© 2007 Lippincott Williams & Wilkins, Inc.

Volume 195(6), June 2007, pp 497-503

Self-Awareness, Affect Regulation, and Relatedness: Differential Sequels of Childhood

Versus Adult Victimization Experiences

[Original Article]

Briere, John PhD*; Rickards, Shannae PhD†

*Department of Psychiatry, Keck School of Medicine, University of Southern California, Los

Angeles, California; and ‡private clinical practice, Thousand Oaks, California.
As author (but not copyright holder) of the MDI, DAPS, and IASC, John Briere receives
royalties from Psychological Assessment Resources, Odessa, FL.
Send reprint requests to John Briere, PhD, Psychological Trauma Program, LAC+USC Medical
Center, Los Angeles, CA 90033. E-mail: jbriere@usc.edu.

Abstract:

This study examined abuse and trauma exposure as it predicted identity problems, affect
dysregulation, and relational disturbance in 620 individuals from the general population.
Multivariate analyses indicated that maternal (but not paternal) emotional abuse was uniquely
associated with elevations on all 7 scales of the Inventory of Altered Self-Capacities (IASC):
Interpersonal Conflicts, Idealization-Disillusionment, Abandonment Concerns, Identity
Impairment, Susceptibility to Influence, Affect Dysregulation, and Tension Reduction Activities.
Low paternal (but not low maternal) emotional support was associated with Interpersonal
Conflicts, Abandonment Concerns, and Tension Reduction Behaviors. Paternal emotional
support did not significantly decrease the negative effects of maternal emotional abuse. Sexual
abuse was predictive of all IASC scales except for Interpersonal Conflicts and Identity
Impairment. Noninterpersonal traumas and adult traumas were typically unrelated to IASC
scales. Childhood emotional and sexual maltreatment—perhaps especially maternal emotional
abuse—may be critical factors in the development of disturbed self-capacities.

Interpersonal victimization, whether physical, sexual, or psychological, is relatively common in

North America and is associated with a variety of immediate and longer-term psychological
symptoms. Those who have been maltreated in childhood or in adulthood, for example, are at
risk for subsequent anxiety, depression, posttraumatic stress, various forms of dysfunctional
behavior, substance abuse, dissociation, and even, in some cases, psychosis (Briere, 2004;
Herman, 1992; Myers et al., 2002; van der Kolk et al., 2005; for reviews). Several Diagnostic
and Statistical Manual (DSM-IV) diagnoses (i.e., acute stress disorder, posttraumatic stress
disorder, the dissociative disorders, and brief psychotic disorder with marked stressors) directly
reflect the effects of traumatic life events on psychological functioning (American Psychiatric
Association, 2000).

Beyond these well-known symptoms of adverse experience, however, is another set of potential
victimization effects, sometimes referred to as impaired self-capacities or self-disturbance. In
contrast to the above symptoms and problems, this less-studied domain was initially rooted in
psychodynamic theory (Kohut, 1977). Introduced to the trauma field by McCann and Pearlman
(1990), and slightly modified by Briere (2000), the construct of impaired self-capacities may be
viewed as comprising at least 3 separate but related types of disturbance: (a) problems in one's
ability to access and maintain a stable sense of identity or self (identity disturbance), (b) an
inability to regulate and/or tolerate negative emotional states (affect dysregulation), and (c)
difficulties in forming and sustaining meaningful relationships with others (relational
disturbance).

Problems in these 3 areas may lead to significant psychosocial difficulties. Individuals with a
less-coherent sense of self, for example, may lack the internal self-monitoring and self-awareness
that would otherwise inform them about their feelings, thoughts, needs, goals, and behaviors, and
may complain of emptiness, confusion about who they “really” are, suggestibility, contradictory
thoughts and feelings, and an inability to set goals for the future (Hamilton, 1988; Kohut, 1977;
McCann and Pearlman, 1990). Similarly, individuals with problems in affect regulation are often
subject to emotional instability or mood swings, problems in inhibiting the expression of strong
affect, and difficulties in terminating dysphoric internal states (Cloitre et al., 2006; Linehan,
1993; van der Kolk et al., 1996). In the absence of sufficient internal affect regulation skills,
some people may respond with external behaviors that distract, soothe, numb, or otherwise
reduce internal distress (Allen, 2001; Briere, 2002). Finally, individuals with relational problems
often find themselves in conflictual or chaotic relationships, frequently have problems forming
intimate adult attachments, may fear abandonment by others, and may engage in behaviors that
are likely to threaten or disrupt close relationships (Collins and Read, 1990; Pearlman and
Courtois, 2005; Simpson, 1990).

