Emotional abuse appears to be the most prevalent form of child maltreatment (Tomison and Tucci, 1997), it is a constituent element of all forms of child maltreatment (Aber, 1989 cited in Glaser, 1993 p.259), and has severe long-term consequences, which may be the most damaging compared to other forms of child maltreatment (Department of Health et al, 1999, p.7; Iwaniec, 1995, p.4). Yet, emotional abuse as a distinct phenomenon has received relatively little attention from researchers and practitioners (Geffner and Rossman, 1998, p.4). Emotional abuse as a category of child maltreatment became a criterion for inclusion on child protection registers in 1980 (Department of Health & Social Security, 1980 cited in Cawson et al, 2000, p.53), and it is the least frequent reason for a child's name to be included on the register (Cawson, 2001, p.20).
Iwaniec says of emotional and psychological abuse it would 'be fair to say that no other form of child abuse has created so many difficulties for practitioners and so much confusion for researchers and theorists alike' (Iwaniec, 1995, p.1). There is limited clarity and consensus in defining and measuring emotional abuse (Iwaniec, 1997, p.371), which has repercussions for identifying its aetiology (theories of causation) and successful intervention and prevention strategies.
For the purpose of the child protection system, the Department of Health employs the following definition of emotional abuse:
'Emotional abuse is the persistent emotional ill-treatment of a child such as to cause severe and persistent adverse effects on the child's emotional development. It may involve conveying to children that they are worthless or unloved, inadequate, or valued only insofar as they meet the needs of another person. It may feature age or developmentally inappropriate expectations being imposed on children. It may involve causing children frequently to feel frightened or in danger, or the exploitation or corruption of children. Some level of emotional abuse is involved in all types of ill treatment of a child, though it may occur alone'. (Department of Health et al, 1999, p.5-6)
A number of issues appear to beset the process of defining emotional abuse, with the following issues addressed in the literature:
The literature indicates that emotional abuse is characterised by a range of behaviours, existing along a continuum of severity, and is a repetitive and sustained abusive relationship.
Glaser, Prior and Lynch state that emotional abuse differs from other forms of child maltreatment since it 'refers to a relationship rather than an event and it does not need to involve physical contact. Such relationships may take different forms and therefore constitute an heterogeneous collection of psychologically undesirable interactions, or forms of ill-treatment, which may be expressed in acts of omission and commission' (Glaser et al, 2001, p.i).
Garbarino et al's influential work defines psychological maltreatment as 'a concerted attack by an adult on a child's development of self and social competence' (Garbarino et al, 1986, cited in Iwaniec, 1997, p.372). They propose five categories of damaging caregiver behaviours:
Garbarino et al indicate that each of these categories of abusive caregiver behaviour has a differential impact on children depending on their age and stage of development (Garbarino et al, 1986 cited in Tomison and Tucci, 1997).
Hart and colleagues held a national conference in the United States to achieve a consensus amongst professionals on a definition of psychological maltreatment. They concluded it:
'consists of acts of omission and commission which are judged on the basis of a combination of community standards and professional expertise to be psychologically damaging. Such acts are committed by individuals, singly or collectively, who by their characteristics (e.g. age, status, knowledge, organisational form) are in a position of differential power that renders the child vulnerable. Such acts damage immediately or ultimately the behavioural, cognitive, affective, social and psychological functioning of the child' (Hart et al, 1987 cited in Tomison and Tucci, 1997.)
Hart et al build on Garbarino et al's typology above, identifying six categories of adult behaviour towards children considered to be emotionally abusive:
Iwaniec defines emotional abuse as 'hostile or indifferent parental behaviour which damages a child's self-esteem, degrades a sense of achievement, diminishes a sense of belonging, prevents healthy and vigorous development, and takes away a child's well-being (Iwaniec, 1995, p.14).
Glaser cites the following as dimensions of emotionally abusive or inappropriate relationships: persistent negative attitudes; promoting insecure attachment; inappropriate developmental expectations and considerations; emotional unavailability; failure to recognise child's individuality and psychological boundaries, and cognitive distortions and inconsistencies (Glaser, 1993, p.254-55).
