Researchers used the National Child Traumatic Stress Network Core Data Set to analyze data from 5,616 youths with lifetime histories of one or more of three types of abuse: psychological maltreatment (emotional abuse or emotional neglect), physical abuse and sexual abuse. The majority (62 percent) had a history of psychological maltreatment, and nearly a quarter (24 percent) of all the cases were exclusively psychological maltreatment, which the study defined as caregiver-inflicted bullying, terrorizing, coercive control, severe insults, debasement, threats, overwhelming demands, shunning and/or isolation.
Children who had been psychologically abused suffered from anxiety, depression, low self-esteem, symptoms of post-traumatic stress and suicidality at the same rate and, in some cases, at a greater rate than children who were physically or sexually abused. Among the three types of abuse, psychological maltreatment was most strongly associated with depression, general anxiety disorder, social anxiety disorder, attachment problems and substance abuse. Psychological maltreatment that occurred alongside physical or sexual abuse was associated with significantly more severe and far-ranging negative outcomes than when children were sexually and physically abused and not psychologically abused, the study found. Moreover, sexual and physical abuse had to occur at the same time to have the same effect as psychological abuse alone on behavioral issues at school, attachment problems and self-injurious behaviors, the research found.