Understanding Child Abuse and Its Effects on Mental Health
Understanding the signs, symptoms, and impacts of abuse and how to keep children safe
August 18, 2023
Children are among the most vulnerable people in our society. This is true across continents, cultures, financial situations, and ethnicities. Our youth are a precious resource and one we should guard carefully.
Unfortunately, many kids are at risk of or are currently experiencing child abuse.
While we often think of abuse as physical, cuts and bruises aren’t a necessary component of child maltreatment. Physical violence is just one form abuse can take. Other forms include sexual abuse, emotional abuse, and neglect.
Child maltreatment can lead to serious mental health concerns, including anxiety, depression, substance use disorders, eating disorders, dissociative identity disorder, and post-traumatic stress disorder (PTSD).
If we want to protect the well-being of children, we must learn to recognize the signs of abuse and know how to respond.
Keep Reading To Learn
- How to recognize child maltreatment
- Why child abuse impacts the entire family
- How to seek help for a child in your family or community
Supporting Youth Mental Health
Dr. Fairlee C. Fabrett shares ways to support child and teen mental health and offers tips to initiate conversations about well-being.
What Is Child Abuse?
Also known as child maltreatment, child abuse is defined by the U.S. government as a parent or caregiver’s act or failure to act that results in physical, sexual, or emotional harm.
The Federal Child Abuse Prevention and Treatment Act (CAPTA) defines child abuse as any physical, sexual, or emotionally damaging act—including neglect—that happens to a person who is under 18 years of age.
Child maltreatment also increases the risk of many adverse physical and emotional conditions later in life.
While parents are often the perpetrators, many other adults can commit child abuse as well. These include other family members, teachers, parents of friends, coaches, medical professionals, and spiritual advisors.
Often, the abuser is someone the child knows well and trusts.
It is also important to note that child abuse can sometimes reference abuse by other minors as well. For example, reporting data from the U.S. Department of Justice shows that more than one in four cases of child sexual abuse are committed by other youth.
Anyone who is concerned about the welfare of a child should reach out to the appropriate authorities.
Physical Abuse
Physical abuse is any intentional aggressive or violent behavior toward a child.
Not all physically abusive actions leave a mark. Evidence of physical abuse is not always obvious or easily seen.
Physical abuse can include:
- Slapping, hitting, punching
- Kicking
- Shaking, shoving
- Burning
Corporal or physical punishment at home, or in some cases at school, is considered by many to be a form of physical abuse and can have long-lasting negative effects on youth.
Sexual Abuse
Child sexual abuse is typically defined as “any sexual experience with a child, which includes sexual activities involving physical contact as well as activities that do not involve contact, such as exposure or voyeurism.”
The World Health Organization (WHO) defines sexual abuse as behaviors that include fondling, penetration, and exposing a child to other sexual activities.
It’s important to recognize that definitions of sexual abuse emphasize the “exploitation of adult authority and power, as children are assumed to be incapable of providing informed consent.”
The internet poses a risk of sexual abuse. While online, children can be coerced into sexual activities and the creation of sexually abusive videos and photographs.
It is important to note that, while sexual maltreatment of children is widely prevalent, the risks increase greatly in crisis situations. The abuse may result from sex trafficking, armed conflict, or intimate partner violence (domestic abuse).
The U.N. Security Council identifies sexual violence against children as one of the six grave violations affecting children the most in times of war. Sexual violence can be used to humiliate a population and create displacement.
Emotional Abuse
Emotional abuse, or emotional or psychological maltreatment, includes behavior that attacks a child’s basic emotional needs or consistently prevents such needs from being met.
Emotionally abusive treatment communicates to children that they are unlovable, endangered, worthless, and flawed. It can include name-calling, rejection, withholding love, or threats of various consequences or punishments.
Chronic yelling, swearing, and insults are also psychologically abusive, as are manipulation and mind games.
Neglect
Neglect is any failure to provide for a child’s basic needs. In addition to physical needs such as shelter, clothing, and food, children also require social and emotional care. For example, caregivers should ensure that children attend school and receive needed medical care.
Essential care for children includes providing understanding and empathy. When children don’t have such support, they are less likely to develop a robust, optimistic, and resilient approach to life.
According to the American Academy of Pediatrics, neglect is the type of abuse most frequently reported to child protective services, followed by physical abuse and sexual abuse. Often, more than one form of maltreatment occurs at the same time.
How Common Is Child Abuse?
Child abuse is common.
The Centers for Disease Control (CDC) reports that at least one in seven U.S. children have experienced abuse or neglect in the past year. This is likely an underestimate because many cases are unreported.
