Unseen Wounds: Understanding the Emotional and Behavioral Correlates of Psychological Abuse in Adolescents

Received 15 May, 2015

Accepted 13 Jun, 2017

Published 31 Dec, 2017

child abuse. Most previous studies concerning emotional and behavioral problems in abused adolescents are about reported cases. Little is known about the relationship between psychological abuse by parents in childhoods and behavioral, emotional problems in adolescence that had never been reported or even recognized. Therefore, aim of this research was to analyze the relationship of psychological abuse with emotional and behavioral problems of adolescents. Sample consisted of 300 adolescents with age range 13 to 17 years from both private and public schools. Psychological Maltreatment Experience Scale (Petretic-Jackson, Betz, & Pitman, 1995) and Youth Self- Report Form (Achenbach & Rescorla, 2001) were used to assess study variables. It was hypothesized that psychologically abusive parenting will have significant positive relation with behavioral problems in adolescents. Findings indicated a significant positive correlation between adolescents’ perception of psychological abuse (verbal abuse, withholding, terrorizing acts, neglectful, and exploitative acts) by both parents and their emotional behavioral problems. Regression analyses revealed that psychological abuse by both parents was found as significant predictors of internalizing, externalizing, and total problem behaviors. Present research may be a contribution in creating awareness among parents about the problem and may increase and complement the existing knowledge of professionals about damaging effect of parental abuse.

Recent researches have documented well established link between adolescents’ experiences of maltreatment and negative behavioral, psychological, and emotional outcomes in adolescence (Ireland, Smith, & Thornberry, 2002; Thornberry, Ireland, & Smith, 2001), and risk for psychiatric disorders, including mood and anxiety disorders (Phillips, Hammen, Brennan, Najman, & Bor, 2005), These well studied documents recommended that any exposure of maltreatment in adolescence increases the risks of many problems such as internalizing problems, externalizing problems, delinquency, and depressive symptoms. In a meta-analysis, Sternberg, Baraderan, Abbot, Lamb, and Guterman, (2006), found in 15 studies that abused children have internalizing and externalizing problems. However, most of the studies have done in developed nations; whereas, research on child abuse and neglect from developing countries is rare. In Pakistan there are not much researches looking into consequences of abuse in children and adolescents has, relatively few researches are done on psychosocial and family factors of abuse (Malik, 2001).

Almost 40 million children are abused worldwide every year and abuse occurs at every socioeconomic level, across all religions, within all cultures, and at every level of education (Butchart & Harvey, 2006). According to a report of UNICEF (2012), abused children and adolescents have more possibilities to face more negative and adverse outcomes throughout their life, such as, mental and physical health problems, relationship problems, behavioral and emotional problems including aggression, delinquency, and criminality.

Awareness about safety, health and rights of children have increased and revealed new prospects to study the difficulties they have to face in their progress (Wilmshurst, 2009). Due to growing information and knowledge, problem behaviors of adolescents have got considerable attention (Harrington, 2001; Rutters & Stevenson, 2008). These problems are very factual, hurting, expensive, and sources of straining and pressure for children, their relatives, families and societies as well (Cummins Mental Health Center; 2003). Behavioral problems, generally explained in psychology are particular behaviors opposite to the norm of community (Barlett, Holditch-Davis, & Belyea, 2005; Hirschi, 2002). These problems generally categorized either Externalizing behavior problems, refers to the problems that are manifested in children’s outward behavior, and reflect the child negatively acting on externalenvironment (Campbell, Shaw, Gillions, 2000; Eisenberg, Pidada, & Liew, 2001), such as disruptive, hyperactive, and aggressive behaviors (Hinshaw, 1987), and rule breaking, and hostility (Achenbach & Edelbrock, 1978). On the other hand, internalizing behavior problems included withdrawn, anxious, and depressed behaviors and it pertains to problems that centrally affect the child’s internal psychological environment rather than the external world (Campbell et al., 2000; Eisenberg et al., 2001).

