According to the American Academy of Pediatrics (AAP) position statement on psychological maltreatment, psychological abuse in young children can be just as damaging in terms of the children’s physical, mental and emotional health than physical abuse like punch, kick or slap.

The August issue of the journal Pediatrics reports that one of the biggest challenges is to detect this prevalent form of child abuse and neglect.

According to Dr. Harriet MacMillan, a professor in the departments of psychiatry and behavioral neurosciences and pediatrics of McMaster University’s Michael G. DeGroote School of Medicine and the Offord Centre for Child Studies, exploiting, belittling, terrorizing or denigrating a child or being emotionally unresponsive as well as corrupting a child to the point where a child’s wellbeing is at risk are all forms of psychological abuse.

MacMillan, who holds the David R. (Dan) Offord Chair in Child Studies at McMaster is one of three authors of the position statement, says: “We are talking about extremes and the likelihood of harm, or risk of harm, resulting from the kinds of behavior that make a child feel worthless, unloved or unwanted.”

She describes a case whereby a mother leaves her child alone in a crib all day or a father who involves his teenage child in his drug habit.

MacMillan continued that parents who raise their voice towards a child after having asked the child for the tenth time to do their chores is not psychological abuse, saying:

“But, yelling at a child every day and giving the message that the child is a terrible person, and that the parent regrets bringing the child into this world, is an example of a potentially very harmful form of interaction.”

Scientific literature has described psychological abuse over two-and-a-half decades ago, yet MacMillan states that it has remained under-recognized and under-reported and that the impact of psychological child abuse “can be as harmful as other types of maltreatment.”

Psychological maltreatment has an impact on the development of children. Psychological abuse is therefore associated with various problems, including disorders of attachment, developmental, educational and socialization problems as well as disruptive behavior.

“The effects of psychological maltreatment during the first three years of life can be particularly profound.”

Psychological abuse happens in many types of families, although it is more frequent in homes where there is family conflict, multiple stresses, physical violence, mental health issues, depression or substance abuse.

Unlike the few existing studies that report on the prevalence of psychological abuse, the position statement reveals that large population-based, self-report studies in the UK and the U.S. have discovered that around 8 to 9% of women and 4% of men reported exposure to severe psychological abuse during childhood.

Pediatricians must be aware if they see potential signs of psychological abuse, even though little evidence is available on potentially successful methods to tackle the problem. The statement indicates that it is vital for children at risk for pediatric, psychiatric and child protective services to collaborate.

Written by Petra Rattue