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Emotional abuse: Helping prevent the problem
PH C
EDITORIAL
B o b b i e C rew N e l m s , P h D, R N , C P N P
Emotional Abuse: Helping Prevent the Problem
E
motional abuse has always been one of the most elusive areas of child maltreatment. It has been difficult to define and thus has been a challenge to identify, prevent, and manage. Indeed, emotional abuse is the least studied of all the forms of abuse, and as a result less is know about its etiology. Persons researching emotional abuse have faced numerous problems because of difficulties regarding definition and measurement (O’Hagan, 1995). However, emotional abuse is often considered the most common form of child maltreatment, and its effect on development can be quite destructive (Garbarino & Garbarino, 1994). Indeed, children who have been emotionally abused may have feelings of helplessness, worthlessness, violation, and shame, similar to children who have been sexually abused (Garbarino & Garbarino, 1994). One of the challenges in studying emotional abuse, as previously noted, is defining it. Briggs and Hawkins (1996) state that most adults will have inflicted emotional abuse on their children at some point just because of the nature of the parent-child relationship. Indeed, isolated instances of parents or other adults responding inappropriately to a child are not viewed as emotional abuse. Unlike physical or sexual abuse, emotional abuse is characterized by a pattern of behavior over time. “Sustained” and “repetitive” actions are viewed as critical aspects of any definition of emotional abuse (O’Hagan, 1995). Because of the difficulty in defining emotional abuse, identifying it has always been a challenge. Child maltreatment is considered the most com-
May/June 2001
mon and yet the most hidden and underestimated form of child maltreatment. Emotional abuse currently accounts for approximately 7% of all reported cases of child maltreatment in the United States, but the National Research Council (1993) notes that the true occurrence is unknown. This lack of identification occurs for several rea-
E
motional abuse...has
been difficult to define and thus has been a challenge to identify, prevent, and manage. sons. First, the effects of emotional maltreatment, such as lags in physical development and learning difficulties, are also found in children who have not experienced maltreatment. Second, the effects of emotional abuse may become evident much later in a child’s life. Third, behaviors of emotionally abused and emotionally disturbed children may be quite similar (National Clearinghouse on Child Abuse and Neglect Information, 1999). As a result of the
intangible nature of emotional abuse, only 20 states have specific statutes defining emotional abuse (Hamarman & Bernet, 2000), and this lack of definition may keep protective service agencies from intervening with these children and families. To address the concerns about defining emotional abuse, Hamarman & Bernet (2000) have identified 7 categories of emotional abuse that we as health care providers can use in our assessment, management, and prevention of this form of maltreatment. The first category is “rejecting.” In this form of emotional abuse the adult does not acknowledge the child’s worth and the legitimacy of the child’s needs. Examples of rejecting behaviors include refusing to show affection to the child and not acknowledging the child’s accomplishments. The adult may view the child as a failure. The second category is “isolating.” In this case the adult excludes the child from the usual social experiences of childhood, keeping the child away from peers. The child thus feels that she or he is alone. Some adults may actually lock a child in a room as part of this isolating behavior. The third category, “terrorizing,” refers to verbal assault of a child by an adult. The child is threatened verbally, and the adult may even use knives or guns to increase the child’s fear. Hamarman and Bernet (2000) do not include
J Pediatr Health Care. (2001). 15, 103-104. Copyright © 2001 by the National Association of Pediatric Nurse Practitioners. 0891-5245/2001/$35.00 + 0
25/8/114791
doi:10.1067/mph.2001.114791
103
PH EDITORIAL C witnessing abuse between parents as this form of emotional abuse. They note that witnessing parent abuse may affect the child’s emotional development but believe it is not considered directly abusive to the child. (I must admit that I do not agree with this view of these researchers.) “Ignoring” is the fourth form of emotional abuse identified by Hamarman and Bernet (2000). An adult who ignores a child does not provide stimulation and responsiveness that are critical to the child’s well-being. The child may not be called by name or be provided appropriate stimulation to promote emotional and cognitive development. The fifth category is “corrupting” behaviors. Corrupting behaviors are shown by an adult who promotes antisocial behavior in the child. The child may be taught delinquent activities, including sexually exploitative behaviors. The result of such a pattern of behavior is that the child becomes unfit for normal social experiences. “Verbally assaulting” is the sixth category of emotional abuse. Name-calling, threats, and sarcastic comments are examples of this form of emotional abuse. Over time the child loses selfesteem and she or he may begin to believe these negative views of themselves that the adults constantly present to the child, such as being worthless or no good. The final category is “over-pressuring,” which refers to the pressure adults place on children to grow up quickly or to achieve too early in the areas of academics, physical and motor skills, or social interactions. The pressure leads the child to think they are never good enough. Examples of over-pressuring are when adults have advanced expectations of the child and punish the child for age-appropriate behaviors. Also, adults may criticize the child and constantly compare the child to other
104
Volume 15 Number 3
Nelms
children who are advanced in their performance, making the child feel inadequate. Hamarman and Bernet are now beginning to work to determine the severity of these behaviors, the adult’s intent, and the resulting harm. The researchers believe that, similar to degrees of homicide, an abusive act that is committed with the intent to harm and that has a high probability of causing harm should be considered severe emotional abuse, whereas a behavior that has neither intent nor high probability of harm should be
I
dentification is the first
important step for this form of abuse, just as it is with physical and sexual abuse.
