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Psychological abuse is even harder on kids than we thought

Psychological abuse is even harder on kids than we thought

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Childhood abuse, neglect and toxic stress are hot topics these days in early childhood circles. Even so, new research suggests there’s a category of childhood trauma that is not only vastly underappreciated, but also far more dangerous than previously noted.

That category? Psychological abuse.

That’s according to a new study released by the American Psychological Association that found that the mental health effects of psychological abuse tend to match or even exceed those of physical and sexual abuse. And when children suffered psychological abuse along with physical or sexual abuse, the effects were far worse than either of the latter two acting alone.

The new research complements a growing body of research that has illuminated the dramatic ways in which childhood adversity, neglect and toxic stress can hinder brain development and lead to a lifetime of poorer health. And the study suggests that mental health professionals and social service workers may not be doing enough to recognize and intervene in such cases of emotional abuse.

For the new study, Joseph Spinazzola of The Trauma Center at Justice Resource Institute in Brookline, Massachusetts teamed with colleagues from prominent medical schools around the country to analyze data from over 5,600 children who had suffered one or more types of abuse: emotional abuse and neglect, physical abuse and sexual abuse.

By drawing on a large national data set made up of youth who were referred to trauma treatment services, researchers were able to measure and compare mental health problems associated with different forms of abuse. Their findings will surprise many:

Psychologically maltreated youth exhibited equivalent or greater baseline levels of behavioral problems, symptoms and disorders compared with physically or sexually abused youth on most indicators.

Compared with physically abused kids, children who suffered psychological abuse were more likely to have behavioral problems at home, attachment problems, depression and anxiety and stress disorders. Compared with sexually abused kids, the emotionally abused youth scored higher on two-thirds of the 27 mental health and behavior indicators the study examined.

It was only when researchers looked at kids who had endured both physical and sexual abuse that they saw similar odds of behavioral problems and psychological disorders as seen in the kids who’d been psychologically abused. (Psychological abuse can take myriad forms, but a few common forms are acts by caregivers that belittle, demean, bully, withhold affection from, exploit or isolate a child.)

Similarly, rates of post-traumatic stress disorder were as high in the emotionally abused kids as they were in the sexual and physical abuse groups.

That’s concerning since, as the study notes, the Diagnostic and Statistical Manual of Mental Disorders doesn’t even recognize psychological maltreatment as one of the stressors leading to PTSD. That means clinicians might miss diagnosing and treating PTSD in such kids, based on the DSM’s guidelines.

The study found that psychological maltreatment was the strongest predictor of problems such as anxiety disorders, depression and attachment problems, and it was also “the strongest predictor of substance abuse.” Substance abuse is a common coping mechanism, but it’ll no doubt come as a surprise to some that psychological abuse would trump sexual and physical abuse in this category.

A 2012 report from the American Academy of Pediatrics starts by pointing out the under-acknowledged nature of a widespread problem:

Psychological or emotional maltreatment of children and adolescents may be the most challenging and prevalent form of child abuse and neglect, but until recently, it has received relatively little attention.

Spinazzola, the study’s lead-author, calls for efforts to boost awareness of emotional abuse:

Child protective service case workers may have a harder time recognizing and substantiating emotional neglect and abuse because there are no physical wounds. 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.

While gut-wrenching stories of physical or sexual abuse tend to dominate headlines and provide steady plotline fodder for “Law and Order”-style procedural dramas, the emotional abuse kids accumulate over time is harder to see and depict. And it doesn’t often generate the same level of moral outrage in our collective consciousness.

Consciousness-raising aside, the report’s specific policy recommendations focus on giving higher priority to psychological abuse in the training of mental health, social service and child welfare workers. But the authors also say providers need better tools for spotting such abuse, as well as more targeted interventions to help young victims recover from its effects.

Spinazzola’s team says that while the childhood trauma treatment centers from which the study drew its data offer more than three dozen different treatments for child trauma, few directly address emotional abuse.

