Emotional Abuse

Intergenerational Transmission

Even when there is no maltreatment (incl. neglect and emotional abuse), children of parents with abuse histories are more likely to have psychopathology in adulthood. Referred to as "the transmission gap."

Secure Child

Explores room and toys with interest in pre-separation episodes. Shows signs of missing parent on separation, often crying by the second separation. Obvious preference for parent over stranger. Greets parent actively, usually initiating physical contact. Usually some contact-maintaining by second reunion, but then settles and returns to play.

Expressed Emotion

Expressed Emotion: Hostility, over-involvement, critical comments. -Hostility: suggestions that symptoms are under patient's control; that not getting better is willful -Over-involvement: exaggerated concern for patient, exaggerated expressions of self-blame for illness. -Criticism: May take form of blaming comments that families believe are helping the patient. Highly predictive of first-onset and relapse

FCAPTA

Federal Child Abuse Prevention and Treatment Act -Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation; or -An act or failure to act which presents an imminent risk of serious harm. -Does not distinguish between acts of omission and acts of commission.

Interpretation of Behavior

How a child interprets the behavior of their parents will predict how they respond to the situation.

Bromberg

Little t counts because, "The loss of any of these processes will lead us to split off parts of our self."

Historical EA

Much of psychoanalysis has focused on such events and has done so at the expense of "big T" trauma. Focus has been on understanding parent's needs and socially-unacceptable urges. E.g., the super-ego which controls the Id Argues that insight is key to healing CBT has less traditionally focused on the loss of self and its origins.

Why might attachment be passed on?

Parent's unresolved trauma generates odd or frightening behaviors. -Vulnerability -Anxiety -Over-protectiveness -Over-indulgent -Dissociative -Transient Anger

Old Theories of EA

-"Refrigerator Mothers" -Schizophrenogenic parenting.

International Adoption

-2% of kids under 18 are living with adoptive families -But constitute 10-15% of kids in inpatient settings. -About 10,000 kids per year come to the US from orphanages. -At least 8 months spent in orphanages.

Frequency of Neglect

-64% of substantiated protective services cases -In kids up to age 4, ¾ of substantiated cases are neglect -At least 42% of cases of death due to child maltreatment are due to neglect -Increases risk for cognitive problems

Where does neglect occur?

-Areas of poverty -Where families have no support -When parents have mental illness, substance abuse problem or developmental disability -In orphanages and juvenile detention centers

Why develop attachment strategies?

-Attachment occurs in dyad. -We develop the strategies which get our needs met within the dyad.

Attachment-Focused Intervention

-Beebe: Looming, intruding Providing feedback to parents about what to expect from their children. -Helping parents recognize triggers and stay present. -Child-parent psychotherapy

Overlooked forms of EA

-Bullying...especially among girls. -LGBT Dutton, 1994; Kelly, 1986: Lesbian couples report higher emotional abuse than gay men or straight couples. Bisexual women report more EA from female partners. -Workplace Huerta et al. showed that sexual harassment was related to PTSD.

Physiology of Neglect

-Delayed motor, hyperactivity, growth delays -Quevedo: Even at age 12, adopted kids still show blunted cortisol and startle -Teicher: Decreased brain volume, corpus callosum volume

Considerations in EA

-Developmental Considerations -Inescapability -Beware the "perfect childhood"...Goldsmith & Freyd: Many who meet criteria for EA do not classify their parents' behavior as abusive.

Attunement

-Exercises oxytocin and vagus. -Develops agency and empathy. -Babies have little control over their heart rate. Adults match, too. -We mirror and imprint behavior. So, what we mirror matters.

Dimensions of EA

-Gaslighting -Hostility, Criticism, and Intrusiveness ("expressed emotion") -Withdrawal of affection -Controlling thoughts/behaviors -Parentification/role inversion (little t) -Shaming/denying needs

Measuring Neglect

-I didn't have enough to eat. -I knew there was someone to take care of me and protect me. -My parents were too drunk or high to take care of the family. -There was someone in my family who helped me feel important or special. -I had to wear dirty clothes. -I felt loved. -People in my family looked out for each other. -People in my family felt close to each other. -There was someone to take me to the doctor if I needed it.

