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ACEs Risk Factor #4: Abuse

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Emotional abuse can include non-physical harm, verbal, or psychological abuse. Growing up I made it my mission to make sure that when I was asked to do something that I did it right the first time so that I could avoid being called names that no young child should be called.

For example, when I learned how to drive, my grandmother taught me using a truck that did not have the R, N, D markings on the dashboard, and no direction was given on how to operate the vehicle, just get in and drive. Well, I failed to progress the gear out of reverse or neutral, and with the names I was called I am amazed that I gathered up the courage to continue to learn. Looking back, I probably learned so that I could someday drive away from the childhood that stole my flame and caused my psychological abuse.

Yates (2007) describes child emotional abuse as a caregiving pattern that conveys to children that they are:

  • Worthless
  • Flawed
  • Unloved
  • Unwanted
  • Endangered
  • Only of value when meeting someone else's needs

Negative outcomes in adulthood that result from emotional abuse includes:

ACE Risk Factor #4: Abuse
  • Anxiety
  • Depression
  • Personality Disorders
  • Suicidal Behavior
  • Low Self-Esteem
  • Health Problems


Regardless of how sexual abuse is defined, the psychological impact on its victim is generally negative and significant. The definition is any sexual act, openly known or unknown, between a child and an adult (or older child) Hall (2011). Incest (or sexual activity with family members) is the most common form of sexual abuse.

This type of abuse does not always include direct touch, other acts that qualify as sexual abuse are:

  • Introduction of pornography prematurely
  • Assault through the internet
  • Manipulation into taking pornographic photos
  • The act of grooming by the offender

The basic rights of human beings are violated by childhood sexual abuse. A person should be able to have sexual experiences within their control and at an appropriate developmental time. Childhood sexual abuse alters normal social growth and could cause psychosocial problems.

The long-term effects of sexual abuse include higher levels of:

  • Depression
  • Guilt
  • Shame
  • Self-Blame
  • Eating Disorders
  • Suicidal Ideation
  • Anxiety
  • Dissociative Patterns
  • Repression
  • Denial
  • Sexual/Relationship Problems
  • Worthlessness

Sex is not a bad thing, except when not developmentally appropriate. For example, having a vehicle is good if it is given at a developmentally appropriate time. We would not let a 5-year-old drive a car, and maybe not even some 16-year-old, but as long as it is introduced with proper developmental stages in mind, it can result in a positive experience.


Physical abuse can result in long-term developmental problems socially, emotionally, physically and can include Appleton (2017):

  • Hitting
  • Shaking (Shaken Baby Syndrome)
  • Throwing
  • Poisoning (Gas/Household Product)
  • Biting
  • Abdominal Trauma
  • Burning/Scalding (Cigarettes/Water)
  • Head Injuries
  • Drowning
  • Broken Bones (Bruising)
  • Suffocating
  • Any physical harm to a child

2/3 of total reports (3 million) made to child protective services (CPS) had sufficient concern to warrant further investigation; over half of qualifying referrals were made by professionals, including doctors, nurses, teachers, law enforcement officers, and counselors Hornor (2005). Three children die every day in America because of child abuse or neglect; 85% are children younger than 6 and 50% are younger than 1.

Child abuse does not apply to one "class" of people; it occurs across all socioeconomic, ethnic, religious, and educational groups.

Specific traits of known abusers can identify potential risk factors, such as:

  • Substance Abuse
  • Mental Illness/Depression
  • Poor Impulse Control
  • Unrealistic Developmental Expectations
  • Unemployment
  • Previous CPS Involvement
  • History of abuse/neglect
  • Developmentally Delayed

Battered child syndrome: A disease in which children are physically abused, generally by a parent/step parent/foster parent. Not until the 19th century were children granted the same legal status as domesticated animals regarding protection against cruelty and/or neglect. Many times, this type of abuse went unnoticed or unreported and became known as "unrecognized trauma" by professionals, including radiologist, orthopedists, pediatricians, and social service workers, causing childhood disability and death Kempe (1985).

Generally, the child's health is below average with signs of apparent neglect, such as: poor skin hygiene, many soft tissue injuries, and malnutrition. To the informed physician, the healing bones tell a story the child is too young or too frightened to tell.

Many times, parents discipline their children the same way they were disciplined, good or bad. It is not uncommon for the abused child to be a product of an unwanted pregnancy that is felt to be extremely inconvenient by one or both parents. Sometimes all children in the family are abused, only one child is not abused while the others are, or one child may be singled out for attack while the others are loved and adored. This may result in children of one household to each have a different memory of their childhood.


Bullying is defined as aggressive behavior or intentional harm by peers (or siblings) that is repetitive and involves an imbalance of power Wolke (2015). Bullying can be actual/direct (hitting, stealing, name calling) or perceived/indirect (social exclusion, rumor spreading).

