How can I recognize parental emotional abuse

3. Medical diagnosis and findings
- Forms of violence against children and young people

3.4. Psychological violence

Ulrich Rüth, Franz Joseph Freisleder

3.4.1. Definition and Epidemiology

The term “emotional abuse” includes attitudes, expressions and actions of caregivers, which overwhelm the child or the young person and give him the feeling of rejection and own worthlessness, which belittle the child or the child in a cynical or sadistic way threaten and terrorize (compare Engfer 1986, see also section 1.1.).

Serious rejection,
terrorize with fear, isolate

Essential aspects of mental abuse are (Garbarino and Vondra 1986):

  • Rejection: constant criticism of the child, belittling, scapegoating, ostentatiously preferring a sibling.
  • Terrorize: scare and intimidate the child with threats.
  • Isolate: Cut off the child from external contacts, convey the feeling of loneliness and abandonment, lock up.
example

A 7-year-old restless boy is constantly criticized for his restlessness, insulted, and portrayed by his parents as stupid and stupid to his older sister. If the school informs him about missing homework, he is locked in the cellar, whereby the parents know that the boy is very afraid of the dark and that they themselves did little to make sure that the homework was complete. In front of other adults, his difficulties are talked about in a derogatory manner, which contributes to increasingly depressive-resigned feelings and an intensification of the disruptive behavior. There are also aspects of neglect when the parents reject a proposed diagnosis for the child. Beating in the sense of physical violence is a matter of course for the boy.

Degradation of self-worth

In US-American literature, the term “emotional abuse” is used, which also includes less extreme forms of emotional abuse. In Germany, the term “emotional cruelty” is associated with an idea of ​​sadistic parenting behavior. But any behavior by attachment figures that lowers the self-worth of a child or adolescent is to be viewed as mental abuse.

3.4.2. Forms of mental abuse

When one speaks of "emotional abuse", one usually assumes that the parents or stepparents of the child concerned are the perpetrators. However, children and young people can also be emotionally abused by other adults, especially educational relatives or by their peers.

3.4.2.1. Mental abuse by parents

Mental abuse through attachment
people are particularly traumatized

Mental abuse by parents or close attachment figures is particularly serious because the necessary protection of the child is not granted by the attachment figures he or she loves and thus the emotional abuse is more traumatized than when it comes from people who are less close. In addition, the child is usually repeatedly exposed to psychological abuse and thus has no possibilities of self-efficacy as a means of coping with trauma. Overall, the long-term consequences of emotional abuse are more serious if they originate from parents or close caregivers.

3.4.2.2. Mental abuse by other caregivers

No apologies
mental abuse

In individual cases, the behavior of educational reference persons can reach the quality of mental abuse. However, competent parents who respond to their children and who believe and trust them can protect them well. It becomes more difficult if the child is not believed or the caregivers identify with the abusive educational authority figure and apologize for their behavior.

example

Contemptuous remarks by a teacher in front of the entire class with disparagement and ridicule torment a 13-year-old, unable-to-learn, overwhelmed student. He has a bad standing in the group anyway, and as an outsider is also exposed to active exclusion from his classmates. The teacher repeatedly asks him to contribute to the lesson he is unable to and asks him about content that he has not mastered. Correct answers are also rated as incorrect.

3.4.2.3. Mental abuse by other children or young people

Mobbing or bullying
by peers

Mental abuse by peers - such as B. "Mobbing" or "Bullying" (see also points 1.2. And 1.4.) - is often not communicated by the children and adolescents concerned because they see no way to avoid this form of abuse or the attempts by adults to help them have been disappointed.

"Mobbing" or "bullying" often affects children with a rather low self-esteem or who are already weak in the group. Physical stigma or illness can also contribute to exclusion. It should be borne in mind that emotional abuse among peers is associated with a high risk of physical abuse. Special forms of bullying can be found today through exclusionary, disregarding behavior in internet forums. Here, parents often know little about the activities and contacts of their children and can therefore not help them sufficiently, perhaps to protect themselves in advance.

example

A 12-year-old high school student is fixed on the floor by classmates in his class during the break. The leader pretends to kick him in the face. The scene regularly takes place when there are no adults to witness what the children are discussing with each other. At other times the boy is labeled derogatory, portrayed as being stupid and ridiculed. The teachers are overwhelmed with the class community. A teacher who is mentally stressed himself stands in front of the class crying because the situation is completely uncontrollable. The situation only becomes clear to the fullest extent when two socially competent girls refuse to receive further schooling in this class and refuse to attend classes.

