement,
enticement, or coercion of any child to engage in or
to assist any other person to engage in any sexually
explicit conduct or the rape, molestation,
prostitution, or other forms of sexual exploitation of
children or incest with children
• Neglect
▫ Is the failure to provide adequate care and
protection for children
▫ Children can be harmed by malicious or ignorant
withholding of physical, emotional, and
educational necessities. N
▫ Neglect include failure to feed children adequately
and to protect them from danger
▫ Physical neglect, medical neglect, educational
neglect
• Physical abuse
▫ As any act that results in a nonaccidental pysical
injury, such as beating, punching, kicking, bitting,
burning, and poisonning
▫ Is the result of unreasonably severe punishment
• Emotional abuse
▫ Occurs when a person conveys to children that
they are worthles, flawed, unloved, unwanted, or
endangered
▫ Include verbal abuse
▫ The severity depend on
 Whether the perpetrator actually intends to inflict
harm on the child
 Whether the abusive haviours are likely to cause
harm to the child
• Sexual abuse
▫ Sexual behaviours between a child and an adult or
between tow children when one of them is
significantly older or uses coercion
▫ Same sex or opposite sex
▫ Including touching breasts, buttocks, and genitals,
whether the victim is dressed or undressed
▫ Pornografi
▫ Trafficking in prostitution of minors
• Ritual abuse
▫ Is controversial
• Perpetrators of abuse
▫ Lack of consistency
 Parent
 Caregiver
 Another adult (stranger)
Epidemiologi
• Same rate male and female maltreatment
• Sexual abuse female higher than male
• Age of 0 to 3 is the higher victims
• Occurs at all socioeconomic level
Faktor penyebab
• Social factors
▫ Poverty
▫ Psychosocial stress
▫ Financial stress
• Education
▫ Less parental education
▫ Underemployment, poor housing
▫ Single parenting
• Multiproblems families
▫ Domestic violence, social isolation, parental mental
illness, many children
• Sexual abuse
▫ Social, cultural, physiological, and psychological
factors all contribute to the breakdown of the
incest taboo
▫ Mental disorder
▫ Intellectual deficiency
▫ Overcrowding, isolation that prevents adequate
extrafamilial contacts
• Intrafamilial sexual abuse
▫ Incest; defined strictly as sexual relations between
close realtives, that is, between a child and the
father, uncle, or sibling
Diagnosis dan gejala klinis
• Tidak ada gejala yang khas dan pasti
▫ Manifestasi emosi yang bervariasi dan keluhan
fisik yang bervariasi
• Physically abuse children
▫ Physical examination and radiological evaluation
show evidence of repeated suspicions injuries
▫ Display behaviors; unusually fearful, docile,
distrustful, and guarded. Or disruptive and
aggressive
• Psychological consequences of physical abuse
▫ Consist wide range effects; affect dysregulation,
insecure and atypical attachment patterns,
impaired peer relationships involving increased
aggression or social withdrawl, and academic
underachievement
▫ Psychopathology; dpression, conduct disorder,
ADHD, oppositional defiant disorder,
dissociation, and PTSD
• Physically abusive parents
▫ Delay seeking help for injuries
▫ The history is incompatible with the physical
findings
▫ Parents blame a sibling or claim the children
injured themselves
▫ Parents had a history of abuse in their own early
lives, a lack of empathy, unrealistic expectations of
the child, impaired parent-child attachment
• Anak korban pelecehan seksual
▫ Anxiety symptoms; fearfulness, phobias,
insomnia, nightmares, somatic complaints, PTSD
▫ Dissociative reactions and hysterical symptoms
 Amnesia, daydreming, trance like states, hyterical
seizures, dissociative identity disorder
▫ Depression; low self-esteem, suicidal
▫ Disturbances in sexual behaviours
▫ Somatic complaints
• Neurobiological consequences of child
maltreatment
▫ Abnormalities in EEG that indicat limbic
irritability
▫ Reduced size of adult hippocampus in MRI
▫ Deficient integration left and right side of the
brain, manifested by reduced size of the corpus
callosum
Treatment and prevention strategies
• Immediate intervention is to ensure the child’s
savety
▫ 6 times experience recurrent maltreatment
▫ Highest within 30 days
• Multimodal treatment
▫ Psychoeducation, anxiety management, cognitive
behavioural intervention
▫ Monitoring and support for long periods of time
after the abuse ended