Childhood psychological abuse as harmful as sexual abuse

Children who are emotionally abused and neglected face similar and sometimes worse mental health problems as kids who are physically or sexually abused, according to a new study.
"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 study lead author Joseph Spinazzola, of The Trauma Center at Justice Resource Institute, Brookline, Massachusetts.
Researchers used the National Child Traumatic Stress Network Core Data Set in the US to analyse data from 5,616 youths with lifetime histories of one or more of three types of abuse: psychological maltreatment (emotional abuse or emotional neglect), physical abuse and sexual abuse.

The majority (62 per cent) had a history of psychological maltreatment, and nearly a quarter (24 per cent) of all the cases were exclusively psychological maltreatment, which the study defined as caregiver-inflicted bullying, terrorising, coercive control, severe insults, debasement, threats, overwhelming demands, shunning and/or isolation.
Children who had been psychologically abused suffered from anxiety, depression, low self-esteem, symptoms of post-traumatic stress and suicidality at the same rate and, in some cases, at a greater rate than children who were physically or sexually abused.
Among the three types of abuse, psychological maltreatment was most strongly associated with depression, general anxiety disorder, social anxiety disorder, attachment problems and substance abuse.

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, the study found.

Moreover, sexual and physical abuse had to occur at the same time to have the same effect as psychological abuse alone on behavioural issues at school, attachment problems and self-injurious behaviours, the research found.
"Child protective service case workers may have a harder time recognising and substantiating emotional neglect and abuse because there are no physical wounds," said Spinazzola.
"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," he said.

The article appears in the American Psychological Association journal Psychological Trauma: Theory, Research, Practice, and Policy.