Emotional abuse and neglect (psychological maltreatment): a conceptual framework

https://doi.org/10.1016/S0145-2134(02)00342-3Get rights and content

Abstract

Objective: Emotional abuse and neglect is an under-recognized, but actually common, form of child abuse. Professionals in the field continue to find difficulty in recognizing and operationally defining it, and experience uncertainty about proving it legally. There are also questions about intervention and therapy to protect the child in the least detrimental manner. These difficulties have led to delays in recognition and protective intervention. Emotional abuse and neglect are defined as a carer-child relationship that is characterized by patterns of harmful interactions, requiring no physical contact with the child. Motivation to harm the child is not necessary for the definition. Unlike sexual abuse that is a secret activity, these forms of ill treatment are easily observable. The child’s development is impaired in all domains of functioning but, not being specific to emotional abuse and neglect, cannot be regarded as diagnostic.

Method: Research, clinical experience and theoretical considerations have led to a conceptual framework and operational definitions of five categories of harmful interactions between parent and child. This framework is contrasted with the APSAC categories.

Results: It is postulated that the different categories of ill treatment respectively require different therapeutic interventions.

Conclusion: Concerns about the presence of emotional abuse need to trigger an assessment process that includes identifying the nature of the abusive or neglectful interactions and a time-limited trial of specific interventions. The family’s response to this process and its outcome will determine the need for statutory involvement, as well as providing a basis for litigation if this is required.

Résumé

Résumé

Objectif: Sévices et négligence psychologiques constituent une forme pas assez reconnue mais vraiment répandue de mauvais traitements à l’égard des enfants. Les professionnels qui exercent dans ce champ continuent à trouver difficile de les identifier et de les définir de façon opérationnelle et ils éprouvent de l’incertitude concernant leur preuve légale. L’intervention et la thérapie posent aussi question lorsque l’on cherche à protéger l’enfant dans la perspective du moindre mal. Ces difficultés ont causé du retard à cerner ces problèmes et à intervenir en vue de leur prévention.

Les sévices et la négligence psychologiques sont définis comme un type de relation entre l’enfant et celui qui en a la garde caractérisé par un mode d’interaction nocif mais ne nécessitant pas de contact physique. Il n’est pas nécessaire qu’il y ait désir de faire du mal à l’enfant. Contrairement aux abus sexuels qui constituent une activité secrète, ces formes de mauvais traitement sont facilement observables. Le développement de l’enfant est mis à mal dans tous les domaines de son fonctionnement mais ceci n’étant pas particulier aux sévices et à la négligence psychologiques n’a pas de valeur pour établir un diagnostic.

Méthode: La recherche, l’expérience clinique et les considérations théoriques ont conduit à un cadre conceptuel et à des définitions opérationnelles de cinq catégories d’interactions nocives entre le parent et l’enfant. Ce cadre est en contraste avec les catégories APSAC.

Résultats: Il est pôstulé que les différentes catégories de mauvais traitements nécessitent chacune des interventions thérapeutiques différentes.

Conclusions: Des inquiétudes concernant la présence de sévices psychologiques imposent de déclancher une procédure d’évaluation qui incluera l’identification de la nature des interactions amenant à maltraiter ou à négliger l’enfant et, pour un temps limité un essai d’interventions spécifiques. La réaction de la famille à cette procédure et son résultat déterminera la nécessité d’une intervention judiciaire, tout comme cela fournira une base pour le procès si celui-ci est exigé.

Resumen

Resumen

Objetivo: El maltrato y la negligencia emocional son formas de maltrato infantil infra-reconocidos, pero frecuentemente comunes. Los profesionales de esta área continúan encontrando difı́cil el reconocer y definirlo operativamente, y experimentan incertidumbres a la hora de verificarlo legalmente. También hay cuestiones acerca de la intervención y la terapia para proteger al niño con el menor detrimento posible. Estas dificultades han provocado retrasos en el reconocimiento del problema y en la intervención de protección.

El maltrato y la negligencia emocional son definidos como una relación cuidador-niño que se caracteriza por patrones de interacciones dañinas, que no requieren contacto fı́sico con el niño. Tampoco es necesaria para su definición el que se dé una motivación de dañar al niño. A diferencia del abuso sexual, que es una actividad secreta, estas formas de maltrato son fácilmente observables. El desarrollo del niño es dañado en todos los ámbitos de funcionamiento pero, no siendo especı́fico con el maltrato y negligencia emocional, no se puede estimar como diagnóstico.

Método: La investigación, la experiencia clı́nica y las consideraciones teóricas conducen a un modelo conceptual y a definiciones operativas de cinco categorı́as de interacciones dañinas entre padre e hijo. Este modelo es contrastado con las categorı́as de APSAC.

Resultados: Se postula que las diferentes categorı́as de maltrato requieren respectivamente diferentes intervenciones terapéuticas.

