Study on yelling

[smalltownpsych]

Just heard on the news today that a new study found yelling at kids was just as harmful as sexual or physical abuse.
Here is a link Yelling at kids can be as harmful as sexual or physical abuse: study
I don’t have time to look further into the study because I am too busy working with victims of severe early childhood trauma that wish that all they had experienced was yelling. In twenty years of clinical practice, I have yet to see the type of sequlae and long term effects that can result from trauma from a patient that had experienced emotional abuse. Not to say that I haven’t treated anyone who had an angry parent and helped them with problems that resulted, it’s just a whole different level. Misinterpretation of overlapping distributions strikes again?

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[cara susanna]

I'm looking at the article and, yeah, there seem to be a lot of potential confounds that would be difficult to untangle (especially in a systematic review). Would be curious to hear others' thoughts, though.

 

[WisNeuro]

I'm looking at the article and, yeah, there seem to be a lot of potential confounds that would be difficult to untangle (especially in a systematic review). Would be curious to hear others' thoughts, though.

Well, there is this

"The observed epidemiological shift is caveated by the fact that these prevalence estimates do not take into consideration the co-occurrence of other maltreatment subtypes. Moreover, across these estimates, terminology interchanges, and measures and definitions vary, limiting the ability to make direct comparisons across settings and populations."

 

[MCParent]

Well, there is this

"The observed epidemiological shift is caveated by the fact that these prevalence estimates do not take into consideration the co-occurrence of other maltreatment subtypes. Moreover, across these estimates, terminology interchanges, and measures and definitions vary, limiting the ability to make direct comparisons across settings and populations."

I bet all the participants with trauma drank water. Water = trauma. Book deal plz

 

[BuckeyeLove]

I've seen this shared on FB and other social media sites. So i immediately assumed there would be methodological issues.

 

[WisNeuro]

I think the part that they lose the narrative is essentially saying that verbal abuse is as bad as sexual abuse. First, there is the issue that the definition of sexual abuse is fairly well defined in the literature, whereas verbal abuse is seemingly anomalous and idiosyncratic. But, to make that claim, with what we know about sexual assault and the rates of PTSD. This study would somehow have to answer the question why 30-60% of the population doesn't have PTSD.

But, after reading the actual paper, which mentions the significant limitations, this again seems to be more of an issue of the reporting of an article, rather than the actual content of the article.

 

[Sanman]

I think the part that they lose the narrative is essentially saying that verbal abuse is as bad as sexual abuse. First, there is the issue that the definition of sexual abuse is fairly well defined in the literature, whereas verbal abuse is seemingly anomalous and idiosyncratic. But, to make that claim, with what we know about sexual assault and the rates of PTSD. This study would somehow have to answer the question why 30-60% of the population doesn't have PTSD.

But, after reading the actual paper, which mentions the significant limitations, this again seems to be more of an issue of the reporting of an article, rather than the actual content of the article.

60% of the population does have PTSD and it needs to be treated NOW! 💰💰💰

Somebody tell Congress.

 

[ClinicalABA]

A New York Post article with an inflammatory headline that at best only slightly misrepresents the actual situation? I find that hard to believe! Surely someone in the comments section there pointed out this error….(checks NYPost comment section and…pokes own eyes out so as never to experience that again).

 

[cara susanna]

I think the part that they lose the narrative is essentially saying that verbal abuse is as bad as sexual abuse. First, there is the issue that the definition of sexual abuse is fairly well defined in the literature, whereas verbal abuse is seemingly anomalous and idiosyncratic. But, to make that claim, with what we know about sexual assault and the rates of PTSD. This study would somehow have to answer the question why 30-60% of the population doesn't have PTSD.

But, after reading the actual paper, which mentions the significant limitations, this again seems to be more of an issue of the reporting of an article, rather than the actual content of the article.

That's what got me too - sexual trauma is likely the most damaging type of trauma someone can experience.

