1. Part 2. Psychological maltreatment: abuse, neglect and rejection

2. Differences and Similarities between physical and psychological abuse
Parents who physically abuse tend to be prepared to talk about their own earlier experiences of abuse
Parents who psychologically abuse, neglect and reject their children are rarely prepared to talk about their early experiences of parental abuse

3. Children who are physically abused may say that they are liked, often by peers who appear to others to dislike them
Children who are psychologically abused, neglected and rejected know that they are disliked by peers
Parallels with children who bully and children who are victims of bullying

4. Defining and recognising psychological abuse Generic term: psychological maltreatment
When discrete (not associated with physical abuse):
May go unnoticed when child is very young
The accumulating effects of psychological abuse over the years

5. Experiences and behaviour of caregivers
Emotionally harsh childhoods
Anxious attachment pattern of withdrawing care and protection when needed
Becoming unavailable and/or unresponsive when care needed
Removing and/or isolating child e.g. locked in bedroom of left with other adults (out of sight, out of mind)

6. Avoid professionals by
Missing hospital and clinic appointments
Failing to keep to health worker home visits
Keeping ‘at risk’ children out of school and indoors
A ‘not existing’ pattern in parents’ contact with professionals (Reder, Duncan & Gray, 1993)
Also failing to give medication (seen and described as ‘unnecessary’)

7. The caregiver-child relationship
A tendency to dismiss the child as weak, pathetic and unworthy of affection when confronted by attachment behaviour
Can terrorise children by threatening to harm them or their pets
More subtly – can indicate regret at child’s birth and continuing existence. May suggest that care-giving is irritating or a waste of time.

8. Care-givers interpretations
Can perceive the child’s distress as behaviour designed to hurt or as evidence of child’s dislike for the caregiver.
Mild psychological maltreatment:
Interpret distress as exaggerated or unnecessary and not warranting response
Severe psychological maltreatment:
Reacting to distress in a hostile, dismissing way
Similar to physical abuse – rejecting or suppressing ay attachment behaviour

9. ‘Expressed emotion’ (Calam et al, 2002)
Mothers prone to making hostile comments about their children are more likely to emotionally maltreat their children
Unresolved childhood losses and trauma are reactivated in interaction with children, particularly when child shows attachment behaviour
Can ‘switch off’ at approach of distressed child

10. The dilemma of anxious-avoidant attachment
The care-giver deactivates attachment related information as an unconscious defence against own memories of maltreatment
All young children ARE dependent and in need of care
The child cannot explore or regulate own emotions leading to greater distress
Believe selves to be not only unloved, but unwanted

11. 6 sub-types of psychological maltreatment (Hart, Brossard & Karlson, 1996)
Spurning
hostile rejection and put downs
Terrorising
threats to abandon, hurt or kill
Isolating child
from activities, particularly ‘fun’ activities
Exploiting and corrupting
E.g. encouraging crime
Denying emotional responsiveness
No praise; instead, criticism of achievements
Failing to meet medical and health needs
Health needs underplayed or denied

12. The child’s behaviour as adaptive
How can the child achieve a regulated state in a hostile environment and reduce risk?
When attachment behaviour reduces emotional availability of care-giver, must internalise anxiety. Suppresses tension to avoid rejection
An avoidant strategy of no demands on care-giver – parent less anxious and rejecting
No displays of negative emotion e.g. crying
No comfort seeking when frightened or ill
BUT still has feelings of fear, desire and anger

13. Compulsive compliance and compulsive self-reliance
Produce the desired behaviour for the care-giver
Do not make demands on the care-giver
Suppress affect and arousal, so cannot reflect on emotions of self and others
High arousal present
Somatic symptoms e.g. hair loss, eczema

14. Non-organic failure to thrive
Refers to growth and development as significantly below expectations for age
Trauma, fear and stress
Adverse effect on endocrine system and nervous system
Can compromise growth hormone production
Psychosocial and hyperphagic short stature syndromes
Can compromise immune system
Frequent illness and waif-like apperarance
At risk or becoming spiteful and selfish, awkward and non-compliant in peer and adult relationships

15. Evidence from neuroscience
Hostile and rejecting care-giving compromises brain development
Rejection and unresponsiveness impair ‘hard-wiring’ (Joseph, 1999; Schore, 2001)
Ability to process and regulate emotional arousal is severely disturbed
Children do not seek comfort/safety when frightened
Do not access parent when the parent is present

16. Internal Working models
Of self
Low self-esteem, self-hating when showing signs of weakness, unworthy of love or protection
Of others
Others are not seen as warm, protective or caring. Presumption of rejection following display of distress. Others who appear weak are to be despised and belittled
Of relationships
Unsafe to depend on others. Intimacy = rejection. Self-reliance and emotional distance = safe. Instrumental attitude to relationships

17. The main difference between physical abuse and psychological abuse
The main difference between physical abuse and psychological abuse? Psychological maltreatment/abuse is more psychologically damaging than physical abuse.