Psychological abuse

Psychological abuse
Classification and external resources
Specialty
ICD-10	T74.3
ICD-9-CM	995.82
Patient UK	Psychological abuse

Psychological abuse, also referred to as psychological violence, emotional abuse or mental abuse, is a form of abuse characterized by a person subjecting or exposing another to behavior that may result in psychological trauma, including anxiety, chronic depression, or post-traumatic stress disorder. Such abuse is often associated with situations of power imbalance, such as abusive relationships, bullying, and abuse in the workplace.

Definitions

As of 1996, there are "no consensus views about the definition of emotional abuse." As such, clinicians and researchers have offered sometimes divergent definitions of emotional abuse. However, the widely used Conflict Tactics Scale measures roughly twenty distinct acts of "psychological aggression" in three different categories:

1. Verbal aggression (e.g., saying something that upsets or annoys someone else);
2. Dominant behaviors (e.g., preventing someone from contacting their family);
3. Jealous behaviors (e.g., accusing a partner of maintaining other parallel relations).

According to the University of Illinois counseling center, ″Emotional abuse is any kind of abuse that is emotional rather than physical in nature. It can include anything from verbal abuse and constant criticism to more subtle tactics, such as intimidation, manipulation, and refusal to ever be pleased. Emotional abuse can take many forms. Three general patterns of abusive behavior include aggressing, denying, and minimizing'.″ Even though there is no established definition for emotional abuse, emotional abuse can possess a definition beyond verbal and psychological abuse. Blaming, shaming, and name calling are a few identifiers of verbal abuse which can affect a victim emotionally. The victim's self-worth and emotional well being is altered and even diminished by the verbal abuse and the result is an emotionally abused victim. The victim may experience severe psychological effects. This would involve the tactics of brainwashing, which can fall under psychological abuse as well, but emotional abuse consists of the manipulation of the victim's emotions. The victim may feel their emotions are being affected by the abuser so much that the victim may no longer recognize what their own feelings are about issue/s the abuser is trying to control. The result is the victim's self-concept and independence are `systematically taken away.

The U.S. Department of Justice defines emotionally abusive traits as including causing fear by: intimidation, threatening physical harm to self, partner, children, or partner's family or friends, destruction of pets and property, forcing isolation from family, friends, or school or work. Subtler emotionally abusive tactics include insults, putdowns, arbitrary and unpredictable inconsistency, and gaslighting (the denial that previous abusive incidents occurred). Modern technology has led to new forms of abuse, by text messaging and online cyber-bullying.

In 1996, Health Canada argued that emotional abuse is "based on power and control", and defines emotional abuse as including rejecting, degrading, terrorizing, isolating, corrupting/exploiting and "denying emotional responsiveness" as characteristic of emotional abuse.

Several studies have argued that an isolated incident of verbal aggression, dominant conduct or jealous behaviors does not constitute the term "psychological abuse." Rather, a pattern of such behaviors is a more appropriate scenario to be considered, unlike physical and sexual maltreatment where only one incident is necessary to label it as abuse. Tomison and Tucci write, "emotional abuse is characterised by a climate or pattern of behavior(s) occurring over time [...] Thus, 'sustained' and 'repetitive' are the crucial components of any definition of emotional abuse." Andrew Vachss, an author, attorney and former sex crimes investigator, defines emotional abuse as "the systematic diminishment of another. It may be intentional or subconscious (or both), but it is always a course of conduct, not a single event."

Pathology

Prevalence

In intimate relationships

Main article: Domestic violence

Domestic abuse—defined as chronic mistreatment in marriage, families, dating and other intimate relationships—can include emotionally abusive behavior. Psychological abuse does not always lead to physical abuse, but physical abuse in domestic relationships is nearly always preceded and accompanied by psychological abuse. Murphy and O'Leary report that psychological aggression by one partner is the most reliable predictor of the other partner's likelihood of first exhibiting physical aggression.