The use of the term 'emotional abuse' is more common in UK literature, whilst American literature tends to refer to 'psychological abuse' (Cawson et al, 2000, p.53). In some of the literature the term 'emotional abuse' is used interchangeable with 'psychological abuse' and others terms such as mental cruelty (Navarre, 1987 cited in Tomison and Tucci, 1997), mental injury (Kavanagh, 1982 cited in Tomison and Tucci, 1997), and psychological battering (Garbarino et al, 1986 cited in Tomison and Tucci, 1997). O' Hagan has proposed a distinction between emotional and psychological abuse arguing that the child's psychological (mental) development is not the same as emotional development (O'Hagan, 1993 cited in Glaser et al, 2001, p.2). He contends that they are not the same, but are not entirely separate experiences since both may be occur at different points in an abusive relationship (O'Hagan, 1995, p.458). Others commentators have grouped emotional and psychological abuse together and employ the broader term of psychological maltreatment (Garbarino et al, 1986 and McGee and Wolfe, 1991 cited in Iwaniec, 1995, p.3), such as Glaser.
Some researchers have focussed on parental behaviours that are considered to be damaging (Bailey and Bailey, 1986 and McGee and Wolfe, 1991 cited in Iwaniec, 1997 p.371); others believe parental behaviour is an inadequate predictor of emotional abuse and have focused on child outcomes (Aber and Zigler, 1981 cited in Iwaniec, 1997, p.371). For example, Kavanagh measures emotional abuse by obvious physical syndromes such as psychosocial short stature or failure-to-thrive (Kavanagh, 1982 cited in Iwaniec, 1997, p.371).
'Emotional abuse does not leave physical injuries and its ongoing nature usually means there is no crisis which would precipitate its identification by the health, welfare or criminal justice systems' (Oates, 1986 cited in Tomison and Tucci, 1997). As a consequence, it is the most hidden and underestimated form of child maltreatment; what Garbarino terms an 'elusive crime' (Garbarino, 1978, p.90). As stated above, emotional abuse was introduced as a criterion for inclusion on children protection registers in England and Wales in 1980. Department of Health guidance on assessing children in need emphasises the necessity of considering the emotional development of the child and the emotional warmth the child receives from his or her carers (Department of Health et al, 2000, p.18-22).
Child protection registers are not a measure of the incidence of emotional abuse but offer some indication of the scale of the problem. However, child protection register statistics appear to under-represent the scale of emotional abuse for a number of reasons. The Department of Health recognises that emotional abuse is inherent in all forms of maltreatment, but other types of abuse have 'primacy in labelling of cases' (Iwaniec, 1997, p.371), with registrations for emotional abuse occurring only when it is the main or sole form of abuse (Department of Health, 2001, p.34). Furthermore, Glaser et al state that 'the difficulty in operationally defining emotional abuse has led to reluctance by professionals to name it' (Glaser et al, 2001, p.i), and there are problems in proving that impairment to a child's development is caused by emotional abuse (Glaser and Prior, 1997, p.324). Finally, Gibbons et al found that a large majority of children referred because of child protection concerns were quickly filtered out of the system and received no protective or support services. This was particularly marked when the referral included allegations of emotional maltreatment or neglect (Gibbons et al, 1995 cited in Wilding and Thoburn, 1997, p.344). In sum, Iwaniec contends that the relatively few registered cases for emotional abuse 'should not in itself be taken to suggest there is no significant problem' (Iwaniec, 1995 cited in Doyle, 1997, p.331).
Emotional abuse is the smallest category of registrations on child protection registers. The table below shows that the number of registrations for emotional abuse as a percentage of all registrations rose between 1997 and 2001, despite the total number of registrations falling in 2001. The number of children registered for emotional abuse at any particular point in time, i.e. as at 31st March 1997 to 2001, has also increased as a percentage of the total number of children on child protection registers at that time.
Glaser and Prior's study of 94 children in 56 families on child protection registers for emotional abuse found that 41% of the children experienced more than one form of ill-treatment. The commonest form of ill-treatment was 'developmentally inappropriate interaction with the child', which was experienced by 42% of the children; denigration or rejection affected 34% of the children, followed by emotional unavailability, unresponsiveness or neglect (28%) (Glaser et al, 2001, p.iii-iv).
Doyle's research revealed that children on the child protection register for emotional abuse most frequently experienced fear-inducing caregiver abusive behaviour (95% of children affected). Other categories of caregiver abusive behaviour experienced by these children were as follows: inappropriate roles (92%); rejection (86%); isolating (54%); degrading (53%); ignoring (28%); corrupting (19%), tormenting (18%) (Doyle, 1997, p.336).
