Psychological maltreatment harmful

Psychological maltreatment in childhood can not only increase – but also independently contribute to – risk for negative outcomes comparable to those imparted by exposure to physical or sexual abuse, according to a new study accepted for publication by the American Psychological Association.

Researchers for “Unseen Wounds: The Contribution of Psychological Maltreatment to Child and Adolescent Mental Health and Risk Outcomes” used the National Child Traumatic Stress Network Core Data Set to analyze data from 5,616 youths with histories of one or more of three types of abuse: psychological maltreatment (emotional abuse or emotional neglect), physical abuse and sexual abuse.

The study cited psychological maltreatment – which can include such actions as caregiver inflicted bullying, terrorizing, coercive control, verbal abuse and threats and shunning/isolation – as the strongest and most consistent predictor of internalizing problems like depression, general anxiety disorder, separation anxiety disorder and attachment problems and also of substance abuse.

Psychological maltreatment was associated with those and other issues at the same rate and, in some cases at a greater rate, than children who were physically or sexually abused, according to the study, which also states that psychological maltreatment that occurred alongside physical or sexual abuse was associated with significantly more severe and far-ranging negative outcomes than when children were sexually and physically abused and not psychologically abused.

Additionally, the psychological maltreatment group reported PTSD symptom frequencies that were equivalent to the other two groups.

“The nuance and expression of distress varies in these three groups,” says the study’s lead author, Joseph Spinazzola, Ph.D., executive director of The Trauma Center at Justice Resource Institute, Brookline, Mass.. “But by and large, the groups are more similar than different. What we are seeing is that maltreatment in any form is bad. Maltreatment perpetrated by parents or caregivers impacts development in really negative ways.”

One thing that differentiated psychological maltreatment from sexual or physical abuse is that the average duration was longer. The average duration of psychological maltreatment is seven years, Spinazzola says. “It’s important for providers to get the difference between a parent that is struggling or overburdened and this chronic, pervasive, prolonged pattern of exploiting, terrorizing, undermining and shunning of a child that lasts for years.”

Spinazzola says boys and girls are equally vulnerable to psychological maltreatment, and perpetrators can be either gender. He says it can be difficult to recognize emotional neglect or abuse because there are no physical wounds and it’s harder to quantify.

“There’s more of a gray area. For example – where does strict parenting or certain kinds of parenting styles or cultural styles of parenting end and psychological mistreatment begin?” he says.

Practitioners must be able to differentiate between a parent who occasionally loses his or her temper versus the more chronic, sustained withholding of care that can have a potent effect on developmental trajectory.

Spinazzola would like to see increased screening for emotional abuse and neglect as well as greater education, support and intervention for caregivers.

“There was a time when there was not a lot of recognition of physical maltreatment in the context of parenting and I think we’ve made really great strides around that and now we’re starting to realize the ways emotional abuse and neglect can have a really negative effect on kids.”