New research suggests it is just as toxic as sexual abuse.

(Photo: Jeremy Tarling/Flickr)

As recent reports regarding actor Stephen Collins remind us, accusations of child sexual abuse reliably produce a reaction of intense horror. But a new study suggests that, if we are to seriously address the mistreatment of children and the long-term damage it creates, we need to broaden our focus.

In an article entitled "Unseen Wounds," a team of researchers argues that childhood emotional abuse—a problem far more widespread than sexual molestation—is linked to just as much suffering and problematic behavior as the victims grow into adolescents.

In a large sample, “psychologically mistreated youth exhibited equivalent or greater baseline levels of behavioral problems, symptoms, and disorders compared with physically or sexually abused youth on most indicators,” writes the researchers, led by Joseph Spinazzola of the Trauma Center at Justice Resource Institute in Brookline, Massachusetts.

The combination of emotional abuse and/or neglect with physical or sexual abuse appears to be particularly toxic, as it was “linked to the exacerbation of most outcomes,” they write in the journal Psychological Trauma: Theory, Research, Practice and Policy. Psychological abuse, the researchers add, can be viewed as “a formidable form of trauma in its own right.”

"The predictive potency of psychological maltreatment appears to be at least on part with physical or sexual abuse across a broad range of adverse outcomes."

The researchers analyzed data on 5,616 youngsters (42 percent boys) from the National Child Traumatic Stress Network core data set. All had been exposed to one or more forms of trauma and had sought treatment in one of the network’s 56 centers.

All underwent a detailed assessment, including a trauma history profile that noted whether they had suffered one or more of the following: Physical abuse/maltreatment, “defined as an actual or attempted caregiver infliction of physical pain or bodily injury;” sexual abuse/maltreatment, “defined as actual or attempted sexual molestation, exploitation, or coercion by a caregiver;” or emotional abuse/psychological maltreatment.

The latter included exposure to one or more abusive behaviors such as bullying, terrorizing, coercive control, severe insults, debasement, or threats—on the “neglect” side of the spectrum—shunning or isolation.

Sixty-two percent of the children had experienced some form of emotional abuse, “with nearly one-quarter of maltreatment cases comprised exclusively of psychological maltreatment.” If you think those latter kids got off easy compared to those who were physically or sexually abused, think again.

While being careful not to claim causality, the researchers report “the predictive potency of psychological maltreatment appears to be at least on par with physical or sexual abuse across a broad range of adverse outcomes.”

They found that emotional abuse or neglect was “the strongest predictor of substance abuse, raising the question of whether substance abuse may serve as an associated coping mechanism.”

Turning to behavioral problems, including self-injury and criminal activity, they found psychological maltreatment “exhibited a strong association comparable to that of physical abuse, and greater than that of sexual abuse.”

In addition, those who had suffered psychological maltreatment reported PTSD symptoms as frequently as those in the physical abuse and sexual abuse groups.

Spinazzola and his colleagues argue these results have important public-policy implications. “Given its predictive potency and widespread prevalence,” they write, “efforts to increase recognition of psychological maltreatment as a potentially formidable type of maltreatment in its own right should be at the forefront of mental health and social-service training efforts.”

Emotional abuse and neglect of children “can be elusive and insidious, and its very nature allows it to hide in plain sight,” they write. “The comparatively covert nature of psychological maltreatment can thus lead investigators to focus on more ‘tangible’ forms of maltreatment, as well as to adopt an apathetic or helpless outlook regarding how best to intervene.”

Clearly, a shift in attitude is desperately needed.