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From Emotional Abuse in Childhood To Psy PDF
From Emotional Abuse in Childhood To Psy PDF
1
Geha Mental Health Center, Petah Tiqva, P.O.B. 102, Israel (49100);
School of Social Work, Bar Ilan University, Ramat Gan, Israel, (52900).
2
School of Social Work, Bar Ilan University, Ramat Gan, Israel, (52900).
Childhood Emotional Abuse and Psychopathology in Adulthood 1
ABSTRACT
Objective: Examination of the course traveled from childhood emotional abuse to
adulthood psychopathology.
Method: one hundred and ninety six undergraduate students, aged 20-45 (M=27;
sd=8.17), answered self-report questionnaires that estimate emotional abuse in
childhood (CTQ), parental attitudes (PBI), psychopathological symptomatology (BSI),
self esteem (RSE), and defense mechanism organization (DSQ).
Results: Reported psychopathological symptomatology highly exceeded the Israeli
norm. Structure Equation Modeling provided a statistically significant explanation
(52%) of the target variable: psychopathology symptomatology. According to the path
model, emotional abuse in childhood and perceptions of controlling and non-caring
parents had an indirect effect on the psychopathology. This was mediated by immature
defenses and low self-esteem.
Conclusions: The manifested psychopathology among adults who underwent emotional
abuse in childhood is produced by the detrimental effect of abuse on personality and
takes the form of immature defense organization and damaged self-representation.
INDODUCTION
In the last decade, research into childhood emotional abuse has produced a consensus
about its adverse psychological and social consequences in adulthood (Varia & Abidin,
1999). However, despite the abundance of research on the various types of abuse, few
studies have examined the long-term consequences of emotional abuse, and most of
these are clinical reports. There has been no study examining empirically the
Emotional abuse, defined as “soul murder” (Garbarino, Guttman & Seeley, 1987),
ignoring the child, all of which undermine the child’s emerging identity. The parents
preserve their harsh control over the humiliated child by presenting their critical and
devaluing attacks as caring and protecting the child's welfare (Thompson & Kaplan,
1996). Research points to the psychopathogenic impact of emotional abuse (Gibb, et al,
2001; Simeon et al., 2001). Empirical research dealing with the consequences of
childhood emotional abuse on adult functioning is scarce, and relates mostly to low
depressive moods, anxiety, suicidal tendencies, eating disorders, and overall psychiatric
symptomatology (Bifulco et al., 2002; Doyle, 2001; Ferguson & Dacey, 1997; Gibb et
al, 2001; Grilo & Masheb, 2002; Hart, Brassard & Karlson, 1996; Mazzeo & Espelage,
2002; Palmer et al, 2001; Portwood, 1999; Rich, Gingerich & Rosen, 1997; Spertus et
All these studies have been carried out within a predominantly direct and linear
understanding the mediating mechanisms that link childhood emotional abuse and
two potential psychodynamic causes for injury to the personality which may lead to
Self esteem - Clinical reports describe the major narcissistic damage to the child’s
personality and the detrimental hindrance to the development of the self, the imprints of
which accompany the child into adulthood (Burland, 1994; McCarthy, 1990; Mrazek &
with inward and outward anxiety. This construct is pertinent to styles of coping which
have been derived from the psychoanalytic theory postulating that these unconscious
1994; Hauser & Safyer, 1995), and as such may have an important role in shaping
various psychiatric disorders (Paris et al., 1996). Psychoanalytic theories have claimed
Vaillant (1992) divided defense mechanisms according to their level of maturity and
reality, splitting, and acting out represent immature (or “primitive”) defenses;
considered neurotic defenses; while sublimation, humor, suppression, and altruism are
On this basis our model hypothesized that the immature defensive organization and
injured self-esteem mediate the process that leads from the experience of childhood
symptomatology in adulthood.
METHOD
Participants
We approached two hundred undergraduate students (66.2% women and 31.5% men)
from six academic institutes in Israel. Their age ranged from 20 to 45 years (M=27;
One person refused to participate. One hundred and ninety nine participants gave their
written informed consent to take part in the study. One returned the questionnaires
explaining that it was difficult for him to answer the questions. Two subjects were
removed from the sample because we realized that they were over 45 years old. Thus
we were left with one hundred ninety six subjects for the study. A closure sheet attached
to the questionnaires suggested that participants approach the investigator for advice on
emotional counseling in response to painful memories that the questionnaire may have
aroused.