With what we’re beginning to learn about the lingering effects of psychological abuse in childhood, that’s overdue for a change.

Photo by U.S. Army via Flickr.


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Sexual abuse IS psychological abuse, so hard to see how they separate the two for measuring.

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I agree that sexual abuse is emotional abuse. There is coercion, threats, shaming and guilt involved among many other emotional abuses a sexually abused person must endure.

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The only thing worse than enduring over 12 years of domestic violence, psychological, emotional, verbal and even spiritual abuse, as well as manipulation, threats, coercion and neglected, while trying to protect your children from the same, is being dragged into court by the perpetrator who is a brilliant pathological liar. I'd fled two years ago with his "blessing" if I didn't press charges, but I'm now finding myself being ripped apart by his lawyers and even a Judge and threatened with sanctions, all because I don't have "third party evidence" or actual proof of the abuses.....which thrust me and my already traumatized children into another nightmare. Because 80-90% was the awful psychological abuse, which requires the evaluation of a qualified therapist to determine, but the Judge has denied, my children who still suffer the effects of his abuse are being forced to attend "reunification therapy" with him, cried when they found out, filed with anxiety and upset, have been regressing ever since the first session, in which he denied all abuse, saying, "Mommy hates Daddy and she wants to make you think I hurt you....but I love you...." Trying to force them to question their own memories and what they've experienced - so he's able to come back into their lives with the Judges blessing, without first having the family or at least the children evaluated and is allowing the exact same psychological abuse all over again! While all types of abuse by parents are damaging, the kind made by psychological abuse has such long term effects, shapes their thought processes, cripples their self esteem, causes such a host of issues and problems that I can't believe that it's taking a back seat to physical abuse.
The majority of people looking through all the huge stacks of 'circumstantial evidence' that I have would immediately draw the conclusion that his presence in their lives is not in their best interests - but in CA Family Court, you must have solid proof- which is crazy when circumstantial evidence sends people to prison for life, but innocent children dont get the benefit of the doubt? Psychological abuse must start to get the attention it deserves and with it the laws. It's so mentally draining, hurtful and damaging and is so difficult to "get over" especially of the perpetrators aren't held accountable.

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The above issue is a PERFECT example of why abuse continues on today!!. This core issue needs to be addressed and fixed before anyone can really tackle issues these children/young adults have from being abused. We as a society are setting young children up for failure by putting kids BACK into the VERY same situation for abuse to continue("reunification therapy") Who are we really helping here?? This is a set up for failure in most cases we really are not looking at the long term results of what effect this type of therapy has on children. Here is where society contributes to the continued escape methods children resort to because its the only thing they can control or turn to. Maybe if studies or looking at that issue it might save one person from turning to drugs alcohol or suicide. That's the issues at hand that children are faced with. Why cant we look at that and help a child and not turn this into another Thomas Valva case or Lisa Steinberg case. I think we as a whole can learn from the past to help the future.

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My father mentally abused me by locking me in a dark bathroom with no windows and with the lights shut and that I couldn't' reach the light switch as I was too short at the time so the bathroom was completely dark and I couldn't see anything in which I got terrified and started to panic and scream for my father to let me out but he continued to hold the door shut and refused to let me out in which I get traumatized by the event and made me afraid of the dark for many years. After many years when I was a teenager, I confronted my dad about him locking me in a dark bathroom when I was a toddler, and he refused to apologize and even justified doing it saying that I was a bad kid at the time and that if he didn't "discipline" me like that I would become even worse and that I would become a criminal, which is TOTAL bullshit as he was making up excuses to mentally abuse me as a toddler and that he would never apologize for this, as that would require for him to admit that he was wrong for psychologically scarring me for life and his ego is TOO big to admit to him being wrong for doing this.


The Center for Health Journalism’s 2023 National Fellowship will provide $2,000 to $10,000 reporting grants, five months of mentoring from a veteran journalist, and a week of intensive training at USC Annenberg in Los Angeles from July 16-20. Click here for more information and the application form, due May 5.


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