A 2005 study by Hamel reports that "men and women physically and emotionally abuse each other at equal rates." Basile found that psychological aggression was effectively bidirectional in cases where heterosexual and homosexual couples went to court for domestic disturbances. A 2007 study of Spanish college students aged 18–27 found that psychological aggression (as measured by the Conflict Tactics Scale) is so pervasive in dating relationships that it can be regarded as a normalized element of dating, and that women are substantially more likely to exhibit psychological aggression. Similar findings have been reported in other studies. Strauss et al. found that female intimate partners in heterosexual relationships were more likely than males to use psychological aggression, including threats to hit or throw an object. A study of young adults by Giordano et al.found that females in intimate heterosexual relationships were more likely than males to threaten to use a knife or gun against their partner.

Numerous studies done between the 1980 and 1994 report that lesbian relationships have higher overall rates of interpersonal aggression (including psychological aggression/emotional abuse) than heterosexual or gay male relationships. Furthermore, women who have been involved with both men and women reported higher rates of abuse from their female partners.

In 1996, the National Clearinghouse on Family Violence, for Health Canada, reported that 39% of married women or common-law wives suffered emotional abuse by husbands/partners; and a 1995 survey of women 15 and over 36-43% reported emotional abuse during childhood or adolescence, and 39% experienced emotional abuse in marriage/dating; this report does not address boys or men suffering emotional abuse from families or intimate partners. A BBC radio documentary on domestic abuse, including emotional maltreatment, reports that 20% of men and 30% of women have been abused by a spouse or other intimate partner.

In the family

See also: Child abuse

Emotional abuse of a child is commonly defined as a pattern of behavior by parents or caregivers that can seriously interfere with a child’s cognitive, emotional, psychological, or social development. Some parents may emotionally and psychologically harm their children because of stress, poor parenting skills, social isolation, and lack of available resources or inappropriate expectations of their children. They may emotionally abuse their children because the parents or caregivers were emotionally abused during their own childhood. Straus and Field report that psychological aggression is a pervasive trait of American families: "verbal attacks on children, like physical attacks, are so prevalent as to be just about universal." A 2008 study by English, et al. found that fathers and mothers were equally likely to be verbally aggressive towards their children.

Choi and Mayer performed a study on elder abuse (causing harm or distress to an older person), with results showing that 10.5% of the participants were victims of "emotional/psychological abuse," which was most often perpetrated by a son or other relative of the victim. Of 1288 cases in 2002–2004, 1201 individuals, 42 couples, and 45 groups were found to have been abused. Of these, 70 percent were female. Psychological abuse (59%) and material/financial (42%) were the most frequently identified types of abuse.

In the workplace

Main article: Workplace bullying

Rates of reported emotional abuse in the workplace vary, with studies showing 10%, 24%, and 36% of respondents indicating persistent and substantial emotional abuse from coworkers.

Keashly and Jagatic found that males and females commit "emotionally abusive behaviors" in the workplace at roughly similar rates. In a web-based survey, Namie found that women were more likely to engage in workplace bullying, such as name-calling, and that the average length of abuse was 16.5 months.

Pai and Lee found that the incidence of workplace violence typically occurs more often in younger workers. "Younger age may be a reflection of lack of job experience, resulting in [an inability] to identify or prevent potentially abusive situations... Another finding showed that lower education is a risk factor for violence." This study also reports that 51.4% of the workers surveyed have already experienced verbal abuse, and 29.8% of them have encountered bullying/mobbing within the workplace.

Characteristics of abusers

In their review of data from the Dunedin Multidisciplinary Health and Development Study (a longitudinal birth cohort study) Moffitt et al. report that while men exhibit more aggression overall, sex is not a reliable predictor of interpersonal aggression, including psychological aggression. The study found that no matter what gender this person is, aggressive people share a cluster of traits, including high rates of suspicion and jealousy; sudden and drastic mood swings; poor self-control; and higher than average rates of approval of violence and aggression. Moffitt et al. also argue that antisocial men exhibit two distinct types of interpersonal aggression (one against strangers, the other against intimate female partners), while antisocial women are rarely aggressive against anyone other than intimate male partners.

Male and female perpetrators of emotional and physical abuse exhibit high rates of personality disorders, particularly borderline personality disorder, narcissistic personality disorder, and antisocial personality disorder. Rates of personality disorder in the general population are roughly 15%-20%, while roughly 80% of abusive men in court-ordered treatment programmes have personality disorders.