Measurements of EA in Kids

-I knew there was someone to take care of me and protect me. -People in my family called me things like "stupid", "lazy", or "ugly". -There was someone in my family who helped me feel important or special. -I thought that my parents wished I had never been born. -People in my family said hurtful or insulting things to me. -I felt that someone in my family hated me.

Measurements of EA

-I showed my partner I cared even though we disagreed. -I explained my side of a disagreement to my partner. -I insulted or swore at my partner. -I showed respect for my partner's feelings about an issue. -I called my partner fat or ugly. -I destroyed something belonging to my partner. -I shouted or yelled at my partner. -I stomped out of the room or house or yard during a disagreement. -I accused my partner of being a lousy lover.

Cultural Views of EA

-Kids as property -Kids as sub-human -Kids as resilient -Patriarchy -Protestant world views

Fox

-Kids in orphanages randomly placed with trained families -Baseline IQ: 77 (21 months) -Any adoption IQ: 85 (42 months) -Specialized adoption IQ: 103 -Distractibility remained

Negative Effects in Adulthood

-Lose 1 month of growth per 3 months of institution care -Early onset puberty -Distractibility

Manifestations of Little t

-Over-looking another person's humanity -Humiliation -Contempt -Dominating -The salience or impact of an event is idiosyncratic

Dyads of Abuse

-Peers -Siblings -Parent-Child -Parent-Grandparent -Spousal/Partner -Bosses

Types of Neglect

-Physical -Medical -Emotional -Educational

Levels of Neglect

-Physical needs -Basic stimulation to support motor, language, cognitive, perceptual development. -Relational needs

Social and Emotional Competence of Neglect

-Poor social understanding -Odd behavior -Low empathy -Flat presentation -No "internal world" or imagination -Lacking spontaneity -Odd attachment behavior -Loss of positive affect

EA Synonyms

-Psychological abuse -Verbal abuse

Impact of Neglect

-Self-regulation/soothing -Emotion/communication -Cognitive deficits/retardation -Physical retardation/failure to thrive -Food hoarding

Controversies in EA

-The controversy cuts both ways: -On the one hand, fights, yelling etc. can be normative. -Not every bad communication is abuse -On the other hand, emotional abuse is not recognized as trauma.

Outcomes of Little t

-Two routes unified by dissociation: Depression/Over-achieving; Entitlement/Narcissism -Both are characterized by splitting off one's memories of pain and one's vulnerability and needs.

Dutra et al.

Emotional Abuse and Parental Hostility predicted adult dissociation.

Tiger Moms (Amy Chua)

"What Chinese parents understand is that nothing is fun until you're good at it. To get good at anything you have to work, and children on their own never want to work, which is why it is crucial to override their preferences. This often requires fortitude on the part of the parents because the child will resist"..."Chinese parents can get away with things that Western parents can't. Once when I was young—maybe more than once—when I was extremely disrespectful to my mother, my father angrily called me "garbage" in our native Hokkien dialect. It worked really well. I felt terrible and deeply ashamed of what I had done. But it didn't damage my self-esteem or anything like that. I knew exactly how highly he thought of me. I didn't actually think I was worthless or feel like a piece of garbage."..."As an adult, I once did the same thing to Sophia, calling her garbage in English when she acted extremely disrespectfully toward me. When I mentioned that I had done this at a dinner party, I was immediately ostracized. One guest named Marcy got so upset she broke down in tears and had to leave early. My friend Susan, the host, tried to rehabilitate me with the remaining guests. The fact is that Chinese parents can do things that would seem unimaginable—even legally actionable—to Westerners. Chinese mothers can say to their daughters, "Hey fatty—lose some weight."