The World Health Organization (WHO; 2002) recognized abuse as physical, psychological, sexual, neglect and commercial exploitation following the real or possible harm to child’s health, safety, growth, and self-respect. Psychological abuse (PA), the most thought provoking and prevailing type of child abuse is under recognized and under reported phenomena (Hibbard et al., 2012), in many cases found most damaging dimension (Barnett, Miller-Perrin, & Perrin, 2005; Trickett, Mennen, Kim, & Sang, 2009). PA may be committed by any individual outside the family, such as teachers, and /or peers but existing evidences and leading theories propose that PA is, generally, perpetrated by primary caregiver/parents in childhood or persistently throughout childhood and adolescence (D’Andrea, Ford, Stolbach, Spinazzola, & Vanderkolk, 2012). It may be described as a single event or series of behaviors of parent comprising threats, fear-provoking, refusal, aggression, teasing, accusing, and percipience against that makes the child feel “worthless, flawed, unloved, unwanted, endangered, or only of value in meeting another’s needs” (Chamberland, Fallon, Black, Trocme, & Chabot, 2012, p. 201).

Parental involvement, relations, and interaction with adolescents change during the period of adolescence and they have to face exceptional difficulties to evaluate the impact of parents (Shearer, Crouter, & McHale, 2005). In the period of separating and developing growing independence from parents, although they seem reserved and detached from parental norms but they are intensively influenced by the attitudes, norms, and behaviors of their parents and caregivers (Hazen, Schlozman, Beresin , 2008). It is significant to understand that PA should not be considered as dysfunctional parenting but categorized as long lasting and severe form of emotionally abusive and neglecting parenting linked with greater risk of psychological damage and destruction to child (Wolf & Mclsaac, 2011). In some families, incongruent and abusive parents criticize their children, give conditional love, and share unreliable moods to child, as well as rejection (Alfandary, 1993). The impact, abuse can have on children, has earned considerable research attention, but the breadth of the topic is so great that there is still much to be done to better understand its influence on children and society (Boxer & Terranova, 2008; Hildyard & Wolfe, 2002). Behavioral problems are one of the most damaging consequences in abused children as compare to non-abused children (Lansford et al., 2006; Mills et al., 2013).

Conceptually and methodologically, PA is very challenging to unpack, with respect to its incremental and possible unique influences and contribution to risk outcomes (Layne, Briggs-King, & Courtois, 2014). Parental acceptance-rejection theorists (Rohner & Rohner, 1980) suggested that rejection of parents toward children may happen in the form of aggressive, hostile, neglectful, and unresponsive behavior which may be perceived as PA. Developmental model proposed that children have to face particular developmental challenges to complete each stage of development. Abuse has prospective effects on their developmental tasks and these effects are influenced by the time of abuse type and experience (Manly, Kim, Rogosch, & Cicchetti, 2001); whereas, coercion theory (Peterson, Forgatch, Yoerger, & Stoolmiller, 1998) suggested that parent-child coercive relations contribute in the development of problem behaviors such as externalizing problems and parents become ineffective. PA can be explained with reference to the above mentioned theories as rejection and coercive relationship between parents and children are important aspect of it.

As compare to physical and sexual abuse, PA is rarely referred to any services agency for protection. There is limited research available in the area of child abuse with special reference to Pakistan, although government and private sector has increased interest in child abuse and its consequences. Pakistan is member of The United Nations Organization, The United Nations Children’s Fund (UNICEF) and The World Organization Against Torture, and Pakistan has appropriate laws to save children from every type of abuse and violence, but problem is that these laws are very poorly implemented. Observing all the factors, present research has basically focused on Pakistani adolescent living with both parents who have never been reported for problem behaviors as well as for abuse experiences. Present study evaluated abuse experiences from the victim’s perspective. Moreover, keeping in mind the importance and significance of issue of child abuse and its consequences, the idea of current research was established to explore the behavioral problems in adolescents who experienced abusive parenting. To assess the experiences of PA, five forms of abuse (verbal, neglect/rejection, withholding support, terrorizing, exploitation, and total psychological abuse), defined by Petretic-Jackson, Betz, and Pitman (1995) were analyzed.

Hypotheses
Following hypotheses were formulated.

1.	There will be significant positive relationship between perceived psychological abuse by father and emotional, behavioural problems in adolescents
2.	There will be significant positive relationship between perceived abuse by mother and emotional, behavioural problems in adolescents
3.	Psychological abuse will predict emotional, behavioral problems in boys and girls

METHOD

Sample
School going adolescents (N = 300), belonged to intact families (living with both parents) were selected from public and private schools of Lahore city. Age range of participants was 13-17 years (M = 14.8, SD = 2.31). Twelve secondary/high schools were selected from three towns of Lahore City District from the list provided by Lahore Education Directorate. The selected high schools were divided into three categories, only boys’ schools, only girls’ schools, and co-educational schools. Class teachers of adolescents of required age group were approached and briefed the research purpose. Initially a sample of 360) was selected from which 35 adolescents were not allowed by their parents to participate, ten adolescents refused to give data at the day of data collection and left questionnaire, and 15 forms were rejected due to incomplete information as they were not forced to complete the scales.

