Author(s): Ami Rokach* and Sybil Chan
Emotional maltreatment is a form of child abuse that may leave no physical scars, but has deep and long-term consequences. When compared to the effects of physical and sexual abuse, its impact has been historically neglected by researchers, despite its existence in all other forms of maltreatment. Beyond its recipient, the alarming effects of emotional abuse are believed to overcome even trans-generational barriers within the household. This poses great risks to the developmental outcomes of children having undergone these circumstances and their future kin. As such, this brief review will describe the signs of emotional maltreatment, its effects, and what can be done to address it.
Among the four most common types of abuse inflicted onto children (i.e., sexual, physical, emotional/psychological, and neglect), the detrimental impacts of emotional and psychological abuse in childhood have been the least studied in the field of childhood maltreatment [1,2]. These two similar, yet different terms, have been used in tandem to describe the deeper impacts of abuse that occurs in toxic parent - child relationships. Emotional abuse has been defined as the repetition of inappropriate affective responses to the emotional needs of a child, while psychological abuse describes prolonged behaviors which damages and reduces the developmental potential of a child’s psycho-emotional maturity like their intelligence, memory, attention and moral development [3-5]. Understanding the distinction of these terms and recognizing its presence within the family household can help reduce the detrimental impacts of these forms of abuse to persist throughout one’s life. Therefore, the following review will briefly identify the current patterns and gaps that exist in the literature concerning the reasons behind early emotional and psychological abuse. It hopes to shed light on the consequences that stem from abusive origins and inspire greater research to be done in this domain of psychology
Interest in the research of emotionally maltreated children only began to emerge in the past couple of decades. The late 1970s began to show the inkling of studies dedicated to the psychological impact of early abuse during childhood. According to the Lourie and Stefano the topic of “emotional maltreatment” was deemed to be one of the four leading principals of interest for the American Humane Association’s Study of Child Abuse and Neglect, which attributed to the growing popularity of clinical research in this field. However, its definition is still a highly debated topic that has been criticized across various domains in healthcare. For example, recognizing the signs of emotional and psychological abuse in children poses many challenges for policymakers and licensed professionals. Discrepancies between what constitutes as abuse, the severity of its impact and the obstacles which prevent individuals to help these victims prevent the disclosure of abuse to be recognized and assessed appropriately under the law [6-11]. This may be due to the research conducted on the matter, and the different research principals used to understand the harmful effects of maltreatment in children. For instance, the voices of child victims are typically underrepresented in favor of data taken from parental informants [10]. This captures a rigid understanding of the nuances involved in abusive households, as the lack of child agency in most psychological and medical literature makes for its understanding to be adult-centric and not representative of the harmed [12,13]. This results in a limited understanding of how children respond to emotional abuse, and what may fall under the definition child maltreatment.
For instance, the inclusion of domestic violence as a form of child abuse has been argued in the literature despite numerous studies citing its harmful impacts on the emotional and psychological development of children [11,14-17]. In all forms, violence should be seen as any action which hurts, frightens or forces one to act against their will - which has substantial repercussions on the memories of children that are involved in these circumstances [18]. Children have reported that the lasting impact of emotional trauma incited by physical abuse was more harmful to their recollections of these events rather than of the abuse itself [19]. According to these children, the nuances involved in conceptualizing violence explain how difficult it is to secure a universal definition of child abuse and maltreatment. Therefore, it is crucial that a more comprehensive and critical synthesis of the literature must be explored to help attune researchers, practitioners and advocates alike in facilitating greater awareness and appropriate responses in preventing children from being harmed.
Although there is no single profile that can be associated with victims of childhood emotional abuse, research has shown that internalizing problems like depression, low self-worth and loneliness are common among these populations. This can impose many problems in young victims. For example, emotional abuse can negatively impact one’s perception of themselves and others. These distorted perceptions have been shown to manifest itself into an extreme fear of talking to others and being scrutinized by those around them. This is also known as Social Anxiety disorder. Studies have shown that social anxiety can negatively affect one’s well-being and daily life such as disordered eating, dysregulated thinking, and poor social functioning. It can lead to individuals developing greater self-esteem issues and have higher tendencies to feel hopeless and less worthy of themselves. This poses many risks for the abused child, as the propensity to internalize negative thoughts and beliefs can intensify the abusive experiences that they may be facing [20-26].
