ABUSE against women and children in South Africa is a stark reality. Victims must seek counselling to improve their recovery. Despite the fact that domestic abuse and violence against women and children are often underreported due to the victim’s fear, statistics of abuse experienced and reported in South Africa remain extremely high, according to Courtney Greene, occupational therapist at Akeso Clinic.ABUSE DEFINEDDefined by the World Health Organisation (WHO) as “a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress”, this broad definition of abuse includes five subtypes, namely physical abuse, sexual abuse, neglect and negligent treatment, emotional abuse and exploitation.CAUSESA number of factors may prompt someone to abuse another person, Greene said: “Often abuse may stem from early learning experiences. Many abusers were abused in their early life and have learnt to see hurtful behaviour as ‘normal’.”The lack of social support or social resources, may also lead to abuse, she said. Caregivers who have the support of an extended family, religious group,or close friends and neighbours, are less likely to lose their self-control under stress.“Likewise, both substance use disorder and mental health disorders may cause a person to abuse someone as alcohol and mood-altering drugs provoke erratic and often violent behaviours. These weaken or remove a person’s inhibitions against violence toward others.“Mental health disorders such as depression, personality disorders, dissociative disorders, adjustment disorders and anxiety disorders can all affect a parents’ ability to care for their children appropriately which unfortunately leads to child abuse and/or neglect.”PSYCHOLOGICAL IMPACTDistorted thought patterns, depression, post-traumatic stress disorder (PTSD), drug dependence (substance use disorder), eating disorders and anxiety disorders are some of the negative psychological effects of abuse, she said.“An article published by the Livestrong foundation mentions three signs of emotional and mental abuse that you can identify in relationships. Jealousy: The abuser often shows signs of extreme jealousy, demanding to know where you go, who you see, and may stop you from seeing certain people and going to certain places. Disrespect: Disrespect by mocking, criticising or humiliating the victim, often in public, trying to shame and embarrass him or her. Control: The aggressor often uses mind games, anger, threats and insults to dominate the victim and control her or his actions and habits. They may tell you what to wear, who you may see, and use threats of violence or self-harm in order to attempt to control the victim.SOMBRE STATISTICSThe South Africa Demographic and Health Survey, conducted by Stats SA in partnership with the South African Medical Research Council, released the following sombre statistics of women abuse and sexual violence against them: 21% of women over the age of 18 years reported that they had experienced violence at the hands of a partner. That’s one in five women. Eight percent of these women reported that they had experienced such violence in the past 12 months of taking the surveyCHILD ABUSEThe repercussions of child abuse and the impact of abuse on their journey to adulthood is also severe, Greene said.Research evidence shows that such abuse has long-lasting psychosocial consequences that impact the social development of children differently. Where girls are victimised for instance, the consequence of abuse can lead to depression, anxiety disorders, substance use disorder, eating disorders, suicidal tendencies and unwanted pregnancy.TREATMENTAlas, the journey to recovery is long. “Abused adults and children often require long-term psychological treatment, including trauma counselling and psychotherapy, in order to treat specific mental health disorders and to learn new ways of dealing with distorted thoughts or feelings (new coping skills).”TELL-TALE SIGNS OF ABUSEPeople who are abused may show the following signs.• Seem afraid or anxious to please their partner.• Talk about their partner’s temper, jealousy or possessiveness.• Have frequent injuries, with the excuse of “accidents”.• Frequently miss work, school or social occasions without explanation.• Dress in clothing designed to hide bruises or scars (e.g. wear long sleeves in the summer or sunglasses indoors).• Show major personality changes (e.g. an outgoing person becomes withdrawn, depressed, anxious or suicidal).• Have limited access to money, credit cards or the car.