Apropos of the breadth of such disturbance, a number of studies link impaired self-capacities
(especially affect dysregulation) to a number of other symptoms and syndromes, including
dysphoric mood, substance abuse, eating disorders, dissociation, and impulsive or self-
destructive behavior (Briere, 2006; Grilo et al., 1997; Stice et al., 1996; Zlotnick et al., 1997).
More generally, self-related symptoms and dysfunctional behaviors are sometimes associated
with borderline personality disorder (American Psychiatric Association, 2000, 2001) or, at lower
symptom intensity, borderline traits or features. In fact, per the current DSM-IV (American
Psychiatric Association, 2000, p. 710), borderline personality disorder can be viewed as a form
of self-disturbance, involving problems in relatedness (e.g., “a pattern of intense and unstable
interpersonal relationships”), identity (e.g., “identity disturbance: unstable self-image or sense of
self”), and affect regulation (e.g., “affective instability due to a marked reactivity of mood”).
Nevertheless, not all individuals who suffer from self-capacity disturbance meet criteria for this
disorder, and may not always be well conceptualized from a personality disorder perspective
(Briere and Scott, 2006; Herman, 1992).

Although various modern writers have discussed some version of self-disturbance at length
(Allen, 2001; Schore, 1994; Siegel, 1999; Stern, 1985), research on self-functions has lagged
behind clinical interest. This relative paucity of empirical data is probably due to the complexity
of the construct (as compared with, for example, anxiety or depression), the tendency for
psychodynamic clinicians to focus less on empirical investigation than on clinical practice, and
the unfortunately small number of standardized and valid psychological measures of self-
capacities available to researchers. As a result, the precise phenomenology of self-disturbance
has not been well mapped nor have its antecedents been fully identified.

Despite the limited research in the area, several studies suggest that self-capacity problems,
symptoms of borderline personality disorder, or disturbed object relations are associated with
childhood experiences of abuse or neglect (Alexander et al., 1998; Elliott, 1994; Herman and van
der Kolk, 1987; Westen et al., 1990; Wilkenson-Ryan and Westen, 2000). The mechanism
whereby child maltreatment may result in later self-disturbance is not entirely clear. However,
various writers suggest that the growing child requires safety, stability, and emotionally attuned
caretakers to develop a positive sense of self, affect regulation skills, and the capacity to form
meaningful relationships (Allen, 2001; Bowlby, 1988; Fonagy et al., 1995; Stern, 1985). In
agreement with both psychodynamic theory (Winnicott, 1965) and attachment theory (Bowlby,
1988), positive attachment experiences with maternal figures may have especially significant
impacts on the growing child's self-development and eventual functioning (Liang et al., 2005;
Schore, 1994). Child abuse and neglect reflects, almost by definition, the absence of this sort of
positive childhood environment, and thus, may logically correlate with subsequent self-
disturbance.

Although self-capacity problems appear to be relatively common among those abused or

neglected as children, few studies in this area have examined the specific characteristics of
adverse experiences over the lifespan as they predict this form of symptomatology. Specifically,
there is very little published research on (a) whether impaired self-capacities are uniquely
associated with childhood maltreatment as opposed to, for example, later trauma in adulthood,
(b) whether the specific nature of the negative experience (e.g., sexual vs. emotional, or
interpersonal vs. accidental) has a bearing on the development of self-disturbance, and (c)
whether different forms of childhood (or adult) victimization are associated with different kinds
of self-capacity problems.

In response to these issues, the current study examined 3 hypotheses. First, we proposed that to
the extent that self-capacities are rooted in relational dynamics, altered self-capacities would
correlate to a greater extent with interpersonal victimization (e.g., child abuse or adult assault)
than noninterpersonal trauma (e.g., accidents or disasters). Second, because self-capacities are
thought to arise largely in the context of child–parent attachment experiences, altered self-
functioning was expected to be associated more with maltreatment in childhood than in
adulthood. Finally, because the development of self-capacities is thought to be contingent upon
emotional attunement between parent and child, childhood emotional abuse and lack of
emotional support were hypothesized to have a stronger relationship to impaired self-capacities
than childhood sexual or physical abuse.