According to UNICEF, around 15 million girls between the ages of 15 and 19 have experienced nonconsensual sex.
According to WHO, nearly three-quarters of the world’s children between the ages of 2 and 4 receive some form of physical punishment from their caregivers. The organization End Violence Against Children states that only 14% of the world’s children are legally protected from corporal punishment.
The CDC states that in 2020, in the U.S. alone, more than 1,700 children died from abuse, neglect, or a combination of the two.
CDC also shares that in the U.S. in 2018, child maltreatment cost $592 billion—an economic burden on the magnitude of other widespread public health concerns, such as heart disease and diabetes.
Signs of Child Abuse
It can be hard to recognize abuse. While the following signs may indicate negative situations other than child maltreatment, they may suggest that a child is being harmed or otherwise experiencing adversity.
Adults should be aware of:
- Sudden changes in behavior, such as aggression or anger, fearful responses, or a decline in academic performance
- Depression and anxiety
- Unusual paranoia or phobias of certain places, people, or situations
- Disturbed sleep or nightmares
- No apparent caregiver or parent in the child’s life
- Poor appearance or hygiene, constant hunger, or other health problems
- Fear of going home
- Many unexplained absences from school
- Self-harm and/or suicide attempts
Any of these indicators may point to concerns about a child’s welfare.
If the child’s safety is in question, report the situation to a trusted authority immediately.
What To Do When Child Abuse Occurs
Child abuse is an incredibly stressful, toxic, and heartbreaking situation for the victim as well as others in the child’s life.
If abuse is suspected or confirmed, it is critical to take action.
What Children Should Do
Child abuse is never the child’s fault. Society has a responsibility to care for children, especially those who are not old enough to care for themselves.
Even if family or community members do not validate the abuse, children have the right to seek help.
Children can seek help by talking to trusted adults, including:
- A teacher, principal, or counselor at school
- A coach, mentor, or spiritual advisor the child trusts
- A friend’s parent or a neighbor
An adult is better equipped than the child to figure out what to do and can help to support or protect the child while the situation is addressed.
Children who do not have the help of a trusted adult can contact Childhelp, the National Child Abuse Hotline at 1.800.4.A.CHILD (1.800.422.4453). Agents are available 24/7 to answer calls and texts from children who need help escaping abuse. Everything is completely confidential.
Children who are in immediate physical danger should contact the police.
If the child is not comfortable contacting the police, they should go to a safe, public place—such as a hospital, library, or school—and talk to someone who can help.
What Adults Should Do
Adults who notice child maltreatment have the responsibility to report it. When the abuse is happening in your own home or extended family, this might feel very difficult.
For those who are worried about the consequences to themselves or their family if they talk about or report abuse, calls can be made anonymously to the Childhelp National Child Abuse Hotline at 1.800.4.A.CHILD (1.800.422.4453).
The Childhelp hotline also helps those who lack support or worry about their own treatment of children under their care. The hotline’s staff will share resources to relieve some of the burden so those struggling can remain the best parent or caregiver they can be.
For teachers or other professionals, it is important to become thoroughly educated about the signs of child abuse.
Community members can help families destigmatize abuse by telling their stories, directing children to youth programs, or referring them to mental health resources for young people.
Suicide: Know the Signs and What To Do
Suicide is a rapidly growing public health crisis. But by learning about it and reducing its stigma, you can help save lives.
The Lifelong Impact of Child Abuse
Because abuse causes a high degree of stress, it can interfere with the healthy development of a child’s brain.
According to the World Health Organization (WHO), such stress can impair how a child’s nervous system and immune system develop. Because of this, survivors of childhood abuse are at an increased risk of physical and mental health problems.
Aside from death or serious physical injury, children who experience abuse are at risk for a number of additional issues. These include risky behavior, obesity, drug and alcohol use, and early pregnancy.
The impact of abuse extends beyond the individual child as well.
Abuse causes traumatic ripples throughout the entire family and can prevent the formation of healthy bonds. It can leave children with an unhealthy impression of family life, which they may carry into their own families later on. Abuse causes negative impacts on a society-wide level.
It is important to note that not all abused children will develop maladaptive behaviors.
Many still learn strong coping mechanisms if they have the help of at least one trusted caregiver. Some children have an innate sense of optimism that helps them.
However, research shows that abuse can lead to an array of negative behaviors and health outcomes.
Mental and Emotional Consequences
Childhood abuse has mental and emotional consequences. Children who experience abuse are more likely to develop anxiety, depression, and memory issues.
