Background: There is a growing clinical and research interest into emotional abuse and its detrimental impact on child welfare and development, yet increasing evidence suggests that it remains both under-recognised and under-reported. Objectives: The primary objective of this study was to describe the prevalence and nature of emotional abuse experienced by a random sample of children referred to a multi-agency Child Protection team, located within an NHS board, due to concerns about maltreatment. The secondary objective of this study was to examine the prevalence of children within the sample who were disabled. Method: The study was a retrospective case note survey. Random samples of 108 case files were selected and reviewed using the Maltreatment Classification Record Abstraction Instrument – MCRAI (Trickett et al., 2009). Fifteen items of parental behaviour regarded as emotionally abusive were coded and organised into four subtypes of emotional abuse. This information was applied to two psychological maltreatment frameworks. Non parametric and descriptive statistics were used for data analysis Results: There was a significant difference found in the identification of emotional abuse between clinician reporting, n=33 (30.6%), at the time of referral and the use of the extraction tool with either psychological framework, n=78(72.2%). There was only a small number of children with a disability identified within the random sample who had experienced abuse and/or neglect n=12. Conclusions: Greater awareness and understanding of emotional abuse would be valuable in ensuring that children’s psychological needs are met and to avoid the detrimental impact of this form of abuse. Clinicians would also benefit from a greater understanding of the complexities of disabilities and how these can impact on child protection investigations.

Objectives: To determine if emotion regulation mediates the link between emotional maltreatment and disordered eating behaviour in a community sample of adolescents. Design and method: Participants were 222 secondary school pupils (aged 14-18 years) from a state high school in a rural area in Scotland. Standardised questionnaire measures were used to gather data on history of emotional abuse and neglect using the Childhood Trauma Questionnaire (CTQ), emotion regulation strategies using the Regulation of Emotions Questionnaire (REQ) and subclinical disordered eating behaviour using the Eating Attitudes Test (EAT-26) and the Dutch Eating Behaviour Questionnaire (DEBQ). Pearson correlation and multiple mediation analyses were conducted to determine significant relationships and to identify whether dysfunctional emotion regulation was a mediator of the relationship between emotional maltreatment and disordered eating behaviour. Results: Multiple mediation analyses found both emotional abuse and emotional neglect to have a significant direct relationship with EAT-26 total score and DEBQ restraint scores - mediated by internal dysfunctional emotion regulation (with external dysfunctional emotion regulation also being a significant mediator in the analysis with emotional neglect and EAT-26 total). The direct relationship between emotional abuse/neglect and DEBQ emotional eating scores was non-significant, although a specific indirect effect through internal dysfunctional emotion regulation was observed. Conclusions: To the best of the author‟s knowledge, this is the first study which has looked at history of emotional maltreatment and disordered eating behaviour focussing on the influence of emotion regulation in particular. Results were indicative of significant indirect effects between emotional abuse and neglect and all measures of disordered eating through internal dysfunctional emotion regulation. Findings suggest the role of emotion regulation warrants further study in the research on childhood maltreatment and disordered eating behaviour.

The purpose of this dissertation was to explore the process by which emotional abuse occurs and is often sustained in sport, and to examine athletes’, parents’, and coaches’ reflections on emotional abuse in the coach-athlete relationship. The methodological approach used for the study was a constructivist and symbolic interactionist approach to grounded theory. Methods were established that were consistent with the iterative nature of grounded theory. In total, 18 retired elite athletes, 16 parents of retired elite athletes, and nine elite coaches participated in the study. In-depth semi-structured interviews were conducted with each participant, and data were coded using open, axial, and selective coding techniques. Athlete data were interpreted to suggest a sequence of stages by which emotionally abusive coach-athlete relations developed and were sustained over time. Furthermore, the perceived impact of emotionally abusive coaching practices on motivation, self-confidence, commitment, and achievement outcomes in sport were discussed. Parent data were interpreted to suggest that parents are socialized into the culture of elite sport and can become silent bystanders to their children’s experiences of emotional abuse. Coaches’ reflections about the reasons for choosing to use emotionally abusive behaviours in the coach-athlete relationship were interpreted to suggest two distinct origins for the use of this behaviour. Additionally, perceived reasons for abandoning emotionally abusive coaching techniques were reported by the coaches. Finally, based on the collective reflections of the athletes, parents, and coaches, an ecological transactional model of vulnerability to emotional abuse in the coach-athlete relationship is proposed. Several implications of the study findings are discussed and questions are posed for future research.