Instruments
Following measures/instruments were used to achieve the objectives of study.

Demographic information sheet. Demographic information considered in the present research was age in years, gender (male & female), number of siblings, birth order of the participant, parents’ information (age, education, profession, monthly income), and family system.

Psychological Maltreatment Experience Scale (PMES; Petretic-Jackson et al., 1995). This Likert scale comprised of 53 items with response options ranging from 1= never to 4 = very often assessing the frequency with which students were subjected to five types of psychological maltreatment; that is, Verbal Abuse on Self-Worth (16 items); Neglectful/Rejecting Behaviors (17 items); Withholding Supportive Behaviors (6 items); Minimizing, Isolating, and Terrorizing (9 items); and Exploitative Parental Behaviors (5 items) from primary caregivers was used. Scale was translated with a rigorous procedure into Urdu language with all protocols of translation and back translation. Translation was done with the help of standard dictionaries as well as bilingual experts of both Urdu and English. Reliability, validity, and inter-rater reliability were calculated. Scale was administered in two separate forms for father and mother. In the present study, Cronbach alpha for Urdu version of PMES was .96 for PA by mother and .95 for PA by father.

Youth Self Report (YSR; Achenbach & Rescorla, 2001). This scale consisted of 112 items used to measure emotional and behavioral problems of adolescents. YSR is scored on 3-point Likert scale, ranging from 0 = not true to 2 = very true. YSR consisted of different problem behavior scales; externalizing problems, internalizing problems and total emotional behavioral problems.

Procedure
Present research was carried out considering all ethical concerns. Topic of study was approved by Advance Board of Research and Studies of University of Punjab, Lahore, Pakistan. Permission from authors of scales, used in research, education department, authorities of public and private schools, selected for data collection, was taken. Every selected school was visited many times before the data collection. Class teachers of required age group were contacted through principal office. Teachers were explained the purpose and procedure of research. Principal and Teachers’ cooperation was highly appreciated as they cooperate with researcher in every respect. Researcher communicated with the class of required age group and explained them that what the research was aimed. They were explained that we have to select those children who have complains that their parents neglect or scold them or verbally harsh with them most of the time.

It was interesting that many students want to participate in research as in Pakistani culture these parental behaviors are very common. Schools provided us a separate class room to collect data. Researcher met the selected students and again explain them the purpose of research collectively as well as research objective was discussed individually. Adolescents, experienced any act, from any person, seemed sexually abusive were not included in the present sample. They were assured about confidentiality and privacy of their information as well as they will be free to withdraw from the research at any point. Then consent forms were given to selected adolescents so that they can take permission from parent. Every student was given the contact no of researcher as well as class teacher so that parents can ask any query regarding research and researcher. Parental consent to allow their child to participate in research was also taken. Participants were verbally briefed about research and then questionnaires were given to them. Researcher was present throughout the procedure of data collection to answer or clarify any query, participants may ask about study as well as to help them if they feel upset during the procedure of responding questionnaires.

RESULTS

Data was cleaned and screened prior to analysis. Data were analyzed for aforementioned hypothesis testing. To find the relationship between variables Pearson correlation was run and to find the significant predictors of problem behaviors, regression analysis was carried out.

Correlational analysis (see Table 1) discovered a significant positive relationship in adolescents’ experiences of abuse and their problem behaviors including internalizing and externalizing problems. Findings indicated that adolescents who perceive their parents more psychologically abusive exhibit significantly greater emotional and behavioral problems. Findings also indicated high correlation between types of psychological abuse.

Table 1:	Correaltion Matrix for Scores on Psychological Abuse and Problem Behaviours in Adolesents (N=300)
Note. Correlations Values Above Diagonal = Father Psychological Abuse and Problem Behaviors; Correlation Values Below Diagonal = Mother Psychological Abuse and Problem Behaviors **p<.01

Problem behaviors are also significantly correlated with each other, that is, there is comorbidity among problem behaviors.

Table 2:	Predicting Internalizing, Externalizing, and Total Problem Behaviors from Psychological Abuse by Parents (N = 300)
Note. PA = Psychological Abuse *p < .01

Regression analysis revealed that psychologically abusive father and mother appeared as significant factors of total emotional behavioral functioning in boys and girls. Internalizing and externalizing behavioral problems has also been considerably anticipated by both parent psychological abuse.