Developing healthy interpersonal relationships may also be challenging for emotionally maltreated youth due to the traumatic experiences they have had from others in their lives [27-29]. Studies have shown that child maltreatment is a risk for loneliness and social isolation [27]. Lonely individuals have been known to get less support from others and in turn, feel more anxious towards people. This creates a vicious cycle which discourages abused individuals from seeking help for their trauma. For example, young women in emotionally abusive relationships report experiencing higher rates of isolation from others [30]. This form of loneliness may encourage negative thinking in the abused and prevent them from utilizing the support systems available to them [31]. Loneliness has also been found to mediate the effects of emotional abuse and social anxiety [27]. Specifically, lower rates of loneliness in people are associated with larger support systems which can reduce the likelihood of developing social anxiety. Overall, vulnerable individuals in abusive households can fall victim to the state of their own destructive thinking. And without adequate support from others, they may psychopathologize these distorted beliefs later in adulthood [31,32].
The lasting effects of emotional maltreatment has been shown to bear even greater consequences on the young developing mind when compared to other forms of abuse like sexual or physical abuse. Its psychological impact on mental health has been well established. For example, research has shown that the relationship between childhood emotional maltreatment and depression is significant. Specifically, Gibb et al. found that diagnoses of major depression were more significantly related to reports of emotional abuse than to sexual or physical abuse alone. This may be related to the feeling of hopelessness experienced by victims of these circumstances. A study by Hamilton and colleagues found that hopelessness acts as a mediator for various forms of emotional maltreatment and has been linked to increased risks for depression and anxiety among adolescents. Its contribution during cases of emotional abuse were found to intensify these symptoms, and negatively impact individuals regardless of race. This is also true for other emotions associated with this form of maltreatment, such as shame, humiliation, anger and worthlessness. These negative feelings are believed to contribute towards the distortive thinking patterns shown in victims of emotional abuse. Likewise, research has shown that emotionally maltreated individuals also experience greater dysfunction and attrition rates from pharmacotherapeutic treatment for social anxiety disorder [SAD]. Even beyond its psychological impact, this suggests that emotionally maltreated individuals may face more challenges in response to treatment for their experiences from childhood [33-39].
internalizing problems like depression, low self-worth and loneliness are common among these populations. This can impose many problems in young victims. For example, emotional abuse can negatively impact one’s perception of themselves and others. These distorted perceptions have been shown to manifest itself into an extreme fear of talking to others and being scrutinized by those around them. This is also known as Social Anxiety disorder. Studies have shown that social anxiety can negatively affect one’s well-being and daily life such as disordered eating, dysregulated thinking, and poor social functioning. It can lead to individuals developing greater self-esteem issues and have higher tendencies to feel hopeless and less worthy of themselves. This poses many risks for the abused child, as the propensity to internalize negative thoughts and beliefs can intensify the abusive experiences that they may be facing [20-26]. Developing healthy interpersonal relationships may also be challenging for emotionally maltreated youth due to the traumatic experiences they have had from others in their lives [27-29]. Studies have shown that child maltreatment is a risk for loneliness and social isolation [27]. Lonely individuals have been known to get less support from others and in turn, feel more anxious towards people. This creates a vicious cycle which discourages abused individuals from seeking help for their trauma. For example, young women in emotionally abusive relationships report experiencing higher rates of isolation from others [30]. This form of loneliness may encourage negative thinking in the abused and prevent them from utilizing the support systems available to them [31]. Loneliness has also been found to mediate the effects of emotional abuse and social anxiety [27]. Specifically, lower rates of loneliness in people are associated with larger support systems which can reduce the likelihood of developing social anxiety. Overall, vulnerable individuals in abusive households can fall victim to the state of their own destructive thinking. And without adequate support from others, they may psychopathologize these distorted beliefs later in adulthood [31,32]. Psychological Consequences of Emotional Maltreatment The lasting effects of emotional maltreatment has been shown to bear even greater consequences on the young developing mind when compared to other forms of abuse like sexual or physical abuse. Its psychological impact on mental health has been well established. For example, research has shown that the relationship between childhood emotional maltreatment and depression is significant. Specifically, Gibb et al. found that diagnoses of major depression were more significantly related to reports of