Conclusiones: Las preocupaciones sobre la presencia de maltrato emocional necesitan provocar un proceso de evaluación que incluya identificar la naturaleza de las interacciones maltratantes o negligentes y un proceso de intervenciones especı́ficas limitadas en el tiempo. La respuesta de la familia a este proceso y sus resultados determinarán la necesidad de implicación de la administración, al igual que dotarán de una base de litigación en caso de que sea necesario.

Introduction

This article explores the place of emotional abuse or psychological maltreatment within the overall context of child abuse and neglect. It revisits definitional issues and briefly considers professional intervention. The focus in this article is on the relationship between the primary caregiver(s) and the child. It needs to be acknowledged that this relationship is invariably nested within the family which is, in turn, significantly influenced by the social environment in which the family is located, and influenced by family members’ own histories.

In considering child abuse and neglect in general, and psychological maltreatment in particular, a central premise is that responsibility for ensuring that the relationship between the parent and the child is nonabusive or neglectful lies with the parent. Children can be temperamentally difficult, provocative or, in some cases, have physical or psychological conditions that cause serious stress for the parent and challenge their ability to cope. However, if the parents are unable to cope, responsible action is to seek help. If the parents, for whatever reason, are unable to seek help, the responsibility lies with others to intervene on behalf of both the child and the parent.

It is now increasingly accepted that emotional abuse and neglect cause significant harm to the child’s development and that this harm extends into adult life (Hart, Binggeli, & Brassard, 1998). Evidence for this has come from a number of follow-up and longitudinal studies which consistently show that emotional abuse and neglect in childhood are associated significantly with a wide range of emotional, behavioral, and cognitive difficulties in later childhood (Erickson, Egeland, & Pianta, 1989), adolescence Herrenkohl et al 1991, Skuse et al 1998, and adulthood Briere and Runtz 1990, Mullen et al 1996. However, in these studies, emotional abuse has either been inferred from descriptions of parent-child interactions, or different operational definitions of the actual term have been used in the various studies.

O’Hagan (1995) has suggested that emotional and psychological abuse are usefully distinguished from each other. Psychological abuse is defined as impeding the mental (especially cognitive) and moral faculties. This distinction is not considered to be useful since cognition and emotion are not independent of each other, cognitive appraisal of experiences contributing to the affective experience and vice versa.

Section snippets

The place of psychological maltreatment in the overall context of child abuse & neglect

Not infrequently, different forms of child abuse and neglect coexist Briere and Runtz 1988, Ney et al 1994. In one study, psychological maltreatment, measured separately, was found in a majority (90%) of children who had also been physically abused and neglected (Claussen & Crittenden, 1991). Moreover, they found that the psychological maltreatment was more strongly predictive of subsequent impairments in the children’s development than the severity of physical abuse. Beyond the physical injury

Epidemiology

It is invariably stated in publications on the subject that emotional abuse or psychological maltreatment are difficult to define and, therefore, to recognize reliably. In the US, states differ in the inclusion or not of emotional abuse under their civil, criminal, and vicarious liability statutes, and there is considerable variation between different states in their rates of evaluation and reporting of emotional abuse (Hamarman, Pope, & Czaja, 2001). US national statistics indicate a rate of

Ill treatment by the parents or impairment of the child’s health and development?

There has been considerable debate about whether the definition of emotional abuse and neglect should refer to the maltreating behavior or to the consequences for the child, and whether evidence of both is required for its recognition. The cumulative conclusion in an issue of the journal Development and Psychopathology (1991), devoted to the discussion of emotional abuse and neglect, was that, for definitional purposes, evidence of the ill treatment rather than harm to the child should be

Effects on the child

The cumulative list of difficulties found in children subjected to emotional abuse and neglect reads like the index of a child psychiatric textbook. In a study of 94 children from 56 families whose names had been placed on the Child Protection Register under the category of Emotional Abuse, we found the following difficulties with which the children presented (Glaser, Prior, & Lynch, 2001). They are listed in Table 4 (missing data on 5 children). It is clear from the table that the children

Conclusions

Emotional abuse and neglect will continue to pose a challenge to professionals concerned with ensuring the well-being of children. When finding oneself involved in a case of psychological maltreatment, it is helpful to ask at what stage of the process one is:

  • Is there suspicion of abuse which requires verification?

  • Is this an assessment of the extent of harm to the child?

  • Is this a time-limited trial for change?

  • Is one in the process of preparing a case for moving the child to an alternative,

Acknowledgements

The author wishes to thank Vivien Prior who has over many years collaborated closely in the research and theoretical development of the framework; and to members of the Parent Interaction with the Child clinical team (PICT) who have contributed to the application and further development of the categories: Margaret Adcock, Hilary Davies, Dr. Jill Hodges, Marta Neal, and Libby Read.

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