METHODS

Procedure

Data for the present study were taken from the normative sample of the Inventory of Altered Self
Capacities (IASC; Briere, 2000), a multidimensional measure of disturbed self-functioning. After
approval was obtained from the institutional review board of the University of Central Florida, a
national sampling service generated a random sample of registered owners of automobiles and/or
individuals with listed telephones in the general population, stratified on geographical location.
Participants were mailed a questionnaire containing, among other measures, the IASC and the
Traumatic Events Survey (TES; Elliott, 1992). Both the IASC and the TES are described below.

Participants received $5.00 for completing the questionnaire. In addition, 70 university students
were tested in the normative study with the same protocol (but without financial compensation)
to provide additional participants in the lower age ranges. University student data were not
included in the current analyses, however. All questionnaires were anonymous, although
financial compensation in the general population sample was tied to names and addresses that
were destroyed before data analysis was initiated. This study, conducted by the IASC test
publisher (Psychological Assessment Resources), has resulted in several published papers (e.g.,
Briere, 2006; Briere and Runtz, 2002), as well as the IASC test manual (Briere, 2000).

Participants

Overall, 620 of 5415 potential participants completed the IASC in the standardization study. A
smaller subgroup (N = 417, 7.7% of the potential sample) also completed the TES—probably
owing to the relative length and complexity of the latter measure. The mean age of this
subsequent group was 49.7 years (SD = 15.4), and 241 (57.8%) were male. Racial composition
was 343 (82.3%) Caucasian, 24 (5.8%) African American, 14 (3.4%) Hispanic, 14 (3.4%) Asian,
12 (2.9%) Native American, 6 (1.4%) “other,” and 4 (1%) did not indicate their race.

Measures

Inventory of Altered Self-Capacities

The IASC is a standardized, 7-scale test, developed to tap disturbed self-capacities in 3 areas:
interpersonal relatedness, identity, and affect regulation (Briere, 2000). IASC items are rated
according to the frequency of certain behaviors or experiences over the prior 6 months, using a
4-point scale ranging from 1 (Never) to 4 (Often). Specific scales are Interpersonal Conflicts
(difficulties in maintaining important relationships), Idealization-Disillusionment (cycles of
valuing then devaluing people), Abandonment Concerns (hypersensitivity to, and fear of,
interpersonal rejection), Identity Impairment (difficulties in maintaining a sense of self and
identity), Susceptibility to Influence (suggestibility and uncritical acceptance of direction or
control by others), Affect Dysregulation (difficulties tolerating and regulating negative
emotions), and Tension Reduction Activities (involvement in distracting external activities as a
way to reduce painful internal states). Research suggests that the IASC is reliable and valid in
general population, clinical, and university samples, and correlates as expected with other self-
related variables, including fearful and preoccupied attachment styles on the Relationship
Questionnaire (Bartholomew and Horowitz, 1991), borderline and antisocial features scales of
the Personality Assessment Inventory (Morey, 1991), interpersonal problems on the Inventory of
Interpersonal Problems (Horowitz et al., 1988), substance abuse and suicidality on the Detailed
Assessment of Posttraumatic Stress (Briere, 2001), Impaired Self-Reference (ISR) on the
Trauma Symptom Inventory (Briere, 1995), and inferred object relations on the Bell Object
Relations and Reality Testing Inventory (Bell, 1995) (Briere, 2000; Briere and Runtz, 2002;
Dietrich, 2003; Runtz et al., 2000). A factor analysis in the normative sample indicated that each
of the IASC scales reflect a separate, self-related symptom dimension (Briere, 2000).

TES

The TES evaluates self-reports of up to 30 different childhood and adult interpersonal and
environmental traumas. It has been used in various studies of abuse and trauma exposure (Briere,
2006; Elliott et al., 2004). Relevant to the current study, the TES includes questions on childhood
and adult physical and sexual victimization, and includes 20-item Emotional Abuse-Maternal
Figure and Emotional Abuse-Paternal Figure scales, each of which can be divided into
Emotionally Abusive Behavior and Emotional Support subscales. Examples of items on the
Emotional Abusive Behavior subscale, rated for the participant's “most difficult year” before age
18, are endorsements of a mother or father figure having “yelled at you,” “rejected you,” and
“humiliated you in front of others.” Emotional Support subscale items (on which low scores
indicate emotional nonsupport) include “showed you that she (or he, depending on the version)
loved you,” “offered to help you,” and “encouraged you to have fun with friends.”

