Emotional Abuse: Signs and Symptoms

The following was adapted from the Massachusetts Department of Social Services Investigation Training manual, “Evidence and Indicators of Maltreatment.”(1)

Behavioral and Physical Indicators
Types of Psychological Maltreatment
Examples of Emotionally Abusive Behaviors by Age

Emotional or psychological abuse is often overlooked by healthcare providers, as there are often no physical signs of abuse. Whenever a child or adolescent presents with psychiatric symptoms or any of the other indicators listed below, the possibility of emotional abuse should be explored.

Children who are experiencing emotional abuse may present with any of the following indicators:

Behavioral Indicators: Physical Indicators:

Habit disorders, such as poor eye contact, sucking, biting, rocking, enuresis, or eating and other food-related disorders
Conduct disorders, including withdrawal and antisocial behavior
Neurotic traits, such as sleeping disorders, inhibition of play, compulsiveness, hysteria, obsession, phobias, and hypochondria
Suspicious, untrusting, pessimistic, depressed, anxious, preoccupied
Inappropriate adult behavior or inappropriate infantile behavior
Developmental lags in mental and emotional growth
Suicide attempts or self-harm
Poor self-image
Running away
Adaptive behavior in an attempt to respond to family’s inconsistent interactions or expectations
Nervous tic, persistent stuttering, or speech disorder
Subservient role in the home
Developmental lag in decision-making
Overriding worry about pleasing authority figures
Anger/hostility when not feeling in control

**Note: many of the above symptoms may be observed in children who are not being maltreated.

Hair missing because of pulling
Nails bitten
Body posture/facial expressions are withdrawn
Hives
Nervous tic
Overweight
Depression - low self-worth, low self-esteem
Thoughts and/or acts of suicide
Rebelliousness
Self-inflicted injuries
Speech disorders
Substance abuse
Delayed physical development
Ulcers, asthma, severe allergies


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If the child or adolescent reports a repeated pattern or extreme incidents of any of the following conditions, psychological maltreatment should be suspected. Such conditions convey the message the the child is worthless, flawed, unloved, endangered, or only valuable when meeting someone else’s needs.

Spurning (Hostile Rejecting/Degrading) - includes verbal and nonverbal caregiver acts that reject and degrade a child:

Belittling, degrading, and other nonphysical forms of overtly hostile or rejecting treatment.
Shaming and/or ridiculing the child for showing normal emotions such as affection, grief, or sorrow.
Consistently singling out one child to criticize and punish, to perform most of the household chores, or to receive fewer rewards.
Public humiliation.

Terrorizing - includes caregiver behavior that threatens or is likely to physically hurt, kill, abandon, or place the child or child’s loved ones/objects in recognizable dangerous situations:

Placing a child in unpredictable or chaotic circumstances.
Placing a child in recognizably dangerous situations.
Setting rigid or unrealistic expectations with threat of loss, harm, or danger if they are not met.
Threatening or perpetrating violence against the child.
Threatening or perpetrating violence against a child’s loved one or objects.

Exploiting/Corrupting - includes caregiver acts that encourage the child to develop inappropriate behaviors (self-destructive, antisocial, criminal, deviant or other maladaptive behaviors):

Modeling, permitting, or encouraging antisocial behavior (i.e. prostitution, performance in pornographic media, initiation of criminal activities, substance abuse, violence to or corruption of others).
Modeling permitting, or encouraging developmentally inappropriate behavior (i.e. parentification, infantalization, living the parent’s unfulfilled dreams).
Encouraging or coercing abandonment of developmentally appropriate autonomy through extreme over-involvement, intrusiveness, and/or dominance (i.e. allowing little or no opportunity/support for the child’s views, feelings, and wishes; micromanaging the child’s life).
Restricting or interfering with cognitive development.

Isolating - caregiver acts that consistently deny the child opportunities to meet needs for interacting/communicating with peers or adults inside or outside of the home:

Confining the child.
Placing unreasonable limitations or restrictions on social interactions with peers or adults in the community.

Denying Emotional Responsiveness (Ignoring) - includes caregiver acts that ignore the child’s attempts and needs to interact (failing to express affection, caring, and love for the child) and showing no emotion in interactions with the child:

Being detached and uninvolved through either incapacity or lack of motivation.
Interacting only when absolutely necessary.
Failing to express affection, caring, and love for the child.

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The following are examples of emotionally abusive caregiver behaviors directed at children of different ages:

