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 The diagnosis is being overlooked and undertreated compared to
physical forms of abuse, researchers say.
“When you look at symptom severity, there was no difference between
the three forms of maltreatment,” said Joseph Spinazzola, lead
author of the study.
Psychological trauma is different from “dysfunctional parenting,”
where moms or dads periodically lose their tempers.
“It’s sort of living in this situation where they’re not receiving
any kind of love or warmth and instead they’re receiving either
hostility, threats or impossible demands, almost as if they are an
enemy or monster, a pathetic unlovable creature . . . .,” said
Spinazzola, executive director of The Trauma Center at Justice
Resource Institute in Brookline, Massachusetts.
The study used the National Child Traumatic Stress Network Core Data
set to analyze the cases of 5,616 youth with histories of
psychological, physical or sexual abuse.
The children were ages 2 to 10 at the start of the data collection,
which took place from 2004 to 2010. Forty-two percent were boys and
62 percent had a history of psychological abuse.
The children and their parents or caregivers were interviewed by
clinicians and also answered questions about behavioral issues and
trauma on questionnaires.
All three groups of children had scores in the same general range
for so-called "internalizing problems," like social withdrawal,
sadness, loneliness, difficulty concentrating or sleeping, and
symptoms like headaches or stomachaches.
But children who had been psychologically abused were more likely to
have negative outcomes over the long-term than victims of physical
or sexual abuse.
They were 92 percent more likely to have trouble with substance
abuse, 78 percent more likely to be depressed, 80 percent more
likely to experience separation anxiety disorder and 92 percent more
likely to be anxious, according to a paper scheduled for an upcoming
issue of the journal Psychological Trauma: Theory, Research,
Practice, and Policy.
Compared to children who had been sexually abused, the psychological
abuse group was also 65 percent more likely to have academic
problems, 91 percent more likely to engage in criminal activity, 47
percent more likely to injure themselves and 147 percent more likely
to have attachment problems.
“One thing that struck me was that, of the forms of trauma measured
by this core data set, psychological abuse was the most enduring
form of maltreatment,” Spinazzola said. “When psychological abuse
co-occurred with the other two, the presence of psychological abuse
heightened the negative effects to a greater magnitude than when
they occurred in the absence of psychological abuse.”
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But psychological abuse is often overshadowed by physical and sexual
abuse, the researchers note. In one previous study, only 7.6 percent
of psychological abuse was reported to child welfare agencies. Other
research found psychological abuse was investigated only 36 percent
of the time (compared to 53 percent of physical abuse cases and 55
percent of sexual abuse).
“I think there’s a hesitancy to label a parent as engaging in
psychological abuse because of that fear of unfairly blaming a
parent for just being human and imperfect,” said Spinazzola.
Spinazzola said that while there have been improvements in educating
child welfare personnel to better recognize psychosocial abuse and
neglect, more work was needed.
“It’s a combination of sort of education and awareness both at the
training level for social workers and graduate training but also
outreach to families. Educating and supporting parents in how to
effectively engage with children and how to manage their own
distress that can affect their ability to be effective parents,”
Spinazzola said.
Dr. Jill Glick, medical director of Child Protective Services at the
University of Chicago Comer Children's Hospital, called the research
“transformational.” Glick was not directly involved in the study,
though she is a colleague of study coauthor Bradley Stolbach.
“When you look at these children, you’re seeing the impact of it is
so significant and what’s happening to them gets lost in the (mix)
of child abuse and neglect,” Glick told Reuters Health.
She said the study was a wake-up call to better identify and
diagnose psychological abuse.
“This paper is telling us we need to have a public surveillance
approach to psychological maltreatment with agreed-upon
definitions,” Glick said. “This is a really good thing that we’re
finally saying this is a terrible form of maltreatment, probably
much more common than we realized.”
SOURCE: http://bit.ly/1DBNJEF Psychological Trauma: Theory,
Research, Practice, and Policy, October 2014.
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