“Sticks and stones, with sufficient strain,

can leave one bruised and broken.

But words can even harm the brain,

no matter how softly spoken.

For even when a cast has

rendered one completely still

stones can only break the body,

while words can break your will.”

Definition

“So much more than name calling. Verbal abuse is the defining of another person’s inner world. It’s like a slam into their consciousness that tells them what they are, what they think, what they feel or what their motives are. It can include threats used to control another human being, to erase their perceptions, and to tell them that they are less than what they are, to define them as objects. It can be defining someone as non-existent in withholding, giving no response, as if they’re not there.

”

- Partricia Evans Author of THE VERBALLY ABUSIVE RELATIONSHIP

Categories of Verbal Abuse

“ Name-calling, belittling, swearing, insulting. (“You are stupid.” “You’re a rotten kid.”)

Indirect criticism, such as disparaging your child to your spouse, also hurts. Just because you’re not berating your child directly doesn’t mean he doesn’t hear it and feel the sting.

Rejecting or threatening with abandonment. (“I wish you’d never been born.” “I should put you up for adoption.”) This kind of verbal abuse creates a sense that your child isn’t wanted in the family.

Threatening bodily harm. Studies have linked verbal aggression and physical aggression: A Harvard study found, for example, that “parents who yell frequently are the ones most likely to hit frequently, and vice versa.” Even if you don’t act on violent threats, they may make your child fear and distrust you.

Scapegoating or blaming. (“You’re the reason this family is such a mess.” “If I didn’t have to take care of you, I could have a better life.” “If you weren’t so clumsy, your sister wouldn’t have gotten hurt.”) Your child will think he’s a bad person who deserves to be unhappy.

Using sarcasm. Making a mocking remark, such as “Now that was smart” when he spills juice on the rug, might seem like a way to avoid direct criticism, but your child is perceptive enough to understand that you’re demeaning him.

Berating your spouse. A study at the University of Maryland, Baltimore County, determined that children who see their parents verbally abusing each other are more likely to be depressed or anxious, and to experience more interpersonal problems of their own. Interestingly, the study also found that verbal aggression between parents was more traumatic to children than physical violence between parents.” [1]

Prevalence of Verbal Abuse

“One national study from the University of New Hampshire found that 63 percent of American parents reported one or more instances of verbal aggression, such as swearing at and insulting their child. [2]

A 2003 survey of nearly 1,000 American parents found that almost 75 percent reported shouting, yelling or screaming at their children during the previous year. On average, they reported doing so at least once a month. But the authors of the study of “psychological aggression” by parents, published in the Journal of Marriage and Family, assumed it happened more often because yelling is “so ordinary and so taken for granted” it does not stand out in one’s memory. “[3]

Impact

“A new study led by Ming-Te Wang, assistant professor of psychology in education in the University of Pittsburgh’s School of Education and of psychology in Pitt’s Kenneth P. Dietrich School of Arts and Sciences suggests that “use of harsh verbal discipline — defined as shouting, cursing, or using insults — may be just as detrimental to the long-term well-being of adolescents.”(as physical discipline)

Rather than minimizing problematic behavior in adolescents, the use of harsh verbal discipline — defined as shouting, cursing, or using insults — may in fact aggravate it. The researchers found that adolescents who had experienced harsh verbal discipline suffered from increased levels of depressive symptoms, and were more likely to demonstrate behavioral problems such as vandalism or antisocial and aggressive behavior.

Adolescents who had experienced harsh verbal discipline suffered from increased levels of depressive symptoms, and were more likely to demonstrate behavioral problems such as vandalism or antisocial and aggressive behavior.” [4]

As Damaging as Physical Discipline?

Wang and Kenny found that the negative effects of verbal discipline within the two-year period of their study were comparable to the effects shown over the same period of time in other studies that focused on physical discipline.

“From that we can infer that these results will last the same way that the effects of physical discipline do because the immediate-to-two-year effects of verbal discipline were about the same as for physical discipline,” Wang said. Based on the literature studying the effects of physical discipline, Wang and Kenny anticipate similar long-term results for adolescents subjected to harsh verbal discipline.”[4]

The Importance Of Consistent Parenting

Significantly, the researchers also found that “parental warmth” — i.e., the degree of love, emotional support, and affection between parents and adolescents — did not lessen the effects of the verbal discipline. The sense that parents are yelling at the child “out of love,” or “for their own good,” Wang said, does not mitigate the damage inflicted. Neither does the strength of the parent-child bond.