Type of Behavior
Infant
Toddler
Rejecting Refuses to accept child’s primary attachment.
Refuses to return smiles, punishes child for vocalizations.
Abandons baby.		 Actively excludes child from family activities.
Refuses to allow child to hug caregiver, pushes child away; treats child differently from siblings.
Terrorizing Consistently violates the child’s ability to handle new situations and uncertainty.
Teases or scares infants by throwing them up in the air.
Reacts in unpredictable ways to the infant’s cries.		 Uses extreme measures to threaten or punish the child.
Verbal threats of mysterious harm such as attacks by monsters, leaving the child in the dark, etc.; alternating rage with warmth.
Ignoring Fails to respond to the infant’s social behaviors which form the basis for attachment.
Mechanical caregiving with no affection; failing to make eye contact with the infant.		 Pattern of apathetic treatment and lack of awareness of the child’s needs.
Does not speak with the child at meals, leaves the child alone for long periods of time, or does not respond to requests for help.
Isolating Denies the child social interactions with others.
Refuses to allow relatives and family friends to visit the infant.
Leaves the infant unsupervised for long periods of time.		 Teaches the child to avoid social contact beyond the caregiver-child interaction.
Punishes child for making social overtures to other children; rewards child for withdrawing from social contacts.
Corrupting Reinforces bizarre habits or creates addictions.
Creates drug dependencies; reinforces sexual behaviors.		 Gives inappropriate reinforcement for antisocial behaviors.
Rewards children for aggressive acts toward animals or other children.
“Brainwashes” child into racism.
Type of Behavior
School-Aged Child
Adolescent
Rejecting Consistently communicates to children that they are inferior or bad.
Uses labels such as “bad child” or “dummy;” tells children they are responsible for family problems.
 Refuses to acknowledge the changes in children as they grow up, attacking their self-esteem.
Treating an adolescent like a young child, excessive criticism, verbal humiliation.
Terrorizing Places children in “double binds” or places inconsistent or frightening demands on children.
Sets up unrealistic expectations and criticizes the child for not meeting them.
Forces the child to choose between parents or primary caretakers.
Teases the child or plays cruel games.		 Threatens to or actually subjects the child to public humiliation.
Threatens to reveal embarrassing facts to the child’s friends.
Forces the child into degrading punishments.
Ignoring Fails to protect the child from threats when caregiver is aware of the child’s need for help.
Fails to protect the child from assault by other family members.
Shows no interest in the child’s education or life outside the home.		 Gives up parenting roles and shows no interest in the child.
Says, “This child is hopeless; I give up” and means it.
Refuses to listen to children’s discussion of their lives and activities.
Focuses on other relationships at the exclusion of children.
Isolating Attempts to remove the child from social relationships with peers.
Refuses to allow other children to visit the home; keeps the child from engaging in after-school activities.		 Over-controls the child’s social interactions, restricting the child’s freedom to an extreme degree.
Refuses to allow and/or punishes the child for engaging in normal social activities (i.e. dating).
Accuses child of lying, doing drugs, etc. whenever the child leaves home.
Corrupting Continues to involve the child in illegal or immoral behavior, encouraging the child to be part of this lifestyle at the expense of healthier behaviors.
Involves the child in prostitution.
Encourages the child to hit or verbally abuse siblings.
Encourages drug use.		 Continues to involve the child in illegal or immoral behavior, encouraging the child to be part of this lifestyle at the expense of healthier behaviors.
Involves the child in prostitution.
Encourages the child to hit or verbally abuse siblings.
Encourages drug use.

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References:
(1) Massachusetts Department of Social Services. Investigation Training: Evidence and Indicators of Maltreatment. March 2002.
(2) U.S. Department of Justice. Portable Guides to Investigating Child Abuse: Child Neglect and Munchausen Syndrome by Proxy. September 1996.
(3) U.S. Department of Justice. Portable Guides to Investigating Child Abuse: Recognizing When a Child’s Injury or Illness is Caused by Abuse. June 1996.
(4) Kendall-Tackett KA, Williams LM, Finklehor D. Impact of sexual abuse on children: a review and synthesis of recent empirical studies. Psychol Bull, 1993; 113:164-80.
(5) Friedrich WN, Fisher J, Broughton D, Houston M, Shafran CR. Normative sexual behavior in children: a contemporary sample. Pediatrics, 1998; 101(4):E9.
(6) Cavanaugh Johnson T. Understanding the sexual behaviors of young children. Siecus Report, August/September.

Adams Classification Table Specific References:
(i) Berenson A, Heger A, Andrews S. Appearance of the hymen in newborns. Pediatrics, 1991; 87:458-465.
(ii) Berenson AB, Heger AH, et al. Appearance of the hymen in prepubertal girls. Pediatrics, 1992; 89:387-394.
(iii) McCann J, Wells R, Simon M, Voris J. Genital findings in prepubertal girls selected for non-abuse: A descriptive study. Pediatrics, 1990; 86:428-439.
(iv) Heger AH, Ticson L, Guerraq L, et al. Appearance of the genitalia in girls selected for nonabuse: Review of hymenal morphology and non-specific findings. J Pediatr Adolesc Gynecol 2002;15:27-35.
(v) Berenson AB, Chacko MR, Wiemann CM, Mishaw CO, Friedrich WN, Grady JJ. A case-control study of anatomic changes resulting from sexual abuse. Am J Obstet Gynecol, 2000;182:820-834.
(vi) McCann, J, Voris J, Simon M, Wells R. Perianal findings in prepubertal children selected for non-abuse: A descriptive study. Child Abuse & Neglect, 1989; 13:179-193.
(vii) Centers for Disease Control and Prevention (CDC) Guidelines, MMWR, Vol. 51, May 10, 2002. http://www.cdc.gov/std/treatment/rr5106.pdf
(viii) McCann J, Voris J, Simon M. Genital injuries resulting from sexual abuse, A longitudinal study. Pediatrics, 1992; 89:307-317.
(ix) McCann J, Voris J. Perianal injuries resulting from sexual abuse: A longitudinal study. Pediatrics, 1993; 91:390-397.
(x) Emans SJ, Woods ER, Allred EN, Grace E. Hymenal findings in adolescent women: Impact of tampon use and consensual sexual activity. J Pediatr,1994; 125:153-160.
(xi) Berenson AB, Grady JJ. A longitudinal study of hymenal development from 3 to 9 years of age. J Pediatr 2002;140:600-607.

Last Updated: February 7, 2004
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