The purpose of this dissertation was to explore the process by which emotional abuse occurs and is often sustained in sport, and to examine athletes’, parents’, and coaches’ reflections on emotional abuse in the coach-athlete relationship. The methodological approach used for the study was a constructivist and symbolic interactionist approach to grounded theory. Methods were established that were consistent with the iterative nature of grounded theory. In total, 18 retired elite athletes, 16 parents of retired elite athletes, and nine elite coaches participated in the study. In-depth semi-structured interviews were conducted with each participant, and data were coded using open, axial, and selective coding techniques. Athlete data were interpreted to suggest a sequence of stages by which emotionally abusive coach-athlete relations developed and were sustained over time. Furthermore, the perceived impact of emotionally abusive coaching practices on motivation, self-confidence, commitment, and achievement outcomes in sport were discussed. Parent data were interpreted to suggest that parents are socialized into the culture of elite sport and can become silent bystanders to their children’s experiences of emotional abuse. Coaches’ reflections about the reasons for choosing to use emotionally abusive behaviours in the coach-athlete relationship were interpreted to suggest two distinct origins for the use of this behaviour. Additionally, perceived reasons for abandoning emotionally abusive coaching techniques were reported by the coaches. Finally, based on the collective reflections of the athletes, parents, and coaches, an ecological transactional model of vulnerability to emotional abuse in the coach-athlete relationship is proposed. Several implications of the study findings are discussed and questions are posed for future research.

This study investigated the relationship between maternal childhood experience of emotional abuse (CEA) and/or emotional neglect (CEN) and subsequent second-generation parenting outcomes. A systematic review of the literature was carried out, with twelve studies included for review. Evidence was found of a relationship between maternal experience of CEA/CEN and a negative impact on the subsequent parent-child relationship and parenting behaviours; including greater dysfunctional parent-child interactions, lower empathy, greater psychological control, greater child maltreatment potential and punitiveness. Evidence in relation to the impact on parenting competence was less robust. For practitioners, these findings highlight the importance of considering maternal childhood experiences when working with parents and when attempting to make sense of children's difficulties. Methodological weaknesses were highlighted and recommendations for future research made. Secondly, a cross-sectional study was carried out which explored whether early maladaptive schemas (EMSs) mediated the relationship between maternal CEA/CEN and attributions of perceived control over failure (PCF) in child care-giving interactions. Mothers (N=111) completed five self-report questionnaires in relation to the above. Multiple mediation analyses using bias corrected bootstrapping were carried out. In line with expectations, significant relationships were found between both CEA and CEN and EMSs. CEN also demonstrated both a direct and indirect effect on PCF score, via the EMSs Social Isolation/Alienation. However, the indirect effect was in the opposite direction to that predicted. No other indirect effects were found. CEA demonstrated neither a direct effect on PCF, nor an indirect effect via any of the EMSs. Results are discussed in the context of current research.