Operational Definitions of Interpersonal Victimization and Noninterpersonal Trauma

Four interpersonal victimization variables were examined in the present study, in addition to
scores on the Emotional Abuse subscales of the TES. These were childhood sexual abuse,
childhood physical abuse, adult sexual assault, and adult physical assault. Childhood physical
abuse was categorized as present on the TES if the participant reported physical aggression by a
parent or caretaker other than spanking, or any intentional parent/caretaker behavior that left a
mark or injury; sexual abuse was indexed as any physical sexual contact from an adult or
someone 5 or more years older than the participant, or any peer sexual contact that was
physically forced. Adult physical assault was defined on the TES as being hit with a hand, fist, or
object that resulted in marks, bruising, bleeding, burns, broken bones, or other serious injury.
Adult sexual assault was defined as any sexual contact that occurred as a result of physical force
or threats. Also based on the TES, 2 noninterpersonal trauma variables were evaluated: self-
reported exposure to a natural disaster or to a serious accident. When either of these 2 variables
was endorsed as positive, the participant was designated as having experienced a
noninterpersonal trauma.

RESULTS
Across gender, 122 (29.3%) and 70 (16.8%) of participants reported childhood physical and
sexual abuse, respectively, on the TES. Adult physical and sexual assault was reported by,
respectively, 117 (28.1%) and 24 (5.8%) of all participants, and 272 (65.2%) reported exposure
to 1 or more noninterpersonal traumas in their lifetimes. Scores on the Maternal and Paternal
Emotionally Abusive Behavior scales were correlated (r = .67, p < .001) and statistically
equivalent (M = 6.2, SD = 9.4 and M = 6.1, SD = 9.2, respectively; t[627] = 0.40, ns).
Participants’ scores on the Maternal Emotional Support and Paternal Emotional Support,
although also strongly correlated (r = .79, p < .001), were significantly different (t[627] = 11.8, p
< .001), with maternal support being endorsed more than paternal support (M = 13.4, SD = 8.9,
vs. M = 10.6, SD = 9.0).

Multiple regression analysis was performed on each IASC scale, entering demographics,
childhood sexual and physical abuse, maternal and paternal emotional abuse and level of
emotional support, adult interpersonal trauma, and noninterpersonal trauma variables at step 1,
followed by all 2-way interactions between participant gender and trauma variables at step 2. As
indicated in Table 1, all IASC scales were predicted by a combination of demographics, child
maltreatment, and adult interpersonal victimization at step 1. No interaction between gender and
any maltreatment or trauma variable was found at step 2.

TABLE 1. Multiple Regression of IASC Scores Using Age, Gender, and Trauma Variables, Step
1 (N = 417) SEE ORIGINAL ARTICLE FOR TABLES

Participant age was associated with 1 IASC scale, Identity Impairment, with younger participants
scoring higher in this area than older participants. Of the 6 child maltreatment variables, maternal
emotional abuse was associated with elevations on all 7 IASC scales, low paternal emotional
support was related to Interpersonal Conflicts, Abandonment Concerns, and Tension Reduction
Activities, and sexual abuse was predictive of all scales but Interpersonal Conflicts and Identity
Impairment. Adult physical assault was related to a single IASC scale, Tension Reduction
Activities. Childhood physical abuse, paternal emotional abuse, low maternal emotional support,
adult sexual assault, and exposure to noninterpersonal trauma were unrelated to any IASC scale.

Because maternal emotional abuse and lack of paternal emotional support emerged as significant
predictors of self-capacity disturbance, an additional set of analyses were performed to examine
whether these 2 variables interacted to affect IASC scale scores—especially whether maternal
emotional abuse effects were reduced in the presence of significant paternal emotional support.
This was evaluated by entering a maternal emotional abuse × paternal emotional support
interaction term into the multiple regression equations described above. Addition of this
interaction term did not predict additional variance in any IASC scale score.