Abusers may aim to avoid household chores or exercise total control of family finances. Abusers can be very manipulative, often recruiting friends, law officers and court officials, even the victim's family to their side, while shifting blame to the victim.

Effects

In intimate relationships

Most victims of psychological abuse within intimate relationships often experience changes to their psyche and actions. This varies throughout the various types and lengths of emotional abuse. Long-term emotional abuse has long term debilitating effects on a person's sense of self and integrity. Often, research shows that emotional abuse is a precursor to physical abuse when three particular forms of emotional abuse are present in the relationship: threats, restriction of the abused party and damage to the victim's property.

Psychological abuse is often not recognized by survivors of domestic violence as abuse. A study of college students by Goldsmith and Freyd report that many who have experienced emotional abuse do not characterize the mistreatment as abusive. Additionally, Goldsmith and Freyd show that these people also tend to exhibit higher than average rates of alexithymia (difficulty identifying and processing their own emotions). This is often the case when referring to victims of abuse within intimate relationships, as non-recognition of the actions as abuse may be a coping or defense mechanism in order to either seek to master, minimize or tolerate stress or conflict. Analysis of a large survey by LaRoche based on Johnson's Typology found that women abused by men were slightly more likely to seek psychological help than men abused by women (63% vs. 62%).

Marital or relationship dissatisfaction can be caused by psychological abuse or aggression. In a 2007 study, Laurent, et al., report that psychological aggression in young couples is associated with decreased satisfaction for both partners: "psychological aggression may serve as an impediment to couples' development because it reflects less mature coercive tactics and an inability to balance self/other needs effectively." In a 2008 study on relationship dissatisfaction in adolescents Walsh and Shulman explain, "The more psychologically aggressive females were, the less satisfied were both partners. Interestingly, the unique importance of males' behavior was found in the form of withdrawal, a less mature conflict negotiation strategy. Males' withdrawal during joint discussions predicted increased satisfaction."

There are many different responses to psychological abuse. Jacobson et al. found that women report markedly higher rates of fear during marital conflicts. However, a rejoinder argued that Jacobson's results were invalid due to men and women's drastically differing interpretations of questionnaires. Coker et al. found that the effects of mental abuse were similar whether the victim was male or female. A 1998 study of male college students by Simonelli & Ingram found that men who were emotionally abused by their female partners exhibited higher rates of chronic depression than the general population. Pimlott-Kubiak and Cortina found that severity and duration of abuse were the only accurate predictors of after effects of abuse; sex of perpetrator or victim were not reliable predictors.

In the family

English, et al. report that children whose families are characterized by interpersonal violence, including psychological aggression and verbal aggression, may exhibit a range of serious disorders, including chronic depression, anxiety, post-traumatic stress disorder, dissociation and anger. Additionally, English et al. report that the impact of emotional abuse "did not differ significantly" from that of physical abuse. Johnson et al. report that, in a survey of female patients, 24% suffered emotional abuse, and this group experienced higher rates of gynecological problems. In their study of men emotionally abused by a wife/partner or parent, Hines and Malley-Morrison report that victims exhibit high rates of post traumatic stress disorder, drug addiction and alcoholism.

Glaser reports, "An infant who is severely deprived of basic emotional nurturance, even though physically well cared for, can fail to thrive and can eventually die. Babies with less severe emotional deprivation can grow into anxious and insecure children who are slow to develop and who have low self-esteem." Glaser also informs that the abuse impacts the child in a number of ways, especially on their behavior, including: "insecurity, poor self-esteem, destructive behavior, angry acts (such as fire setting and animal cruelty), withdrawal, poor development of basic skills, alcohol or drug abuse, suicide, difficulty forming relationships and unstable job histories." Also, these children often grow up to become parents who abuse their own children, either emotionally or otherwise, due to the child's development being impaired in all domains of functioning.

Oberlander, et al. performed a study which discovered that among the youth, those with a history of maltreatment showed that emotional distress is a predictor of early initiation of sexual intercourse. Oberlander, et al. state, "A childhood history of maltreatment, including...psychological abuse, and neglect, has been identified as a risk factor for early initiation of sexual intercourse...In families where child maltreatment had occurred, children were more likely to experience heightened emotional distress and subsequently to engage in sexual intercourse by age 14. It is possible that maltreated youth feel disconnected from families that did not protect them and subsequently seek sexual relationships to gain support, seek companionship, or enhance their standing with peers." It is apparent that psychological abuse sustained during childhood is a predictor of the onset of sexual conduct occurring earlier in life, as opposed to later.