Children may block out traumatic memories. Sometimes, this can lead to memory issues and other problems that affect areas of life beyond the abuse.
Shame and guilt often also result, with children sometimes blaming themselves for the situation or viewing themselves as somehow defective.
They may feel guilty for failing to say “no” or for getting pleasure from a sexual situation they did not want to be in. In order to hide the abuse from others, they may withdraw, isolate, and have a hard time making friends.
People who experienced childhood abuse may have intrusive thoughts, flashbacks, and nightmares, which can be symptoms of PTSD. Abuse can also result in emotional numbing, social isolation, and panic. There can also be physical reactions that disrupt the body’s normal functioning by impairing both mental and physical processes.
It is important for children to work through the effects of abuse in healthy ways. Ideally, they can do so under the care of a mental health professional.
When distress remains unaddressed, children can carry self-developed coping strategies, such as avoidance and numbing, into adulthood.
Caregivers should learn how to recognize the signs of mental health concerns in children. While abuse is not the only cause of emotional trauma, low self-esteem, or shame, it is often a contributing factor.
When the abuse is sexual, societal stigma can create an extra layer of shame or a reluctance to speak up.
When some signs of distress go unaddressed, they can increase and develop into suicidal ideation or other types of self-harm.
Risky Behavior
Studies have found that child maltreatment is correlated with a greater tendency toward risky behavior. This can include risky sexual behaviors, such as having sex at an early age or having multiple sexual partners.
However, abuse is also linked to increases in other types of risk-taking behavior.
For instance, a 2020 study of adolescent and young adult females found associations between childhood abuse and antisocial behaviors, such as lying, stealing, trespassing, vandalizing (like graffiti), and physical fighting.
Evidence also suggests that child abuse is linked to later increases in substance misuse.
Children who experience any form of maltreatment are more likely to engage in smoking, drinking, and/or drug use when they grow up.
Substance misuse increases their risk of overdose, substance dependency, health problems, and engaging in abusive behaviors in their own families later in life.
Obesity
Research has found a link between childhood abuse and obesity. As with any other chronic health condition, many factors play into whether an individual develops obesity.
Of course, not all people who have obesity experienced abuse in childhood.
However, people who experience abuse may gain excess weight for the following reasons:
- In an effort to cope with negative feelings that result from childhood abuse, either current or in the past, individuals may turn to food as comfort
- People may put on weight in an attempt to desexualize themselves to prevent abuse from happening again
Pregnancy, STDs, and Health Risks
Sexual abuse correlates to youth pregnancy, with both immediate and long-term consequences.
Sexual violence against a youth can result in pregnancy. However, research also shows that experiencing sexual violence in early adolescence is linked to subsequent pregnancy (not related to the abusive circumstance) later in adolescence.
A 2018 study that followed 4594 U.S. youth over a period of 2 years found that girls who experienced sexual abuse were more than twice as likely to become pregnant in their teen years. They were also more likely to misuse substances, experience depressive symptoms, and have lower self-esteem.
Sexual violence may lead to sexually transmitted infections (STIs). It may also result in other physical harm, like internal pain and external tearing.
Perpetuation of Abuse and Violence
Children who were abused may grow up to perpetuate abuse.
Sometimes they become part of abusive relationships, where they experience or perpetrate abuse. Or they may go on to abuse their own children, mirroring how they themselves were treated as children.
Some reasons why a history of childhood abuse can be a factor include:
- Abuse was normalized in childhood, so it feels familiar
- Feelings of anger, inadequacy, or insecurity
- Attempts to rewrite the narrative by engaging in a relationship with a new abuser but creating a different outcome (where the abused person triumphs over the abuser)
- Feelings of love, comfort, and arousal are tied up with feelings of abuse and therefore become entangled in later relationships
The cycle of abuse is a complex issue. A history of child abuse does not mean that someone will go on to abuse others or experience abuse again. It is, however, one possible factor.
Other risks include substance use, having a mental health condition, and experiencing a lack of social support and economic resources.
Family Ripple Effects
Abuse can cause generational effects as well as immediate ripples within a family.
When family, friends, or community members learn about instances of abuse, they may feel shocked and confused.
Non-offending parents may have trouble understanding the abuse, struggle with where to turn for help, and fear the consequences for the child and the family.