Even lapsing only occasionally into the use of harsh verbal discipline, said Wang, can still be harmful. “Even if you are supportive of your child, if you fly off the handle it’s still bad,” he said. [4]

Key Facts on How Abuse Effects Brain Development

Dr. Martin Teicher’s work extends beyond studies regarding the effects that verbal abuse has on brain development. One of the most fascinating findings that Dr. Teicher’s large body of work shows is that, not only is the brain molded by experiences that occur throughout the lifespan, but “there are particular stages of development when experience exerts either a maximal (sensitive period) or essential (critical period) effect”

Thus, if stress exposure targets different brain regions based on ages of exposure, then exposure at different ages may lead to different clinical outcomes. Childhood exposure sensitizes the individual to later emergence of depression during adolescence.

(This is important to understand when considering the results of studies which document the impact of verbal abuse.)

[10]

The hippocampus is part of a system that commands many bodily functions: the limbic system, which is located in the brain’s medial temporal lobe. The hippocampus is responsible for long-term or “declarative” memory.

The corpus callosum consists of about 200 millon axons that interconnect the two hemispheres. The primary function of the corpus callosum is to integrate motor, sensory, and cognitive performances between the cerebral cortex on one side of the brain to the same region on the other side.[11]

The Prefrontal Lobes are important for

Attention

Execution Function

Working Memory

Motivation

Behavior Inhibition

Delayed Impact

In addition, it appears as though the effects of child abuse are delayed. On average, there is a 9 year gap between exposure to childhood sexual abuse and emergence of depression.

“Subjects who developed major depression had the onset occur between 10–20 years of age (mean survival 15.0 years; 95% CI: 13.6–16.4 years). The average time from onset of CSA(childhood sexual abuse) to onset of major depression, in those who developed depression, was 9.2 ± 3.6 years. Mean survival time from onset of CSA to onset of depression for the entire sample was 11.47 years (95% CI: 9.80–13.13 years). Mean survival from offset of CSA (first episode if there were multiple perpetrators) was 9.55 years (95% CI: 7.45–11.65 years). “ [12]

The Brain on Verbal Abuse

“Verbal assault can alter the way a developing brain is wired,” says Martin Teicher, associate professor of psychiatry at Harvard Medical School.

Brain scans reveal decreased activity in parts of the brain concerned with emotion and attention. Patients with a history of sexual abuse or intense verbal badgering showed less blood flow in a part of the brain known as the cerebellar vermis. The vermis aids healthy people to maintain an emotional balance, but in those with a history of childhood abuse, that stabilizing function may become impaired.

He and his colleagues have already found evidence of anxiety, depression, and brain differences in a study of 554 college students exposed to loud yelling, screaming, and belittling remarks directed at them. The latter include remarks like “You’re stupid,” “You’ll never amount to anything,” and “Why can’t you be more like your cousin?” From this study, Teicher concludes that “exposure to verbal aggression may have effects as powerful as physical or nonfamilial sexual abuse.”

Harsh punishment, unwanted sexual advances, belittling, and neglect are thought to release a cascade of such stress hormones, which produces an enduring effect on the signals that brain cells send and receive from each other. As a result the brain becomes molded to overrespond to stress. [5]

In 2009, Martin Teicher and collegues published an article entitled ”Preliminary evidence for white matter tract abnormalities in young adults exposed to parental verbal abuse.”, which documents their research on how verbal abuse impacts the brain. Diffusion Tensor Imaging (DTI) was used to ascertain whether PVA was associated with abnormalities in brain white matter (WM) tract integrity.

(Facts for understanding the images)

*Diffusion tensor imaging (DTI) measures the direction of movement of water molecules within and along axons, which comprise the bundles of nerve fibers in the brain’s white matter.

*Fractional anisotropy(FA) is the uniformity of water flow throughout the brain. areas with low FA are indicative of axonal injury, and areas with abnormally high FA, as compared to healthy brains.

The arcuate fasciculus is a white-matter fiber tract that links lateral temporal cortex with frontal cortex via a dorsal projection that arches around the Sylvain fissure.