Childhood Emotional Abuse and Psychopathology in Adulthood 5
Measures
childhood experiences. The Emotional Abuse subscale reflects the degree to which
called me things like stupid, lazy, or ugly"). The Physical Abuse subscale reflects the
degree to which respondents were physically assaulted in ways that might result in
injury (e.g., "I was punished with a belt, a board, a cord, or some other hard object").
The Sexual Abuse subscale reflects respondents' experiences of coercive sexual contact
(e.g., "Someone tried to make me do sexual things or watch sexual things," "Someone
molested me"). The Emotional Neglect subscale reflects the degree to which
respondents' emotional needs were not met (e.g., "I felt loved" [reverse scored]). The
Physical Neglect subscale reflects the degree to which respondents' physical needs were
not met (e.g., "I didn't have enough to eat"). Each subscale is composed of five items.
Three additional items assess tendencies to minimize or deny abuse. Respondents rate
the truth of each item on a scale of 1 to 5, from "Never true" to "Very often true" when
they were growing up. Thus, scores range from 5 to 25 for each abuse type. The CTQ
ranging from .79 to .86 over an average of 4 months, internal consistency reliability
coefficients ranging from =.66 to =.92 across a range of samples (Bernstein & Fink,
1998), convergent validity with ratings of childhood maltreatment of both clinicians and
therapists, and a consistent five-factor structure (Bernstein & Fink, 1998; Bernstein et
In the current study high internal reliability was found in all the sub-scales (emotional
abuse - =.83; physical abuse - =.80; sexual abuse - =.81; emotional neglect - =.88;
physical neglect - =.82]. The correlations between emotional neglect and emotional
Parental Bonding Instrument (PBI; Parker et al., 1979), a 25 item self-report measure
designed to assess adults’ perceptions of their parents' bonding behavior during the first
16 years of life. Subjects were asked to complete the questionnaire twice, once with
reference to their mother, once to their father. Each item describes a type of parental
behavior, and subjects are asked to indicate the degree to which it applies to the parent
Care and Overprotection. The Care subscale contains 12 items that measure
The PBI has been used in many psychological and psychiatric studies and has been
found to possess a robust factor structure and a high test-retest reliability (Parker, 1990).
Furthermore, support for the construct and predictive validity of the PBI has been found
in clinical samples (Parker, 1989, 1993; Wilhelm & Parker, 1990; Zweig-Frank & Paris,
1991) and in previous studies among Israeli adults and adolescents (Bachar, Canetti,
Galilee-Weisstub et al., 1998). In the present study, the Care and Overprotection scales
had high internal consistency: Cronbach's alpha was .92 for maternal care, .94 for
paternal care, .85 for maternal overprotection, and .89 for paternal overprotection.
Childhood Emotional Abuse and Psychopathology in Adulthood 7
ranges from 1–4, with higher scores indicating higher self-esteem. The RSE has high
internal consistency ( - .88-.92), high test-retest validity (r = .85), and high levels of
validity when compared with other scales and with reports of interviewed raters (r=.67-
.56) (Corcoran & Fischer, 1987). The present study found high internal consistency -
=.90.
Defense Style Questionnaire -(DSQ; Bond, 1986), a self-rating scale with 88 items,
Statements represent the following defense mechanisms, clustered into four defense
that interfere with the individual's ability to take constructive action on his/her own
of self and others into good and bad. These two scales reflect immature- primitive
kind, helpful, and not angry. Adaptive defenses (suppression, sublimation, and humor)
The DSQ has good test-retest reliability and has been cross-validated by correlations
with other instruments measuring defenses (Ego Function Questionnaire; Bond et al.
1983; Defense Mechanism Rating Scales–DMRS; Bond, Perry, & Gautier, 1989;
Hersoug, Sexton & Hoglend, 2002). Studies have also reported on its ability to
Childhood Emotional Abuse and Psychopathology in Adulthood 8
discriminate among patients at different levels of functioning (Bond & Vaillant, 1986;
In this study we clustered the defense styles according to their maturity level (Vaillant,
good reliability for the immature-primitive defenses ( =.83), moderate for the neurotic
defenses ( =.75), and low for the mature defenses ( =.54). Because the main goal of
the study was to examine the association between the use of immature-primitive
defenses and the impact in adulthood of childhood emotional abuse, we used only the
scale of these defenses, comprised of 34 items; a higher score indicates salient use of
immature defenses.