Additional impacts of abuse on the family include:
- Anger toward other family members for not preventing harm
- Unwarranted anger toward the child victim for inadvertently bringing about challenges within the family
- Fear of the abuser
- Anxiety or worry about the victim of abuse
- Fear that others will find out—with resulting social implications, including isolation and stigma
- Confusion, uncertainty, guilt, and self-blame, which can lead to depression
- PTSD for family members who either discovered the abuse or watched it play out
- A sense of loss: of the family’s innocence or of the world as a safe place
- Lost relationships: with the abuser (if the abuser was a friend or family member) or with family and friends who disbelieve abuse and side with the abuser
- Relocation to a new home, school, or place of worship to avoid the abuser or reminders of the abuse
Unfortunately, shock and denial can prevent some non-offending family members from believing a child who reports abuse. Such lack of support compounds the harm to the youth.
Several studies show that when caregivers believe a child and report abuse, the child will have better mental health outcomes. Family members who receive therapy in the aftermath of abuse have fewer mental health symptoms.
Societal Impacts
Child maltreatment poses a significant burden to society. Some of the costs include medical care for injuries and ongoing mental health treatment.
Child abuse also increases government costs for child protective services and the foster care system.
Children who experience violence in childhood have a 13% greater chance of not graduating from high school, which increases their risk of living in underprivileged conditions.
Research shows an association between child maltreatment and later criminal behavior. In addition, the increased school dropout rates of victims of abuse deprive society of productive workers.
Want to understand more about mental health? Watch our webinar series!
Risk Factors Associated With Child Abuse or Maltreatment
It’s not always easy to tell when a child is being abused, but it is possible to learn to recognize the signs of a child or a family at risk.
Parents, caregivers, teachers, and medical professionals can learn about the individual, relational, community, and societal factors that may lead to an elevated risk for children in their environment.
According to the World Health Organization (WHO) and the Centers for Disease Control (CDC), the following risk factors may increase the risk that a parent or caregiver may abuse a child:
- Having children 4 years of age or under
- Not wanting the pregnancy or child in the first place
- Difficulty bonding with a newborn
- Caring for children with special needs, colic or constant crying, or unusual physical characteristics
- Having neurodiverse children
- Learning that children are LGBTQ+
- Having a history of abuse from their own parents or caregivers
- Poverty
- Lack of social support and/or no help from extended family
- Being young, single, or having many children
The risk of child abuse increases when the relationship between parents is strained or there is a high level of conflict. Negative communication styles within the family can also be a flag.
Risk also rises when there is other violence in the family or in surrounding relationships.
Additionally, factors within communities and society may increase the risk of child maltreatment, including:
- Socioeconomic and gender inequality
- Lack of services critical to survival, such as affordable food, medical care, or housing
- Widespread availability of drugs and alcohol
- Use of corporal punishment
- Lack of community activities for young people
The possibility of abuse increases when children are separated from their parents or family. Such situations can occur in refugee situations, when children are under institutional care, or if they belong to a marginalized group.
With increased awareness as well as education about child abuse resources, community members can be prepared to address abuse if it arises.
Decreasing the Risk of Child Abuse
Fortunately, several factors help prevent child maltreatment or lessen negative effects in the aftermath of abuse. It is possible to make changes to protect a child at risk of abuse.
Support for Children
Encouraging optimism, self-esteem, humor, independence, self-reliance, and creativity in kids fosters resiliency.
Caring, positive role models also make a huge difference in a child’s ability to overcome maltreatment.
Support for Parents/Caregivers
Parents and other adults who have community support and close ties to friends, family, or government resources are less likely to perpetrate abuse.
Parents who receive education and gain the ability to meet their own and their children’s basic needs are also less likely to abuse.
Children are less likely to be abused when parents have enough money and community support. Such factors decrease stress and increase the amount of time parents can be present with their children.
Support From Communities
Stable housing, affordable medical care, social services, food access, and educational resources are all critical in preventing child abuse.
Communities that provide good work opportunities for parents, safe places for children to go after school, and economic help when needed can reduce the incidence of abuse.
McLean Is Here to Help
If your child needs help managing mental health challenges, call us today at 877.626.8140 to learn more about McLean’s world-class treatment options.
Treatment for Survivors of Child Abuse
Different forms of therapy are effective, depending on the age of the child and specific family circumstances.
Treatment for the impacts of child abuse can take the form of individual therapy, parent/child therapy, family therapy, and support groups.
Depending on a family’s circumstances, a member of social services may visit a family’s home regularly to make sure a child is living in safe conditions and receiving care.
Below are just a few examples of treatments that can help children who have experienced abuse.
Child-Parent and Infant-Parent Psychotherapy
In these therapies, therapists work in joint sessions with parents and young children (ages 0-5) to process trauma.