“Detailed tractography of left arcuate fasciculus fibers in a representative subject color coded by fiber direction. Yellow region marks segment of the pathway delineated by Tract-Based Spatial Statistics as having significantly lower Fractional anisotropy in subjects with Parental verbal abuse versus controls.”[14]

The cingulum is a collection of white matter fibers projecting from the cingulate gyrus to the entorhinal cortex in the brain, allowing for communication between components of the limbic system.

“Detailed tractography of left cingulum bundle fibers in a representative subject color coded by fiber direction. Yellow region marks segment of the pathway delineated by TBSS as having significantly lower Fractional anisotropy in subjects with Parental Verbal Abuse versus controls.”[14]

The Fornix is a C-shaped bundle of fibers, also known as axons, which carry signals from the hippocampus to other parts of the brain.

Detailed tractography of left fornix fibers in a representative subject color coded by fiber direction. Yellow region marks segment of the pathway delineated by TBSS as having significantly lower FA in subjects with PVA versus controls.[14]

“Overall, results from this study support a hypothesis that the brain is chiseled in precise ways by exposure to adverse early experience. Analysis of neural connectivity patterns provides preliminary but intriguing evidence that the arcuate fasciculus, cingulum bundle and fornix may be vulnerable to the effects of early stress. Diminished fiber integrity, aberrant crossing patterns, alterations in axonal diameter, or extent of myelination along portions of these pathways may underlie some of the psychiatric and neurocognitive consequences of childhood abuse. “[14]

“These findings and the present results suggest that the development of auditory association cortex involved in language processing may be affected by exposure to early stress and/or emotionally abusive language.”- Martin Teicher[9]

As Damaging As Sexual Abuse?

“Because exposure to verbal aggression has received relatively little attention as a specific form of abuse compared to physical and sexual abuse, Martin Teicher and three colleagues of Harvard University — Jacqueline Samson, Ann Polcari, and Cynthia McGreenery — set out to do a study comparing the impact of childhood verbal abuse in both the presence and absence of physical and sexual abuse and exposure to family violence.

They recruited 554 young people, aged 18 to 22 years, who responded to advertisements. About half were women and most were white. They all filled out questionnaires about unhappy childhoods and verbal abuse.

Verbal abuse, the researchers found, had as great an effect as physical or nondomestic sexual mistreatment. Verbal aggression alone turns out to be a particularly strong risk factor for depression, anger-hostility, and dissociation disorders. The latter involve cutting off a particular mental function from the rest of the mind. In one type of dissociation, the person can’t recall part of his or her personal history. Other types involve hallucinations, feeling unreal or unstable, unconsciously converting painful emotions into physical symptoms, and multiple personalities.

“Our findings raise the possibility that exposure to verbal aggression may affect the development of certain vulnerable brain regions in susceptible individuals,” Teicher’s group warns. “Alternatively, such exposure in childhood may put into force a powerful negative model for interpersonal relationships.” Possible consequences could include insecure attachments to others, negative feelings about oneself in relation to others, poor social functioning, and lowered self-esteem and coping strategies. Worse, says, Teicher, “such possibilities are not mutually exclusive.”

Teicher shows that, indeed, exposure to verbal abuse does affect certain areas of the brain. These areas are associated with changes in verbal IQ and symptoms of depression, dissociation, and anxiety.

The effects of verbal abuse were worse than witnessing serious domestic violence and as serious as sexual abuse outside the home, but not as bad as sexual abuse by a family member. Of 54 people in the study who witnessed domestic violence, 35 saw their mothers being threatened or assaulted. Twenty-three witnessed brothers and sisters being physically mistreated. Thirteen of these attacks involved severe beatings.” [6]

[7]

“The Limbic System Checklist-33 was created to evaluate the frequency with which subjects experience symptoms often encountered as phenomena of ictal temporal lobe epilepsy, as described by Spiers et al. These items consist of paroxysmal somatic disturbances, brief hallucinatory events, visual phenomena, automatism, and dissociative experiences.” [7]

“The Dissociative Experience Scale consists of 28 questions that assess the frequency of various dissociative experiences. Scores on each item range from 0 to 100, and they are averaged to provide an index score. Total scores under 20 capture most healthy subjects and patient groups with no appreciable dissociative symptoms.”[7]

[7]

Peer Verbal Abuse

In 2010 Dr. Martin H. Teicher and colleagues sought to ascertain what the effects of exposure to peer verbal abuse are in young adulthood. They asked “whether childhood exposure to peer verbal abuse in the absence of physical bullying was associated with elevations in psychiatric symptoms, similar to the effects they observed with childhood exposure to parental verbal abuse.” Dr.Teicher and colleagues also “examined diffusion tensor imaging scans from a group of healthy volunteers to ascertain whether the integrity of white matter tracts might be affected by exposure to peer verbal abuse, as they had recently observed in individuals exposed to parental verbal abuse.