DISCUSSION

The current results suggest that impaired self-capacities are especially associated with adverse
interpersonal—as opposed to noninterpersonal—events, and are largely restricted to child—as
opposed to adult—maltreatment. The primary predictors of self-disturbance were childhood
emotional abuse, emotional nonsupport, and sexual abuse. Specifically, Interpersonal Conflicts,
Idealization-Disillusionment, Abandonment Concerns, Identity Impairment, Susceptibility to
Influence, Affect Dysregulation, and Tension Reduction Activities were all associated with
having been emotionally abused by a mother figure; Interpersonal Conflicts, Abandonment
Concerns, and Tension Reduction Behaviors were associated with low levels of emotional
support by a father figure; and all areas of self-disturbance except for Interpersonal Conflicts and
Identity Impairment were associated with childhood sexual abuse. In contrast, adult traumas
(other than physical assault) and adult exposure to noninterpersonal violence were not uniquely
associated with any IASC scales. In the only finding for adult trauma, adult physical assault was
related to a single IASC scale, Tension Reduction Behavior, perhaps suggesting that those who
tend to “act out” or externalize emotional distress are at more risk for assault.

The finding that maternal emotional abuse was especially related to self-disturbance is in
agreement with data suggesting that mother–child relational disturbance is specifically predictive
of later borderline symptoms (Salzman et al., 1997), and aligns with the work of Schore (1994),
Siegel (1999), and Stern (1985), who view impaired self-capacities as at least partially the result
of disrupted mother–child attachment. The reasons for the specific importance of maternal—as
opposed to paternal—emotional abuse in the development of self-symptoms are not entirely
clear. One possibility is that inherent, psychobiological factors may especially heighten the
importance of the mother–child dyad (Bowlby, 1988), and thus the impacts of maternal
emotionally abusive behavior when it occurs. Alternatively, or in addition, these findings may
reflect the effects of sex-role socialization in North American society, wherein mothers are
generally expected to be more involved in child rearing than fathers (Steil, 2000) and, thus, are
likely to have greater relative impacts—in the absence of paternal involvement—when they
emotionally maltreat their children.

Paternal emotional responses were not unrelated to self-capacities, however. In 3 instances

(Interpersonal Conflicts, Abandonment Concerns, and Tension Reduction Behaviors), the
absence of emotional support by a father figure made an independent contribution to self-
disturbance, above and beyond maternal emotional abuse. These data represent a relatively new
finding in the child maltreatment literature and potentially highlight the role of paternal
emotional relatedness in children's self-development. If replicated, such data indicate that both
maternal and paternal behaviors may affect self-functioning, in contrast to perspectives that
focus primarily on maternal failings. They also suggest a possible new area of inquiry, i.e., the
relative impacts of emotionally abusive behaviors versus the absence of emotionally supportive
behaviors, perhaps especially in the context of parent gender. In the present study, maternal
emotional support was more prevalent than paternal support, yet paternal nonsupport was the
critical variable. Emotional abuse, on the other hand, was as prevalent in fathers as mothers, yet
only maternal abuse appeared to be associated with symptoms. Unfortunately, although paternal
support was associated with less self-capacity problems, high paternal support did not appear to
reduce the negative effects of maternal abuse.

The apparent primacy of childhood emotional abuse and nonsupport in self-capacity disturbance
suggests its aversive nature and substantial impacts. As such, it may be appropriate to refer to
significant emotional abuse or neglect as “traumatic” (Allen, 2001; Briere, 2006). However,
because childhood emotional maltreatment does not typically involve a threat to bodily integrity,
it does not constitute a trauma as defined by “Criterion A1” of the DSM-IV (American
Psychiatric Association, 2000). Whether this definitional issue should be resolved in the
direction of viewing emotional maltreatment as an adverse (but not traumatic) event, or,
alternatively, as evidence that the current DSM-IV trauma definition requires further attention,
awaits further consideration.

In addition to the effects of emotional abuse and nonsupport, childhood sexual victimization was
associated with several forms of self-related symptomatology, per other investigations (Elliott,
1994; Herman and van der Kolk, 1987). These results, however, contradict those of Messman-
Moore et al. (2005), who found that adult exposure to sexual trauma was more related to ISR
than was exposure to childhood sexual abuse. As Messman-Moore et al. note, their unexpected
finding may be due to various factors, including the limited range of self-disturbance potentially
present in their sample of university students, the temporarily self-destabilizing effects of acute
sexual assault, and the possibility that the measure that they used (the ISR scale of the Trauma
Symptom Inventory; Briere, 1995) may have been inadequate to tap the entire construct of self-
disturbance. Apropos of this last issue, the current study employed the IASC, which separates
identity, affect regulation, and relational difficulties into individual scales—a strategy that may
have advantages over a single summary scale such as the ISR, including greater differentiation of
childhood versus adult victimization effects.