 

[tr]

Did you guys look at this study? It's a systematic review of 170 full-text articles (Peter Fonagy is senior author).

https://www.sciencedirect.com/science/article/pii/S0145213423003824

Outcomes did not include diagnosed PTSD. They included things like conduct problems, substance problems, early intercourse, obesity, hypertension, etc.

I don't know what 'as bad' means without reference to a specific outcome, but certainly diagnosed PTSD is not the only adverse effect of exposure to early life adversity.

I don't really find these results surprising, but in general I would say they accord with numerous studies I've collaborated on where, among the 5 subscales of the CTQ, the Emotional Abuse subscale stands out as the most strongly predictive of a range of adverse behavioral and physiological outcomes.

 

[smalltownpsych]

Did you guys look at this study? It's a systematic review of 170 full-text articles (Peter Fonagy is senior author).

https://www.sciencedirect.com/science/article/pii/S0145213423003824

Outcomes did not include diagnosed PTSD. They included things like conduct problems, substance problems, early intercourse, obesity, hypertension, etc.

I don't know what 'as bad' means without reference to a specific outcome, but certainly diagnosed PTSD is not the only adverse effect of exposure to early life adversity.

I don't really find these results surprising, but in general I would say they accord with numerous studies I've collaborated on where, among the 5 subscales of the CTQ, the Emotional Abuse subscale stands out as the most strongly predictive of a range of adverse behavioral and physiological outcomes.

I think the problem is not that people can suffer lasting effects from maltreatment in childhood as much as the message that being yelled at is automatically abusive and that it is “trauma”. There are a lot more factors that go into emotional abuse and the headline is missing that. I actually think that appropriate expressions of anger from caregivers can be helpful for emotional development and that if we continue to move toward protecting all kids from any potential adverse experiences that are within the range of normal, then we are actually not helping them. I grew up in a time when adults could hit you if you misbehaved, and they definitely could yell at you, not always sure that was a bad thing.

 

[borne_before]

Did you guys look at this study? It's a systematic review of 170 full-text articles (Peter Fonagy is senior author).

https://www.sciencedirect.com/science/article/pii/S0145213423003824

Outcomes did not include diagnosed PTSD. They included things like conduct problems, substance problems, early intercourse, obesity, hypertension, etc.

I don't know what 'as bad' means without reference to a specific outcome, but certainly diagnosed PTSD is not the only adverse effect of exposure to early life adversity.

I don't really find these results surprising, but in general I would say they accord with numerous studies I've collaborated on where, among the 5 subscales of the CTQ, the Emotional Abuse subscale stands out as the most strongly predictive of a range of adverse behavioral and physiological outcomes.

Sigh... any study that looks at parental abuse without looking or discussing the role of genetics/heredity is dead to me. I bet the apples don't exactly fall far from the tree regarding conduct problems, substance use, early intercourse, obesity, hypertension, etc.

To flirt with causality over this stuff without looking at genetics is daft.

 

[borne_before]

Hello,

I'm your typical - highly verbal, white, educated, parent that this article is written for.

I feel a lot of parental guilt throughout the day. I and my wife work white collar jobs, sending our kids to good NAEC daycare to the tune of about $2600 a month. Although we are excellent providers for our family, providing lots of nutritious food that they don't really eat, do fun things on the weekends, keep them clean, etc., I feel tremendous amounts of guilt that my kids are basically being raised by other people and I only see them for three hours after school before bedtime.

Sometimes my kiddos misbehave. Sometimes my kiddos bother me. Sometimes I yell at them. Sometimes I say some ****ty things to them. I often feel bad about that.

This article basically is saying I am as bad as a sexual abuser? Oh great, here's another thing for me to feel guilty about. Maybe I spend the next three to four hours on parenting facebook groups that advocate gentle parenting.

That'll assuage my guilt.

 

[WisNeuro]

I think the bigger issue is that the research is all over the place and the studies it includes use a very disparate amount of both definitions of verbal abuse, as well as varying outcome measures. More than half of the studies included did not even use established measures, they made up their own.

