Psychological Maltreatment: The Wounds We Don’t Talk About
Reading time: 5 to 7 minutes
An In-depth Series (Part 1 of 4)
When we think of child abuse, most of us picture the obvious: bruises, broken bones, visible neglect. These are the injuries that make headlines, trigger investigations, and prompt urgent action.
But there’s another kind of harm—just as real, just as damaging—that leaves no visible trace. It doesn’t show up on X-rays or in photographs, and it often hides in plain sight.
Every day, children hear words or endure behaviors that chip away at their self-worth: “You’re useless.” “I wish you were never born.” Or maybe they face years of cold silence, rejection, or humiliation from someone meant to protect them. These aren’t one-off moments of frustration—they are persistent, patterned acts that can change the course of a child’s life.
This is psychological maltreatment (PM)—a form of abuse that doesn’t always make it into case files, but can leave scars that last a lifetime (APSAC, 2019). And while you can’t see those scars, you can often see the way they shape a child’s emotions, behaviors, and even their health decades later.
How Psychological Maltreatment Came Out of the Shadows
For decades, emotional harm was treated as an afterthought in child protection. Physical injuries were easy to document; emotional wounds were easier to dismiss.
That began to shift in the 1980s, when researchers like Dr. Marla Brassard and Dr. Stuart Hart reframed PM as a distinct category of abuse, not just a symptom of other maltreatment (Brassard & Donovan, 2006). Their work pushed the field forward, influencing definitions used in courtrooms, child welfare policies, and professional training manuals.
Some states eventually recognized PM as a reportable offense. The American Professional Society on the Abuse of Children (APSAC) later published guidelines for investigating it (APSAC, 2019)—a milestone in giving PM the same legitimacy as other abuse forms. But here’s the catch: definitions still vary widely from state to state. That means a child in one jurisdiction might be protected under law, while another child facing the same harm elsewhere might not be (Baker, 2009).
It’s a patchwork approach to a national problem.
The Damage You Can’t See—but Can’t Ignore
The myth that “sticks and stones may break my bones, but words will never hurt me” is not just wrong—it’s dangerous. Psychological maltreatment can be just as harmful as physical or sexual abuse, and in some cases, the emotional consequences are even worse (Hart & Brassard, 1991).
Emotional and Mental Health
Victims of PM often lack the visible evidence to “prove” their suffering, which can make them feel confused, isolated, and even complicit in their own harm. Over time, they may develop low self-esteem, anxiety, depression, suicidal thoughts, and difficulty regulating their emotions (Baker & Schneiderman, 2015; Baldwin et al., 2023).
Even in children who aren’t in clinical treatment, research shows emotional maltreatment predicts long-term mental health struggles—especially when combined with factors like anxious attachment or gender-specific vulnerabilities (Falgares et al., 2024).
Cognitive and Academic
When a child is told over and over again that they’re stupid, lazy, or worthless, it doesn’t just hurt their feelings—it rewires how they see themselves and their abilities. Psychological maltreatment can lead to problems with concentration, problem-solving, and academic performance (Brassard, Hart, Baker, & Chiel, 2019). These setbacks can quietly close doors to opportunities for years to come.
Social and Relational
Trust is a fragile thing. Children who grow up in emotionally abusive environments often have difficulty forming secure attachments. They might withdraw from friendships, lash out at peers, or later enter into unhealthy or abusive relationships (Glaser, 2002).
Physical Health
Psychological maltreatment doesn’t just live in the mind—it can live in the body. Adverse childhood experiences, including emotional abuse, are linked to measurable changes in brain structure and increased risk of adult health issues like cardiovascular disease, autoimmune disorders, and depression (Anda, Felitti, & Bremner, 2006). Brain imaging shows that children exposed to PM may have altered white matter connectivity in areas essential for emotional regulation and decision-making (Chung et al., 2023).
A Story That Could Be Anyone’s
Consider Liam (a composite case). His father never raised a hand against him. But day after day, Liam heard: “You’re stupid.” “You’ll never amount to anything.” “You’re a waste of space.”
By age 10, Liam was anxious, withdrawn, and avoiding school. Teachers assumed he was just shy. Neighbors noticed nothing unusual. By the time his mental health crisis became undeniable, years of emotional abuse had already shaped his worldview, his relationships, and his belief in his own worth.
Liam’s story isn’t rare—it’s just rarely recognized. And that’s the danger.
Why We Miss It
If PM is this harmful, why is it so often overlooked?
It leaves no bruises. There’s nothing to photograph or X-ray.
Short windows of observation. Professionals—teachers, doctors, caseworkers—often see kids only briefly, too little time to spot patterns.
Blurred lines with “strict” parenting. Occasional frustration doesn’t meet the threshold for PM; the key is persistence, severity, and the harm it causes.
Cultural norms. Behaviors seen as abusive in one context might be normalized in another.
Possible warning signs include extreme fear of making mistakes, hypersensitivity to criticism, stress-related ailments like headaches or stomachaches, and overheard chronic yelling or shaming (Baker, 2009). But without consistent definitions and thorough training, these signals can be easy to dismiss or misinterpret.
Scholar’s Corner
“Psychological maltreatment is at least as harmful as other forms of child abuse and neglect, yet it is the least likely to be identified, substantiated, and addressed.”
Why This Series Matters
This is just the beginning. Over the next three parts, we’ll unpack exactly how to spot that harm—and how to stop it—before it lasts a lifetime:
Part 2 – The definition of PM, including APSAC’s seven categories and the “harm standard.”
Part 3 – How PM is identified, the risk and protective factors at play, and what multidisciplinary teams can do.
Part 4 – Prevention, intervention, and policy reforms that could make a real difference.
Something To Think About
“Somewhere near you, there’s a child who seems a little too quiet, a little too careful. Maybe they flinch when spoken to sharply, or maybe they’re the “perfect” student who never causes trouble. What if what you’re seeing isn’t just shyness or good behavior, but the aftermath of years of words and actions that have left invisible wounds? ”