The Silence and Severity of Childhood Emotional Abuse
Although treatment considerations for adults with histories of childhood physical and sexual abuse has grown over the years, psychotherapeutic treatment focusing on adults with childhood emotional abuse histories is in its nascency—at best. Emotional abuse and its impacts also tend to remain unseen, unacknowledged, and underreported by the general public and professionals (Chamberland, et al., 2005; Twaite & Rodriguez-Srednicki, 2004). The relatively common American adage of “Sticks and stones may break my bones, but words will never hurt me!” exemplifies social misconceptions surrounding emotional abuse. Childhood emotional abuse only appears covert because it is more difficult to detect and define than other forms of abuse (Hornor, 2012), especially because there is not one prevailing definition of emotional abuse that all can reference. For instance, childhood emotional abuse has been conceptualized as all of the following:
- “verbal assaults on a child’s sense of worth or well-being or any humiliating or demeaning behavior directed toward a child by an adult or older person” (Bernstein et al., 2003);
- “persistent, non-physical, harmful interactions with the child by the caregiver, which include both commission [abuse] and omission [neglect]” (Glaser, 2011);
- “repeated patterns of caregiver behavior or a serious incident that transmits to the child that [they are] worthless, flawed, unloved, unwanted, endangered, or only of value in meeting another’s needs” (American Professional Society on the Abuse of Children; Myers et al., 2002).
Despite the nebulousness and silence surrounding this form of abuse, 36% of identified childhood abuse cases report incidence of emotional abuse (Chamberland et al., 2011; Sedlak et al., 2010; Tonmyr et al., 2011) with emerging evidence that its detrimental impacts are at least equivalent to, and in some studies, found to be greater than among those who experience other forms of abuse (e.g., physical abuse, sexual abuse; Burns et al., 2010; Dias et al., 2015; Hodgdon et al., 2018; Nguyen-Feng et al., 2017; Wright et al., 2009). Even when controlling for exposure to physical and sexual abuse, which tend to overlap experiences of emotional abuse (Dias et al., 2015), associations between emotional abuse and distress still persist (Paul & Eckenrode, 2015). Furthermore, childhood emotional abuse has been linked with a host of increased mental and physical health concerns in adulthood, such as:
anxiety (Taillieu et al., 2016); bipolar disorder (Etain et al., 2010); borderline traits (Allen, 2008; Kuo et al., 2015); depression (Gibb et al., 2007; Taillieu et al., 2016; van Harmelen et al., 2010); disordered eating (Feinson & Hornik-Lurie, 2016); dissociative symptoms (Briere & Runtz, 1988); externalizing conduct problems (Caples & Barrera, 2006); low self-esteem (Mullen et al., 1995); negative affect (Nguyen-Feng et al., 2019); paranoid ideation (Dias et al., 2015); perceived stress (Nguyen-Feng et al., 2019); post-traumatic stress (Wekerle et al., 2009); relationship difficulties (Bigras et al., 2015); sexual problems (Mullen et al., 1995); sleep problems (Wijma et al., 2007); social anxiety (Reinelt et al., 2013); somatic symptoms (Samelius et al., 2007); and suicidal behaviors (Bifulco et al., 2002).
In light of this, we hope to break the silence around the severity of childhood emotional abuse and discuss possible psychotherapy considerations for adult clients with childhood emotional abuse histories.
Why is Childhood Emotional Abuse So Hurtful in Adulthood?
There are a few ideas that may explain why the impact of childhood emotional abuse is so long-standing, negatively impacting various domains across adulthood. Emotional abuse tends to occur more often than other forms of abuse that may occur in discrete, singular incidents—furthermore, emotional abuse co-occurs more commonly than not with other forms of abuse and maltreatment; in addition to being more frequent, is also often more chronic due to it being unrecognized (Dias et al., 2015; Spinhoven et al., 2010). The chronicity of emotional abuse, which targets how children see and feel about themselves, is compounded with important developmental periods in a child’s life where they develop secure attachment (Erikson et al., 1996; Sroufe et al., 2005) and a positive sense of abilities and self (Shonk & Cicchetti, 2001; Arslan, 2017; Stuewig & McCloskey, 2005; Taussig & Culhane, 2010).
