Emotional abuse and neglect (psychological maltreatment): a conceptual framework.

OBJECTIVE Emotional abuse and neglect is an under-recognized, but actually common, form of child abuse. Professionals in the field continue to find difficulty in recognizing and operationally defining it, and experience uncertainty about proving it legally. There are also questions about intervention and therapy to protect the child in the least detrimental manner. These difficulties have led to delays in recognition and protective intervention. Emotional abuse and neglect are defined as a carer-child relationship that is characterized by patterns of harmful interactions, requiring no physical contact with the child. Motivation to harm the child is not necessary for the definition. Unlike sexual abuse that is a secret activity, these forms of ill treatment are easily observable. The child's development is impaired in all domains of functioning but, not being specific to emotional abuse and neglect, cannot be regarded as diagnostic. METHOD Research, clinical experience and theoretical considerations have led to a conceptual framework and operational definitions of five categories of harmful interactions between parent and child. This framework is contrasted with the APSAC categories. RESULTS It is postulated that the different categories of ill treatment respectively require different therapeutic interventions. CONCLUSION Concerns about the presence of emotional abuse need to trigger an assessment process that includes identifying the nature of the abusive or neglectful interactions and a time-limited trial of specific interventions. The family's response to this process and its outcome will determine the need for statutory involvement, as well as providing a basis for litigation if this is required.