A new study published in the American Psychological Association journal Psychological Trauma: Theory, Research, Practice and Policy suggests that psychological abuse during childhood can be just as damaging as physical or sexual abuse. Using information from the National Child Traumatic Stress Network Core Data Set, the researchers analyzed the mental health histories of 5,161 adolescents and pre-adolescents who experienced one or more forms of abuse as children. They discovered that childhood emotional abuse led to just as many mental health problems among the study subjects as physical or sexual abuse. Some disruptive or destructive behaviors were even more common in those with a history of psychological abuse compared to other forms of abuse. For the purposes of the study, the research team defined psychological abuse as \u201cbullying, terrorizing, coercive control, severe insults, debasement, threats, overwhelming demands, shunning and\/or isolation.\u201d Sixty-two percent of the study subjects experienced psychological abuse, and 24 percent experienced exclusively psychological abuse with no accompanying sexual or physical abuse. Some Problems More Common Among Psychological Abuse Victims Children who suffered exclusively psychological abuse showed similar rates of anxiety, depression, post-traumatic stress, low self-esteem and \u201csuicidality\u201d as children who suffered exclusively physical abuse or sexual abuse. The most common disorders seen among this population were major depressive disorder, general anxiety disorder, social anxiety disorder and substance abuse, and these concerns were associated more strongly with psychological abuse than with the two other forms of abuse. Certain problems such as behavioral problems at school, self-harming behavior and attachment issues were actually more common with psychological abuse. Children who suffered from both sexual abuse and physical abuse showed similar rates of these problems as children who experienced psychological abuse alone. The most severe psychological consequences were observed in children who had suffered from psychological abuse in addition to either sexual or physical abuse, or both. Even children who suffered from both sexual abuse and physical abuse did not typically face consequences as severe as the children who suffered psychological abuse and another form of abuse. The issues seen among these young people were frequently more numerous and more severe, and more likely to result in far-reaching consequences. Psychological Abuse Can Be Harder to Recognize and Address Despite the serious harm that results for psychological abuse, this form of abusive behavior toward children does not have the same kind of stigma as sexual or physical abuse. While physical punishment like whipping and spanking has fallen out of social favor, the line between verbal discipline and abuse can seem less plain. Abusive behaviors like shunning or isolating children can be even more insidious because they can be acted out without any vocal abuse. The results of psychological abuse are also much less obvious to outsiders. While bruises and other injuries that may result from chronic physical abuse are hard to disguise in the long run, the psychological scars from emotional abuse can be much more subtle, or harder to trace back to the source. Behavioral problems, anxiety or depression may not immediately suggest an abusive home the way repeated bruises or broken bones might. As study lead author Joseph Spinazzola, Ph.D., points out, even suspected cases of child abuse that are referred to child protective services can be short on clear evidence for psychological abuse or neglect. Without incontrovertible physical evidence, child protective services often have a difficult time proving their case and getting the authorities to take protective action.