The RCPsych Article of the Month for October is ‘Emotional abuse and neglect in a clinical setting: challenges for mental health professionals‘ and the blog is written by author Dr Simon Wilkinson published in BJPsych Bulletin.

So why this paper?  Working as a consultant child and adolescent psychiatrist means that I have encountered a number of worrying interactions between a parent and child that have obviously been contributing to the child’s difficulties.  This is even before moving to a post in a specialist NHS service that sees children and families where there are complex safeguarding concerns. 

I have experienced that the next steps in identifying and addressing possible emotional abuse and neglect (EAN) can be challenging but can lead to positive change.  At the same time I have become aware of an increasing amount of evidence linking emotional abuse and neglect to the risk of developing a number of psychiatric disorders, underlining the importance of intervening effectively. 

I decided to write the paper (with the help of some very experienced colleagues) to help other clinicians when they find themselves in similar situations.  Dr Apostu was a trainee when she worked with a child whose wellbeing she was concerned for:   the troubling experience of seeing emotional abusive interactions not being explicitly identified and addressed in the care plan also provided an impetus for the article.  It was important to us to have as broad an audience as possible, so that the paper could be read by psychiatrists working with adult patients who are parents as well as those working within CAMHS settings.   

To help with identification, we have described recognised patterns of interaction in EAN that go beyond parenting difficulty.  Spotting these common patterns can assist with communicating concerns to relevant professionals as well as providing a focus for treatment.  Understanding aspects of the child’s world, such as how the child sees him- or herself and what his or her expectations are of caregivers, is crucial in demonstrating potential harm.  There are many interventions which may be effective, such as treating depression in a parent, support with substance misuse, and parenting work, both group-based and individual, which can help parents to positively reinforce more adaptive behaviour, mentalise their children’s experiences and have developmentally appropriate expectations.  These interventions may need to be provided within a child protection framework.  I hope that this paper enables clinicians to feel more confident not just about recognising EAN, but also that effective help can be provided to children and their parents afterwards.

Emotional abuse and neglect in a clinical setting: challenges for mental health professionals by Dejong and colleagues offer a reminder that a substantial portion of the risk for developing mental disorder in adulthood is adversity in childhood that is, at least theoretically, amenable to psychosocial interventions. While sexual and physical abuse have received most attention and  lead to obvious harms, emotional neglect is harder for clinicians to identify and research has been skewed towards rejection and neglect. The authors highlight other forms of emotional abuse, when to suspect these in the clinic, and how to respond. This is an educational must-read for clinicians wanting to update their knowledge on the impact of this form of childhood adversity on psychopathology and how it can be ameliorated.

Norman Poole

BJPsych Bulletin Editor in Chief