Although emotional maltreatment is clearly a very important issue that impedes youths' development, it has only recently begun to receive the attention it deserves. The present study hypothesized that for adolescents with high self-worth, high religiosity, high parent and peer support, high family cohesion, and low family conflict the negative effects of emotional abuse on internalizing symptomatology would attenuate. Additionally, the same protective factors were hypothesized to moderate the relationship between emotional and physical abuse and adolescent internalizing symptomatology. Two samples were used in order to test the aforementioned hypotheses: 1) a whole sample that consisted of adolescents with no or any emotional and physical abuse (N = 220) and 2) a no physical abuse sample that consisted of adolescents with no or any emotional abuse (N = 118). In order to assess the study variables the following measures were used: Conflict Tactics Scale-PC, Self-Perception Profile, Youth Religiosity Scale, Inventory of Parent and Peer Attachment, Family Environment Scale, and Youth Self Report. None of the study's hypotheses were supported by the current data. It is assumed that this might be due to the sample's nature and it is suggested that future studies utilize a sample with different age groups and with higher reports (means) of emotional and physical abuse. However, the findings suggested that emotional abuse had a stronger effect on internalizing symptomatology than physical abuse, and the significant main effects of self-worth, parent support, peer support, and family cohesion indicated the importance of their presence in adolescents' psychological adjustment. / Ph. D.

Millions of children participate in sport and through their participation come into contact with coaches who are there to guide and support them. However, it has been observed that not all children’s relationships with their coaches have been positive ones, and concerns have been raised about the nature of the child-athlete relationship within the sports context. This research sought to use theory from child maltreatment research and apply it within a sports context to investigate perceived child athlete experiences. The research used both qualitative and quantitative methodologies to investigate retrospectively athletes’ perceptions of, and emotional responses to their coach’s behaviour. The initial study used qualitative method to establish if key theoretical frameworks from outside sport had a resonance and relevance within a sports context. Twelve elite athletes, all of whom had been identified as ‘elite’ when children reported that they had experienced negative coaching behaviour on a frequent basis they also reported negative emotional responses to this behaviour, and emotional problems as a consequence of how they were coached when they were children. Study Two (n=229), focused on broadening the research to access a larger population of athletes in order to examine their perceptions and experiences of being coached. In order to achieve this aim a new questionnaire, the Sport Emotional Response Questionnaire (SER-Q), was developed. The SER-Q was grounded in the real-life experiences of those athletes in Study One, and as such represented their expert opinions of their coaches’ behaviour. Through factor analysis, a 22-item questionnaire was established which measured frequency of negative (i.e. emotionally abusive) coach behaviour, athletes’ emotional response and perceived effect on performance. Results from this study showed that frequency of negative coach behaviour and emotional response were significantly and negatively correlated such that, as the frequency increased so did the negative emotional response. Study Three (n=314), was a confirmatory study, and found similar results to Study Two. Study Four (n=543), sought to investigate, through the SER-Q, specific questions in relation to: competitive level, athlete gender, and type of sport (either team or individual) and gender of the coach. Results revealed that there were no significant differences between athlete gender, type of sport and coach gender. However, significant results were found in relation to competitive level. Elite athletes (international-level and national-level) reported experiencing significantly more frequent negative coach behaviour: they also reported a greater negative emotional response to it than any of the non-elite (recreational-level, club-level and regional-level) groups. Finally, Study Five examined the perceived performance effect, and found a significant negative relationship with frequency, such that has the frequency increased so did the perceived negative performance effect; and a significant positive relationship with emotional response. Further results from this Study Five also found that there were only significant differences in relation to competitive level. Again elite athletes reported significantly greater detriments to their perceived performance resulting from their coach’s behaviour than did non-elite athletes. A consistent finding across all the studies was that when athletes reported ‘never’ having experienced emotionally abusive behaviour from their coach, they always reported ‘no emotional response’, and no effect on their performance. Therefore, the SER-Q was able to discriminate between these two populations of athletes. Overall, the findings from these studies have contributed to the development of a theoretical model that describes the process of emotional abuse from a child athlete perspective. Secondly, the findings reveal that elite athletes report different experiences of being coached when children than non-elite athletes. Furthermore, these studies found that theories anchored in family settings can be used to explore issues within a sports setting, and thus the child maltreatment perspective has relevance in developing sports specific theory in relation to the coach-child athlete relationship. A consistent finding across all the studies was that when athletes reported ‘never’ having experienced emotionally abusive behaviour from their coach, they always reported ‘no emotional response’, and no effect on their performance. Therefore, the SER-Q was able to discriminate between these two populations of athletes. Overall, the findings from these studies have contributed to the development of a theoretical model that describes the process of emotional abuse from a child athlete perspective. Secondly, the findings reveal that elite athletes report different experiences of being coached when children than non-elite athletes. Furthermore, these studies found that theories anchored in family settings can be used to explore issues within a sports setting, and thus the child maltreatment perspective has relevance in developing sports specific theory in relation to the coach-child athlete relationship.