"However, the outcomes of interest were varied with few repeat studies exploring the same outcome in the same age group. The largest number of repeat studies was three (delinquent behavior in childhood in relation to ‘verbal abuse’; aggression in children/adolescents in relation to ‘verbal hostility’) and the majority of outcomes were explored only once."

"Additionally, other than ‘yelling and screaming’ no behavior was consistently identified across terminologies studied"

Also, this was a mostly retrospective study of adults, likely retrospective self-report. I haven't had the time yet, but I'm wondering about the actual quality and n's of the studies included.

"Among the studies reporting prevalence, estimates ranged from 7.0 % to 95 % with a median of 46 %."

It's not that it's not an important area of study, it's just that I'm not sure what this "systematic review" accomplishes. The data are so disparate and limitations so significant that you can't really conclude anything other than this area needs to be studied with more rigor.

 

[tr]

Sigh... any study that looks at parental abuse without looking or discussing the role of genetics/heredity is dead to me. I bet the apples don't exactly fall far from the tree regarding conduct problems, substance use, early intercourse, obesity, hypertension, etc.

To flirt with causality over this stuff without looking at genetics is daft.

There are obvious limitations to doing this in humans, but really a wealth of cross-fostering studies in animals (mice, rats, macaques) that demonstrate a variety of adverse behavioral outcomes in adult offspring who were cross-fostered to mothers on the low-nurturing end of the normal spectrum of maternal care. I really see no reason why these results would not apply to humans as well.

Also, this was a mostly retrospective study of adults, likely retrospective self-report. I haven't had the time yet, but I'm wondering about the actual quality and n's of the studies included.

I think the retrospective self-report is definitely a huge issue and wonder whether the reason why the Emotional Abuse subscale has such strong apparent associations with behavioral outcomes is because it is the scale that has the most room for interpretation by the responder and thus a given childhood environment could be selectively 'overreported' as EA by people who are already prone to psychopathology ('orchids') and 'underreported' as EA by people who are more resilient ('daisies').

But that really doesn't explain the animal data, and I think the burden of proof would be on the person claiming that humans are unique in being unaffected by suboptimal early rearing environments that fall short of overt physical/sexual abuse.

I feel a lot of parental guilt throughout the day. I and my wife work white collar jobs, sending our kids to good NAEC daycare to the tune of about $2600 a month. Although we are excellent providers for our family, providing lots of nutritious food that they don't really eat, do fun things on the weekends, keep them clean, etc., I feel tremendous amounts of guilt that my kids are basically being raised by other people and I only see them for three hours after school before bedtime.

Arguably, if the home environment is suboptimal, the kids are better off spending more time in a day care where the caregivers are well regulated and emotionally consistent. Alloparenting is an evolutionary and historical norm for our species. See Sarah Blaffer Hrdy's Mothers and Others for an enlightening perspective on this topic.

Sometimes my kiddos misbehave. Sometimes my kiddos bother me. Sometimes I yell at them. Sometimes I say some ****ty things to them. I often feel bad about that.

Everything's a spectrum, kids are annoying, toddlers are infuriating, and I doubt the parent exists who has never ever raised their voice.
But the bottom line is that calm, well-regulated parents generally raise calm, well-regulated children (in the long term - not talking about toddler behavior here).
Should we not acknowledge this reality lest we offend parents who fall short of that ideal?

 

[WisNeuro]

There are obvious limitations to doing this in humans, but really a wealth of cross-fostering studies in animals (mice, rats, macaques) that demonstrate a variety of adverse behavioral outcomes in adult offspring who were cross-fostered to mothers on the low-nurturing end of the normal spectrum of maternal care. I really see no reason why these results would not apply to humans as well.



I think the retrospective self-report is definitely a huge issue and wonder whether the reason why the Emotional Abuse subscale has such strong apparent associations with behavioral outcomes is because it is the scale that has the most room for interpretation by the responder and thus a given childhood environment could be selectively 'overreported' as EA by people who are already prone to psychopathology ('orchids') and 'underreported' as EA by people who are more resilient ('daisies').