parents about which behaviors are and are not appropriate, again emphasizing the notion of a pattern of behavior and not just a single occurrence. We can also look for these categories of emotional abuse in our assessment of children and their parents. These specific behaviors make it easier to identify emotional abuse, and thus we may be able to make earlier interventions or referrals. Hamarman and Bernet’s (2000) approach can help us be more effective in both preventing and managing this important aspect of child maltreatment. By defining this elusive type of child maltreatment, we can begin to replace vague, subjective views with specific examples. Identification is the first important step for this form of abuse, just as it is with physical and sexual abuse. Now we can hope that more advances will be made in this type of maltreatment and that prevention and management efforts can be more effective. Perhaps the time has come to finally make more progress in this important area of child abuse. —Bobbie Crew Nelms, PhD, RN, CPNP
REFERENCES considered mild abuse. They believe that the determination of intent is a key responsibility of professionals who are evaluating potential emotional abuse. The researchers note that mild abuse should lead to therapeutic counseling, whereas severe abuse should result in legal action against the adult. This comprehensive overview of emotional abuse can be very helpful to clinicians who work with children and families. We can use these categories of emotional abuse, including examples, in a variety of ways. For example, our efforts to prevent emotional abuse could include presenting the categories in parenting classes. We can educate
Briggs, F., & Hawkins, R. (1996). Child protection: A guide for teachers and child care professionals. St. Leonards, NSW: Allen & Unwin. Garbarino, J., & Garbarino, A. C. (1994). Emotional maltreatment of children (rev. ed.). Chicago: National Committee to Prevent Child Abuse. Hamarman, S., & Bernet, W. (2000). Evaluating and reporting emotional abuse in children. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 928-930. National Clearinghouse on Child Abuse and Neglect Information. (1999). Defining child maltreatment [On-line]. Available: http://www.calib. com/nccanch/pubs/usermanuals/basic/ section2.htm. National Research Council. (1993). Understanding child abuse and neglect. Washington, DC: National Academy Press. O’Hagan, K. (1995). Emotional and psychological abuse: Problems of definition. Child Abuse and Neglect, 19, 449-461.
JOURNAL OF PEDIATRIC HEALTH CARE
EDITORIAL
B o b b i e C rew N e l m s , P h D, R N , C P N P
Emotional Abuse: Helping Prevent the Problem
E
motional abuse has always been one of the most elusive areas of child maltreatment. It has been difficult to define and thus has been a challenge to identify, prevent, and manage. Indeed, emotional abuse is the least studied of all the forms of abuse, and as a result less is know about its etiology. Persons researching emotional abuse have faced numerous problems because of difficulties regarding definition and measurement (O’Hagan, 1995). However, emotional abuse is often considered the most common form of child maltreatment, and its effect on development can be quite destructive (Garbarino & Garbarino, 1994). Indeed, children who have been emotionally abused may have feelings of helplessness, worthlessness, violation, and shame, similar to children who have been sexually abused (Garbarino & Garbarino, 1994). One of the challenges in studying emotional abuse, as previously noted, is defining it. Briggs and Hawkins (1996) state that most adults will have inflicted emotional abuse on their children at some point just because of the nature of the parent-child relationship. Indeed, isolated instances of parents or other adults responding inappropriately to a child are not viewed as emotional abuse. Unlike physical or sexual abuse, emotional abuse is characterized by a pattern of behavior over time. “Sustained” and “repetitive” actions are viewed as critical aspects of any definition of emotional abuse (O’Hagan, 1995). Because of the difficulty in defining emotional abuse, identifying it has always been a challenge. Child maltreatment is considered the most com-
May/June 2001
mon and yet the most hidden and underestimated form of child maltreatment. Emotional abuse currently accounts for approximately 7% of all reported cases of child maltreatment in the United States, but the National Research Council (1993) notes that the true occurrence is unknown. This lack of identification occurs for several rea-
E
motional abuse...has
been difficult to define and thus has been a challenge to identify, prevent, and manage. sons. First, the effects of emotional maltreatment, such as lags in physical development and learning difficulties, are also found in children who have not experienced maltreatment. Second, the effects of emotional abuse may become evident much later in a child’s life. Third, behaviors of emotionally abused and emotionally disturbed children may be quite similar (National Clearinghouse on Child Abuse and Neglect Information, 1999). As a result of the
intangible nature of emotional abuse, only 20 states have specific statutes defining emotional abuse (Hamarman & Bernet, 2000), and this lack of definition may keep protective service agencies from intervening with these children and families. To address the concerns about defining emotional abuse, Hamarman & Bernet (2000) have identified 7 categories of emotional abuse that we as health care providers can use in our assessment, management, and prevention of this form of maltreatment. The first category is “rejecting.” In this form of emotional abuse the adult does not acknowledge the child’s worth and the legitimacy of the child’s needs. Examples of rejecting behaviors include refusing to show affection to the child and not acknowledging the child’s accomplishments. The adult may view the child as a failure. The second category is “isolating.” In this case the adult excludes the child from the usual social experiences of childhood, keeping the child away from peers. The child thus feels that she or he is alone. Some adults may actually lock a child in a room as part of this isolating behavior. The third category, “terrorizing,” refers to verbal assault of a child by an adult. The child is threatened verbally, and the adult may even use knives or guns to increase the child’s fear. Hamarman and Bernet (2000) do not include