This combination of negative events during this critical time period leads to a “perfect storm” in which children may begin to internalize and believe what they are told about themselves, manifesting in both hurtful cognitive and emotional manners. That is, these verbal degradations that are part of emotional abuse (e.g., “you’re useless”; “why were you even born?”) directly target the formation of negative cognitions, which in turn increases vulnerability to distress (Rose & Abramson, 1992). Similarly, verbal degradation or discounting of a child’s emotional hurt and feelings may lead to the child being particularly sensitive (Bounoua et al., 2015) and unable to accept their own emotions later on in life (Gratz et al., 2007), resulting in avoidance both outwardly and inwardly (Gratz et al., 2007; Reddy et al., 2006). This snowballs into an inability to cope effectively. However, by understanding theories on why childhood emotional abuse is so hurtful, mental health professionals can have a better sense of what to target to allow such clients to thrive.
As Mental Health Professionals, What Can We Do?
Until enough research provides rigorous evidence on best practices in treating adult clients with histories of emotional abuse, we may only offer light suggestions on what we can do as mental health professionals. These are our five key suggestions, although there are surely various other areas that practitioners may explore:
- Screen for emotional abuse during intakes, initial assessments, and as needed during the psychotherapeutic process. Prioritize and assess for emotional abuse as you would any other risk factor or potentially traumatic event. Psychological maltreatment screeners that have adequate psychometric properties include: Childhood Maltreatment Interview Schedule (Briere, 1992); Childhood Trauma Interview (Fink et al., 1995); Childhood Trauma Questionnaire (Bernstein & Fink, 1998).
Practitioners may also choose to ask about childhood emotional abuse with the following questions:
- Growing up, did anyone in your home say or do things that led you to feel worthless / flawed / unworthy of love / unloved / unwanted / unsafe / of little value aside from meeting others’ needs?
- In your childhood, did you feel as though any caregiver / adult / older person emotionally hurt you? What did they say or do to you?
- Thinking back to your childhood, what were some of the most positive words that your caregiver(s) said to you? What were some of the most negative words that your caregiver(s) said to you?
Although these suggestions focus on adult clients, we recommend that practitioners working with youth also conduct these screenings for a holistic and preventive approach to trauma treatment. For instance, the Trauma History Profile of the National Child Traumatic Stress Network’s Core Data Set screens for psychological maltreatment among children and adolescents.
- Focus effort and attention toward the therapeutic alliance. Because adults with childhood emotional abuse histories may be distrustful and sensitive to perceived negative feedback at times, mental health practitioners need to be particularly mindful in building rapport. Through a strong working alliance, practitioners and clients may also feel more comfortable in discussing alliance ruptures as they arise.
- Encourage a curious stance towards the client’s emotions and internal states. Turning inwards tends to be avoided among childhood emotional abuse survivors. Thus, it is important to teach coping skills around mindfulness, distress tolerance, acceptance, and perceived control in emotions that arise and how to respond to them.
- Explore how childhood emotional abuse has impacted client’s social support and functioning. Psychotherapy may involve delineating healthy attachment styles as well as willingness to seek support, which are areas commonly impacted by childhood emotional abuse. Provide positive reinforcement to client for efforts in making changes in these areas.
- Unpack client’s negative self-schemas and self-concepts. Examine how these constructs relate to client’s self-esteem, self-worth, and psychological and somatic health concerns. Gently challenge and assist client in rewriting these negative, seemingly ingrained narratives to become evolving stories of resilience and growth.
With these general suggestions in mind, we hope that the mental health field may shift its attention to this unseen, unacknowledged, and unreported yet deeply detrimental form of childhood abuse. In turn, we hope that mental health professionals create a path for the understanding of childhood emotional abuse in the broader human services field as well as the general public. Ultimately, we hope to squash the silence around childhood emotional abuse so that it may be viewed, assessed, reported, and researched with the same serious considerations of other abuse types.
The impact of childhood emotional abuse goes beyond the critical developmental periods in which the abuse occurs. Childhood emotional abuse has been linked to both mental and physical impairments and other negative sequelae well into adulthood. However, emotional abuse remains difficult to detect and recognize; this invisibility is partly due to lack of clarity in defining emotional abuse despite its high prevalence and co-occurrence with other forms of abuse. As mental health practitioners, we need to screen for and validate experiences of emotional abuse among adults whom we treat and serve. Since trust and healthy self-narratives may be eroded by this chronic and deeply rooted form of abuse, we need to provide a particular focus on the therapeutic alliance in addition to the client’s internal states, social support, and self-schemas. With these suggestions in mind, we hope that adult clients with silent experiences of childhood emotional abuse will finally be heard and seen. Further, we hope for increased awareness, acknowledgement, and attention around emotional abuse that will ultimately lead to better informed psychotherapeutic practices.