3.4.2.4. Special forms of mental abuse

Mental abuse can also be present in a situational context that is not at all recognized by the caregiver, but is nevertheless responsible:

  • Inclusion of the child or the adolescent in existing partner conflicts with fueling a loyalty conflict for the child and thus an attack on the bond with the other parent.
    example

    An 11-year-old boy is alienated from his father, who has meanwhile been divorced from his mother and to whom there is a great emotional attraction, by the mother, who, contrary to actual circumstances, is affected by the difficult financial situation allegedly caused by the father, by physical attacks by the father in the History, terrorizing calls and hatred of the mother's boyfriend reported.

 

  • Exaggerated parental performance expectations of children and young people in the school context with massive restrictions on an age-appropriate lifestyle, e.g. B. by studying for hours from afternoon to evening.
    example

    A 13-year-old boy with learning disabilities has to practice at home for six to eight hours a day, because his parents want to “force” the successful attendance of a secondary school.

  • Involving a Child or Adolescent in Parental Problems in Parental Psychiatric Disorder. This can be the case with suicidality and delusion on the part of a parent, exposure to extreme parental mood swings, e.g. B. with parental personality disorders, or an addiction disease of the parents. The resulting emotional overload can reach the value of mental abuse.
    example

    A 16-year-old has to experience the marital conflict of her parents, who are accentuated in her personality, with mutual threats of suicide, but also threats to kill one another. During one of her mother's repeated suicide attempts, the emergency doctor, misjudging her age, advised her in an aside that it would be better not to be in the parents' household if there was a weapon or, in particular, a pistol.

    example

    A single mother suffering from psychosis tells her 9-year-old son in detail about her delusional system, tells him to avoid the dangerous radiation, and then, as with her last episode of illness, her moods and behavior are no longer understandable and foreseeable for the boy .

  • Excessive and inappropriate upbringing methods in children with child psychiatric disorders.
    example

    A motoristically restless, attention-disturbed elementary school pupil with difficulties in learning to read and write has to copy incorrect texts over and over again until they are free of errors - which he cannot succeed - and then receives house arrest as a punishment, which, however, gives him residual possibilities of his self-regulation through motor movement takes. Any irritation that occurs is then punished by the parents again with restrictive punishments and extensions of house arrest, which fuel the spiral of escalation in behavior.

  • If necessary help is not given to children with psychiatric problems, they can be exposed to excruciating demands on performance or demands on their behavior that cannot be met. Here there are transitions to neglect, since necessary diagnostic measures and perhaps also drug treatment are neglected.
    example

    The suggestion by the school to subject a learner, impaired primary school pupil to a performance diagnosis and to have a child psychiatric examination in order to provide him with sufficient help such as additional support, possibly medication and, if necessary, appropriate schooling, is rejected by the legal guardians. They explain that they have also made it through school themselves, that their son should just make an effort, be less lazy and not need any special treatment.

3.4.2.5. Mental abuse rarely occurs alone

Mental abuse often
Combination with other forms of abuse

Mental abuse is rarely the only form of abuse. For those who are prepared to abuse their child emotionally, the threshold to physical abuse is often lower. When there are references to emotional abuse, the possibility of physical and sexual violence and possibly neglect must always be considered. Mental abuse by other children can also be accompanied by physical violence, which must be taken into account when questioning.

Evidence of physical
Pay attention to penalties

Parents who punish their child a lot often try all forms of punishment. Abusive physical punishment in particular is often accompanied by additional emotional abuse through abuse and unjustified criticism and worthlessness. Parents don't beat up silently.

In the course of a physical examination, due to the connection between mental abuse and physical violence, discrete traces are particularly important and the explanatory models given for the consequences of injuries must be checked.

3.4.3. Examination and assessment

Mental abuse can
reinforce existing problems

The report on the abusive behavior is decisive for the assessment of the mental abuse. Observable psychological symptoms of emotionally abused children or adolescents are often caused by the abuse. However, pre-existing developmental disorders or child psychiatric problems may have triggered the abuse. Mentally abused children or adolescents have seldom internalized a secure bond. This makes them more vulnerable to unfavorable consequences of mental abuse in the direction of reduced self-esteem and a subsequent unfavorable spiral of development.

