Copyright Helen Munro 2004-2008 1 Page 1 of 7 NON-ACCIDENTAL INJURY: THE BATTERED PET SYNDROME Summary Notes Companion animals and society It comes as a surprise to some people that pets have been part of society for thousands of years. However, despite this long history, it is still true to say that animals engender little or no interest for a sizeable proportion of the human population. This does not mean that these people may misuse animals merely that they may be indifferent to them, and find it very difficult to understand, let alone accept, that animals can play a major part in the lives of others, and indeed are regularly considered to be important members of the family. This lack of understanding may have an important effect on the various agencies involved in dealing with family violence. For example, in the United Kingdom, many of the refuges available for women and children escaping from violent homes do not allow family pets. This has the unfortunate result that many women, because of fears about the safety of the family pets, simply feel unable to leave violent homes. (Or, having left, they return home time and time again.) What is abuse of animals? Confusion often surrounds the word abuse, particularly with regard to animals, because animal abuse has, universally, been used very loosely to encompass a great variety of circumstances. Animal cruelty, maltreatment and animal abuse are all terms that are used interchangeably, without any clear and accepted definition or understanding of what exactly they mean. To make matters even more complicated, the question of whether a situation, or an act, is judged abusive depends on the views that society holds with regard to particular groups of animals. For example, society s attitude to what is acceptable with regard to the keeping and use of farm livestock, and to laboratory animals, is quite different from what would be regarded as acceptable in the family pets. In other words, treatment tolerated in one group of animals might well be regarded as abusive in another. However, in companion animals, confusion can be avoided by applying the tried and tested terminology (sometimes called a typology ) developed successfully by the medical profession for children. And it can also be used in appropriate cases in any other animal groups. Use of this terminology has two advantages: first, it allows a common language between veterinarians and other health professionals, and secondly, it promotes consensus on consistent terminology - a very important factor when carrying out research in this field. The terminology divides abuse into four basic types 1. Note that more than one type may be present at the same time. 1 All rights reserved. No part of this manuscript may be reproduced or transmitted in any form, or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the author.
1. Physical abuse (synonyms: non-accidental injury/nai) Includes physical actions such as kicking, punching, throwing (e.g. against walls, downstairs, out of windows), beating, burning, microwaving, tumble-drying, drowning, and asphyxiation. Also includes the administration of drugs or poisons. May be familiar as Battered child syndrome or Shaken baby syndrome In companion animals is referred to as Battered pet syndrome 2. Sexual abuse Any use of an animal or child for sexual gratification This term is preferable to the term bestiality, which focuses primarily on the perpetrator, and conveys no sense of the physical harm to the animal that may occur. 3. Emotional abuse For example, habitual verbal harassment by threats, or threatening behaviour 4. Neglect Failure to provide the basic necessities of life, physical and/or emotional e.g. food, shelter, medical or veterinary attention, affection. The term non-accidental injury simply means that the injury was caused deliberately. Although physical abuse of an animal is sometimes inflicted in full public view, other cases of physical abuse occur behind closed doors at home. It is these hidden cases that are particularly referred to as non-accidental injury cases. Background In 1962, a highly influential paper was published in the Journal of the American Medical Association. To capture attention, the author, Dr. C. Henry Kempe, gave the paper a deliberately emotive title The Battered-Child Syndrome 2. This paper forced the medical profession to acknowledge that deliberate injury of children by their parents was a reality. After its publication there was an explosion in research on child abuse, and as a result diagnostic guidelines to aid the recognition of child abuse in general and deliberate physical injury (NAI) in particular are now well established. (Note that diagnostic