emotional abuse than to sexual or physical abuse alone. This may be related to the feeling of hopelessness experienced by victims of these circumstances. A study by Hamilton and colleagues found that hopelessness acts as a mediator for various forms of emotional maltreatment and has been linked to increased risks for depression and anxiety among adolescents. Its contribution during cases of emotional abuse were found to intensify these symptoms, and negatively impact individuals regardless of race. This is also true for other emotions associated with this form of maltreatment, such as shame, humiliation, anger and worthlessness. These negative feelings are believed to contribute towards the distortive thinking patterns shown in victims of emotional abuse. Likewise, research has shown that emotionally maltreated individuals also experience greater dysfunction and attrition rates from pharmacotherapeutic treatment for social anxiety disorder [SAD]. Even beyond its psychological impact, this suggests that emotionally maltreated individuals may face more challenges in response to treatment for their experiences from childhood [33-39]. Early adversity and negative life events have also been shown to predict significant increases in depressive symptoms of maltreated individuals. The course of depression in abused victims has been widely shown to differ from those without stressful childhoods. In that, the effects of stress on the body changes over the course of depression. Stress desensitization, as postulated in Post’s kindling hypothesis, describes the process by which individuals develop a lower threshold for depression to be elicited after its initial episode. The impact of the first traumatic event, like abuse in childhood, is believed to leave the person ‘scarred’ and more vulnerable to the effects of stress later in life. This can pose detrimental risks in the context of emotionally maltreated children. Stress plays a mediating role in the relationship between early adversity and the onset of major depression [MDD] in youth. In fact, emotionally maltreated children are three to four times more likely to develop MDD in their lifetime - with more severe and longer courses occurring in earlier cases of abuse [40-49]. Findings from Shapero et al. further supports the stress sensitivity hypothesis for early emotional abuse. Individuals with more severe histories of emotional abuse were shown to experience greater depressive symptoms during stressful life events. These findings were consistent with research by Harkness et al. who found that abused individuals reported lower severity levels of stressful life events prior to their depression onset that those without a history [50,51].
Moreover, early experiences of stress and adversity has been linked to disruptions in the neurological and biological development of several mechanisms related to stress [52]. Hyperactivity in the hypothalamic-pituitary-adrenal (HPA) axis has been shown to impact individuals with MDD [53]. Specifically, women with histories of childhood abuse have exhibited increased activity in HPA and autonomic responses to stress when compared to controls [54]. This may reflect the body’s ‘involuntary defeat strategy’, which demonstrates a primitive response in our reptilian brain that aims to de-escalate potentially harmful events through the activation of several neurological structures [55]. In turn, the primal response of this strategy may produce maladaptive responses to stress due to the prolonged overactivity of various stress mechanisms in the brain [56]. As a result, the role of chronic stress experienced by emotionally maltreated individuals can induce everlasting effects on the developing brain and invoke the emergence of other disorders associated with behavioral dysregulation [53].
Additionally, the development of other psychiatric and behavioral disturbances in victims of emotional maltreatment have also been seen in the literature [57]. Women with histories of childhood psychological abuse suffer greater dissociative experiences than non-abused women [58]. In turn, victims of emotional maltreatment have also been linked to developing several personality disorders as well [59-61]. It has been shown that the trauma from these early experiences can predict later diagnoses of post-traumatic stress disorder, the emergence of psychotic symptoms and increases in substance use problems [33,35,62,63]. Overall, victims of this abuse suffer greatly from their experiences, and generally experience a decreased quality of life [39].
However, it must be noted that different forms of emotional maltreatment pose different outcomes in its symptomology later in life. Emotional neglect is the most pervasive and passive form of emotional maltreatment that effects 6.2% of Americans withhistories of abuse [64]. It involves the omission of emotional warmth and care which invalidates an individual’s affectional needs during early childhood. On average, mothers of emotionally neglected children were found to experience more complex stressors in their lives (i.e., substance abuse, mental health, social housing, etc.) and risk factors in their development [34]. These cases tended to reflect longer instances of abuse with greater emotional harm inflicted onto its victims [65]. Emotionally neglected individuals have also been linked to the development of distinctive personality disorders [PDs] such as histrionic, borderline, schizoid, and avoidant PD [61,66]. Relations to these outcomes are speculative but are believed to be associated with the chronic victimization of individuals in these circumstances [65].