But that really doesn't explain the animal data, and I think the burden of proof would be on the person claiming that humans are unique in being unaffected by suboptimal early rearing environments that fall short of overt physical/sexual abuse.


Arguably, if the home environment is suboptimal, the kids are better off spending more time in a day care where the caregivers are well regulated and emotionally consistent. Alloparenting is an evolutionary and historical norm for our species. See Sarah Blaffer Hrdy's Mothers and Others for an enlightening perspective on this topic.


Everything's a spectrum, kids are annoying, toddlers are infuriating, and I doubt the parent exists who has never ever raised their voice.
But the bottom line is that calm, well-regulated parents generally raise calm, well-regulated children (in the long term - not talking about toddler behavior here).
Should we not acknowledge this reality lest we offend parents who fall short of that ideal?

What animal model approximates the disparate "verbal abuse" category from this review? I'm very familiar with the animal model literature and PTSD. It was a large part of my thesis and later dissertation, but I don't recall any piece being logically related to something like this.

 

[tr]

What animal model approximates the disparate "verbal abuse" category from this review? I'm very familiar with the animal model literature and PTSD. It was a large part of my thesis and later dissertation, but I don't recall any piece being logically related to something like this.

Look, individual types of parenting behavior are species specific, so you can't study a particular behavior that is unique to humans (i.e. the use of human language) in an animal model. Just like you wouldn't grade a human being's parenting skill on their frequency of licking their offspring.

But parental nurturing behavior in general is pan-mammalian, and occurs on a spectrum among individual mouse, rat, and macaque parents, just like it does among humans. And exposure to the low ends of that spectrum reliably result in predictable effects on offspring personality and behavior, including reduced exploratory behavior, reduced social interest, proclivity for substance abuse, etc.

https://www.science.org/doi/full/10.1126/science.277.5332.1659

https://www.sciencedirect.com/science/article/pii/S0091305708001433

https://www.sciencedirect.com/science/article/pii/S0079612301330224

Effects of Cross Fostering on Open-Field Behavior, Acoustic Startle, Lipopolysaccharide-Induced Corticosterone Release, and Body Weight in Lewis and Fischer Rats - Behavior Genetics

Lewis (LEW/N) and Fischer (F344/N) rats differ on a myriad of behavioral and physiological endpoints, some of which have been reported to be affected by maternal experience in outbred rats and other strains. To assess whether epigenetic factors contribute to the differential behavioral responses...

link.springer.com

But among the broad spectrum of suboptimal behavioral and physiological outcomes associated with early life stress, I'm not sure why you are bringing up PTSD specifically? I don't think it was even mentioned as an outcome in the Fonagy review.

 

[WisNeuro]

Look, individual types of parenting behavior are species specific, so you can't study a particular behavior that is unique to humans (i.e. the use of human language) in an animal model. Just like you wouldn't grade a human being's parenting skill on their frequency of licking their offspring.

But parental nurturing behavior in general is pan-mammalian, and occurs on a spectrum among individual mouse, rat, and macaque parents, just like it does among humans. And exposure to the low ends of that spectrum reliably result in predictable effects on offspring personality and behavior, including reduced exploratory behavior, reduced social interest, proclivity for substance abuse, etc.

https://www.science.org/doi/full/10.1126/science.277.5332.1659

https://www.sciencedirect.com/science/article/pii/S0091305708001433

https://www.sciencedirect.com/science/article/pii/S0079612301330224

Effects of Cross Fostering on Open-Field Behavior, Acoustic Startle, Lipopolysaccharide-Induced Corticosterone Release, and Body Weight in Lewis and Fischer Rats - Behavior Genetics

Lewis (LEW/N) and Fischer (F344/N) rats differ on a myriad of behavioral and physiological endpoints, some of which have been reported to be affected by maternal experience in outbred rats and other strains. To assess whether epigenetic factors contribute to the differential behavioral responses...

link.springer.com

But among the broad spectrum of suboptimal behavioral and physiological outcomes associated with early life stress, I'm not sure why you are bringing up PTSD specifically? I don't think it was even mentioned as an outcome in the Fonagy review.

