Though the scars of psychological abuse may not be as immediately visible as a bruise or a broken bone, a new statement by a leading journal in children’s medicine says psychological abuse can be just as damaging to a child’s health as physical abuse.

The statement co-authored by Dr. Harriet MacMillan of McMaster University in Hamilton, Ont. and published Monday in the medical journal Pediatrics, says that psychological abuse may be the most challenging and pervasive form of abuse and neglect.

Although the phenomenon was described in scientific journals more than 25 years ago, it continues to go under-recognized and under-reported, said MacMillan, a pediatrician and psychiatrist at McMaster.

Psychological abuse includes acts such as belittling, terrorizing, exploiting, emotional unresponsiveness and corrupting a child to the point that their well-being is at risk, said MacMillan.

"For the most part we are talking about chronic, repetitive types of parental behaviour," MacMillan said in an interview with The Canadian Press. “Any caregiver can commit acts of psychological abuse or, through what we call acts of omission, psychological neglect."

MacMillan stressed that the statement is referring to extreme behaviour, and gave the example of a mother leaving an infant alone in a crib all day or a father getting his teenager involved in a drug abuse habit.

“We are talking about extremes and the likelihood of harm, or risk of harm, resulting from the kinds of behavior that make a child feel worthless, unloved or unwanted,” MacMillan said in a statement.

So while yelling at a child to put on their running shoes for the eighth time is not psychological abuse, persistent verbal abuse may be, she said.

“Yelling at a child every day and giving the message that the child is a terrible person, and that the parent regrets bringing the child into this world, is an example of potentially very harmful form of interaction,” MacMillan said in the statement.

The statement says that emotional abuse hinders a child’s development and has been linked to developmental and educational problems, socialization problems and disruptive behaviour.

MacMillan says that while this form of abuse can occur in all different types of families, it is more common in households that experience multiple stresses including family conflict, mental health issues, physical violence, depression and substance abuse.

According to the statement, psychological abuse is especially harmful during the first three years of a child’s life.

Dr. Marcella Donaruma of the Texas Children’s Hospital in Houston welcomed Monday’s statement and told The Canadian Press that children exposed to psychological abuse have an increased risk in adulthood to certain physical health problems including heart disease and certain types of cancers.

They also have an increased risk of abusing drugs and have an overall diminished life span in comparison to kids who did not experience psychological abuse, she said.

The statement notes that while there are no definitive statistics on the prevalence of kids who experience psychological abuse, large studies conducted in the U.K. and the U.S. found around eight to nine per cent of women and four per cent of men reported exposure to severe mental abuse during childhood.

The statement says pediatricians need to be sensitive to the possibility of psychological abuse in their patients and take time to speak to a young patient alone if they suspect any form of emotional mistreatment.

It also urges for increased collaboration among pediatric, psychiatric and child protective services to help children at risk of sustained mental abuse.

With files from The Canadian Press