Violences et maltraitances intrafamiliales (conjugales, infantiles et sur personnes âgées) : aspects épidémiologiques et approche psychopathologique

Intra-familial violence and abuse includes domestic violence that is not specifically identified as violence against women, abuse and violence against children or elderly relatives. This article provides a legal definition of the notions of violence and abuse. Abuse is virtually inseparable from the notion of vulnerability, which appeared in the 1994 Penal Code in France. The present article summarizes current epidemiological data in France and worldwide and highlights the obvious underestimation of domestic violence both in France and in other parts of the world. One French survey reported that in 1997, 50,000 women were victims of rape and more recently, that 225,000 women had reported being victims of domestic violence. In 2021, there were 143 murders in the context of domestic violence, 85% of which involved women. The mechanisms of this violence are usually described as consisting of 4 cyclic phases alternating between a climate of tension, aggression, disempowerment, and remission (repentance on the part of the perpetrator). From a psychodynamic viewpoint, the phenomenon of ascendancy, initially conceptualized by Freud, makes it possible to understand the submission of the victim towards the aggressor. This phenomenon can lead to the inability of the perpetrator to recognize the otherness of the other (the victim). Systemic approaches recall the notion of circular causality, making the victim part of the system without denying the responsibility for his acts on the part of the perpetrator. The consequences are usually very negative representations of self for the victim and an increased dependence toward the aggressor. The judicial and clinical world has for several years advocated dealing with perpetrators of conjugal violence by issuing an injunction to submit to treatment. This can also include victims who consent to these therapeutic proposals. Child abuse in France involved more than 35,000 children in 2018. In 80% of the cases, the perpetrators were one of the victim's parents. The abuse ranged from psychological violence (about 30%) to sexual violence (3.6%). Globally, the prevalence of physical violence against children was estimated to concern from 5 to 35% of children in 2014. Fifteen to 30% of girls versus 5 to 15% of boys are thought to have suffered some form of sexual violence. The tender age of the child is the first risk factor, given that 50% of violent deaths in 2011 concerned subjects under the age of four months. From a psychodynamic perspective, child abuse and violence induce trauma with lasting effects on the personality. Several authors mention resulting attachment disorders and behaviors similar to the Stockholm syndrome. Furthermore, in the neurosciences, repeated trauma is considered to lead to disruption between warning neuroanatomical structures and memorization structures, preventing the memorization of events as representations in a space-time continuum, and retaining them only as a strong stress signal. In addition to violent deaths and immediate traumatic facial injuries, this abuse leads to precarious physical and mental health throughout life. The abuse of older people has become a fact of society worldwide. This phenomenon potentially affects 141,000,000 people worldwide and nearly 7000 people in France. The victims are most often women, widows, and dependents and with some financial resources. The perpetrators are often reported to be exhausted caregivers, but this does not explain the frequency of abuse involving money. Prosecutions after the facts are reported are rare. There is an obvious, underestimation of intra-familial violence both in France and globally, whether this relates to the problems involved in reporting such incidents, or to the ambiguous definitions attributed to abuse. This article underlines how violence against the elderly is less often reported to the courts than those against women and children. Finally, the authors propose a psychopathological approach, neuroscientific insights and therapeutic perspectives on intra-family violence and abuse.