Cite This Article
Nguyen-Feng, V. N., Sundstrom, M., Asplund, A., & Hodgdon, H. (2020, March). Bringing attention to childhood emotional abuse in psychotherapy with adults. [Web article]. Retrieved from https://societyforpsychotherapy.org/bringing-attention-to-childhood-emotional-abuse-in-psychotherapy-with-adults
Allen, B. (2008). An analysis of the impact of diverse forms of childhood psychological maltreatment on emotional adjustment in early adulthood. Child Maltreatment, 13(3), 307-312. https://doi.org/10.1177%2F1077559508318394
Arslan, G. (2017). Psychological maltreatment, emotional and behavioral problems in adolescents: The mediating role of resilience and self-esteem. Child Abuse and Neglect, 52, 200-209. https://doi.org/10.1016/j.chiabu.2015.09.010
Bernstein, D. P., & Fink, L. (1998). Childhood Trauma Questionnaire: A retrospective self-report: Manual. Harcourt Brace and Company.
Bernstein, D. P., Stein, J. A., Newcomb, M. D., Walker, E., Pogge, D., Ahluvalia, T., Stokes, J., Handelsman, L., Medrano, M., Desmond, D., & Zule, W. (2003). Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse and Neglect, 27(2), 169-190. http://dx.doi.org/10.1016/S0145-2134(02)00541-0
Bifulco, A., Moran, P. M., Baines, R., Bunn, A., & Stanford, K. (2002). Exploring psychological abuse in childhood: II. Association with other abuse and adult clinical depression. Bulletin Menninger Clinic, 66(3), 241-258. https://doi.org/10.1521/bumc.184.108.40.20666
Bigras, N., Godbout, N., Hébert, M., Runtz, M., & Daspe, M. (2015). Identity and relatedness as mediators between child emotional abuse and adult couple adjustment in women. Child Abuse and Neglect, 50, 85-93. http://dx.doi.org/10.1016/j.chiabu.2015.07.009
Bounoua, N., Felton, J. F., Long, K., Stadnik, R. D., Loya, J. M., MacPherson, L., & Lejuez, C. W. (2015). Childhood emotional abuse and borderline personality features: The role of anxiety sensitivity among adolescents. Personality and Mental Health, 9(2), 87-95. http://doi.org/10.1002/pmh.1295
Briere, J. (1992). Child Maltreatment Interview Schedule. In J. Briere (Ed.), Child Abuse Trauma: Theory and Treatment of the Lasting Effects (pp. 165-177). Sage Publications
Briere, J., & Runtz, M. (1988). Multivariate correlates of childhood psychological and physical maltreatment among university women. Child Abuse and Neglect, 12(3), 331-341. https://doi.org/10.1016/0145-2134(88)90046-4
Burns, E. E., Jackson, J. L., & Harding, H. G. (2010). Child maltreatment, emotion regulation, and posttraumatic stress: The impact of emotional abuse. Journal of Aggression, Maltreatment and Trauma, 19(8), 801-819. http://dx.doi.org/10.1080/10926771.2010.522947
Caples, H. S., & Barrera, M. (2006). Conflict, support and coping as mediators of the relation between degrading parenting and adolescent adjustment. Journal of Youth and Adolescence, 35(4), 599-611. http://doi.org/10.1007/s10964-006-9057-2
Chamberland, C., Fallon, B., Black, T., & Trocme, N. (2011). Emotional maltreatment in Canada: Prevalence, reporting and child welfare responses (CIS2). Child Abuse and Neglect, 35(10), 841-854. https://doi.org/10.1016/j.chiabu.2011.03.010
Chamberland, C., Laporte, L., Lavergne, C., Tourigny, M., Wright, J., Helie, S., et al. (2005). Psychological maltreatment of children reported to youth protection services: A situation of grave concern. Journal of Emotional Abuse, 5(1), 65-94. https://doi.org/10.1300/J135v05n01_03
Dias, A., Sales, L., Hessen, D. J., & Kleber, R. J. (2015). Child maltreatment and psychological symptoms in a Portuguese adult community sample: The harmful effects of emotional abuse. European Child and Adolescent Psychiatry, 24(7), 767-778. http://doi.org/10.1007/s00787-014-0621-0
Erikson, M., & Egeland, B. (1996). The quiet assault: A portrait of child neglect. In J. Briere, L. Berliner, S. Bulkley, C. Jenny & T. A. Reid (Eds.), The Handbook of Child Maltreatment (pp. 4-20). Sage Publications.