Since psychological symptoms are unspecific, the multitude of possible symptoms cannot be used to safely conclude that there was psychological abuse. At best, with observable, typical symptoms of a post-traumatic disorder with z. B. recurring nightmares of abusive situations, frightfulness, affective dysregulation, fears and dissociative symptoms, one could think of traumatizing experiences of violence if there is still no report on mental abuse.

3.4.4. documentation

Document statements verbatim

As with all forms of circumstances that are not “objective” but only reported, the most literal documentation of a statement is decisive (see also section 4.2.10.). This includes apparently unimportant details of the statement as well as the psychological state of the child or young person when making the statement. The documentation of details of the statement is of great importance because it can later support the credibility in a special way, especially when these details go beyond the actual content of the statement. Should spontaneous improvements occur, these should also be properly documented.

3.4.5. Consequences of mental abuse

In contrast to physical violence, one initially sees no consequences of the mental abuse in the child. At first, children do not distance themselves from their caregiver, and their ability to express themselves is often insufficient to report subtle variants of emotional abuse. Symptoms of emotionally abused children are often so unspecific that z. B. from a child's depression cannot be deduced from mental abuse.

How serious the resulting consequences are also depends on the child concerned [or Adolescents] and his personality. It is therefore particularly difficult to identify this form of abuse.

Recognizing emotional abuse
only possible via a value system

Identifying and objectively identifying psychological abuse is only possible through a binding system of values, which is based on an unconditional psychological integrity of the child in education and which regards this as central to the development of children. Therefore, multicultural, but also subcultural attitudes can contain other values ​​with regard to the child's well-being. Psychological abuse as a term can only be seen in the context of the respective surrounding society. At the same time, the term is also subject to historical development.

Mental abuse
in a historical and cultural context

Historical digression: It was not until the 1970s that the term “parental authority” was replaced by the term “parental custody”. And only after the turn of the millennium was a ban on violence in parental upbringing legally introduced. Swedish studies from the 1980s showed that the introduction of the ban on violence was accompanied by a decrease in corporal punishment, with a share of initially 75% to 50% of all children. Social attitudes and developments towards mental abuse should also be understood in their cultural and historical context. The behavior of parents and caregivers is assessed significantly differently today than it was 50 or even 100 years ago.

Do previous traumas
more prone to the consequences of abuse

The severity of the consequences of mental abuse for a child or adolescent depends on their age, mental state, possibly also on their intellectual abilities and the conceivable evasive and coping options, but also on the respective previous experience. Earlier traumas already experienced and subsequently experienced defenselessness make them more susceptible to future consequences of the trauma.

Attachment to abusers
initially to adjustment services

An existing bond with their abusers leads the emotionally abused children to adapt. Although they were locked up in the basement and were scared to death, they then present themselves as good and cheerful in order to avoid the threat of further abuse and to keep the unpredictable abuser "happy". Only when these children can no longer adapt do they show clearer symptoms, for example anxiety, panic reactions or even more difficult educational management or school failure.

But especially children who are originally impaired in their ability to adapt and self-regulation are increasingly becoming victims of mental abuse, which is all the more serious due to a low self-esteem.

If parents themselves name their aggressive or abusive behavior and thus open themselves to a discussion, the conditions for a change at the parent level are more favorable. If parents are willing to reflect on and change their behavior, they can be placed in specialist bodies such as youth welfare offices or other child and youth welfare institutions and services (e.g.Educational counseling center, offers from the child protection association, etc.) should be successful in defining and implementing further assistance (for the offers and services of child and youth welfare, see section 2.4.).

Unfavorable long-term prognosis
for the emotionally abused

In the long term, children and adolescents who have experienced mental abuse have significantly less favorable development opportunities than those who are not affected. In adulthood, mentally abused people are more likely to be victims of bullying or bullying or get into dysfunctional partner relationships. They are chronically restricted in their self-worth, their professional performance, but also in their personal development.

3.4.6. Case management in mental violence

Involvement of the youth welfare office

If mentally abusive behavior is observed or reported, but denied by the parents, there is usually little chance of intervention. It is precisely here that the involvement of third parties is necessary to clarify further necessary measures:

  • Advice with the youth welfare office (anonymously also possible),
  • if necessary, notification to the youth welfare office.

! Note:

For specific case management in detail, see also Chapter 4, for the framework conditions and prerequisites for interdisciplinary cooperation, see especially Chapter 2.

By law, the youth welfare office is the central point when it comes to questions of child protection and in particular the clarification of the existence of a child welfare risk as well as ensuring the child’s welfare. There is an obligation to involve the youth welfare office if, from a medical point of view, this is necessary to avert a risk to the child's welfare (for details, see sections 2.3.3. And 2.3.4.).