All required assumptions for regression analysis were tested before the analysis. Size of sample (N = 300) was appropriate for no of independent variables measured in study, that is 15 participants per predictor (Tabachnick & fidell, 2007). Singularity assumption was met and highly correlated independent variables were excluded from hierarchical regression. Sub variables of psychological abuse were not entered in analysis due to high inter-correlation in variables. Scatter plot and residuals of data indicated the assumption of normality, linearity, and homoscedasticity were satisfied (Pallant, 2001).

A two stage hierarchical multiple regression was conducted on internalizing, externalizing, and total emotional behavioral functioning. All nominal variables, e.g. education of father and mother were dummy coded. Demographic variables, income of family, family system (neuclear & joint), family size (small & large), education of father and mother were entered in first step and in second step psychological abuse by both parent was entered.

Table 3:	Demographic Variables and Psychological Abuse Predicting Internalizing, Externalizing, and Total Behavioral Functioning (N = 300)
Note. PA = Psychological Abuse *p < .01

The hierarchical multiple regression revealed that only one demographic factor, nuclear family system was found significant predictor, and significantly contributed in model and ccounted for 7% variance in internalizing problems. In the second stage, psychological abuse by both parents was found significant factors of internalizing problems and added in R² = .47, this change is significant. Together all significant factors contributed 46% variance in internalizing problems. Regression analysis for externalizing problems and total emotional behavioral functioning, two factors (large family and nuclear family) contributed 7% variance and one factor (nuclear family) contributed 6% variance; respectively. Moreover in second stage, psychological abuse by both parents significantly contributed in regression model for externalizing and total emotional behavioral functioning respectively.

DISCUSSION

Findings of present study enlighten the potential effects of psychological abuse, and revealed a robust association between experiences of parental psychological abuse and problem behaviors in adolescents assessed in the study. Findings of present research added weight in the evidence that psychological abuse is one of the most damaging types of abuse (Layne, et al., 2014). Research established that types of psychological abuse usually occur together and it is essential to discriminate the particular effect of different types (Finkelhore, Ormord, Tumer, & Hamby, 2005), therefore, this study is a struggle to differentiate diverse forms of psychological abuse associated with diverse consequences.

All factors of psychological abuse have damaging belongings on emotions and behavior of adolescents. Verbal abuse, neglect, withholding support, terrorizing acts, and exploitative by parents seems very strong correlate of all problem behaviors. Findings provided strong support with existing researches, that parental verbal abuse is significantly linked with greater predictive effects on depression, and aggression in youth (Teicher, Samson, Pocari, & McGreenery, 2006). It was found that neglect and rejection of mother and father has also significant relationship with problem behaviors. Concerns of neglect are always hard to find as neglect is neither apparent nor easily observable on children. Previous researches also indicated that neglecting a child is linked with problem behaviors including social and attachment problems (Miller-Perrin & Perrin, 2007). Any form of psychological abuse is destructive as findings revealed in present research, the parental terrorizing and exploitative acts toward children had significant relation with all problem behaviors. Researchers have already found that every form of psychological abuse can predict problem behaviors (Allen, 2008; Linder & Collins, 2005; Schneider, Ross, Graham & Zielinski, 2005), as terrorizing behaviors of parents predicted anxiety and somatic complaints (Allen, 2008), ignoring behavior of parents predicted depression and neglected adolescents show long term adversarial consequences e.g. depression and anxiety (English et al., 2005; Salzinger, et al., 2007; Springer, Sheridon, Kuo, & Carnes, 2007) as well as, inattention, aggression, noncompliance, hyperactivity, conduct problems, and delinquency (Caples & Barrera, 2006; Manly, Kim, Rogosch, & Cicchetti, 2001).

While, defining psychological abuse and studying the negative effects of it, theoretical work on it explained that psychologically abusive behaviors should be studied into its subtypes it will be more specific to study the nature and outcomes of every type individually. New researchers have started empirical studies to study various form of psychological abuse as different types linked with different consequences (Arata, Langhinrichsen-Rohling, Bowers, & O’Brien, 2007). Findings of present research revealed that all types of psychological abuse have strong significant positive correlation as well as with total psychological abuse score. Existing researches also explained the relationship between types of abuse (Higgins & McCabe, 2001; Edwards, Holden, Felitti, & Anda, 2003). Many studies reported significant correlation between all forms of abuse (Karlovic, 2001; Fabijanic, Buljan-Flander, & KarlovicFabijanic, 2002). Moreover some studies also reported that exposure to emotional and physical abuse predicts other abuse experiences (Ney, Fung, & Wickett, 1994; McGee, Wolfe, & Wilson, 1997).

