Verbal Abuse and Witnessing Violence in Childhood: Psychiatric Effects
Verbal Abuse and Witnessing Violence in Childhood: Psychiatric Effects
Sticks, Stones and Hurtful Words: Relative Effects of Various Forms of Childhood Maltreatment
Teicher MH, Samson JA, Polcari A, McGreenery CE
Am J Psychiatry. 2006;163:993-1000
To explore the effects of 4 kinds of child abuse, researchers used advertisements to recruit 554 adults aged 18-22 years . Of the total group, 68% were women and 304 had been abused during childhood. The subjects provided self-reports of verbal, physical, and sexual abuse and exposure to domestic violence (seeing someone else being physically abused). Outcomes, examined mostly with standardized questionnaires, were dissociative experiences; symptoms of anxiety, depression and somatization; and "limbic irritability," a symptom cluster including brief hallucinations, automatisms, and others on a 33-item checklist. According to the researchers, such symptoms "are dramatically influenced by abuse history."
The effect sizes of a history of either verbal or physical abuse on limbic irritability scores were similar. The effect of 2 kinds of abuse on limbic irritability scores was greater than the effect of 1 kind of abuse, and 3 kinds of abuse had the greatest effect. The effect size of combined verbal abuse and exposure to domestic violence on dissociation scores (d = 1.428) was approximately as high as the effect size of familial sexual abuse alone (d = 1.333). The effect size of combined exposure to verbal abuse and domestic violence on depression and anxiety was greater than the effect size of any one of the other kinds of abuse. The authors wrote that, given the trend for more symptoms with more kinds of abuse, "combined exposure to less blatant forms of abuse may be just as deleterious as the most egregious acts."
The obvious flaws in the study are its nonrandom recruitment of subjects, retrospective design, and reliance on self report. Recall by traumatized subjects of past abuse may have introduced bias, and the debate on suggestibility of such patients continues. Strengths include a relatively large sample size and use of questionnaires and scales for outcomes, although no specific diagnoses were assigned. Furthermore, the validity and significance of "limbic irritability" may be questionable in many clinicians' minds. The association of anxiety, depression, and dissociation with nonphysical abuse, however, does have clear clinical relevance. Despite its deficits, the study provides evidence that clinicians should take verbal abuse of children seriously and consider warning parents that substitution of physical punishment with emotional and verbal interventions may carry its own risks.
Abstract
Sticks, Stones and Hurtful Words: Relative Effects of Various Forms of Childhood Maltreatment
Teicher MH, Samson JA, Polcari A, McGreenery CE
Am J Psychiatry. 2006;163:993-1000
To explore the effects of 4 kinds of child abuse, researchers used advertisements to recruit 554 adults aged 18-22 years . Of the total group, 68% were women and 304 had been abused during childhood. The subjects provided self-reports of verbal, physical, and sexual abuse and exposure to domestic violence (seeing someone else being physically abused). Outcomes, examined mostly with standardized questionnaires, were dissociative experiences; symptoms of anxiety, depression and somatization; and "limbic irritability," a symptom cluster including brief hallucinations, automatisms, and others on a 33-item checklist. According to the researchers, such symptoms "are dramatically influenced by abuse history."
The effect sizes of a history of either verbal or physical abuse on limbic irritability scores were similar. The effect of 2 kinds of abuse on limbic irritability scores was greater than the effect of 1 kind of abuse, and 3 kinds of abuse had the greatest effect. The effect size of combined verbal abuse and exposure to domestic violence on dissociation scores (d = 1.428) was approximately as high as the effect size of familial sexual abuse alone (d = 1.333). The effect size of combined exposure to verbal abuse and domestic violence on depression and anxiety was greater than the effect size of any one of the other kinds of abuse. The authors wrote that, given the trend for more symptoms with more kinds of abuse, "combined exposure to less blatant forms of abuse may be just as deleterious as the most egregious acts."
The obvious flaws in the study are its nonrandom recruitment of subjects, retrospective design, and reliance on self report. Recall by traumatized subjects of past abuse may have introduced bias, and the debate on suggestibility of such patients continues. Strengths include a relatively large sample size and use of questionnaires and scales for outcomes, although no specific diagnoses were assigned. Furthermore, the validity and significance of "limbic irritability" may be questionable in many clinicians' minds. The association of anxiety, depression, and dissociation with nonphysical abuse, however, does have clear clinical relevance. Despite its deficits, the study provides evidence that clinicians should take verbal abuse of children seriously and consider warning parents that substitution of physical punishment with emotional and verbal interventions may carry its own risks.
Abstract
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