In the workplace

Sexual harassment is a form of psychological abuse of a sexual nature. For the victims of sexual harassment, negative psychological and emotional effects often occur. Some studies tend to focus on psychological abuse within the workplace. Namie's study of workplace emotional abuse found that 31% of women and 21% of men who reported workplace emotional abuse exhibited three key symptoms of post-traumatic stress disorder (hypervigilance, intrusive imagery, and avoidance behaviors). The most common psychological, professional, financial, and social effects of sexual harassment and retaliation are as follows:

• Psychological stress and health impairment, loss of motivation
• Decreased work or school performance as a result of stressful conditions; increased absenteeism in fear of harassment repetition
• Having to drop courses, change academic plans, or leave school (loss of tuition) in fear of harassment repetition and/or as a result of stress
• Being objectified and humiliated by scrutiny and gossip
• Loss of trust in environments similar to where the harassment occurred
• Loss of trust in the types of people that occupy similar positions as the harasser or his/her colleagues, especially in cases where they are not supportive, difficulties or stress on peer relationships, or relationships with colleagues
• Effects on sexual life and relationships: can put extreme stress upon relationships with significant others, sometimes resulting in divorce
• Weakening of support network, or being ostracized from professional or academic circles (friends, colleagues, or family may distance themselves from the victim, or shun him or her altogether)
• Depression, anxiety and/or panic attacks
• Sleeplessness and/or nightmares, difficulty concentrating, headaches, fatigue
• Eating disorders (weight loss or gain), alcoholism, and feeling powerless or out of control

Prevention

In intimate relationships

Recognition of abuse is the first step to prevention. It is often difficult for abuse victims to acknowledge their situation and to seek help. For those who do seek help, research has shown that people who participate in Intimate Partner Violence Prevention Program report less psychological aggression toward their targets of psychological abuse, and reported victimization from psychological abuse decreased over time for the treatment group.

There are non-profit organizations which provide support and prevention services, such as the Domestic Abuse Helpline for Men & Women (in the USA), operated by staff and trained volunteers to offer information and crisis intervention to victims of domestic violence.

In the family

Child abuse in the sole form of emotional/psychological maltreatment is often the most difficult to identify and prevent, as Child Protective Services is often the only method of intervention, and the institute "must have demonstrable evidence that harm to a child has been done before they can intervene. And, since emotional abuse doesn’t result in physical evidence such as bruising or malnutrition, it can be very hard to diagnose." Some researchers have, however, begun to develop methods to diagnose and treat such abuse, including the ability to: identify risk factors, provide resources to victims and their families, and ask appropriate questions to help identify the abuse.

In the workplace

The majority of companies within the United States provide access to a Human Resources department, in which to report cases of psychological/emotional abuse. Also, many managers are required to participate in conflict management programs, in order to ensure the workplace maintains an "open and respectful atmosphere, with tolerance for diversity and where the existence of interpersonal frustration and friction is accepted but also properly managed." Organizations must adopt zero-tolerance policies for professional verbal abuse. Education and coaching are needed to help employees to improve their skills when responding to professional-to-professional verbal abuse.

Popular perceptions

Several studies found double standards in how people tend to view emotional abuse by men versus emotional abuse by women. Follingstad et al. found that, when rating hypothetical vignettes of psychological abuse in marriages, professional psychologists tend to rate male abuse of females as more serious than identical scenarios describing female abuse of males: "the stereotypical association between physical aggression and males appears to extend to an association of psychological abuse and males". Similarly, Sorenson and Taylor randomly surveyed a group of Los Angeles, California residents for their opinions of hypothetical vignettes of abuse in heterosexual relationships. Their study found that abuse committed by women, including emotional and psychological abuse such as controlling or humiliating behavior, was typically viewed as less serious or detrimental than identical abuse committed by men. Additionally, Sorenson and Taylor found that respondents had a broader range of opinions about female perpetrators, representing a lack of clearly defined mores when compared to responses about male perpetrators.