guidelines may sometimes be referred to as diagnostic features, diagnostic indicators or diagnostic pointers.) Evidence that there is a link between violence to people and violence to animals has been growing for some years 3. And as long ago as 1983 a senior British social worker, James Stuart Hutton, suggested that evidence of abuse (of all types) in the family pet might be a useful piece of intelligence for early identification of abuse in other members of the family the children, for example 4. However, to be able to use abuse of animals as just such an indicator requires guidelines similar to those established for children - to aid recognition of deliberate injury. Unfortunately, veterinary health professionals have been in a difficult situation, because such guidelines were not developed until a few years ago. Research has now established the basic diagnostic pointers for the recognition of NAI in dogs and cats. They have been developed from a study of the experiences of 1000 anonymous veterinarians in small animal practice in UK. 5,6,7,8 [This study was supported by the Royal Society for the 2
Prevention of Cruelty to Animals (the RSPCA, which covers England and Wales) and, in Scotland, the Scottish Society for Prevention of Cruelty to Animals (Scottish SPCA).] The study results highlighted strong similarities between NAI in animals and children. The circumstances of violence, the actual acts involved, the excuses offered, and the resulting injuries, are remarkably similar, be the victim animal or child. This is quite simply because there is a common denominator the human perpetrator. Pointers to non-accidental injury in pets The features in dogs and cats that point towards NAI are listed below. It cannot be overemphasised that no single feature is diagnostic; rather, it is a combination that raises concern, and this combination is variable. 1. Certain aspects in the history, e.g. The history given for the animal is inconsistent with the injuries. (i.e. the story given doesn t fit with the injury. Usually the injuries are too severe for the history supplied) The history is discrepant (i.e. more than one explanation for the injury is given, or the story varies from person to person. In other words, conflicting histories are offered.) There has been a previous injury or death in another animal in the same household, or belonging to the same owner Lack of history of motor vehicle accident (MVA) or any other possible accident No evidence of bone pathology or bleeding disorders Family violence is known or suspected 2. Implication of a particular person as the perpetrator Family member (including children) Owner (self admission) Lodger, neighbour, stranger 3. Behaviour of the owner and/or the animal arouses concern, e.g. Owner angry on questioning/reluctant to give history/shows lack of concern for the pet. Animal shows fear of owner/develops fear of people/happier when separated from the owner (e.g. when hospitalised) 4. Repetitive injury Animal is presented more than once with injuries, or different ages of injury are found on examination Injury type may vary with each episode, but bone fractures feature prominently High index of suspicion 5. Type of injury Certain injuries arouse suspicion because they are unusual, or do not fit with the owner s explanation. 3
For interest, pointers to non-accidental injury in children are summarised below. Note that, as with pets, it is a variable combination of these features that arouses concern. The history is inconsistent with the injury (usually, the injuries are too severe for the history supplied) The history is discrepant (i.e. changes in the telling, or from person to person) Repetitive injury Patterns of injury (e.g. fingertip bruising; crescent shaped [human] bite marks) Unusual parental behaviour Abnormal appearance/behaviour of the child The child may say something (but babies and very young children are unable to do so) Age of dogs and cats who have suffered a non-accidental injury Statistically, both dogs and cats are likely to be less than two years of age 6. Gender of dogs and cats who have suffered a non-accidental injury Male dogs are more likely to be attacked than female dogs 6. However, there is no such statistical difference for cats. Perpetrators Men and women both attack their children, but severe violence is more frequently associated with men. In animal cases it seems that the majority of perpetrators are men. (But note that both sexes neglect animals.) Fabricated or induced illness (FII). [This is the current term for a form of abuse that is probably familiar as Munchausen syndrome by proxy 8.] Fabricated or induced illness is a rare form of abuse that, by convention, has been given a separate chapter in paediatric texts. FII involves the falsification of illness in a child by a carer, the motivation being to gain attention and sympathy for the carer. In the veterinary context, the illness is fabricated, or induced, in an animal. 