MHM Magazine

20 | MENTAL HEALTH MATTERS | 2022 | Issue 6 MHM all with great impact on their future prospects,” Dr Allers said. The types of abuse overlap, in that children who suffer physical and sexual abuse are likely also to experience emotional abuse and neglect. Almost 70% of South African children will experience any type of abuse before the age of 17 and 27% will be victim to multiple types of abuse. Exposure to family conflict and domestic violence also constitutes emotional abuse and leaves lifelong scars, Dr Allers pointed out. This was particularly concerning for South African children, with domestic violence at “epidemic proportions” and intimate partner violence affecting between a third and a half of households. “All abuse leaves emotional or psychological scars. While physical injuries can heal, emotional scars are disabling and crippling to most individuals, and psychological abuse and neglect are much more prominently associated with mental illness in later life than physical or sexual abuse,” Dr Allers added. The impact on children’s future mental health is substantial, he said, with a third of all psychiatric disorders originating before the age of 14 and half before 18 years of age. The Children’s Act of 2005 defines abuse as any form of harm or ill-treatment deliberately inflicted on a child, including assault, deliberate injury, sexual abuse, bullying, exploitation or exposing or subjecting a child to behaviour that may harm the child (such as exposure to domestic violence). Dr Allers said there was a lack of knowledge of what emotional abuse entails and the signs and symptoms, and it was often not addressed as it is more difficult to define and recognise than physical abuse. Emotional abuse is more subtle, ongoing, and generally not connected to a single incident such as a beating or sexual assault. Forms of emotional or psychological abuse include withholding love and support, rejection, berating and threatening the child, insults and name-calling, belittling or humiliation, cold-shouldering, guilt-tripping, and emotional blackmail. Acts of emotional neglect include spending little time interacting or talking with the child, being unresponsive to or dismissing their feelings, giving little positive feedback or praise, persistently finding fault, and offering little help or encouragement when they are struggling with schoolwork or other tasks. “At the other end of the scale, overprotection is just as detrimental to children as neglect. A child cannot live a normal life and develop positive life skills if they are overprotected. There needs to be a balance in protecting children, as both ends of the spectrum amount to child abuse,” Dr Allers said. He said signs of emotional abuse and neglect in children included anxiety and depression symptoms, isolating themselves, disruptive behaviour, mood changes including aggression and agitation, depression, sleep problems, school refusal or lower school performance, and developmental and language delays. There is also a heightened risk of self-harm and suicidal behaviour, he said. He emphasised that medical professionals and social workers are bound by law to report any form of child abuse, including emotional abuse. “Where emotional abuse or neglect is suspected, children should be referred for psychological interventions that can help them to cope and rebuild their self-esteem, and abusers must be dealt with by the legal system”, he said.