Is Emotional Abuse as Harmful as Physical and Sexual Abuse?

A pair of recent studies asserts that psychological abuse may be as harmful as other forms of child maltreatment, including physical and sexual abuse.

Although researchers describe emotional abuse of children as widely prevalent, it has not always been seen as serious or as damaging as other forms of maltreatment. But as researchers link psychological abuse to mental health-related issues later in life, these findings raise questions about the implications for screening, treating and preventing childhood trauma.

A new study released last week in JAMA Psychiatry suggests that emotional abuse is just as damaging as violent abuse when it comes to mental and behavioral health. Children who have experienced psychological abuse exhibit trauma-related health issues at the same rate as their peers who have suffered physical or sexual abuse.

In a paper titled “Assessment of the Harmful Psychiatric and Behavioral Effects of Different Forms of Child Maltreatment,” the authors examined nearly 2,300 children ages 5 to 13 who attended a summer camp for low-income children in New York from 1986 to 2012. About half had a documented history of some form of maltreatment, including physical, sexual and emotional abuse. The authors described emotional abuse as including behaviors such as ridicule, intimidation, rejection and humiliation.

All children who had a history of abuse manifested similar mental health and behavioral issues, such as anxiety, depression, rule-breaking and aggression, according to David Vachon, a McGill University researcher and the paper’s lead author.

But even more surprising was that different types of maltreatment had similar consequences, he said.

“Physically abused children and emotionally abused children had very similar problems,” Vachon said in an email to The Chronicle.

These findings come on the heels of a similar study published last year in Psychological Trauma: Theory, Research, Practice, and Policy and were recently revisited in the August 2015 issue of the American Psychological Association’s Monitor on Psychology.

In a paper titled “Unseen Wounds: The Contribution of Psychological Maltreatment to Child and Adolescent Mental Health and Risk Outcomes,” researchers led by Joseph Spinazzola of the Trauma Center at the Justice Resource Institute came to similar conclusions.

The study revealed that children who have experienced emotional abuse and neglect deal with comparable and sometimes worse mental health issues than those children who have been physically or sexually abused. A group of children who had been psychologically abused scored higher on 21 of 27 indicators of risk behaviors, behavioral problems, functional impairments, symptoms and disorders, as compared with groups of children who had been physically or sexually maltreated. And when it came to post-traumatic stress disorder (PTSD), children with a history of emotional abuse reported PTSD symptoms just as much as those children who suffered other forms of abuse.

In the “Unseen Wounds” study, the authors examined the records of more than 5,600 children from a National Child Traumatic Stress Network (NCTSN) data set who were receiving clinical treatment at one of 56 facilities across the country.

For Spinazzola, the results of the study call attention to the need for more attention on emotional maltreatment, which he says is less likely to be reported and less likely to be substantiated.

“Historically, emotional abuse and neglect have been, if not overlooked, then outright minimized as trauma types,” Spinazzola said.

Mark Testa, a social work professor at the University of North Carolina, estimates that less than 10 percent of investigated reports of child maltreatment have been attributed to psychological maltreatment. But Testa says that recent research on the developing brain offers reasons to think the impact of psychological maltreatment could be more significant than previously thought.

For frontline social workers, the signs of psychological maltreatment are much less apparent than physical abuse and neglect. For example, emotional abuse can’t be discerned by looking at visible bruises or empty refrigerators.

A better approach, he suggests, is to look at emerging findings on consequences of poor social and emotional parenting on brain development. Emotional abuse and neglect could contribute to toxic stress, a factor that researchers from the Harvard Center on the Developing Child and others have linked to health, behavioral and psychological effects later in life.

“Recent evidence from research suggests that we should seek ways of making the invisible more visible through more sensitive assessment instruments so that public policy can be more responsive to psychological maltreatment,” Testa wrote in an email to The Chronicle.

In the past 15 years, research and evidence-based practices around child trauma have grown more prolific, Spinazzola said, recalling the growth of PTSD resources available on the NCTSN web site from a handful to more than 3,000.

But for emotional abuse, the level of information and treatment may lag behind therapies aimed at the trauma caused by physical and sexual abuse.

“Some treatment manuals don’t even have a page of language on what to look for and what to think about while working with kids who have been psychologically maltreated,” he said. “There’s work to be done there because the clinical profiles can be different.”

Richard Epstein, a research fellow at Chapin Hall research center at the University of Chicago, agrees that emotional abuse hasn’t always garnered the same attention as other forms of maltreatment.

Mental health professionals have long been aware of the toxic consequences that accompany sustained psychological abuse, but Epstein says that before moving forward on changes to policy and practice, a consensus must emerge on what constitutes emotional abuse.

“The main challenge, from a policy perspective, is that in order to create a greater focus on emotional abuse and neglect we would first need clear definitions of emotional abuse and neglect that made intuitive sense to everyone,” Epstein said. “Although researchers and mental health professionals might currently have clear understandings of these issues, I think it is also probably safe to say that many others do not.”

Spinazzola acknowledges that there’s a perception in some quarters that emotional abuse and neglect is a grey area. Part of that may be due to the fact that, unlike other forms of maltreatment, emotional abuse may take place over the course of many years—he says the average duration of psychological trauma is seven years—leading to a chronic erosion of an individual’s sense of self. 

“We’re doing a better job picking up neglect and we’re improving as a country in terms of recognizing some of the more subtler forms of trauma,” Spinazzola said, “but we still have a way to go in terms of emotional abuse and emotional neglect.”