Part 2. Psychological maltreatment: abuse, neglect and rejection

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

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

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

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)

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’)

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.

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

‘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

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

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

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

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

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

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

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

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.