“Detailed ratings of symptoms and exposure to emotional abuse and trauma were collected and analyzed from our multistudy community database of 1,662 young adults (636 male and 1,026 female) 18–25 years of age who responded to an advertisement entitled “Memories of Childhood.” All participants gave informed consent prior to participation. We focused on a group of 848 participants (363 male and 485 female, with a mean age of 21.8 years [SD=2.1]) who had no exposure to domestic violence, childhood sexual abuse, parental physical abuse, or peer physical bullying and a subset of 707 participants (298 male and 409 female, with a mean age of 21.9 years [SD=2.1]) who in addition had no exposure to either maternal or paternal verbal abuse; exposure to verbal abuse was defined as a maternal or paternal score ≥40 on the Verbal Abuse Questionnaire.”[8]

The results are shocking…

Questionnaire scores.

Peer vs Parental Abuse

Incidence and Timing of Exposure to Peer Verbal Abuse

“Exposure peaked during the middle school years (grades 6–8, typically ages 11–14). Children exposed to peer verbal abuse during elementary school often had this exposure persist into middle school. However, 9.8% of participants in the community sample were exposed to significant levels of peer verbal abuse during middle school but not elementary school.”[8]

Neuroimaging Sample

. Regions in the Corpus Callosum (CC) and Posterior Corona Radiata (PCR) in Which Correlations Were Observed Between Degree of Exposure to Peer Verbal Abuse and Mean Diffusivity (MD), Radial Diffusivity (RD), and Fractional Anisotropy (FA)a

a Regions were identified with diffusion tensor imaging and the tract-based spatial statistics tool in FSL. Blue coloring indicates a positive correlation with diffusion measurements. Red coloring indicates an inverse correlation with measures of fractional anisotropy. The sample consists of 63 participants who had no exposure to childhood sexual abuse, witnessing of domestic violence, parental or peer physical abuse, or parental verbal abuse and were free of axis I and II disorders.

Discussion Section from Martin Teicher’s Peer Abuse Study

“Exposure to peer verbal abuse was associated with increased drug use and elevated psychiatric symptom ratings.

Substantial exposure was associated with a greater than twofold increase in clinically significant ratings of depression, a threefold to fourfold increase in anxiety and “limbic irritability,” and 10-fold increase in dissociation.

This level of peer verbal abuse was reported by 9.2% of participants who had no exposure to childhood sexual abuse, witnessing of domestic violence, or parental physical or verbal abuse and by 17.9% of the entire community sample. Hence, exposure to substantial levels of peer verbal abuse is a relatively common occurrence.

Moreover, the effects of childhood exposure to peer verbal abuse on risk of psychopathology in early adulthood mirror results we previously reported for parental verbal abuse (5). Thus, verbal aggression from peers is an important and potent childhood stressor.

Middle school was the peak period of exposure to peer verbal abuse, with 9.8% of our community sample newly exposed.

This finding fits with previous observations that peer physical aggression declines over the period from ages 8 to 18 while peer verbal abuse increases from ages 8 to 11, plateaus, and then declines from ages 15 to 18).”

Timing

More importantly, the timing of exposure appears to shape its impact. Path analysis suggests that exposure during the middle school years (ages 11–14) was the most consequential and was associated with symptoms of anxiety, depression, dissociation, “limbic irritability,” and degree of drug use.

Overall, there were no significant associations between these symptoms and degree of exposure during elementary or high school when degree of middle school exposure was excluded. However, exposure at early and later ages amplified the association between symptom ratings and middle school exposure, more than doubling the amount of variance explained.

This suggests that exposure during elementary and high school may sensitize or reinforce the effects of exposure during middle school.

These findings are consistent with previous reports indicating that exposure to peer verbal abuse in secondary school is more serious than peer verbal abuse during primary school .

This may be because children in primary school predominantly engage in dyadic relationships, which can attenuate the perceived impact of bullying outside the dyad.

