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 **Note: many of the above symptoms may be observed in children who are not being maltreated. |
- Hair missing because of pulling |
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.
- 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.
- 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.
- 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.
- Confining the child.
- Placing unreasonable limitations or restrictions on social interactions with peers or adults in the community.
- 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.
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. |
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.