Background: Childhood emotional abuse can lead to mental illness. Research about emotional abuse is limited and therefore complicates the work of the nurse, since understanding of what emotional abuse means is of importance. Aim: The aim of this study was to describe what consequences people may suffer later on in life if they were exposed to emotional abuse or emotional neglect as a child. Method: A literature overview was performed by collecting and analysing eight quantitative studies, two qualitative studies and one study with mixed-method. The analysis was performed according to Friberg's three-step-model. Results: Childhood emotional abuse showed to affect the victims mental health later on in life. There were many different mental illnesses associated with persons that had experienced emotional abuse in their childhood. Personality disorders, depression and eating disorder was found to have a significant connection of mental health outcomes based of childhood emotional abuse. There were also a significant connection with social inhibiting states such as anxiety, post traumatic stress syndrom (PTSD), low self-esteem and low self-image. Conclusion: More information about how to detect and prevent emotional abuse of children is needed. Nurses also need more knowledge about how to handle the care of adult patients struggling with mental illness due to childhood trauma. / Barn som utsätts för psykisk misshandel (PM) eller psykisk försummelse (PF) är ofta svåra att uppmärksamma. Att de flesta som utsätts lever i tysthet kan vara en förklaring till att forskning kring ämnet är begränsad. PM har visats vara den mest förekommande formen av misshandel mot barn. Det har även framkommit att PM är den misshandelsform som lämnar störst avtryck på barnet. Vårdpersonal är skyldig att anmäla om ett barn misstänks vara utsatt för PM. Dock är detta en problematisk uppgift när befintlig kunskap kring ämnet är otillräcklig. Ofta bär barnet med sig sitt trauma upp i vuxna år som leder till psykiska besvär och kan påverka deras liv negativt. PM har även en tendens att gå i arv och kan begränsa ett utsatt barns kapacitet i en framtida föräldraroll. Denna studie avser att öka kunskap kring PM av barn genom att påvisa vilka konsekvenser det kan leda till. Kunskap om detta kan medföra att omvårdanden för utsatta barn förbättras och livslånga konsekvenser kan förhindras. Alternativt kunna ge bättre omvårdnad till vuxna patienter som blivit utsatta i sin barndom, genom att vår studie kan öka förståelsen för andra människors lidande. Resultatet i föreliggande studie visar på en mängd allvarliga konsekvenser för den utsattas psykiska hälsa. Det övergripande ämnet i studien är därför psykisk ohälsa med huvudteman som är tänkt att kategorisera hälsotillstånden ytterligare i form av psykisk sjukdom, socialt hämmande tillstånd samt negativ självuppfattning.