A recent NSPCC study into the prevalence of child abuse in the UK surveyed 2,869 18-24 year olds. It found that 'terrorising' was the most common form of emotionally abusive behaviour experienced by the respondents (34%), which constituted threats to harm the child or someone or something the child loves, threatening with fear figures, and threats to have the child sent away. Second to this was 'psychological domination and control' - which includes attempts to control the child's thinking, and isolation from other sources of support and development - which was recorded by almost one quarter of the respondents. Almost one in five respondents reported some psycho/physical control (17%) - physical acts which exert control and domination but cause distress rather than pain or injury, such as locking the child up or washing out the mouth with soap, and 18% experienced humiliation and/or attacks on self-esteem (18%). A small proportion of the respondents had experienced multiple attacks on their emotional well-being within the family (Cawson, 2001, p.21; Cawson et al, 2000, p.72). Three percent of respondents said that they were not well cared for because they were given too little affection as a child (Cawson et al, 2000, p.71).
The survey also constructed a system to measure the severity and frequency of emotional maltreatment. Respondents were assigned a 'score' on seven dimensions of potentially emotionally damaging treatment, indicating how many of the treatments had been experienced. Scores ranged from 0 to 14; zero being no potentially damaging treatments experienced and 14 indicating that a wide range of treatment with the potential for abusiveness had been experienced. The mid-point score of seven was established as the measure of emotional maltreatment because it represented that respondents recorded adverse treatment in at least four of the seven dimensions. The survey revealed that 6% of the sample had scores of seven or above, and these were assessed as experiencing emotional maltreatment (Cawson et al, 2000, p.69-70).
Doyle's survey into the prevalence of emotional abuse indicated that in a population survey of 504 respondents, 29% had been emotionally abused by carers; compared to 9% who had been sexually abused, and 14% who had been physically abused (Doyle, 1997, p.334-5).
The US National Incidence Study of Child Abuse and Neglect reports an overall rate of child maltreatment of 1,553,8000 defined by the 'harm standard'. Of these, 204,500 are recorded for emotional abuse (28%); a further 212,800 children come under the category of emotional neglect (Sedlak and Broadhurst, 1996, p.3-3).
Tomison and Tucci (1997) state that 'there is a dearth of knowledge surrounding the causes of emotional abuse'. Doyle's research indicated that 'emotional abuse appeared to be found in a broad range of families although it was more prominent in those exposed to multiple stresses' (Doyle, 1997, p.330).
The Department of Health states that 'domestic violence, adult mental health problems and parental substance misuse may be features in families where children are exposed to such [emotional] abuse'(Department of Health et al, 1999, p.7). These issues are echoed by the research literature.
Glaser and Prior's study of 94 children in 56 families on child protection registers for emotional abuse found that 63% of the families, affecting 69% of the children, displayed parental attributes considered to contribute to the significant harm of the child. These included mental ill-health including suicide attempts and threats, domestic violence, and alcohol and drug abuse (Glaser et al, 2001, p.iii), and existed either singly or in combination in any one family. Doyle's research indicated that 28% of mothers and 23% of father figures of registered children were referred for help with drink problems, and domestic violence was a central issue in 26% of register cases and a peripheral one in 28% (Doyle, 1997, p.335). Chaffin et al's research contends that depression and substance abuse are likely to increase the potential for emotionally abusive behaviour (Chaffin et al, 1996 cited in Tomison and Tucci, 1997).
The literature also addresses whether social-economic and demographic aspects are risk factors. Crittenden contends that 'parents who provide materially for their children can be emotionally neglectful' (Crittenden, 1999, p.57). Doyle cites two British studies which report the predominance of emotional abuse in less affluent socio-economic groups (Furnell et al, 1988 and Hickox and Furnell, 1989 cited in Doyle, 1997, p.332), whilst another study cites examples of emotional abuse in wealthy families (Covitz, 1986 cited in Doyle, 1997, p.332). Doyle's research suggests 'there were no significant differences in culture, ethnic group, religion and class or a [family] member with a physical or learning disability' (Doyle, 1997, p.335).