In contrast, research exploring the unique effects of emotional abuse has shown greater and potentially more severe outcomes in its course. This can be seen through a variety of different forms such as rejecting or gaslighting an individual to doubt their own beliefs and thoughts. Surprisingly, increases in depression and social anxiety were more strongly related to the emotionally abused but not neglected individuals [36]. Its impact on people with SAD has led to significantly decreased rates of treatment retention overtime and associations with paranoid, schizotypal and narcissistic personality disorders [39,59,61]. In turn, emotional abuse is believed to be present in all forms of maltreatment throughout childhood and understood to have the strongest relations with mental health problems later in life [62].
Overall, it is evident that the dysfunctional relationships evident within abusive households compromises the child’s and caregiver’s ability to adequately meet each other’s needs. Seminal research by Mary Ainsworth and John Bowlby have stressed the importance of proper, secure attachments amongst parent-child dyads. Complications involved with this formative relationship negatively affects later personality and psychopathological development in children [67,68]. Especially in the context of the abusive household, the challenges associated with poor emotional regulation, low self-esteem and negative autonomic thinking contributes to the overall cycle of abuse that mediates the impact of emotional maltreatment on child victims [37,69-71].
Foundations of an emotionally abusive household may begin even before the birth of a child. Factors such as marrying the wrong partner, becoming disillusioned during a marriage, or even finding substitutes on whom to vent their anger to may precipitate child emotional abuse. Additionally, partners who had undergone unwanted pregnancies may resort to despising their children and manifest their energies in recognizing their own unfulfilled needs during their own childhood. Alcoholism and other forms of substance abuse may intensify these behaviours and leave the caregivers psychologically, if not physically, absent as well. Children in these circumstances are often left alienated and emotionally deprived; becoming the primary subjects of emotional abuse and second-hand abuse through shame and humiliation [72-76].
It is clear that the relationship between caregivers within a family unit play a significant role in mitigating the impact of emotional abuse in children and youth. Children of separated or divorced parents may feel torn by their loyalties to each parent and feel restless about their future. This form of familial triangulation may compel parents to use vicious tactics in order to ‘win over’ their children and instill negative values about their respective former partner(s) [3]. Additionally, caregivers with histories of mental illness are more likely to react in emotionally inappropriate ways in response to their child’s needs [77]. This is exemplified in cases where parents who were also emotionally abused in their youth must now deal with their own internal struggles whilst being a caregiver themselves [78]. As a result, many children within these families fall victim to becoming the scapegoats of their parents’ troubles and the punching bags of toxic behaviours.
Almost all parents are guilty of inducing some degree of emotional maltreatment on their children throughout their lifetime [78]. However, the legal statutes which address the severity of this mental injury has operated for a long time without an adequate definition for these actions [79]. At present, the legal definitions of emotional or psychological abuse are reserved for the act of verbal, emotional or threatened harm, while emotional or psychological neglect describes the inadequate nurturance of children through insufficient care, affection, or permittance of dangerous behaviours like drug use to persist [6,75,80]. Research has shown that many of these tragic cases tend to follow a similar, destructive pattern of behaviour by caregivers which can be shared across many victims of abuse including:
• Rejection. The refusal of a caregiver to acknowledge the worth or validity of a child’s need for survival.
• Isolation. Attempts to prohibit the child from forming friendships with others and damaging their self-esteem.
• Terrorizing. Frightening the child through verbal assaults to create a climate of fear that discourages them from seeking help.
• Corrupting. Permittance and encouragement of destructive and antisocial behaviours which reinforce child deviancy [75,79,80].
Additional behaviours noted in abusive parents also involve a history of animal cruelty and the destruction of personal possessions [81]. These inattentive and often aggressive behaviours fall under ‘psychological torture’ or ritualized abuse, which uses extreme fear in the child to inflict severe mental injuries that negatively affect one’s mental health and sanity [3]. Its distinction from emotional abuse focuses more on its intense damage to the child’s psycho-emotional state and is often seen in various cultural practices. For example, in African or Native American folklore, children are threatened by a mythical entity called the “bogeyman” which is used as a story passed down for generations as a means to gain control over youth [4]. Psychological abuse also typically features more sinister implications for the child’s ever-developing self-concept [79]. This can be seen in the case of abrasive child-rearing practices used by traditional parents. In a case study conducted by Mass and Geaga-Rosenthal, an 11-year old Chinese-American boy developed a facial tic in response to the highly stressful environment created by his parents [82]. Disapproving of his average academic performance at school, the boy was highly scrutinized for his work and proceeded to live with the somatic symptom for many years to come [80]. From this, we can understand that specific parenting styles derived from various cultural values may pose children at risk for being the victims of psychological abuse. As such, it is clear that greater research observing the relationship between culture-specific parenting practices and emotional/psychological abuse must be done to understand its impact on later child development.
