Evaluating and Reporting Emotional Abuse in Children: Parent-Based, Action-Based Focus Aids in Clinical Decision-Making

Abstract

Although physical and sexual abuses ate well recognized by the medical and legal systems, there has been difficulty and reluctance in addressing the issue of emotional abuse in children. This is unfortunate because all cases of physical abuse contain a coexisting emotional component whose impact may persist long after physical injuries have healed (Claussen and Crittenden, 1991; Hamarman and Ludwig, 2000). Furthermore, children may suffer emotional injuries in the absence of physical or sexual attacks. Emotional abuse distorts the processes of attachment and affective development (Pearl, 1994). Emotional abuse also may impair the child's capacity to develop appropriate emotional responses and may lead to lifelong emotional difficulties (Brothers, 1989; Ferguson and Dacey, 1997; Hart et al., 1998; Kent and Waller, 1998; McGee et al., 1997). Some of the difficulties in evaluating and reporting emotional abuse in children have derived from a lack of consensus definitions and guidelines delineating severities (American Professional Society on the Abuse of Children, 1995; Kaplan et al., 1999; Kavanagh, 1982; O'Hagan, 1995; Sedlakand Broadhurst, 1996; Thompson and Kaplan, 1996). For example, although the DSM-IVprovides diagnostic criteria for parent-child relational problems (V61.20), physicalabuse of child (V61.21), sexual abuse ofchild (V61.2l), and neglect ofchild (V61.21), there is no diagnosis for rhe emotional component of abuse (American Psychiatric Association, 1994). Similarly, neither the American Psychiatric Association nor the American Academy of Child and Adolescent Psychiatry has published practice parameters on the subject of emotional abuse of children. The intangible nature of emotional trauma makes medical and legal interventions troublesome, especially when similar