Literature on the impact of domestic violence on children's psychological development is beginning to emerge. For example, Jaffe et al found that infants exposed to domestic violence displayed poor health, poor sleeping habits, excessive screaming and attachment disorders (Jaffe et al, 1990 cited in Iwaniec, 1997, p.374).
Pillari states that emotional abuse is intergenerational, highlighting patterns of scape-goating in families where caregivers project onto their children their own inability to resolve the consequences of their experiences of emotional abuse (Pillari, 1991 cited in Tomison and Tucci, 1997).
Doyle states that 'there appears to be no type of child who is more vulnerable to emotional abuse in terms of age, gender, ordinal position in family and health or disability' (Doyle, 1997, p.335). However, her research did suggest that 'children with disabilities and their siblings have a number of burdens, such as isolation and discrimination, that compound the emotional abuse' (Doyle, 1997, p.335).
Iwaniec identifies two issues when considering intervention, firstly the appropriateness of formal child protection processes, and secondly the fact that there is little literature and research on effectively treating cases of emotional abuse (Iwaniec, 1997, p.380). Doyle reinforces the necessity of the following information for successful intervention: the incidence and prevalence of emotional abuse, parental and child risk factors, what behaviours constitute emotional abusive interactions, what the likely signs in the children are, and what factors survivors of emotional abuse found helpful (Doyle, 1997, p.332-3). However, as the foregoing discussion has indicated, there is limited research on these aspects, which in turn hinders the development of literature, research and practice on effective intervention and preventative strategies (Glaser, 1993, p.252; Iwaniec, 1997, p.380). Furthermore, emotional abuse requires special attention to disentangle it from other forms of child maltreatment (Iwaniec, 1997, p.370).
Glaser and Prior, and Wilding and Thoburn consider the role and appropriateness of the child protection system in cases of emotional abuse. Furthermore, the nature of emotional abuse as a sustained, negative relationship is cited as incongruent with child protection system's focus on incidents (Glaser and Prior, 1997 cited in Cawson, 2001, p.21). Glaser and Prior question the suitability of immediate use of formal child protection procedures in the investigation and assessment of suspected emotional abuse. They discuss the need for early multi-agency based intervention programmes to address the abusive relationship prior to child protection procedures. This will hopefully ameliorate the situation and deflect the need for investigation and registration (Glaser and Prior, 1997, p.326). They contend that 'the response to recognition of emotional abuse is more appropriately considered as working towards protection' (Glaser and Prior, 1997, p.315).
Wilding and Thoburn's research found that the assessment of families of children referred because of concerns about emotional abuse and neglect tended to be low key and to concentrate on 'risks', rather than on the needs of the children (Wilding and Thoburn, 1997, p.343). They found that cases involving suspected emotional maltreatment were more likely to be subject to section 47 enquiries (44%), with a general of assessment of need the next most likely course of action (24%). In 8% of cases there was an assessment for a specific service, and only 3% were immediately provided with a service (Wilding and Thoburn, 1997, p.351). They conclude that 'actual or likely emotional harm [to the child] did not appear to be given the priority which earlier research suggests is essential if long-term damage to children's life chances is to be avoided' (Wilding and Thoburn, 1997, p.354).
Glaser states that there are three different aspects to professional intervention in psychological abuse: recognition by professionals and carers; working towards change within the relationship with the care-giver(s), through interaction between the carer(s) and the child, and with the child individually; and acknowledgement when sufficient change is not possible and hence the need for separation (Glaser, 1993, p.261).
However, there are some questions about the efficacy of family support programmes in cases of emotional abuse. Glaser et al caution that there 'is uncertainty about how to intervene effectively, particularly with those families who have difficulty in acknowledging the emotional abuse' (Glaser et al, 2001, p.1). Cawson asks whether family support and interventions can be successful since 'adults who seek psychological domination over children may have need to control and exploit others - needs which have little to do with parental skill deficits or external stresses' (Cawson, 2001, p.21). Furthermore, Doyle states that if emotional abuse is as prevalent as her research study suggests (29% - see above), then 'something more fundamental than intervention in individual cases and family support programmes is required' (Doyle, 1997, p.339). Hart advocates the necessity of a positive ideology of children (Hart, 1988 cited in Doyle, 1997, p.339), and Patterson and Thompson cited the importance of respect for children (Patterson and Thompson, 1980 cited in Doyle, 1997, p.339).
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