Another perspective is also possible. We recently published data indicating that there are sensitive periods when brain regions are most susceptible to the effects of childhood sexual abuse . The hippocampus was most vulnerable to childhood sexual abuse occurring at ages 3–5 years and 11–13 years. It is possible that the hippo-campus is also susceptible to other forms of abuse occurring during these years. Anxiety, depression, dissociation, and temporal lobe epilepsy-like symptoms have all been associated with aspects of hippocampal function . Hippocampal volume was not assessed in this study.

Diffusion tensor imaging, however, revealed an association between degree of exposure to peer verbal abuse and measures of mean diffusivity, radial diffusivity, and fractional anisotropy in the splenium of the corpus callosum and the overlying corona radiata. The corpus callosum is a massive fiber tract interconnecting the left and right hemispheres. The corona radiata contains both descending and ascending axons that carry nearly all of the neural traffic to and from the cerebral cortex. Many of these axons pass through the corpus callosum. Studies suggest that alterations in radial diffusivity but not axial diffusivity, as observed, result from effects on myelin rather than axon numbers .

Corpus callosum alterations appear to be the most consistent finding in maltreated children, and it is perhaps remarkable that they emerged in a sample of comparison subjects with no axis I or II disorders.

The sensitive period for the splenium (the most caudal portion of the corpus callosum) likely occurs during the middle school years, given the rostral-caudal progression of corpus callosum myelination and our finding that the rostral body of the corpus callosum had a sensitive period between ages 9 and 10 .

It is interesting to speculate on how white matter alterations in the splenium might be related to elevated risk for depression, dissociation, or substance abuse. Fibers passing through the splenium interconnect the right and left occipital and inferior temporal cortices. Together these regions comprise the ventral visual processing stream, which has reciprocal connections with the hippocampus.

The visual cortex is a plastic structure that is extensively modified by early experience. We previously reported that exposure to childhood sexual abuse was associated with a 12%–18% reduction in gray matter volume in the right and left primary and secondary visual cortex. We have also found similar alterations in witnessing domestic violence (unpublished data). While the visual cortex plays a critical role in sensory perception, it may have additional functions.

A reproducible finding in major depression is a substantial reduction in occipital cortex g-aminobutyric acid (GABA), which is restored following treatment with antidepressants or ECT. Exposure to early stress may target GABA-ergic interneurons or fiber pathways of the visual cortex and increase risk for the development of mood disorders. We and others have also speculated that alterations in the corpus callosum may set the stage for dissociative phenomena by diminishing intrahemispheric integration.

It is also possible that lack of integration between right and left hemispheric processing of visual cues may lead to greater cue-induced craving in substance users and enhanced risk for abuse and dependence.

This study is unique for a number of reasons. First, it assessed and controlled for exposure to other forms of mal-treatment, such as childhood sexual abuse and parental verbal abuse. Second, it focused entirely on peer verbal abuse as a specific form of childhood trauma distinct from peer abuse involving physical assaults. Third, effects of exposure during different developmental stages were assessed based on our finding of “sensitive periods” when brain regions are particularly susceptible to abuse.”[8]

Further Reading

http://consumer.healthday.com/encyclopedia/children-s-health-10/child-development-news-124/yelling-at-children-verbal-abuse-648565.html [1]

http://pubpages.unh.edu/~mas2/VB35C1.pdf [2]

http://bostonparentspaper.com/article/why-yelling-at-your-kids-never-works.htm l[3]

http://www.news.pitt.edu/news/yelling-doesn-t-help-may-harm-adolescents-pitt-led-study-finds [4]

http://news.harvard.edu/gazette/2003/05.22/01-brain.html [5]

http://news.harvard.edu/gazette/story/2007/04/verbal-beatings-hurt-as-much-as-sexual-abuse/ [6]

http://ajp.psychiatryonline.org/doi/pdf/10.1176/ajp.2006.163.6.993 [7]

http://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2010.10010030 [8]

http://www.ncbi.nlm.nih.gov/pubmed/20483374 [9]

http://www.thebalancedmind.org/sites/default/files/Teicher.pdf [10]

http://cnsvp.stanford.edu/atlas/corpus_callosum.html [11]

http://drteicher.wordpress.com/2009/06/15/delayed-onset-of-depression/ [12]

http://www.ncbi.nlm.nih.gov/pubmed/18692174 [13]

http://www.ncbi.nlm....PMC2652864/[14]