Etain, B., Mathieu, F., Henry, C., Raust, A., Roy, A., Germain, A., Leboyer, M., & Bellivier, F. (2010). Preferential association between childhood emotional abuse and bipolar disorder. Journal of Traumatic Stress, 23(3), 376-383. https://doi.org/10.1002/jts.20532
Feinson, M. C., & Hornik-Lurie, T. (2016). Binge eating & childhood emotional abuse: The mediating role of anger. Appetite, 105, 487-493. https://doi.org/10.1016/j.appet.2016.05.018
Fink, L. A., Bernstein, D., Handelsman, L., Foote, J., & Lovejoy, M. (1995). Initial reliability and validity of the Childhood Trauma Interview: A new multidimensional measure of childhood interpersonal trauma. The American Journal of Psychiatry, 152(9), 1329-1335. https://doi.org/10.1176/ajp.152.9.1329
Gibb, B. E., Chelminsky, I., & Zimmerman, M. (2007). Childhood emotional, physical and sexual abuse and diagnoses of depressive and anxiety disorders in adult psychiatric outpatients. Depression and Anxiety, 24(4), 256-263. https://doi.org/10.1002/da.20238
Glaser, D. (2011). How to deal with emotional abuse and neglect—Further development of a conceptual framework (FRAMEA). Child Abuse and Neglect, 35(10), 866-875. http://dx.doi.org/10.1016/j.chiabu.2011.08.002
Gratz, K. L., Bornovalova, M. A., Delany-Brumsey, A., Nick, B., & Lejuez, C. W. (2007). A laboratory-based study of the relationship between childhood abuse and experiential avoidance among inner-city substance users: The role of emotional nonacceptance. Behavior Therapy, 38, 256-268. http://doi.org/10.1016/j.beth.2006.08.006
Hodgdon, H. B., Spinazzola, J., Briggs, E. C., Liang, L., Steinberg, A. M., & Layne, C. M. (2018). Maltreatment type, exposure characteristics, and mental health outcomes among clinic referred trauma-exposed youth. Child Abuse and Neglect, 82, 12-22. https://doi.org/10.1016/j.chiabu.2018.05.021
Hornor, G. (2012). Emotional maltreatment. Journal of Pediatric Health Care, 26(6), 436-442. http://dx.doi.org/10.1016/j.pedhc.2011.05.004
Kuo, J. R., Khoury, J. E., Metcalfe, R., Fitzpatrick, S., & Goodwill, A. (2015). An examination of the relationship between childhood emotional abuse and borderline personality disorder features: The role of difficulties with emotion regulation. Child Abuse and Neglect, 39, 147-155. https://doi.org/10.1016/j.chiabu.2014.08.008
Mullen, P. E., Martin, J. L., Anderson, J. C., Romans, S. E., & Herbison, G. P. (1995). The long-term impact of the physical, emotional, and sexual abuse of children: A community study. Child Abuse and Neglect, 20(1), 7-21. https://doi.org/10.1016/0145-2134(95)00112-3
Myers, J. E. B., Berliner, L., Briere, J., Hendrix, C. T., Jenny, C., & Reid, T. A. (2002). The American Professional Society on the Abuse of Children Handbook on Child Maltreatment (2nd ed.). American Professional Society on the Abuse of Children.
Nguyen-Feng, V. N., Baker, M. R., Merians, A. N., & Frazier, P. A. (2017). Sexual victimization, childhood emotional abuse, and distress: Daily coping and perceived control as mediators. Journal of Counseling Psychology, 64(6), 672-683. http://dx.doi.org/10.1037/cou0000244
Nguyen-Feng, V. N., Romano, F. N., & Frazier, P. A. (2019). Emotional abuse moderates efficacy of an ecological momentary stress management intervention for college students. Journal of Counseling Psychology, 66(4), 461-472. http://dx.doi.org/10.1037/cou0000332
Paul, E., & Eckenrode, J. (2015). Childhood psychological maltreatment subtypes and adolescent depressive symptoms. Child Abuse and Neglect, 47, 38-47. https://doi.org/10.1016/j.chiabu.2015.05.018
Reddy, M. K., Pickett, S. M., & Orcutt, H. K. (2006). Experiential avoidance as a mediator in the relationship between childhood psychological abuse and current mental health symptoms in college students. Journal of Emotional Abuse, 6(1), 67-87. https://doi.org/10.1300/J135v06n01_04
Reinelt, E., Stopsack, M., Aldinger, M., John, U., Grabe, H. J., & Barnow, S. (2013). Testing the diathesis‐stress model: 5‐HTTLPR, childhood emotional maltreatment, and vulnerability to social anxiety disorder. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 162(3), 253-261. https://doi.org/10.1002/ajmg.b.32142
Rose, D. T., & Abramson, L. Y. (1992). Developmental predictors of depressive cognitive style: Research and theory. In D. Cicchetti & S. Toth (Eds.), Rochester Symposium on Developmental Psychopathology, Volume 4. 323-349. University of Rochester Press.