These would be good analogues to some level of neglect, but hard to make a jump to "yelling." I'm not saying that a certain level/severity of yelling won't have some measurable level of negative outcomes later in life, just that it's a mistake to equate that to actual physical and sexual abuse. Also, while the animal literature on stress and negative outcomes is well known, it is also well known that these are usually extreme conditions in the animal models, and that they often do not hold up well when applied to human experiments. I wouldn't be close to equating the animal model to the current study, besides being a different species, nowhere near the DV being explored.

 

[borne_before]

There are obvious limitations to doing this in humans, but really a wealth of cross-fostering studies in animals (mice, rats, macaques) that demonstrate a variety of adverse behavioral outcomes in adult offspring who were cross-fostered to mothers on the low-nurturing end of the normal spectrum of maternal care. I really see no reason why these results would not apply to humans as well.

My main point here is that: some kids probably behave in manners that lead to more getting yelled at. Do they have "difficult temperaments? Are they clumsy? Do they suck at impulse control? Are they oppositional? Do they have ADHD?

Not that they deserve it, but some kids really do a lot to create a mismatch.

What do we know about temperament, ADHD, etc.? It's highly heritable. When we compare getting yelled at with sexual abuse, we are not creating a control. Kids who are likely to be yelled at probably have parents with similar temperaments and proclivities that engender them to abusing kids. Same genes, different behavioral phenotype of abuse. What we need to do is look at kids who have been yelled at, vs kids who haven't been yelled at. Take those kids, control for the type of abuse, and viola - similar outcomes - because they have similar parents who also had difficult temperaments, etc.

Everything's a spectrum, kids are annoying, toddlers are infuriating, and I doubt the parent exists who has never ever raised their voice.
But the bottom line is that calm, well-regulated parents generally raise calm, well-regulated children (in the long term - not talking about toddler behavior here).
Should we not acknowledge this reality lest we offend parents who fall short of that ideal?

Am I the only one here who works with adopted kids or kids in foster care? They like never ever behave like their adoptive parents. Even those kids who are adopted at birth, say from the 15yo cheerleader who dun got knocked up and didn't baste her kid in a steady soup of booze, tobacco, and methamphetamine, tend to behave like the 15 year bio parents. Getting knocked up early is a stand in for poor impulse control, after all.

This reminds of this: The Last Psychiatrist: What Goes Wrong In A Psychiatrist's Family?

This may need it's own post (actually i'm gonna make one). In a world where parents are being told to be a good parent is to basically be their kids therapists 24/7, **** is going to get ****ed.

Parents need to be parents. Honestly, if they're angry parents - be consistently angry - so the kid knows what's next if they **** up. But, it teaches them consistently. At least, later in life, they can figure that they just have an angry dad.

Do you see how that's different from real sexual, neglect, or physical abuse? That's what I think @smalltownpsych was getting at.

I wish the messaging about parenting would chill a little. It should be "Their behavior was largely determined when you nutted in their father. But, we can do some things about that - develop a prosthetic social environment, if needed. But for the vast vast vast majority - you're kids are gonna be alright, even if you yell at them sometimes, in fact, they probably need that behavioral feedback."

But the bottom line is that calm, well-regulated parents generally raise calm, well-regulated children

It's becuase they have genes that create that phenotype.

 

[Sanman]

It should be "Their behavior was largely determined when you nutted in their father. But, we can do some things about that - develop a prosthetic social environment, if needed. But for the vast vast vast majority - you're kids are gonna be alright, even if you yell at them sometimes, in fact, they probably need that behavioral feedback."

You sure about that?

Not that I completely disagree with the sentiment. I propose an experiment: let's take a group of people (maybe the folks here on SDN) and split them into two groups. One will be yelled at and the other will be beaten with sticks. Which experimental condition would each of you like to be placed in?