Bullying is a major risk factor for poor physical/mental health and impacts adult roles of:

  • Forming Lasting Relationships
  • Integrating into Work
  • Being Economically Independent

 There are three main ways to be involved in bullying:

  • Victim - The person being bullied
  • Bully/Victim - A subgroup of victims who display bullying behavior
  • Bully - The person doing the bullying

90% of cyberbullying (any bullying performed electronically by cellphone or internet) victims are also bullied face to face. It is more common for children to experience bullying from peers than by parents or other adults, but it does happen.

Bullying is seen as an evolutionary gain towards high status, control, dominance, access to resources, secure survival, reduced stress, and more mating opportunities. Bullies are found in all socioeconomic and ethnic groups.

Victims are at a higher risk of somatic (colds) and psychosomatic (headaches, stomachaches, sleep problems, more likely to smoke) issues and may later develop anxiety or depression disorders leading to self-harm or suicidal ideation.

Bully/Victims have a slightly higher risk of physical/mental health problems than pure victims and are found to be impulsive as well as have poor self-regulation of their emotions. For example, this would be a child that is bullied as a victim at home by siblings, but then goes to school and becomes a bully to other children. This could also be a role reversal for the parent and the child; the parent was bullied as a child by their parents and grew up to be the bully who now does the same to their own children, the victims. Bullying gives them a sense of power and control, especially narcissistic parents, and feeds the vicious cycle of abuse.

Bullies are highly competent manipulators, strong ringleaders, are found to be healthier/stronger than children not involved in bullying, and perpetuate dating violence by eighth grade.

Chronic victims and bully/victims who are at risk of failure to complete high school or college are also at an increased risk of poorer income and job performance. In the USA, it is estimated that preventing high school bullying results in lifetime cost benefits of over $1.4 million per individual Masiello (2012).

Domestic Violence

Domestic violence (also called intimate partner violence - IPV) affects people of all ages, races, genders, and can include all forms of abuse:

  • Verbal/Emotional
  • Sexual
  • Physical
  • Destruction of Property

The view of the male as dominating perpetrators and women as the vulnerable victim was first introduced in the 1960s; many still hold the same view today.

What studies have shown, and many individuals have experienced is that:

  • Women can be violent towards men - also known as gender symmetry
  • Same-sex relationships experience domestic violence episodes

In both cases, the group fails to report the abuse due to shame, fear of ridicule by law enforcement, or lack of societal support and therefore are misconceived by the public as not existing. Suffering becomes a vicious cycle when mental health issues make a victim more vulnerable which cycles back to victimization and continues Alejo (2014).

No matter the role played in violence, victim or batterer, everyone pays the consequence of short- and long-term health problems, such as:


  • Anxiety
  • Alcohol abuse
  • Substance abuse
  • Depression
  • Personality Disorders
  • Posttraumatic Stress Disorder (PTSD)
  • Social dysfunction
  • Sleeping Disorders
  • Eating Disorders
  • Suicide


  • Bite marks
  • Concussions
  • Miscarriages
  • Loss of hearing/vision
  • Cuts/Bruises
  • Migraines
  • Permanent Disfigurement
  • Heart disease
  • Cancer
  • Death

Being a child trapped in the chaos of domestic violence in the home is scary when you know all the mental and physical impacts it could have on your health over time. A child cannot be cared for properly in a home that experiences violence in any form. Many times, the parents are so tired from fighting or dealing with mental health episodes, the children are left to raise themselves and try their best to stay out of the way.


Alejo, K. (2014). Long-Term Physical and Mental Health Effects of Domestic Violence. Themis: Research Journal of Justice Studies and Forensic Science, 2(5). doi:

Appleton, J. V., and Sidebotham, P. ( 2017). Physical Abuse of Children. Child Abuse Rev., 26: 405– 410. doi: 10.1002/car.2505.

Hall, M., & Hall, J. (2011). The long-term effects of childhood sexual abuse: Counseling implications. Retrieved from

Hornor, G. (2005) Physical Abuse: Recognition and Reporting. Journal of Pediatric Health Care, 19(1), 4-11. doi:

Kempe et al. (1985). The Battered-Child Syndrome. Child Abuse & Neglect, 9, 143-154. Retrieved from

Masiello M, Schroeder D, Barto S, et al. (2012). The cost benefit: a first-time analysis of savings [Bullying]. Highmark Foundation, 1–13.

Wolke, D., & Lereya, S. T. (2015). Long-term effects of bullying. Archives of disease in childhood, 100(9), 879–885.

Yates, T. M. (2007). The Developmental Consequences of Child Emotional Abuse: A Neurodevelopmental Perspective. Journal of Emotional Abuse, 7(2), 9-34.

<#3 Risk Factor - Early Hospitalization                                  #5 Risk Factor - Neglect>


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