Paediatrics: Emotional abuse

Emotional abuse

Persistent, emotional ill-treatment of a child that results in severe impair-ment in emotional development. This may involve:

• Conveying to children that they are worthless or unloved.

• Imposing age or developmentally inappropriate expectations.

• Causing children to frequently feel frightened and threatened.

• Seeing or hearing the ill-treatment of another as in domestic violence.

This form of abuse often co-exists with other forms of ill treatment.

Presentation

This is almost always gradual and difficult to diagnose. Symptoms are largely behavioural and may include:

• Being excessively clingy.

• Attention-seeking behaviour.

• Overly anxious.

• Overly serious.

• Being anxious to please.

Parental behaviours are a clue to the diagnosis. Any of these must be per-sistent and severe, and have a major impact on the child in order to reach the threshold for emotional abuse:

• Persistently –ve view of the child.

• Inconsistent and unpredictable responses.

• Expectations that are very inappropriate.

Induction of a child into bizarre parental beliefs.