Educational Neglect

(e.g., failure to educate a child or attend to special education needs)

Physical Neglect

(e.g., failure to provide necessary food or shelter, or lack of appropriate supervision)

Medical Neglect

(e.g., failure to provide necessary medical or mental health treatment)

Emotional Neglect

(e.g., inattention to a child's emotional needs, failure to provide psychological care, or permitting the child to use alcohol or other drugs)

Avoidant Child

(or Dismissing) Fails to cry on separation from parent. Actively avoids and ignores parent on reunion, i.e., by moving away, turning away, or leaning out of arms when picked up. Little or no proximity or contact seeking, no distress, and no anger. Response to parent appears unemotional. Focuses on toys or environment thought procedure.

Avoidant Adult

(or Dismissing) Not coherent. Dismissing of attachment-related experiences and relationships. Normalizing ("excellent, very normal mother"), with generalized representations of history unsupported or actively contradicted by episodes recounted. Transcripts also tend to be excessively brief, violating the maxim of quantity.

Resistant Child

(or Preoccupied) May be wary or distressed even prior to separation, with little exploration. Preoccupied with parent throughout procedure, may seem angry or passive. Fails to settle and take comfort in parent on reunion, and usually continues to focus on parent and cry. Fails to return to exploration after reunion.

Resistant Adult

(or Preoccupied) Not coherent. Preoccupied with or by past attachment relationships/experiences, speaker appears angry, passive, or fearful. Sentences often long, grammatically entangled or filled with vague usages ("dadadada", "and that"). Transcripts often excessively long, violating.

Disorganized Adult

(or Unresolved) During discussions of loss or abuse, individual shows striking lapse in the monitoring of reasoning or discourse. For example, individual may briefly indicate a dead person is believed still alive in the physical sense, or was killed by a childhood thought. Individual may lapse into prolonged silence, or eulogistic speech.

Disorganized Child

(or Unresolved) The infant displays disorganized and/or disoriented behaviors in the parent's presence, suggesting a temporary collapse of behavioral strategy. For example, the infant may freeze with a trancelike expression, hands in air; may rise at parent's entrance, then fall prone and huddled on the floor; or may cling while crying hard and leaning away with gaze averted.

What is Trauma?

An event or events involving actual or threatened death, serious injury, or threat to physical integrity. The individual's response includes intense fear, helplessness or horror. --DSM-IV

Drama of the Gifted Child

Because of their own dissociated painful memories of being treated with contempt, parents overlook their children's needs by -Contempt, treating needs as weakness -Getting their own care-taking or self-esteem from their children, disregarding kids' emotions -As a result, children learn that needs are unacceptable, that they must be who someone wants them to be in order to be loved -To get rid of parts of themselves which might be unacceptable to others. -Miller's goal is to help people find their actual feelings and wishes, buried beneath what others want them to feel.

Secure Adult

Coherent, collaborative discourse. Valuing of attachment, but seems objective regarding any particular event/relationship. Description and evaluation of attachment-related experiences is consistent, whether experiences are favorable or unfavorable.

Communication in Schizophrenic Families

Communication in patient's families: less coherent, direct. -Fears about patients' violations of social norms may exacerbate poor communication (Kymaliainen, 2008) -Reminder: What is the "borderline" in borderline?

Cycle of Violence

Remember: -Increased risk of maltreatment after experiencing childhood abuse. -Even in the absence of overtly abusive behaviors, parents may be emotionally cruel or dismissive of a child's needs.

Kohut

Self Psychology... Little t counts because, "To develop into healthy adults, we need: -Mirroring -Twinship -Idealized figures"

Failure to Thrive

The child's weight, height, and motor development fall significantly short of average growth rates: lower 5% not due to endogenous factors.

Little t

The subtle, persistent ways in which one is treated which convey that one's self or parts of one's self are unacceptable and will result in abandonment, and must therefore be hidden from oneself and from the world. Rather than fear or horror, these experiences are mostly centered around shame, a sense of badness, and a fear of abandonment.

Attachment

Without intervention, most people stay in the same attachment style from 18 months through adulthood.

Neglect

is the failure of a parent, guardian, or other caregiver to provide for a child's basic needs.