 

[tr]

My main point here is that: some kids probably behave in manners that lead to more getting yelled at. Do they have "difficult temperaments? Are they clumsy? Do they suck at impulse control? Are they oppositional? Do they have ADHD?

Not that they deserve it, but some kids really do a lot to create a mismatch.

What do we know about temperament, ADHD, etc.? It's highly heritable. When we compare getting yelled at with sexual abuse, we are not creating a control. Kids who are likely to be yelled at probably have parents with similar temperaments and proclivities that engender them to abusing kids. Same genes, different behavioral phenotype of abuse. What we need to do is look at kids who have been yelled at, vs kids who haven't been yelled at. Take those kids, control for the type of abuse, and viola - similar outcomes - because they have similar parents who also had difficult temperaments, etc.

Am I the only one here who works with adopted kids or kids in foster care? They like never ever behave like their adoptive parents. Even those kids who are adopted at birth, say from the 15yo cheerleader who dun got knocked up and didn't baste her kid in a steady soup of booze, tobacco, and methamphetamine, tend to behave like the 15 year bio parents. Getting knocked up early is a stand in for poor impulse control, after all.

This reminds of this: The Last Psychiatrist: What Goes Wrong In A Psychiatrist's Family?

This may need it's own post (actually i'm gonna make one). In a world where parents are being told to be a good parent is to basically be their kids therapists 24/7, **** is going to get ****ed.

Parents need to be parents. Honestly, if they're angry parents - be consistently angry - so the kid knows what's next if they **** up. But, it teaches them consistently. At least, later in life, they can figure that they just have an angry dad.

Do you see how that's different from real sexual, neglect, or physical abuse? That's what I think @smalltownpsych was getting at.

I wish the messaging about parenting would chill a little. It should be "Their behavior was largely determined when you nutted in their father. But, we can do some things about that - develop a prosthetic social environment, if needed. But for the vast vast vast majority - you're kids are gonna be alright, even if you yell at them sometimes, in fact, they probably need that behavioral feedback."

But the bottom line is that calm, well-regulated parents generally raise calm, well-regulated children

It's becuase they have genes that create that phenotype.

Look, I'm not here to get into a nature/nurture debate. That's a hoary old false dichotomy and at this point the answer is settled science: It's Both.

And certainly, I agree that inherited and environmental factors can reinforce dyadic behavioral patterns in either vicious or virtuous cycles.

But critically, genetic inheritance cannot be intervened upon in humans (excepting recent rare and heroic efforts in gene therapy for monogenic disorders like sickle cell), whereas environmental factors are much more amenable to improvement.

I agree, some kids are jerks. Given that starting point, they are still going to have better outcomes overall if they have a calm, well-regulated, predictable parent than if they have an angry, inconsistent parent.

By the way I totally disagree that an angry parent can be consistent. Angry people are out of control, and that inevitably results in unpredictability. You can be authoritarian and consistent (of course, that doesn't have the most optimal results either compared to warm/authoritative), but not angry and consistent.

 

[tr]

Just to add another point on the demand for data that disentangle inherited from environmental influences, there are some human cross-fostering data available as well, using samples of children conceived with assistive reproductive technology (IVF with own egg vs donor egg). Obviously these are tricky samples to recruit so it's a much more limited literature than the animal cross-fostering literature.

But here, for example, is one showing a robust association between maternal antisocial behavior and child conduct problems regardless of whether the mother used her own egg or a donor egg. Note that the negative association of child conduct disorder with breastfeeding is evident only in the related group, which is completely consistent with what we already know about breastfeeding being essentially a proxy for better psychosocial functioning in mothers, which accounts for essentially all differences observed in the long term between children who were vs were not breastfed as infants. However, the positive association of child conduct disorder with maternal antisocial behavior is equally evident in the unrelated group, indicating that it is not an inherited effect.