Broader stressors involved in the toxic environment of an abusive household must also be recognized when conceptualizing the rootof maltreatment in children. Unemployment, poverty, marital conflict, and divorce are common pressures that parents face which can encourage abusive behaviours to begin [6]. And when living in a society that does little to support or respect parents for their roles as caregivers, psychological maltreatment may unfold. High parenting stress has often been associated with greater risks for maltreatment and places strains on the child - caregiver relationship [83-85]. Children in these dyads are often perceived to be more difficult by their caregivers due to the high parental expectations placed onto them [78]. In turn, these children may begin to develop a poorer self-concept, and value themselves as unworthy for adequate love or attention [79,80,86-88]. Therefore, expressing their frustrations and defeat through retaliation that encourages the cycle of abuse to persist.
For instance, the development of internalizing and externalizing behaviours in children of emotional abuse has been well-established in the literature [39,62,89]. Children from abusive households are likely to harbour low self esteem and ability to regulate their difficult emotions. This can impede their ability to build resilience against these stressful environments, which has been shown to serve as a protective factor against the emotional and behavioral problems commonly associated with psychologically maltreated individuals. Poor parent child relationships within these families also contributes to a child’s development of maladaptive behaviours and processes. These negative relations may challenge a child’s perception of others and impact their sense of trust and loyalty to others around them [21]. In turn, the internal working models of the abused child may become distorted through these early life experiences and be manifested in their personal relationships later on [39,72]. Therefore, resulting in a cycle of abuse to persist for generations to come.
The covert nature of emotional abuse also makes it challenging for individuals to recognize its occurrence early on in a child’s life. It is often seen as a secondary and less significant form of maltreatment when compared to the evident wounds associated with cases of physical abuse. This is further supported by research conducted by Korbin et al. which found that only 42% of caregivers ranked emotional and verbal maltreatment as abuse. Its effects often present themselves in insidious ways, especially throughout young, romantic relationships experienced during early adulthood. A study by Colman and Widom found that children with abusive backgrounds struggle with establishing healthy, intimate relationships during adulthood. The warning signs associated with this are frequently overlooked and misunderstood as ‘normal’ interactions in such relations, making it a serious manner that needs to be addressed to avoid harm in the future. For example, the use of verbally aggressive communication amongst adolescent peer groups has become more acceptable and commonplace than ever before. Those who are familiar with this type of language may not recognize the potentially harmful intentions behind these words and fail to recognize the context of these toxic relationships. In turn, emotionally abusive language may be promoted and become normalized within these relationships to encourage an abusive cycle of communication to continue [90-96].
Understanding how to navigate through these toxic encounters also requires experience that younger people may lack. For example, older adolescents have been shown to be aware of the toxic behaviours associated with the ‘personal degradation’ or ‘public humiliation’ of their partner(s). However, when asked how to deal with these insults, both male and female youth were only able to suggest passive responses to these alarming exchanges [97].
Disturbingly, males were shown to be more accepting of these behaviours than females. This may be reflective of the societal expectations placed onto males as the more dominant figure in the relationship. Men are expected to remain strong in times of adversity, and may normalize these alarming behaviours when elicited by others - including their partners. This contradicts the stereotyped belief of the vicious, male perpetrator existing in all cases of abuse. As a result, male victims may be subjected to harsher judgements by others in society, and may be less knowledgeable of how to appropriately respond to such signs in abusive, romantic relationships [98]. Therefore, it is imperative that both men and women should be taught how to identify varying forms of emotional abuse and learn how to protect themselves from these harmful behaviours.
Overall, it is clear that lasting harm does not require a physical wound for it to bear dangerous consequences. But instead, it is the invisible scars that are left behind closed doors which bear the most potent strains on one’s life. The presence, effects, and outcomes of early emotional abuse poses substantial risks to the developmental trajectory and future of victims across the world. Children who suffer from this form of abuse are more likely to face challenges associated with the trauma of these formative experiences. As such, efforts placed into research concerning the long-term impacts of early emotional maltreatment is essential for developing interventions to minimize its prevalence. We must heed the treacherous outcomes associated with young victims of maltreatment to the public in order to stop it from occurring. And with time, hopefully reduce the prospect of intergenerational trauma to be transmitted for generations to come.
