July 30, 2012 -- Psychological child abuse is common but underreported in the U.S., the nation's largest pediatric health group says.
Like physical and sexual abuse, psychological abuse can cause devastating and lifelong harm.
In a new report, the American Academy of Pediatrics (AAP) is calling on pediatricians to be alert to signs of such abuse in young patients.
"Psychological maltreatment often occurs with other forms of abuse, but this isn't always the case," says co-author Roberta Hibbard, MD, of Riley Hospital for Children at Indiana University Health in Indianapolis.
"It is one of the most devastating forms of abuse," she says. "Broken bones heal, but being belittled, terrorized, or neglected by a parent can impact self-esteem, attachments, and other aspects of development for a lifetime."
What Is Psychological Abuse?
There is no universally agreed upon definition of psychological abuse. But most cases involve a pattern of behaviors by a parent or other caregiver that leads a child to believe he or she is unloved or unwanted.
Specific types of psychological abuse identified in the report include these actions by a parent or caregiver:
Ridiculing a child. Comments or actions, especially in public, that:
- Belittle a child
- Criticize a child in a derogatory way
Terrorizing a child. For example, if you:
- Place a child in a dangerous situation
- Threaten to harm a child if unrealistic expectations aren't met
Isolating a child. For example, if you:
- Confine or imprison a child
- Restrict a child's social interactions
Exploiting a child. For example, if you take steps that exploit or corrupt a child, such as:
- Encourage or be a model for anti-social behavior
- Encourage behavior that's not appropriate for the child's age
Being detached from your child. For example, if you:
- Interact with your child only when necessary
- Don't nurture your child
- Fail to praise your child
"All parents do things they may regret from time to time. But a chronic pattern of belittling, denigrating, or neglecting a child constitutes psychological abuse," says Harriet MacMillan, MD. She is a professor of psychiatry and behavioral sciences at McMaster University in Ontario, Canada.
As director of Riley Hospital's Child Protection Program, Hibbard and her team evaluate about 2,000 cases of suspected child abuse every year.
She remembers the cases of Brandi Zachary and her older brother as among the worst examples of neglect she has ever seen.
The two were victims of psychological neglect and malnourishment at the hands of their parents until a friend became suspicious and called child protective services.
The children were kept in a filthy, locked closet day and night for at least a year.
When the abuse was discovered Brandi was 2 1/2 years old and weighed just 14 pounds. She had not yet learned to walk or talk.
Now 19, Brandi went public with her story earlier this year in an effort to help make people aware of the importance of reporting abuse and neglect.
Her birth parents were convicted of felony neglect, and she has had no contact with them since she was removed from the home 17 years ago. She was adopted several years later.
She changed her last name from Zachary to that of her adoptive parents. She's on track to complete her undergraduate degree in psychology in two years, despite being legally blind as a result of the neglect she suffered.
"Her story is amazing. And it really does illustrate the importance of speaking up if you suspect abuse," Hibbard says. "Someone who knows or suspects that a child is being neglected has a moral, if not a legal, obligation to report it."
Treating Abused Kids, More Research Needed
It's not clear how many children experience ongoing psychological abuse at the hands of parents or other caregivers. That's because such abuse is widely underreported, the report noted.
In one large study conducted in the U.S. and U.K., about 9% of women and 4% of men reported exposure to severe psychological abuse during childhood.
Other surveys conducted in the U.S. found emotional abuse to be the most frequently reported form of victimization.
The report calls for more research to develop and test effective treatments for children who have experienced psychological abuse, either alone or combined with other forms of abuse.
The report is published in the August issue of Pediatrics.