Using a genetically informative design to examine the relationship between breastfeeding and childhood conduct problems - European Child & Adolescent Psychiatry

A number of public health interventions aimed at increasing the uptake of breastfeeding are in place in the United States and other Western countries. While the physical health and nutritional benefits of breastfeeding for the mother and child are relatively well established, the evidence for...

link.springer.com

 

[borne_before]

You sure about that?

Not that I completely disagree with the sentiment. I propose an experiment: let's take a group of people (maybe the folks here on SDN) and split them into two groups. One will be yelled at and the other will be beaten with sticks. Which experimental condition would each of you like to be placed in?

 

[smalltownpsych]

I have never actually hit a child, at least not since I was one too, but I have yelled at a few from time to time. Sometimes I yelled at them because they were hitting each other. “I don’t care who started it, if you don’t knock it off, then I’ll finish it.” I don’t know if I’ve ever used that exact verbiage but growing up with four of us siblings, my dad used that line a few times and it was delivered with volume. All these years later, with much therapy, knowledge, and personal growth, I am extremely grateful for having had a strong father in my life that sometimes yelled at me.

 

[Sanman]

I have never actually hit a child, at least not since I was one too, but I have yelled at a few from time to time. Sometimes I yelled at them because they were hitting each other. “I don’t care who started it, if you don’t knock it off, then I’ll finish it.” I don’t know if I’ve ever used that exact verbiage but growing up with four of us siblings, my dad used that line a few times and it was delivered with volume. All these years later, with much therapy, knowledge, and personal growth, I am extremely grateful for having had a strong father in my life that sometimes yelled at me.

But according to the New York Post (that bastion of truth), he yelled at you and that means you are now the victim of childhood verbal abuse. Because in a vacuum where CVA is not well defined, it means all behavior that is not completely calm. I am not even sure how CVA could be defined separately from emotional abuse. At the end of the day, abuse can take many forms and not all anger is abuse. I leave with this clip regarding the age old wisdom of abuse:

 

[WisNeuro]

And that is part if the issue here. "Verbal abuse" is not well defined and can literally mean anything on a very wide spectrum, that is completely open to personal recollection decades later as assessed by this review. An ill defined construct, inadequately measured. So, how can we trust the outcomes. Garbage in, garbage out.

 

[tr]

And that is part if the issue here. "Verbal abuse" is not well defined and can literally mean anything on a very wide spectrum, that is completely open to personal recollection decades later as assessed by this review. An ill defined construct, inadequately measured. So, how can we trust the outcomes. Garbage in, garbage out.

Sure. But this applies to physical and sexual abuse as well. I refer you to this shocking paper comparing objectively documented abuse with subjective reports of the same. Spoiler: Very poor agreement.

Objective and subjective experiences of child maltreatment and their relationships with psychopathology - Nature Human Behaviour

In a cohort of 1,196 children followed to age 29 years, the authors found that risk of psychopathology was more strongly associated with subjective recall of childhood maltreatment histories than with objective, court-documented evidence of maltreatment.

www.nature.com

"Objective and subjective measures of child maltreatment identified largely distinct groups of participants (Cohen’s κ = 0.25) with poor agreement across all maltreatment types (child physical abuse κ = 0.09; child sexual abuse κ = 0.17; child neglect κ = 0.32; Fig. 1, column 1 and Supplementary Table 1)"

 

[tr]

You sure about that?

Not that I completely disagree with the sentiment. I propose an experiment: let's take a group of people (maybe the folks here on SDN) and split them into two groups. One will be yelled at and the other will be beaten with sticks. Which experimental condition would each of you like to be placed in?

Ok sure, but how about this alternative "would-you-rather" scenario:

1) Your alcoholic father wakes you out of a sound sleep at midnight to scream at you about how worthless you are, several nights per week for your entire childhood. Never lays a hand on you

2) Your otherwise generally loving and consistent father whacks you with a shoe, as punishment for specific transgressions, on 3 separate occasions over the course of your childhood

Which one would you pick? Which one do you think is more likely to lead to long term psychopathology?