3.4.6.1. Basic intervention options

Parental behavior is decisive

If psychological abuse is found, the personality of the parents plays an important role in the further course of action.

  • If the parents concerned are known to have psychiatric illnesses, the parents' ability to control reality, the extent to which they are overwhelmed and the danger they pose must be assessed:
    • Consultation with the youth welfare office on how to proceed,
    • Obtaining information on the psychiatric treatment of the parents, consultation with the parents' practitioners (generally with the patient's consent).
  • If special personality disorders are known or suspected in the parents, the possibility of physical violence by the parents must always be considered in the case of sadistic behaviors, for example:
    • Physical examination, assessment,
    • Consultation with the youth welfare office on how to proceed, also depending on other findings.
  • If parents can name their own excessive demands and if their mentally abusive behavior is the repetition of their own experience, protection options for the child are given through special help measures by the child and youth welfare service:
    • Consultation with the youth welfare office on how to proceed.
    • Involvement of the youth welfare office also through the parents' own initiative, but then checking whether help has been accepted.

3.4.6.2. Mental abuse by parents or legal guardians

If there are indications of emotional abuse, the following must be checked:

  • Are the parents able to question their behavior and engage in alternative behaviors? Do you see your behavior as an overwhelming reaction or do you justify your behavior? Are you ready to accept educational help?
    If so:
    • Involvement of the youth welfare office on a voluntary basis with the aim of
      • educational help for parents,
      • Diagnosis and help for the affected child or adolescent through the cooperation of the parents.
  • Mentally abusive parents who are unwilling or unable to change their behavior endanger the child's well-being:
  • Involvement of the youth welfare office with joint advice on how to proceed,
  • Check whether it is necessary to take the child out of the family, even temporarily (taking into care by the youth welfare office, see section 2.4.3.).

3.4.6.3. Mental abuse by third parties

Can legal guardians
get active yourself

The following must be checked:

  • Are the parents / legal guardians able to recognize the abusive behavior and to intervene themselves to ensure the best interests of the child?
    • Involvement of the youth welfare office on a voluntary basis to support the parents in their efforts to protect the child.
    • If necessary, voluntary involvement of other helpers, e.g. B. child psychiatric diagnostics for help definition together with the youth welfare office.

3.4.6.4. Acute endangerment of the child's well-being - acute interventions

The more sadistic the mental abuse,
all the more likely other forms of violence

The following must be checked:

  • Do emotionally abused children or young people need to be protected from their parents immediately? Is there an acute form of danger? The more sadistic the mental abuse is, the greater the risk that further forms of violence will occur.
    • Consultation with the youth welfare office on how to proceed, if necessary taking the child or young person into care.
  • Which of the child's or adolescent's own disorders contributed to abusive parental behavior? What need for help is there due to child disorders? What current disorders are there now, what was pre-existing, what is the consequence of abuse?
When removed from the family
think about further diagnostics of the child!

Even if the child or adolescent is removed (for information on taking into care, see Section 2.4.3.), Further diagnostics must be considered in order to be able to define and implement specific help for the child or adolescent that goes beyond the acute measure:

  • Child and adolescent psychiatric diagnosis - treatment,
  • psychotherapeutic treatment / trauma treatment,
  • Modeling of the wider living environment (schooling, living situation),
  • Clarification of the relationship situation with the abusers, examination of the extent to which contact with them is helpful or harmful.
Table 8: Types of abuse, symptoms, findings and interventions
Abusers Forms of abuseSymptomsFindingsInterventions
parentsMental abuse when overwhelmed.Unspecific symptoms, e.g. T. Reinforcement of previously existing regulatory problems.Parents report their own behavior.Voluntary help possible.
Mental abuse as a result of parental personality problems.Unspecific symptoms, e.g. Initially adapted, but emotionally frozen children.- Abuse is reported casually at first. - Abuse is reported by the child when it has become unbearable.- Believe the child / young person. - Advice with the youth welfare office. - Check involuntary assistance. - Intervention, possibly even against the will of the parents.
Mental abuse in connection with other forms of abuse.- Traces of physical or sexual violence. - Other symptoms rather unspecific.- Abuse is reported when the child becomes unbearable. - Additional physical findings.- Advice with youth welfare office. - Check removal from family.
Other adultsReductions by educational reference persons.- Unspecific symptoms. - If necessary, refusal of contact with the reference person (school refusal). - Children / adolescents who are already weakened in self-esteem. - Parents who seem rather helpless towards institutions.- Parents don't believe their children enough. - Parents seem overwhelmed by the behavior of third parties.- Support parents in their trust in their children - Provide support for parents for their further course of action. - Advice with youth welfare office.
Other minorsBullying and bullying e.g. B. by schoolmates.- Children / adolescents who are already weakened in self-esteem. - Children / adolescents with problems in group integration. - Unspecific symptoms.- Children report to their parents too late. - Teachers realize the extent of the situation too late. - Parents are overwhelmed with the overall situation.- Promote contact between children / adolescents and caregivers. - Inform caregivers. - Advice with youth welfare office and school.