Emotional abuse in childhood is linked to an increased risk for internalizing symptoms such as depression and anxiety in adulthood. Religious social support offers a promising defense in maintaining mental well-being in the face of trauma. This study aims to investigate if religious social support in childhood will moderate the impact of negative outcomes associated with emotional abuse. Further, this study will examine whether and how gender and ethnicity impact this relationship. The sample includes undergraduate students attending East Tennessee State University, located in the southeastern United States (n = 471, 73% female, 11% African American, M age = 20.37, SD = 4.84). Participants completed an online survey that asked about childhood experiences (e.g., emotional abuse, emotion socialization, religious social support) as well as current mental health (e.g., anxiety, depression). Data was analyzed using Statistical Software for the Social Sciences. Bivariate relations were examined through Pearson’s correlations and moderated moderation was tested via the Hayes Process Macro (version 3.0, Model 3). Results indicated that religious social support from childhood was negatively related to depression and anxiety whereas negative religious experiences from childhood were positively related to depression and anxiety. Harsh emotion parenting from childhood was positively related to depression and anxiety in adulthood. Results did not find support for moderated moderation for predicting depression or anxiety. Chi-squared indicated no significant differences in the percentage of individuals who endorsed childhood emotional abuse due to ethnicity, gender, or the interaction of gender and ethnicity. Future research would benefit from longitudinal designs that follow children across time to better understand whether and how religious social support may be a buffer for emotional abuse experienced in childhood.

Children less than one year of age are a vulnerable population. Injury, and child abuse and neglect (child maltreatment) are causes of morbidity and mortality in this population. The literature suggests that the family characteristics of both sub-populations are similar and they may be the same sub-population (Peterson and Brown 1994). Large scale studies have revealed that there are multiple risk markers that are predictive of child abuse and neglect (Browne 1995, Sidebotham et al. 2001, 2002). There is mixed evidence as to whether home visiting can have an impact on preventing injury and child abuse and neglect. This study aims to show that children who are injured and maltreated are the same sub-population. The study also examines the impact of child, family and societal risk markers on the likelihood of a child presenting for an injury or child maltreatment, and the effect of home visiting on the outcomes of injury and/or child maltreatment. This study is a retrospective cohort study using administrative data from three administrative data systems. The data from these systems were merged as part of a work project and de-identified. The de-identified data set contained data at an individual child level and formed the study sample. There were 11,821 children in the sample who lived within the Royal Children's Hospital Health Service District. Variables included demographic data, family characteristics, service contacts which included injury and Child Advocacy Service contacts (a proxy for child maltreatment). The main results of the study indicate there is a small cross-over of the sub-populations and these children are an extremely at-risk sub-population with a very high prevalence of risk markers. The research found that for children less than one year of age the 4.1% of the study sample presented for an injury contact and 1.1% of the study sample has a Child Advocacy Service (CAS) contact. There was 5.17% of the injury sub-population, compared to 0.93% of the non-injured population who had a CAS contact. Nineteen percent (19 %) of children who had a CAS contact also had an injury contact. The study also found that sole parents, mothers with an intellectual disability, and mothers who live in temporary/rental housing are predictors of injury and child maltreatment. Another finding is that an injury contact is a significant predictor of child maltreatment. A child who had an injury was 9 times more likely to attend for a CAS contact than a non-injured child (AOR 9.087 significant at 95% confidence interval (CI), (4.863-17.073). The introduction of home visiting into the model was examined and it was found that more than one home visit has the potential to reduce the likelihood of a child having child maltreatment contact if the mother is a sole parent, less than 20 years of age, abused as a child, lives in a family violence situation, has a mental health problem, is intellectual disabled or uses illicit substances. Whilst the results show a reduction, the impact clinically would be that home visiting as a single strategy will not prevent a CAS contact. The service implications of the study revealed that, there is a high usage of Department of Emergency Medicine (DEM) of Triage Category 4 and 5 clients. This presents an opportunity to look at alterative service model for these clients. Not all CAS clients were seen by the Primary Care Program, this also presents an opportunity to develop a pathway back to preventative health care services for this vulnerable group. The practice implications are that further research is required to identify the decision making process within DEM for injury presentation to identiy the indicators that DEM staff use to make a referral to the CAS. The identification of risk by Child Health Nurses requires further research to identify if the low occurrence of family risk variables in the study sample is a result of interview skills or data recording. The study has identified that there is a cross-over sub-population of injured and maltreated children. The research findings will provide information not previously available in the Australian context. At a service level the findings provide data to improve practice and service delivery.