Childhood emotional abuse – a lifetime of invisible scars
More than a third of South African children under the age of 17 suffer emotional abuse and neglect, resulting in invisible scars that put them at greater risk of mental illness and limit their chances of a fulfilling and functional adult life.
Psychological abuse and neglect of children’s emotional needs for affection and support is committed most often by those closest to them and responsible for their nurturing and development – parents, caregivers and relatives,[i] and it cuts across all levels of society and income.
Although physical abuse in childhood is the most prevalent, affecting 56.3% of children, the risk of developing serious mental health problems is four times greater for the 35.5% who suffer emotional and psychological abuse,[ii] says Dr Eugene Allers, spokesperson for the South African Society of Psychiatrists (SASOP).
While physical and sexual abuse are regularly seen in the courts and the headlines, psychological abuse, including emotional neglect, receives much less attention and awareness but is one of the most traumatic forms of abuse that a child can experience, he said.
“Children should be given the best opportunities in life; living in loving homes, free from all forms of abuse. This will ensure their optimal development, with less chance of psychological or psychiatric problems later in life. Children that are abused, often become abusers, continuing the vicious cycle.
“The childhood trauma of emotional abuse and neglect affects the child’s sense of self and their capacity to trust and build healthy relationships. It can also affect a child’s physical health and educational outcomes, all with great impact on their future prospects,” Dr Allers said.
The types of abuse overlap, in that children who suffer physical and sexual abuse are likely also to experience emotional abuse and neglect. Almost 70% of South African children will experience any type of abuse before the age of 17, and 27% will be victim to multiple types of abuse.[iii]
Exposure to family conflict and domestic violence also constitutes emotional abuse and leaves lifelong scars, Dr Allers said. This was particularly concerning for South African children, with domestic violence at “epidemic proportions” and intimate partner violence affecting between a third and a half of households.[iv]
“All abuse leaves emotional or psychological scars. While physical injuries can heal, emotional scars are disabling and crippling to most individuals, and psychological abuse and neglect are much more prominently associated with mental illness in later life than physical or sexual abuse ([v]),” Dr Allers said.
The impact on children’s future mental health is substantial, he said, with a third of all psychiatric disorders originating before the age of 14 and half before 18 years of age.[vi]
The Children’s Act of 2005 defines abuse as any form of harm or ill-treatment deliberately inflicted on a child, including assault, deliberate injury, sexual abuse, bullying, exploitation or exposing or subjecting a child to behaviour that may harm the child (such as exposure to domestic violence).
Dr Allers said there was a lack of knowledge of what emotional abuse entails and the signs and symptoms, and it was often not addressed as it is more difficult to define and recognise than physical abuse.
Emotional abuse is more subtle, ongoing, and generally not connected to a single incident such as a beating or sexual assault.
Forms of emotional or psychological abuse include withholding love and support, rejection, berating and threatening the child, insults and name-calling, belittling or humiliation, cold-shouldering, guilt-tripping, and emotional blackmail.
Acts of emotional neglect include spending little time interacting or talking with the child, being unresponsive to or dismissing their feelings, giving little positive feedback or praise, persistently finding fault, and offering little help or encouragement when they are struggling with schoolwork or other tasks.
“At the other end of the scale, overprotection is just as detrimental to children as neglect. A child cannot live a normal life and develop positive life skills if they are overprotected. There needs to be a balance in protecting children, as both ends of the spectrum amount to child abuse,” Dr Allers said.
He said signs of emotional abuse and neglect in children included anxiety and depression symptoms, isolating themselves, disruptive behaviour, mood changes including aggression and agitation, depression, sleep problems, school refusal or lower school performance, and developmental and language delays.
There is also a heightened risk of self-harm and suicidal behaviour, he said.
He emphasised that medical professionals and social workers are bound by law to report any form of child abuse, including emotional abuse.
“Where emotional abuse or neglect is suspected, children should be referred for psychological interventions that can help them to cope and rebuild their self-esteem, and abusers must be dealt with by the legal system, he said.
[i] Meinck F, et al. (2016). Physical, emotional and sexual adolescent abuse victimisation in South Africa: Prevalence, incidence, perpetrators and locations. Journal of Epidemiology & Community Health. 70 (9). https://www.researchgate.net/publication/297715693_Physical_emotional_and_sexual_adolescent_abuse_victimisation_in_South_Africa_Prevalence_incidence_perpetrators_and_locations
[ii] As above.
[iii] As above.
[iv] Brits E. Daily Maverick: South Africa’s staggering intimate partner violence stats aren’t shifting – here’s what we can do about it. https://www.dailymaverick.co.za/article/2022-06-14-intimate-partner-violence-in-s-africa-the-staggering-stats-and-the-solutions/
[v] Fusar-Poli P, et al. (2017). Deconstructing vulnerability for psychosis: Meta-analysis of environmental factors psychosis in subjects at ultra high-risk. European Psychiatry. Vol 40. https://www.sciencedirect.com/science/article/pii/S0924933816301389?via%3Dihub
[vi] Solmi M, et al. (2021). Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies. Molecular Psychiatry 27. https://www.nature.com/articles/s41380-021-01161-7