Children who have suffered from neglect and emotional abuse may face the same or worse mental health issues as children who have been sexually or physically abused, says a new study published by the American Psychological Association (APA). In spite of this fact, prevention programs and treatment plans rarely address mental issues related to childhood psychological abuse. The article “Unseen Wounds: The Contribution of Psychological Maltreatment to Child and Adolescent Mental Health and Risk Outcomes” appears in a special online issue of the APA journal Psychological Trauma: Theory, Research, Practice, and Policy on October 8, 2014.
“Given the prevalence of childhood psychological abuse and the severity of harm to young victims, it should be at the forefront of mental health and social service training,” said the study’s lead author Joseph Spinazzola, PhD, of The Trauma Center at Justice Resource Institute, Brookline, Massachusetts. Data from the National Child Traumatic Stress Network Core Data Set was used to study 5,616 youth with lifetime histories of one or more of three types of abuse: psychological maltreatment (emotional neglect or emotional abuse), sexual abuse, and physical abuse.
Many patients (62 percent) experienced psychological maltreatment, and 24 percent of all cases were exclusively psychological maltreatment. The study defined psychological maltreatment as caregiver-inflicted bullying, coercive control, overwhelming demands, debasement, extreme insults, terrorizing, threats, and isolation and/or shunning. Psychological abuse caused children to suffer from anxiety, low self-esteem, depression, post-traumatic stress disorder symptoms, and suicidal thoughts at the same or at a higher rate than children who experienced physical or sexual abuse.
Psychological maltreatment had the strongest association with attachment difficulties, depression, social anxiety disorder, general anxiety disorder, and substance abuse when compared to other types of abuse. When researchers compared children who had been physically or sexually abused with children who experienced all three types of abuse, children who experienced all three had much more severe and far-ranging negative incomes. Abuse can lead to behavioral problems at school, self-injury, and attachment problems. Physical and sexual abuse needs to happen at the same time to have the same effect as psychological abuse alone.
“Child protective service case workers may have a harder time recognizing and substantiating emotional neglect and abuse because there are no physical wounds,” Spinazzola said. “Also, psychological abuse isn’t considered a serious social taboo like physical and sexual child abuse. We need public awareness initiatives to help people understand just how harmful psychological maltreatment is for children and adolescents.“
According to the U.S. Children’s Bureau, nearly 3 million children in the US experience some kind of abuse every year. The perpetrators are usually a parent, family member, or another adult caregiver. In In 2012, The American Academy of Pediatrics identified psychological maltreatment as “the most challenging and prevalent form of child abuse and neglect.”