J Pediatr Health Care. (2001). 15, 103-104. Copyright © 2001 by the National Association of Pediatric Nurse Practitioners. 0891-5245/2001/$35.00 + 0
25/8/114791
doi:10.1067/mph.2001.114791
103
PH EDITORIAL C witnessing abuse between parents as this form of emotional abuse. They note that witnessing parent abuse may affect the child’s emotional development but believe it is not considered directly abusive to the child. (I must admit that I do not agree with this view of these researchers.) “Ignoring” is the fourth form of emotional abuse identified by Hamarman and Bernet (2000). An adult who ignores a child does not provide stimulation and responsiveness that are critical to the child’s well-being. The child may not be called by name or be provided appropriate stimulation to promote emotional and cognitive development. The fifth category is “corrupting” behaviors. Corrupting behaviors are shown by an adult who promotes antisocial behavior in the child. The child may be taught delinquent activities, including sexually exploitative behaviors. The result of such a pattern of behavior is that the child becomes unfit for normal social experiences. “Verbally assaulting” is the sixth category of emotional abuse. Name-calling, threats, and sarcastic comments are examples of this form of emotional abuse. Over time the child loses selfesteem and she or he may begin to believe these negative views of themselves that the adults constantly present to the child, such as being worthless or no good. The final category is “over-pressuring,” which refers to the pressure adults place on children to grow up quickly or to achieve too early in the areas of academics, physical and motor skills, or social interactions. The pressure leads the child to think they are never good enough. Examples of over-pressuring are when adults have advanced expectations of the child and punish the child for age-appropriate behaviors. Also, adults may criticize the child and constantly compare the child to other
104
Volume 15 Number 3
Nelms
children who are advanced in their performance, making the child feel inadequate. Hamarman and Bernet are now beginning to work to determine the severity of these behaviors, the adult’s intent, and the resulting harm. The researchers believe that, similar to degrees of homicide, an abusive act that is committed with the intent to harm and that has a high probability of causing harm should be considered severe emotional abuse, whereas a behavior that has neither intent nor high probability of harm should be
I
dentification is the first
important step for this form of abuse, just as it is with physical and sexual abuse.
parents about which behaviors are and are not appropriate, again emphasizing the notion of a pattern of behavior and not just a single occurrence. We can also look for these categories of emotional abuse in our assessment of children and their parents. These specific behaviors make it easier to identify emotional abuse, and thus we may be able to make earlier interventions or referrals. Hamarman and Bernet’s (2000) approach can help us be more effective in both preventing and managing this important aspect of child maltreatment. By defining this elusive type of child maltreatment, we can begin to replace vague, subjective views with specific examples. Identification is the first important step for this form of abuse, just as it is with physical and sexual abuse. Now we can hope that more advances will be made in this type of maltreatment and that prevention and management efforts can be more effective. Perhaps the time has come to finally make more progress in this important area of child abuse. —Bobbie Crew Nelms, PhD, RN, CPNP
REFERENCES considered mild abuse. They believe that the determination of intent is a key responsibility of professionals who are evaluating potential emotional abuse. The researchers note that mild abuse should lead to therapeutic counseling, whereas severe abuse should result in legal action against the adult. This comprehensive overview of emotional abuse can be very helpful to clinicians who work with children and families. We can use these categories of emotional abuse, including examples, in a variety of ways. For example, our efforts to prevent emotional abuse could include presenting the categories in parenting classes. We can educate
Briggs, F., & Hawkins, R. (1996). Child protection: A guide for teachers and child care professionals. St. Leonards, NSW: Allen & Unwin. Garbarino, J., & Garbarino, A. C. (1994). Emotional maltreatment of children (rev. ed.). Chicago: National Committee to Prevent Child Abuse. Hamarman, S., & Bernet, W. (2000). Evaluating and reporting emotional abuse in children. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 928-930. National Clearinghouse on Child Abuse and Neglect Information. (1999). Defining child maltreatment [On-line]. Available: http://www.calib. com/nccanch/pubs/usermanuals/basic/ section2.htm. National Research Council. (1993). Understanding child abuse and neglect. Washington, DC: National Academy Press. O’Hagan, K. (1995). Emotional and psychological abuse: Problems of definition. Child Abuse and Neglect, 19, 449-461.
JOURNAL OF PEDIATRIC HEALTH CARE