Therapists help children and parents talk about difficult experiences, respond to difficult feelings and behaviors, and create a family story that leads to healing.
Play Therapy
Specially trained therapists help children express themselves and process abuse through therapeutic play.
In play therapy, children act out their emotional life and address problems through materials including blocks, puppets, clay, and paint.
Through this active form of therapy, children can develop better coping skills and improved relationships with caregivers.
Trauma-Focused Cognitive Behavioral Therapy
TF-CBT helps children and teens heal by addressing distorted beliefs associated with mistreatment. With TF-CBT, children can discuss traumatic events in a supportive environment, where they can process the trauma and learn coping skills.
TF-CBT involves parents and caregivers who were not abusive. In treatment, they learn to cope with the distress of abuse that happened to their child.
Parents and caregivers learn positive parenting skills, stress management, behavior management, and effective communication.
Child Abuse Can Be Addressed – Yes, There is Hope
Child abuse is a wide-ranging issue that can have lifelong repercussions.
Children who experience abuse may develop mental health concerns, such as anxiety, depression, and PTSD. They are more likely than their peers to engage in risky behaviors and experience a range of stressors, including early pregnancy and suicide attempts.
The toxic stress of child abuse can also make victims more susceptible to physical illnesses, including obesity, diabetes, and cancer.
Given the seriousness of child abuse, it is imperative to protect young people. Stable housing, affordable medical care, and food assistance are just some of the social factors that can help prevent maltreatment.
At the individual level, adults can recognize abuse, report it, and support the child.
Children whose experiences are validated, and who receive counseling after abuse, have better mental health outcomes. Caring role models can make a difference in a child’s ability to overcome maltreatment.
Through public policies, community programs, and individual action, over time we can work toward decreasing the incidence and severity of child abuse.
Want More Information?
Looking for even more information about the effects of child abuse? You may find these resources helpful.
Articles, Videos, and More
Learn more about child abuse and what you can do if you or a loved one is struggling with their mental health.
- Fast Facts: Preventing Child Abuse & Neglect – CDC
- How to Report Child Abuse and Neglect – Child Welfare Information Gateway
- Supporting Your Children – National Domestic Violence Hotline
- 10 Ways to Teach Children to Speak Up About Sexual Abuse – Child Mind Institute
- Kids’ Mental Health: What to Look for and When to Act – NAMI
- Video: Trauma in the United States and Around the World
- Podcast: Engaging With Closed-Off Kids & Teens
- Find access to all McLean’s child and adolescent mental health resources
Helpful Links
These organizations may also have useful information on child abuse prevention and mental health support:
Childhelp
Serving the U.S. and Canada, the Childhelp National Child Abuse Hotline is staffed 24 hours a day, 7 days a week with professional crisis counselors who—through interpreters—provide assistance in over 170 languages.
The hotline offers crisis intervention, information, and referrals to thousands of emergency, social service, and support resources. All interactions are confidential. To contact the hotline, call or text 1.800.4AChild (1.800.422.4453), para español, presiona el 1.
Crisis Text Line
This text hotline is available to provide support for any crisis. Text HOME to 741741 from anywhere in the United States. A live, trained counselor receives the text and responds from a secure online platform.
Darkness to Light
This organization is a leader in child abuse prevention, advocacy for behavioral impact, education, training, and research. It also has a 24/7 hotline where callers can have questions answered or can talk with a trained crisis counselor. To access the hotline, call 1.866.FOR.LIGHT (1.866-366-5444) or text LIGHT to 741741.
National Center for Missing & Exploited Children
The National Center for Missing & Exploited Children is the largest and most influential child protection organization in the United States. They operate a 24-hour call center and cyber tipline where people can report information about a missing or exploited child. For more information, call 1.800.THE.LOST (1.800.843.5678) or visit the cyber tipline.
National Domestic Violence Hotline
Highly trained expert advocates offer free, confidential, and compassionate support, crisis intervention information, education, and referral services to domestic violence survivors. Support is offered 24/7 in over 200 languages. To access the hotline, call 1.800.799.SAFE (7233) or text START to 88788. Live chat is available on their website.
State Child Abuse and Neglect Reporting Numbers
The U.S. Department of Health and Human Services provides a directory of state toll-free numbers and websites to report child abuse and neglect to specific agencies.
Stop It Now!
This organization prevents the sexual abuse of children by mobilizing adults, families, and communities through direct support, information, and resources to take actions that protect children before they are harmed. Call 1.888.PREVENT to reach the Stop It Now! hotline.
