Opinion

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Adolescent to parent violence: GPs need more support

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Recently, the RACGP Specific Interests Abuse and Violence in Families and Child and Young Person’s Health groups held a joint meeting on the topic of adolescent to parent violence.
 
Here, we discussed that often GPs are caring for both the adolescent using violence, as well as the parent experiencing it, with the GPs in attendance saying it’s an area they would like more assistance with.
 
While adolescent to parent violence is highly under-researched, we know that mothers are most commonly the recipient of the violence and that while adolescents of either gender can use violence, the presentation of violence may differ based on gender.
 
Shame can also affect both parent and adolescent, sometimes preventing disclosure, even to protective services.
 
We recognise this area can be very emotionally challenging for GPs themselves.
 
Adolescent to parent violence may be more likely if there is disability, including intellectual, learning disability or acquired, challenges with emotional regulation or within families existing within a subculture that normalises violence, either within their family, peers or community. 
 
Disengagement with school, or drug dependency may also exacerbate the use of violence.
 
GPs can support families by recognising the complex interactions at play, including developmental changes in adolescence, and challenges some adolescents may face in expressing themselves.
 
For parents and practitioners, the challenge is to be supportive of the developmental changes without dismissing them, while also acknowledging that every generation faces different challenges that may not always be understood within the family system.
 
Although our focus was on adolescent to parent violence, we note that these dynamics often begin earlier, and GPs can play an important preventive role.
 
We also acknowledged that even for the most grounded young person, adolescence is a tricky stage for everyone.
 
GPs can sometimes provide a safe space for the adolescent, particularly where there may be limited other safe spaces for them. 
 
We also recognise that adolescent to parent violence is nearly always egodystonic – misaligned with the values of both the young person and their family.
 
As was noted, young people often bring a strong set of values to their lives – one suggested approach was to ask, “how did it shape you?”, “how did it become your behaviour?” as a way of exploring this with an adolescent.
 
The reflections from GPs about adolescent to parent violence and how the presentation may evolve over time also parallels other research on family violence. 
 
A study following the ‘Timelines of psychological, physical and sexual intimate partner violence among a nationally representative sample of Australian women’ from the Royal Women’s Hospital and University of Melbourne shows how intimate partner violence often unfolds over time.
 
For the first time, a large group of female survivors were asked to map out such a timeline of events.
Emotional abuse, like isolation and control, usually starts before physical or sexual abuse.
 
It often begins before major commitments, such as moving in or having children. Key findings include:

• 36.6% of women experienced a mix of physical, emotional and sexual abuse in the past year
• sexual abuse often became worse after childbirth
• around one in three women still fear a current or former partner
• most women sought help because they were worried about the impact of abuse on their children.

The findings highlight the need to recognise early signs and act sooner to support women and prevent harm. This research is part of the UNCOVER Project, led by the Safer Families Centre.
 
The Ten to Men: The Australian Longitudinal Study on Male Health has also been sharing periodic reports on data.
 
The outcomes from the study are still ongoing, but the Ten to Men Insights #3 report, published by the Australian Institute of Family Studies, explores the self-reported use of IPV among Australian men aged 18–57, drawing on data from waves 1–4 of the study (2013–22).
 
Key findings include:
 

• One in three men reported using some form of IPV by 2022, up from one in four in the initial wave
• Emotional abuse was the most common form (32%)
• Men reporting depressive symptoms or suicidal thoughts in 2013–14 were more likely to report IPV use by 2022
• Social support and paternal affection were protective factors

These findings show associations, not causation, but reinforce the importance of providing long-term support to men and families, particularly those reaching out for mental health support.
 
These studies also reinforce what we as GPs are seeing within families – how interpersonal interactions can evolve from early childhood to adolescence to adulthood. 

More research needs to occur to understand how violence unfolds in families and longitudinally.
 
The reflections on adolescent to parent violence highlight the emotional impact that violence has on families, including an adolescent who may be using violence, parental recipient, as well as the GP involved in care and supporting the family. 
 
I hope these reflections may assist other GPs who work with families.
 
I would also like to acknowledge the contributions from Dr Tim Jones, Chair of RACGP Specific Interests Child and Young Person’s Health, and Monash University Associate Professor Jenny Neil for this article.
 
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abuse and violence adolescents family violence intimate partner violence young people’s health

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