The differential associations between some (but not all) forms of child maltreatment with certain
(but not all) self-capacities in the current study suggests that it may be inappropriate to
generalize that child maltreatment, per se, is related to adult self-capacity disturbance. Physical
child abuse, for example, was not associated with any form of self-disturbance, whereas maternal
(but not paternal) emotional abuse was a broad predictor of self-symptoms. Sexual abuse was
intermediate in its effects: related to 5 of 7 forms of self-disturbance, but less powerfully
predictive than maternal emotional abuse. Low paternal emotional support was associated with 3
of 7 symptom types, whereas low maternal support was unrelated to later self-dysfunction.
Finally, although Interpersonal Conflicts and Identity Impairment were associated with maternal
emotional abuse, neither was related to sexual abuse. These data emphasize the
multidimensionality of both child maltreatment and adult self-disturbance, as well as indicating
that certain forms of child abuse and neglect are potentially more impactful than others. For
example, the current results suggest that childhood sexual abuse, although significantly related to
impaired self-capacities, is second to the effects of childhood maternal abuse. Such data do not
mean that sexual abuse is less than psychologically toxic, but rather that another form of child
maltreatment—one less addressed in the literature—may be even more traumagenic. Additional
study is clearly indicated to determine the reasons (whether biological, attachment-related, or
sociocultural) for this specific effect.

The relationship between certain forms of child maltreatment and later self-dysfunction suggests
the potential benefit of addressing childhood emotional and sexual abuse in the treatment of self-
disturbance. This may include interventions that involve the activation and processing of
negative abuse- or neglect-related self-schemas in the context of an ongoing therapeutic
relationship (Briere and Scott, 2006; Pearlman and Courtois, 2005), and/or that focus on the
specific results of such maltreatment, such as cognitive distortions, negative self-perceptions, and
affect skill deficits (Cloitre et al., 2002, 2006; Follette and Ruzek, 2006; Linehan, 1993). In
either instance, increasing clinical awareness of the possible maltreatment-related etiology of
adult self-capacity disturbance is likely to increase the specificity of psychological interventions
in this area.

The present findings should be viewed in light of the methodology of this study. First, the sample
consisted solely of nonclinical participants and thus may not generalize completely to clinically
presenting individuals. Because the level of both trauma exposure and self-capacity problems
may have been less severe than what is typically found in clinical groups (Briere, 2000), the
current study may underestimate phenomena (e.g., relational difficulties) and associations that
are more visible in help-seeking individuals. On the other hand, use of a general population
sample may have reduced the effects of unmonitored, yet potentially biasing variables (e.g.,
socioeconomic/demographic status) more relevant to clinical samples. Second, the relatively low
return rate for this study increases the likelihood that the data reported here are not fully
representative of the general population—instead merely constituting a relatively large sample of
nonclinical individuals who were not selected on the basis of any specific dependent or
independent variable. Third, the cross-sectional nature of this study means that the influence of
certain potentially confounding variables cannot be entirely ruled out. For example, some
abusive or neglectful behaviors may arise in the context of parental psychopathology that, in
turn, may be genetically transmissible—potentially augmenting the correlation between abusive
parental behavior and children's psychological symptoms. Finally, the retrospective self-report
nature of this study introduces potential confounds associated with under- or overreporting of
trauma exposure and/or symptomatology, although the anonymous nature of this survey is likely
to have reduced any secondary gain for response distortion.

In conclusion, the current results highlight the potential role of certain forms of childhood
maltreatment in the development of identity disturbance, affect dysregulation, and relationship
problems. Although subject to the interpretive constraints of any cross-sectional study, they
especially suggest that maternal emotional abuse, paternal emotional nonsupport, and childhood
sexual abuse are specific, independent risk factors for self-disturbance. These data join other
recent studies (see reviews by Erickson and Egeland [2002] and Hart et al. [2002]) that highlight
the probable negative impacts of emotional abuse and neglect above and beyond the more
established detrimental effects of childhood sexual and physical maltreatment.

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Key Words: Self-capacities; affect regulation; trauma; child abuse; IASC