When a child gets a "boo-boo," parents respond promptly with a Band-Aid and sympathy. If we see someone in the grocery store hit their child, we shake our heads and question their parenting skills, and perhaps report them to child services. But when parents ignore their kids' mental and emotional needs, we often don't even notice - and if we do, we look the other way. Why do physical hurts grab our attention so much more than emotional ones? Perhaps it is because emotional pain is less tangible and the effects less immediate and obvious. Yet many children report that psychological abuse is worse than hitting. Recent research in the journal Pediatrics confirms this sentiment, showing that psychological abuse can be as damaging to a child's well-being as physical abuse. According to the American Academy of Pediatrics, psychological abuse is the most common form of child abuse as well as the most challenging type to identify and address. What Is Psychological Abuse? Most parents occasionally raise their voices when they disapprove of their child's behavior. Does this rise to the level of psychological abuse? Probably not. In a 2003 study published in The Journal of Marriage and Family, 88 percent of families admitted shouting, yelling or screaming at their children. Abusive behavior, by contrast, is usually extreme and repeated often. "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," said Dr. Harriet MacMillan, a professor of psychiatry and behavioral sciences at McMaster University in Ontario, Canada. There is no clear definition of the type of behavior that rises to the level of psychological abuse. Examples of psychological abuse include: \tEmotional unresponsiveness (e.g., leaving an infant alone in a crib all day) \tCorrupting a child or putting them in a dangerous situation (e.g., doing drugs with a child or encouraging them to commit illegal acts) \tYelling at a child every day \tSending the message your child is a bad person \tAvoiding contact or communication with your child \tExposing a child to verbal abuse or domestic violence between parents or caretakers \tTelling a child they are unloved or unwanted \tThreatening to harm or abandon your child or destroy their possessions \tHumiliating a child in front of others \tUndermining the value of a child's feelings or opinions \tConstantly ridiculing or criticizing a child \tTreating a child like a servant \tHaving unrealistic or rigid expectations \tKeeping a child in a constant state of fear \tForcing a child to choose sides in a divorce \tDepriving a child of normal social interaction The Effects of Psychological Abuse Studies suggest that as many as 9 percent of women and 4 percent of men were exposed to severe psychological abuse as children. Psychological abuse has been linked with attachment disorders, behavioral problems, shorter life expectancy, and developmental, social and intellectual deficits. The effects are particularly damaging if the abuse occurs within the first three years of life. In addition to being harmful, abusive tactics often prove ineffective. Children as young as 4 or 5 stop responding to a parent's constant yelling. They also tend to display more aggressive, rebellious behavior, such as refusing to share or show empathy, and withdraw in social situations. Parents are more likely to engage in psychological abuse if they are chronically stressed, struggle with mental health issues such as depression or substance abuse, or if one or both parents are physically violent. Many don't even realize that their behaviors rise to the level of abuse or that they are doing irreparable harm to their child. As parents, we don't always agree with other parents' disciplinary practices. After all, there is a wide range of approaches that can be considered "normal." But if you suspect psychological abuse, err on the side of reporting it just as you would physical harm. Children's futures depend on all of us doing our part to understand, recognize and report this type of mistreatment.