Brief Symptom Inventory (BSI; Derogatis & Spencer, 1982; Derogatis & Melisaratos,
53 items that elicit perception of symptoms in the last month. BSI assesses
The scale is used to assess the mental health of several populations (Canetti, Shalev &
Kaplan De-Nour, 1994). All subscales range from 0–4, with higher scores indicating
more mental health problems. The current study found high internal reliability for the
General Severity Index ( = .96), and moderate internal reliability for the nine sub-
scales ( = .62–.84).
Childhood Emotional Abuse and Psychopathology in Adulthood 9
RESULTS
31.2% of the participants reported never having experienced emotional abuse, 47.7%
reported single episodes, 14.6% reported that they experienced emotional abuse
experienced parental emotional abuse very often. Among those who reported emotional
abuse (physical, sexual, or neglect) while 30.69% reported experiencing only emotional
abuse.
Descriptive Statistics
Table 1 presents the means and sd's of the research variables as measured by the CTQ,
PBI, DSQ, RSE and BSI questionnaires. As can be seen from the table the parental care
and control scores in our study exceeded those reported among adolescents from intake
families. The self esteem scores exceeded those reported by Gross and Keller (1992),
that stemmed from adults who underwent childhood emotional abuse. The reported
Israeli norm (GSI - M=1.86; sd=.60, compared to the norm .75, sd=.50; Canetti,
Shalev & Kaplan De-Nour, 1994) as well as the norm obtained from an American
sample by the instrument's developers (.83, sd=59; Derogatis & Spencer, 1982).
Table 2, show that the more severe the experience of childhood emotional abuse the
symptomatology. Similarly, the lower the level of self-esteem; and the more controlling
Childhood Emotional Abuse and Psychopathology in Adulthood 10
and non-caring the parents the higher the levels of immature defense mechanisms and of
Our research model assumes that the experience of childhood emotional abuse and
We used structural equation modeling by LISREL (8.0) to examine the research model.
The exogenous variables were emotional abuse and parental care and control; the
mediating variables were immature defense mechanisms and self-esteem; and the
df=14; p=.15; RMR=.032 (RMR= Root Mean Square Residual). Figure 1 presents only
the arrows that represent significant (p<.05 and higher) results, therefore the “paternal
care” variable whose contribution was insignificant (r=.08; p=.09) is not shown.
The figure shows that emotional abuse contributed most in predicting the mediating
variables (immature defense mechanisms and self esteem), and a minor but still
parental (both maternal and paternal) control and by maternal care, and 29% of the
maternal care and maternal control. The coefficient indicated that the level of
abuse and controlling parenthood, and in reverse ratio to the experience of caring
motherhood. Conversly, the less the reported amount of emotional abuse and controlling
parenthood and the more caring the mother, the higher the level of self esteem.
The target variable was psychopathology symptomatology. Its explained variance was
high, standing at 52%. Only immature defenses and self esteem showed a direct effect
higher than that of self esteem. According to the path model, childhood emotional
abuse, perceptions of maternal care and control and of paternal control had an indirect
effect on psychopathology and was mediated by immature defenses and self esteem.
DISCUSSION
The results of our study, especially those of the Structure Equation Modeling (SEM)
Our findings are consistent with clinical descriptions of developmental and personality
damage caused by parental emotional abuse (e.g., McCarthy, 1990) as well as with
low self esteem (Gross & Keller, 1992; Loos & Alexander, 1997; Rich, et al, 1997).
Emotionally abused victims may adopt a negative self-image (Frankel, 2002) and may
believe that they are not good enough to warrant the parent’s attention (Loos &
Alexander, 1997) through introjecting the injurious parents’ criticism and insults.
Childhood Emotional Abuse and Psychopathology in Adulthood 12
High scores of parental care were significantly negatively correlated with parental
control (r=-.42). These findings might support those of Varia and Abidin (1996) that
Burland (1994) and McCarthy (1990) suggested that in order to survive, the victims
deny and isolate themselves from the abusive relationships by splitting their parents'
images.
