The effect of parental emotional abuse on the severity and treatment of PTSD symptoms in children and adolescents

Chris Hoeboer; Carlijn de Roos; Gabrielle E van Son; Philip Spinhoven; Bernet Elzinga

doi:10.1016/j.chiabu.2020.104775

The effect of parental emotional abuse on the severity and treatment of PTSD symptoms in children and adolescents

Child Abuse Negl. 2021 Jan:111:104775. doi: 10.1016/j.chiabu.2020.104775. Epub 2020 Nov 3.

Authors

Chris Hoeboer¹, Carlijn de Roos², Gabrielle E van Son³, Philip Spinhoven⁴, Bernet Elzinga⁵

Affiliations

¹ Leiden University, Institute of Psychology, Section Clinical Psychology, Leiden, the Netherlands; Parnassiagroep, PsyQ The Hague, the Netherlands. Electronic address: c.m.hoeboer@fsw.leidenuniv.nl.
² Amsterdam University Medical Centre, Department of Child and Adolescent Psychiatry, Amsterdam, the Netherlands. Electronic address: c.deroos@debascule.com.
³ Rivierduinen, Department for Quality of Care, the Netherlands. Electronic address: g.vanson@rivierduinen.nl.
⁴ Leiden University, Institute of Psychology, Section Clinical Psychology, Leiden, the Netherlands; Leiden University Medical Center, Department of Psychiatry, the Netherlands. Electronic address: Spinhoven@fsw.leidenuniv.nl.
⁵ Leiden University, Institute of Psychology, Section Clinical Psychology, Leiden, the Netherlands. Electronic address: Elzinga@fsw.leidenuniv.nl.

PMID: 33158585
DOI: 10.1016/j.chiabu.2020.104775

Abstract

Background: Maltreatment by a primary caregiver is an important risk factor for the development of PTSD symptoms. Whereas meta-analyses indicate that parental emotional abuse is one of the most common forms of maltreatment, the impact of emotional abuse on PTSD symptoms and treatment effectiveness is still unclear, especially in children.

Objective: We aimed to investigate the impact of parental emotional abuse on PTSD symptom severity and effectiveness of trauma treatment in children and adolescents.

Method: In an outpatient sample (N = 287, mean age = 15.5 years), emotional abuse, index traumatic event, and PTSD symptoms were assessed at baseline. Thereafter, patients received evidence-based treatment for trauma-related symptoms embedded in a broader (systemic) treatment package. In a subsample (n = 130, mean age = 15.3 years) PTSD symptoms were assessed again 6 and 12 months after baseline.

Results: Emotional abuse (rather than any other type of maltreatment) was associated with more severe PTSD symptoms in all symptom clusters. This was independent of whether emotional abuse was reported as index traumatic event or not. Moreover, PTSD symptoms were significantly reduced 6 months after the start of trauma-focused treatment, and emotional abuse was associated with more severe PTSD symptoms over the course of treatment.

Conclusions: These findings underline the detrimental nature of emotional maltreatment in the context of PTSD symptomatology and treatment effectiveness. This calls for routine assessment of parental emotional abuse in the diagnostic phase, even when this is not the reason of referral.

Keywords: Abuse; Child/adolescent; Maltreatment; Neglect; PTSD/posttraumatic stress disorder; Trauma; Treatment.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Child
Child Abuse / psychology*
Emotional Abuse / psychology*
Female
Humans
Male
Netherlands
Parents
Risk Factors
Stress Disorders, Post-Traumatic / etiology*
Stress Disorders, Post-Traumatic / psychology
Stress Disorders, Post-Traumatic / therapy*
Treatment Outcome
Young Adult