Need Help? Contact us via phone or e-mail. Your Feedback
login / join us


From Maltreatment to Psychiatric Disorders in Childhood and Adolescence: The Relevance of Emotional Maltreatment

Sage journals

Franziska.Schlensog-SchusterJan Keil 


Different forms of maltreatment are thought to incur a cumulative and non-specific toll on mental health. However, few large-scale studies draw on psychiatric diagnoses manifesting in early childhood and adolescence to identify sequelae of differential maltreatment exposures, and emotional maltreatment, in particular. Fine-grained multi-source dimensional maltreatment assessments and validated age-appropriate clinical interviews were conducted in a sample of N = 778 3 to 16-year-olds. We aimed to (a) substantiate known patterns of clinical outcomes following maltreatment and (b) analyse relative effects of emotional maltreatment, abuse (physical and sexual), and neglect (physical, supervisory, and moral-legal/educational) using structural equation modeling. Besides confirming known relationships between maltreatment exposures and psychiatric disorders, emotional maltreatment exerted particularly strong effects on internalizing disorders in older youth and externalizing disorders in younger children, accounting for variance over and above abuse and neglect exposures. Our data highlight the toxicity of pathogenic relational experiences from early childhood onwards, urging researchers and practitioners alike to prioritize future work on emotional maltreatment.

Child maltreatment ranks among the childhood adversities with the most pathogenic impact on mental health from adolescence onwards (McLaughlin et al., 2012). Yet, routine clinical practice and research predominantly focus on maltreatment exposures with more visible signs, such as physical abuse, and their mental health sequelae (Li et al., 2016). Conversely, despite their higher prevalence (Stoltenborgh et al., 2012), “hidden” subtypes, such as neglect and emotional maltreatment, have been vastly understudied (Thyen, 2008). Emotional maltreatment (EM) – also known as psychological maltreatment and mental cruelty – is difficult to define, detect and operationalize both in research and clinical practice (Baker & Brassard, 2019Hart et al., 2017). Additionally, a tendency to minimize or underestimate EM may affect reports of caregivers and professionals as well as child protection service (CPS) records, calling for a multi-source approach in this area (Baker et al., 2021Sierau et al., 2017). Correspondingly, despite substantial literature on physical and sexual abuse, major gaps still exist regarding the patterns of clinically relevant diagnostic outcomes of EM as well as their potential age-dependency (Cicchetti & Toth, 2016). While some recent work highlights the immediate risk for psychiatric disorders following maltreatment in early childhood (Winter et al., 2022), other work points to delayed effects (Andersen, 2016) as well as a more pervasive impact of maltreatment during adolescence (e.g., Thornberry et al., 2010). The present study seeks to address this imbalance in the literature by analyzing the relative influence of EM as compared to physical and sexual abuse as well as neglect on diagnostic outcomes among youth ranging from 3 to 16 years, with both maltreatment and clinical assessments indexed by detailed and age-appropriate reliable and valid instruments.