Psychological maltreatment can include terrorizing, belittling or neglecting a child, the pediatrician authors say.
"We are talking about extremes and the likelihood of harm, or risk of harm, resulting from the kinds of behavior that make a child feel worthless, unloved or unwanted," Harriet MacMillan, one of the three pediatrician authors, told reporters.
What makes this kind maltreatment so challenging for pediatricians and for social services staff, however, is that it's not defined by any one specific event, but rather by the nature of the relationship between caregiver and child. That makes it unusually hard to identify.
Keeping a child in a constant state of fear is abuse, for example. But even the most loving parent will occasionally lose their cool and yell. Likewise, depriving a child of ordinary social interaction is also abuse, but there's nothing wrong with sending a school-aged boy to stew alone in his room for an hour after he hits a younger sibling.
All of this means that, for an outsider who observes even some dubious parenting practice, it can be hard to tell whether a relationship is actually abusive, or whether you've simply caught a family on a bad day.
Psychological abuse can also include what you might call "corrupting a child" — encouraging children to use illicit drugs, for example, or to engage in other illegal activities.
In their Pediatrics paper, MacMillan and co-authors say that 8% to 9% of women and 4% of men reported severe psychological abuse in childhood when the question was posed in general-population surveys of the U.S. and Britain.
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