This research also found that emotional and behavioral problems correlate with each other i.e. there is significant covariance between internalizing and externalizing problem. Many problems have comorbidity. There are many other studies which provided the evidence of link among different emotional, behavioral and mental health problems (e.g. Lavy, Hay, Bennett, & Mcstephen, 2005). Researchers found that hyperactivity and inattention was related to conduct problems and externalizing problems (Hinshaw, 1987). Covariance of internalizing and externalizing problems has been well documented in the literature (Boylan, Vaillancourt, Boyle, & Szatmari, 2007; Oland & Shaw, 2005). Aggressive adolescents can also suffer anxiety, depressed children may display conduct problems. There is possibility that externalizing behaviors and criminal acts and violence are found at the same time in children and adolescents (Farrington, 1997). In the same way adolescents suffering from externalizing problems also face anxiety and depression during their development (APA, 1994).

Regression analysis was carried out to analyses the predictive value of psychological abuse for emotional behavioral problems. Types of psychological abuse were not put in regression due to high inter-correlation in types of abuse. Findings of regression analysis, supported the fact that PA by both parents has appeared as a significant predictor of negative outcomes in youth, linking PA with internalizing problems (Trichett, Kim, & Prindle, 2011), and externalizing problems (Ford, Fraleigh, & Connor, 2010).Relatively little research has been carried out to analyze the influence of fathers on the behavior of children (Cabrera, Shannon, & Tamis-LeMonda, 2007; Coley & Medeiros, 2007). Although increasing evidences suggested that role of both parents influences the children behavior (Lewis & Lamb, 2003), but in recent years participation of father in family has increased, and his role is considered very important (Cabrera et al., 2000).

Present research also support the importance of father as abusive father appeared as more strong predictor of all internalizing, externalizing, and total problem behaviors than abusive mother. Besides abusive parenting, demographic variables age, family income, parental education, family size and family system were analyzed in the hierarchical aggression to see the effects of these variables. Findings revealed that only two demographic factors nuclear family system and large family appeared significant predictors of problem behaviors. Researches has supported that many demographic factors contributed in the development of problem behaviors including large family size, (Dubow & Luster, 1990), but findings of present research has suggested that abusive parenting is strong contributor in behavior problems above all other factors of victim and family such as age and gender of child, parental education and economic condition.

Overall, this study tried to gain better understanding of psychosocial reality of those cases of abuse never reported and never labeled as serious enough. Although no causal relationship can be established from present research findings but findings reveal that children experience more psychological abusive parenting exhibit more externalizing and internalizing behavioral problems. Child behavior is an outward manifestation of his or her inner security and strength. In the light of findings of this research, conclusion may be drawn that abuse experiences in childhood might develop emotional and behavioral problems. Findings clearly revealed that abusive parenting can predict the adolescents’ problem behaviors.

LIMITATIONS AND SUGGESTIONS

While interpreting the findings of present study, limitations of study should be kept in mind. Study was relied upon self-report responses which may be a reason of subjective judgment and memory changes or recall bias. Cross informant reports can place more confidence on findings. Due to small data, findings have restricted generalizability. More over sample of research was recruited only from urban region of Lahore and on only school going adolescents. A large sample size from Madrassa schools, rural population as well as adolescents who were not going to any type of school should be included. Research did not examine some facts of abuse such as duration, age of onset, timing of exposure to abuse which may interact in the adolescents outcomes (Pynoos et al., 2014).

IMPLICATIONS OF RESEARCH

Findings of research have wide implications as target of research was neglected and least heard population (Children & adolescents) and addressed a very sensitive phenomena i.e. child psychological abuse in Pakistani families. Moreover, current research is a step to unfold the different types of psychological abuse, commonly used by parents but never recognized as well as reported as abuse, at least among normative Pakistani families. Findings of this research may attain the attention of parents, working psychologists, school psychologists to understand and identify the parenting behaviors, perceived as abuse by children and adolescents. These adolescents need attention and support so that they can express and discuss their feelings instead of ignoring or suppressing to avoid negative consequences. This study gave voice to adolescents to express their feelings. Parents, teachers, child protection agencies, and professional as well should be aware about problems of children. There is intense need to increase the parental awareness about life long consequences of their parenting styles and practices which derail the normal personality development.

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