Studies show the predictive power of defenses for mental health; immature defenses
symptoms (Cramer & Block, 1998; Muris & Merckelbach, 1996; Watson, 2002).
difficulties at the age when these defenses were developmentally predominant (e.g.,
maintain self-esteem, the young child makes strong use of the defenses available at that
appropriate age (Cramer & Block, 1998). Massive and long-term overuse of these
al, 1994; Grilo & Masheb, 2002; Paris, 1997; Paris et al. 1996; Zweig-Frank & Paris,
1991; Zanarini et al., 1997). Bond, et al (1994), and Paris et al. (1996) support
personality disorder by reporting that borderline personality disorder was linked with
adaptive defenses.
Childhood Emotional Abuse and Psychopathology in Adulthood 13
The Structure Equation Modeling (SEM) analysis indicates that contrary to maternal
care, paternal care has a non-significant contribution to immature defenses and self-
esteem, suggesting that paternal care is less influential. This outcome may stem from
the fact that mothers are generally considered to be the more nurturing parent and
indeed often play more of a nurturing role than fathers (Varia & Abidin, 1999). These
results are consistent with those of Paris et al.(1996) who reported that only maternal
control was a risk factor in predicting immature defenses. Self esteem however, is
either mothers or fathers can have a detrimental effect on the self-esteem. Similar results
were found by Loos and Alexander (1997), who reported that both maternal and
paternal verbal aggression and emotional neglect predict low self-esteem and loneliness
in adulthood.
Limitations
The study has several limitations that must be considered when interpreting the data.
The study was based on retrospective self-labeling of the subjects, as being emotionally
abused in childhood, without objective verification. The passage of time and distance
from childhood experiences may have blurred the reported abuse. Other personality
depression) which may have contributed to the perceived childhood abuse were not
examined. Additionally, participants who have immature defense styles and certain
Moreover, participants who have maladaptive defense systems may engage in mutually
provocative interactions with parents, may perceive their childhood negatively and may
Childhood Emotional Abuse and Psychopathology in Adulthood 14
suffer from adult psychopathology. We should consider the possibility that some reports
of parental abuse were the product of other personality disturbances which distorted the
We included in the study subjects who reported exclusive emotional abuse (30.69%)
together with those who reported emotional abuse accompanied by other experiences of
abuse and emotional neglect. These correlations may point to an adulteration of the
researches (e.g., Hamarman, & Bernet, 2000; Iwaniec, 1996) suggest that the difficulties
in segregating emotional abuse from other types of abuse, especially emotional neglect,
which Garbarino [1987) views as tangential to emotional abuse, is one reason for the
immature and the more mature mechanisms and, implicitly, of a richer picture of the
Conclusions
The distribution of the reported childhood emotional abuse resembles the "normal
curve". This is a distressing finding since emotional abuse is difficult to quantify and
investigate and therefore often remains underreported, leaving most of the victims
strengthen our findings. Further studies are needed to identify profiles of defenses
resulting from emotional abuse combined with physical or sexual abuse or neglect.
Longitudinal studies could clarify whether the effect of emotional abuse is more
detrimental at a young age or during adolescence when the major developmental task is
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Table 1: Means and sd of the CTQ, PBI, DSQ, RSE and BSI questionnaires
M sd Other studies
Emotional abuse 15.1 6.9 10.61
Maternal care 34.4 5.9 30.12
Maternal control 18.20 5.2 10.52
Paternal care 31.5 7.5 27.72
Paternal control 16.8 5.7 8.22
Immature defense 3.22 .96 *
mechanisms
Self esteem 33.0 5.5 32.43
Psychopathological 1.86 .60 .754
symptomatology .835
(GSI)
1
Bernstein & Fink, 1998 (among college undergraduates).
2
Canetti et al., 2000 (intact families)
3
Gross & Keller, 1992
4
Canetti et al., 1994
5
Derogatis & Spencer, 1982
* The immature defense scale was derived from the DSQ items
according to Vaillant’s (1992) categories of defenses by maturity levels.
Childhood Emotional Abuse and Psychopathology in Adulthood 22
-.32*** R2=.29*
.30 Immature defense
R2=.52***
.14* mechanisms .54***
-.57*** Maternal control
Psychopathological
-.13* -.52***
.37***
Symptomatology
-.42***
-.16* Self esteem -.27***
. 51***
Maternal care
.20*
-.22** R2=.30***
Paternal control -.13*