Samelius, L., Wijma, B., Wingren, G., & Wijma, K. (2007). Somatization in abuse women. Journal of Women’s Health, 16(6), 909-920. https://doi.org/10.1089/jwh.2006.0103
Sedlak, A. J., Mettenburg, J., Basena, M., Petta, I., McPherson, K., Greene, A., & Li, S. (2010). Fourth National Incidence Study of Child Abuse and Neglect (NIS-4). United States Department of Health and Human Services Administration for Children and Families. https://www.acf.hhs.gov/sites/default/files/opre/nis4_report_congress_full_pdf_jan2010.pdf
Shonk, S. M., & Cicchetti, D. (2001). Maltreatment, competency deficits, and risk for academic and behavioral maladjustment. Developmental Psychology, 37(1), 3-17. http://dx.doi.org/10.1037/0012-16220.127.116.11
Spinhoven, P., Elzinga, B. M., Hovens, J. G., Roelofs, K., Zitman, F. G., van Oppen, P., & Penninx, B. W. (2010). The specificity of childhood adversities and negative life events across the life span to anxiety and depressive disorders. Journal of Affective Disorders, 126(1-2), 103-112. http://dx.doi.org/10.1016/j.jad.2010.02.132
Sroufe, L. A., Egeland, B., Carlson, E. A., & Collins, W. A. (2005). The Development of the Person: The Minnesota Study of Risk and Adaptation from Birth to Adulthood. Guilford Press.
Stuewig, J., & McCloskey, L.A. (2005). The relation of child maltreatment to shame and guilt among adolescents: Psychological routes to depression and delinquency. Child Maltreatment, 10(4), 324-336. https://doi.org/10.1177%2F1077559505279308
Taillieu, T. L., Brownridge, D. A., Sareen, J., & Afifi, T. O. (2016). Childhood emotional maltreatment and mental disorders: Results from a nationally representative adult sample from the United States. Child Abuse and Neglect, 59, 1-12. https://doi.org/10.1016/j.chiabu.2016.07.005
Taussig, H., & Culhane, S. (2010). Emotional maltreatment and psychosocial functioning in preadolescent youth placed in out-of-home care. Journal of Aggression, Maltreatment and Trauma, 19(1), 52-74. https://doi.org/10.1080/10926770903476008
Tonmyr, L., Draca, J., Crain, J., & MacMillan, H. L. (2011). Measurement of emotional / psychological child maltreatment: A review. Child Abuse and Neglect, 35(10), 767-782. https://doi.org/10.1016/j.chiabu.2011.04.011
Twaite, A., & Rodriguez-Srednicki, O. (2004). Understanding and reporting child abuse: Legal and psychological perspectives: Part two: Emotional abuse and secondary abuse. The Journal of Psychiatry and Law, 32(4), 443-481. https://doi.org/10.1177%2F009318530403200402
van Harmelen, A. L., de Jong, P. J., Glashouwer, K. A., Spinhoven, P., Penninx, B. W., & Elzinga, B. M. (2010). Child abuse and negative explicit and automatic self-associations: The cognitive scars of emotional maltreatment. Behaviour Research and Therapy, 48(6), 486-494. https://doi.org/10.1016/j.brat.2010.02.003
Wekerle, C., Leung, E., Wall, A.M., MacMillan, H., Boyle, M., Trocme, N., & Waechter, R. (2009). The contribution of childhood emotional abuse to teen dating violence among child protective services-involved youth. Child Abuse and Neglect, 33(1), 45-58, http://doi.org/10.1016/j.chiabu.2008.12.006
Wijma, K., Samelius, L., Wingren, G., & Wijma, B. (2007). The association between ill-health and abuse: A cross-sectional population based study. Scandinavian Journal of Psychology, 48(6), 567-575. https://doi.org/10.1111/j.1467-9450.2007.00553.x
Wright, M. O. D., Crawford, E., & Del Castillo, D. (2009). Childhood emotional maltreatment and later psychological distress among college students: The mediating role of maladaptive schemas. Child Abuse and Neglect, 33(1), 59-68. https://doi.org/10.1016/j.chiabu.2008.12.007