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May 8, 1981

Violence Begins at Home

JAMA. 1981;245(18):1852. doi:10.1001/jama.1981.03310430044021

It is no secret that not every home is as sweet as nostalgic Western songs would lead us to believe. There are homes in which violence flourishes, often unnoticed by outsiders. An example of such violence is child abuse. This can present itself as physical injury or psychic trauma, the latter a result of the former or caused by direct verbal assaults on the child, or by violent behavior of parents, which frightens him.

Child abuse may not be readily recognizable to medical observers when the abuser provides a plausible alternative explanation for the injuries. Here the examining physician, with his powers of observation and deduction coupled with an attentive ear to social history, may come to the diagnostic rescue. Such a rescue is sometimes effected under the most bizarre of circumstances. Meadow1 described two families in which parental Munchausen syndrome expressed itself in inventing fictitious symptoms for their