When considering the emotional state of psychological abusers, psychologists have focused on aggression as a contributing factor. While it is typical for people to consider males to be the more aggressive of the two sexes, researchers have studied female aggression to help understand psychological abuse patterns in situations involving female abusers. According to Walsh and Shluman, "The higher rates of female initiated aggression [including psychological aggression] may result, in part, from adolescents' attitudes about the unacceptability of male aggression and the relatively less negative attitudes toward female aggression". This concept that females are raised with fewer restrictions on aggressive behaviors (possibly due to the anxiety over aggression being focused on males) is a possible explanation for women who utilize aggression when being mentally abusive.

Some researchers have become interested in discovering exactly why women are usually not considered to be abusive. Hamel's 2007 study found that a "prevailing patriarchal conception of intimate partner violence" led to a systematic reluctance to study women who psychologically and physically abuse their male partners. These findings state that existing cultural norms show males as more dominant and are therefore more likely to begin abusing their significant partners.

Dutton found that men who are emotionally or physically abused often encounter victim blaming that erroneously presumes the man either provoked or deserved the mistreatment of their female partners. Similarly, domestic violence victims will often blame their own behavior, rather than the violent actions of the abuser. Victims may try continually to alter their behavior and circumstances in order to please their abuser. Often, this results in further dependence of the individual on their abuser, as they may often change certain aspects of their lives that limit their resources. Studies show that emotional abusers frequently aim to exercise total control of different aspects of family life. This behavior is only supported when the victim of the abuse aims to please their abuser.

Many abusers are able to control their victims in a manipulative manner, utilizing methods to persuade others to conform to the wishes of the abuser, rather than to force them to do something they do not wish to do. Simon argues that because aggression in abusive relationships can be carried out subtly and covertly through various manipulation and control tactics, victims often don't perceive the true nature of the relationship until conditions worsen considerably.

Cultural causes

Some scholars argue that for hundreds or thousands of years, male dominated societies have created negative attitudes towards women among many men. They also state that wife abuse stems from "normal psychological and behavioral patterns of most men ... feminists seek to understand why men, in general, use physical force against their partners and what functions this serves for a society in a given historical context". Similarly, Dobash and Dobash claim that "Men who assault their wives are actually living up to cultural prescriptions that are cherished in Western society--aggressiveness, male dominance and female subordination--and they are using physical force as a means to enforce that dominance," while Walker claims that men exhibit a "socialized androcentric need for power".

While some women are aggressive and dominating to male partners, some studies show that the majority of abuse in heterosexual partnerships, at about 80% in the USA, is perpetrated by men. (Note that critics stress that this Department of Justice study examines crime figures, and does not specifically address domestic abuse figures. While the categories of crime and domestic abuse may cross-over, most instances of domestic abuse are either not regarded as crimes or reported to police—critics thus argue that it is inaccurate to regard the DOJ study as a comprehensive statement on domestic abuse.) A 2002 study reports that ten percent of violence in the UK, overall, is by females against males. However, more recent data specifically regarding domestic abuse (including emotional abuse) report that 3 in 10 women, and 1 in 5 men, have experienced domestic abuse.

Commentators argue that legal systems have in the past endorsed these traditions of male domination, and it is only in recent years that abusers have begun to be punished for their behavior. In 1879, Harvard University law scholar wrote, "The cases in the American courts are uniform against the right of the husband to use any chastisement, moderate or otherwise, toward the wife, for any purpose."