7, 9, 10, 11 Sexual abuse The study on non-accidental injury, although not intended to investigate sexual abuse, identified a number of cases in the dog and cat. It is the very fact that the abuse involves the sexual organs or anus/rectum that distinguishes the abuse as sexual in nature. Physical injury to both sexes may result, which, depending on the actual type of sexual act carried out, can be very severe. Until very recently, there has been a remarkable paucity of information in English language veterinary literature. 9 However, there is a substantial body of published reports (mainly involving farmed livestock) in several European languages 11. Advice from the Royal College of Veterinary Surgeons in the United Kingdom Since January 2003, the RCVS Code of Professional Conduct has covered Animal abuse, child abuse and domestic violence. The section on abuse (Supporting Guidance, Chapter 14 Client Confidentiality ) gives advice to veterinarians in the UK on breaching client confidentiality, and it can be downloaded from the Code of Professional Conduct on the RCVS website 12. The section also contains a web link to a booklet called Understanding the Links. This booklet, published by the NSPCC (National 4
Society for the Prevention of Cruelty to Children) contains information for professionals on the links between animal abuse, child abuse, and domestic violence. There is also a separate section on giving evidence in court (Supporting Guidance, Chapter 22 Giving evidence for court ) which gives clear information on the role of a witness and the difference between a professional and an expert witness as well as guidance for writing an expert report. 5
References 1. MUNRO, R; MUNRO, HMC (2008). Fundamentals of Abuse. In: Animal Abuse and Unlawful Killing: Veterinary Forensic Pathology, Saunders Elsevier, pp.3-5. 2. KEMPE, CH; SILVERMAN, FN; STEELE, BF; DROEGEMULLER, W; SILVER, HK. (1962) The Battered-Child Syndrome. Journal of the American Medical Association. 181:17-24. 3. Arkow, P. (1994) Child abuse, animal abuse and the veterinarian. Journal of the American Veterinary Medical Association. 204: 1004-1007. 4. HUTTON, J. (1983) Animal abuse as a diagnostic approach in social work: a pilot study. In: Katcher A.H.; Beck A.M. eds. New Perspectives on our Lives with Companion Animals. Philadelphia: University of Pennsylvania Press, pp 444-447. 5. MUNRO, HMC; THRUSFIELD, MV. (2001) Battered Pets : features that raise suspicion of nonaccidental injury. Journal of Small Animal Practice, 2001. 42: 218-226. 6. MUNRO, HMC; THRUSFIELD, MV. (2001) Battered Pets': non-accidental physical injuries found in dogs and cats. Journal of Small Animal Practice. 42: 279-290. 7. MUNRO, HMC; THRUSFIELD, MV. (2001) Battered Pets : sexual abuse. Journal of Small Animal Practice. 42: 333-337. 8. MUNRO, HMC; THRUSFIELD, MV. (2001) Battered Pets': Munchausen syndrome by proxy (factitious illness by proxy). Journal of Small Animal Practice. 42: 385-389. 9. MUNRO, HMC. (2006) Animal sexual abuse: A veterinary taboo? Guest editorial. The Veterinary Journal 172, 195-197. doi:10.1016/j.tvjl.2005.08.033 10. HVOZDIK, A. et al (2006). Ethological, psychological and legal aspects of animal sexual abuse. The Veterinary Journal 172, 374-376. 11. MUNRO, R; MUNRO, HMC (2008). Sexual Abuse of Animals. In: Animal Abuse and Unlawful Killing: Veterinary Forensic Pathology, Saunders Elsevier, pp.94-96. 12. RCVS. Code of Professional Conduct. www.rcvs.org.uk (Checked for access September 2013) Further reading 1. McGuiness, K, Allen, M. & Jones, B.R. (2005). Non-accidental injury in companion animals in the Republic of Ireland. Irish Veterinary Journal, 58, 392-395. 2. The International Handbook of Animal Abuse and Cruelty (2008). Frank R. Ascione, Editor. Purdue University Press, West Lafayette, Indiana. 3. Bateson, P. (2000). Behavioural development in the cat. [Citing Martin, P. (1982). Weaning and behavioural development in the cat. Ph.D. thesis, University of Cambridge] In: The Domestic Cat. Eds. Dennis C. Turner & Patrick Bateson). 2 nd edition, Cambridge University Press, pp. 9-22. 4. Child Abuse and Neglect: A Clinician s Handbook, 2 nd ed. (1999). Hobbs, C.J., Hanks, H.G.I. & Wynne, J.M. Churchill Livingstone, London. 5. Physical Signs of Child Abuse: A Colour Atlas. 2 nd ed. (2001). Hobbs, C.J. & Wynne, J.M. W.B. Saunders. 6. Diagnostic Imaging of Child Abuse. 2 nd ed. (1998). Kleinman, Paul K. Mosby.