3.4.7. Case studies from practice

Case study 1

Even while she is still in kindergarten, a girl is regularly provided by her parents with clothes in which she is known to be ashamed. Attempts by the child to escape the clothing by wetting them are answered by the mother by purchasing several identical sets. When shopping in the city, the child sometimes has to wait for the mother “good” for hours at certain locations. A systematic demotivation begins in elementary school when the child is told that it is stupid, that it cannot learn, that it is no good anyway. At the same time, frequent pediatrician visits demonstrate the special level of care, and the child is frightened about medical issues. A child psychologist engaged in early adolescence is irritated by the child's destructive fantasies and their emotional distress, but is dazzled by the parents' perfect manners and their credible concerns about the emotional state of their daughter. Further therapy does not come about due to the refusal of the child given by the parents. In adolescence, the disrespectful behavior of parents increases. Relatives know about the child's plight, but do not see any opportunities for intervention if the care is externally very good. A befriended family repeatedly takes the young person in at short notice, but still does not experience the actual extent of the disparagement, disdain and demotion in the parental home. The parents want their daughter to be housed closed. However, due to their learning history, young people can show themselves to be so well adapted to the youth welfare office that the authorities offer outpatient assistance instead of closed accommodation. The parents do not accept the outpatient support services and there is no further support process. A handle for "compulsory" help in favor of the young people does not exist due to the information available from the youth welfare office. Only dropping out of school shortly before the age of majority and “fleeing” to a partner end the domestic emotional abuse. Due to her previous experience, the young person can no longer accept help from the youth welfare office. No further intervention is advised by the youth welfare office due to the age of the young people.

In the case of these young people, the environment and in some cases also professional helpers were aware of considerable educational grievances. In the case of externally good care, however, insufficient attention was paid to the possibility of serious emotional abuse. The actual extent of the mental abuse was therefore not recognizable, so that the necessary help did not come about.

Case study 2

A 12-year-old boy who was adopted from abroad with his brother is clearly degraded, degraded and described as bad and incompetent in his adoptive family compared to his brother. He is the family's scapegoat and is treated massively injustice to his brother, with the older brother spreading lies. The somewhat older brother is rather calm, very successful at school and adjusted in behavior. The 12-year-old shows a livelier temperament and certain problems at school, which further fuel a family dynamic of emotional exclusion, which subsequently becomes completely independent. The family's pediatrician sees the school situation on the one hand, but also the boy's behavioral problems, and urges a more detailed diagnosis, which is initially rejected. After consulting the pediatrician with the youth welfare office, the parents can be motivated to carry out an outpatient diagnosis. There, the mentally abusive situation at home is increasingly becoming apparent. The clinical evidence suggests at least further inpatient diagnostics, but also a removal of the boy from the family.

The parents do not want an inpatient admission on site. The father never appears in the chosen clinic, which is further away. There it becomes clear that the boy needs increased educational support in the meantime and that placement in a curative-therapeutic-oriented facility would make sense. Contact with the youth welfare office is initially refused by the mother and presented as not only unnecessary, but bypassing the need. After consultation and agreement with the youth welfare office regarding taking into care and signals from the boy that he does not want to return home, the overall situation is explained to the parents. These only superficially give in and ultimately refuse the necessary assistance, so that the youth welfare office brings about custody intervention via the family court. The parents remain unapologetic and blame the authorities as well as their boy and his supposed malevolence. Despite all the contradictions, the mother maintains a certain amount of contact with her adoptive son, who, with his full consent and is relieved, is placed in an institution by the youth welfare office.

With the help of a step-by-step approach and successful agreements between the experts involved, the parents' unwillingness to work together constructively and the necessary measures to ensure the child's well-being were successfully implemented.