Emotional Maltreatment of Children: Relationship to Psychopathology

In its broadest sense, childhood emotional maltreatment is the breadand- butter of clinical psychiatry and general psychotherapy. Nonetheless, its weight in mainstream psychiatric research remains surprisingly light. Black and colleagues1 reported a total of only 279 articles on child psychological or emotional abuse retrieved from 3 major databases between 1974 and 1998. This small number contrasts with the thousands of publications on sexual and physical abuse. Furthermore, the literature on emotional maltreatment remains almost entirely descriptive. This is in contrast to research of other types of maltreatment, especially sexual abuse, in which researchers have begun to systematically examine neurocognitive and neurobiologic correlates.

While sexual abuse is almost always unequivocal (at least when known) and even physical abuse is usually clearcut (with the exception of appropriately timed and culturally sanctioned spanking or other low-grade physical interventions that are well controlled and consistently intended to benefit a child), emotional maltreatment is more difficult to define and more elusive in its detrimental impact. Emotional maltreatment is of 2 major types, further complicating matters; again, this is different from physical and sexual maltreatment. One type, emotional abuse, the more obvious analog to physical or sexual abuse, is easier to identify and to measure. The other type, emotional neglect, is more subtle yet pervasive and possibly more damaging than emotional abuse, and poses even more challenging barriers to definition and study. Emotional neglect is often better recognized via comparison with its opposite—warm and involved parenting.

Research studies that comprehensively assess and integrate findings across different types of childhood maltreatment remain relatively few. Studies of physical and sexual abuse have often examined these forms of abuse in a vacuum, without attending to the broader emotional and psychosocial environment in which they take place.

Briere and Runtz2 highlighted the potential pitfalls in the conclusions of studies that examined only certain types of childhood maltreatment. Such conclusions can run the risk of making false attributions of current symptoms or problems, since findings thought to be associated with one form of abuse actually could be arising from another coexisting form of abuse. As Rosenberg³ noted, this compartmentalization has extended well beyond narrow research interests to funding sources, social service agencies, and even advocacy groups that have traditionally been concerned with different types of child maltreatment.

Claussen and Crittenden⁴ addressed the complexity of the interaction between different types of child maltreatment. They found that in a large sample of children, psychological maltreatment was present in most cases of physical abuse and, more important, predicted poor outcomes, whereas physical abuse severity did not. This finding might not surprise many clinicians, who can readily recall patients who have confessed that they could take the beatings, whereas it was the words—spoken and unspoken—that scarred them more deeply.

According to Hamarman and colleagues, ⁵ there are still no consensus definitions to guide us in the identification of emotionally abused children. The DSM-IV provides V-codes for the identification of parent-child relational problems, specifying physical abuse, sexual abuse, and neglect (usually physical), but not emotional abuse.

However, there are several well–thought-out proposed classifications in the literature for emotional maltreatment. Garbarino and associates⁶ defined psychological maltreatment as “a concerted attack by an adult on a child's development of self and social competence” and proposed 5 forms of psychological maltreatment: rejecting, terrorizing, isolating, ignoring, and corrupting. Hart and Brassard⁷ delineated 5 subtypes of emotional maltreatment: spurning, terrorizing, isolating, exploiting/corrupting, and denying emotional responsiveness (Table). These 5 emerged as conceptually distinct subtypes that are largely nonoverlapping and moderately correlated with each other.