While recognizing that researchers have done valuable work and highlighted neglected topics critics suggest that the male cultural domination hypothesis for abuse is untenable as a generalized explanation for numerous reasons:

• Many variables (racial, ethnic, cultural and subcultural, nationality, religion, family dynamics, mental illness, etc.) make it difficult or impossible to define male and female roles in any meaningful way that apply to the entire population.
• Studies show that disagreements about power-sharing in relationships are more strongly associated with abuse than are imbalances of power.
• Peer-reviewed studies have produced inconsistent results when directly examining patriarchal beliefs and wife abuse. Yllo and Straus argued that "low status" women in the United States suffered higher rates of spousal abuse; however, a rejoinder argued that Yllo and Straus's interpretive conclusions were "confusing and contradictory". Smith estimated that patriarchal beliefs were a causative factor for only 20% of wife abuse. Campbell writes that "there is not a simple linear correlation between female status and rates of wife assault." Other studies had similar findings. Additionally, a study of Hispanic Americans revealed that traditionalist men exhibited lower rates of abuse towards women.
• Studies show that treatment programs based on the patriarchal privilege model are flawed due to a weak connection between abusiveness and one's cultural or social attitudes.
• Numerous empirical studies challenge the concept that male abuse or control of women is culturally sanctioned. Such studies show that abusive men are widely viewed as unsuitable partners for dating or marriage. A minority of abusive men qualify as pervasively misogynistic. The majority of men who commit spousal abuse agree that their behavior was inappropriate. A minority of men approve of spousal abuse under even limited circumstances. Furthermore, the majority of men are non-abusive towards girlfriends or wives for the duration of relationships, contrary to predictions that aggression or abuse towards women is an innate element of masculine culture.
• Dutton argues that the numerous studies establishing that heterosexual and gay male relationships have lower rates of abuse than lesbian relationships, and the fact that women who've been involved with both men and women were more likely to have been abused by a woman "are difficult to explain in terms of male domination." Additionally, Dutton suggests that "patriarchy must interact with psychological variables in order to account for the great variation in power-violence data. It is suggested that some forms of psychopathology lead to some men adopting patriarchal ideology to justify and rationalize their own pathology."

Influences from religion

Some argue that fundamentalist views of religions, which have developed in male-dominated cultures, tend to reinforce emotional abuse. A researcher states, "Gender inequity is usually translated into a power imbalance with women being more vulnerable. This vulnerability is more precarious in traditional patriarchal societies."

The Book of Genesis has often been cited as an example of a Christian text that has been used to justify men abusing women: "in sorrow thou shalt bring forth children: and thy desire shall be to thy husband, and he shall rule over thee."

Islam is also often criticized for the inequality of men and women observing the religion. Women who observe Islamic traditions frequently veil themselves with a hijab and also cover the rest of their bodies entirely with clothing. Western societies often remark on the inequality of women in Islamic cultures. The Quran addresses the issue of women covering their body: "Tell the believing woman to cast down their eyes, guard their chastity, and not to show off their beauty except what is permitted by the law. Let them cover their breasts with their veils. They must not show off their beauty to anyone other than their husbands, father, father-in-laws, sons..." This may lead readers to believe that the Quran only restricts women in sexual matters. Writers of 'Human Rights: new perspectives, new realities', however, state, "Contrary to common belief some quranic restrictions apply equally to men and women; the Quran advises both sexes to be chaste, avoid temptation, conceal their private parts, and "cast down their eyes...But, the Quran includes some more specific references to women's concealing."

Another religion in which women are perceived to be treated as inferior to men is that of Buddhism. Vinaya-pitaka section of the Tripitaka (Pali Canon) states that female Buddhists are referred to as bhikkuni (nun), while males are bhikku (monk). A nun has rules in addition to those given to a monk, which include subordination to monks; the most senior nuns are to be considered inferior to a monk on his first day. O'Brien includes information to state that this section of the Tripitaka is often disputed, as discrepancies between this section and the Pali Bhikkuni Vinaya (the section of the Pali Canon dealing with the rules for nuns) often arise. O'Brien concludes, "the more odious rules were added after the Buddha's death. Wherever they came from, over the centuries the rules were used in many parts of Asia to discourage women from being ordained." O'Brien later states that Buddhism today is striving for equality between the sexes, which shows that progress is slowly changing the perception of women in the Buddhist monasteries.

Critics also suggest that fundamentalist religious prohibitions against divorce make it more difficult for religious men or women to leave an abusive marriage: A 1985 survey of Protestant clergy in the United States by Jim M Alsdurf found that 21% of them agreed that "no amount of abuse would justify a woman's leaving her husband, ever," and 26% agreed with the statement that "a wife should submit to her husband and trust that God would honor her action by either stopping the abuse or giving her the strength to endure it."

See also

2