 

[cara susanna]

I'm wondering, is it useful to separate yelling/verbal aggression out from emotional abuse as a whole?

I remember back in college we read an article about how the issue with defining emotional abuse is that we don't want to create this "bare minimum" threshold for people to pass.

 

[Sanman]

Ok sure, but how about this alternative "would-you-rather" scenario:

1) Your alcoholic father wakes you out of a sound sleep at midnight to scream at you about how worthless you are, several nights per week for your entire childhood. Never lays a hand on you

2) Your otherwise generally loving and consistent father whacks you with a shoe, as punishment for specific transgressions, on 3 separate occasions over the course of your childhood

Which one would you pick? Which one do you think is more likely to lead to long term psychopathology?

Okay. However, the confound here is duration of trauma. All this would prove is that prolonged trauma is worse than isolated incidents. The article headline suggests that yelling can be equally traumatic to physical or sexual abuse. In my example, duration would be equal. So how about this:


1) Your father wakes you out of a sound sleep at midnight to scream at you about how worthless you are on 3 separate occasions over the course of your childhood . Never lays a hand on you

2) Your otherwise sometimes loving father whacks you with a shoe, as punishment for specific transgressions, on 3 separate occasions over the course of your childhood.

Alternatively this:

1) Your alcoholic father wakes you out of a sound sleep at midnight to scream at you about how worthless you are, several nights per week for your entire childhood. Never lays a hand on you.

2) Your otherwise alcoholic father beats you with a baseball bat until you hospitalized with broken bones on 3 separate occasions over the course of your childhood.

These examples are a bit harder to rank, no? The first set may lead to no lasting trauma from either individual. The second set may both lead to lifelong consequences.

 

[tr]

Okay. However, the confound here is duration of trauma. All this would prove is that prolonged trauma is worse than isolated incidents. The article headline suggests that yelling can be equally traumatic to physical or sexual abuse. In my example, duration would be equal. So how about this:


1) Your alcoholic father wakes you out of a sound sleep at midnight to scream at you about how worthless you are on 3 separate occasions over the course of your childhood . Never lays a hand on you

2) Your otherwise generally loving and consistent father whacks you with a shoe, as punishment for specific transgressions, on 3 separate occasions over the course of your childhood.

Alternatively this:

1) Your alcoholic father wakes you out of a sound sleep at midnight to scream at you about how worthless you are, several nights per week for your entire childhood. Never lays a hand on you.

2) Your otherwise alcoholic father beats you with a baseball bat until you hospitalized with broken bones on 3 separate occasions over the course of your childhood.

These examples are a bit harder to rank, no? The first set may lead to no lasting trauma from either individual. The second set may both lead to lifelong consequences.

I mean, I think we're agreed that duration and severity are critical factors, and that comparing different subtypes of maltreatment to each other doesn't make a ton of sense as an exercise, no?

 

[Sanman]

I mean, I think we're agreed that duration and severity are critical factors, and that comparing different subtypes of maltreatment to each other doesn't make a ton of sense as an exercise, no?

Absolutely. That said, equating "yelling" (and not necessarily verbal abuse) to physical and sexual abuse is a bit ridiculous. As if sustained verbal abuse is the same thing as isolated moments of yelling at one's child.

 

[tr]

Absolutely. That said, equating "yelling" (and not necessarily verbal abuse) to physical and sexual abuse is a bit ridiculous. As if sustained verbal abuse is the same thing as isolated moments of yelling at one's child.

Sure, definitely; but I think that framing is on the NY Post, not on Peter Fonagy.

Slapping your kid with a rolled up newspaper on a few occasions isn't the same as routine and repeated beatings either. But we could call them both 'hitting,' and there are lots of popular media headlines about hitting kids being bad for them. Are those not equally problematic?

 

[Sanman]

Sure, definitely; but I think that framing is on the NY Post, not on Peter Fonagy.

Slapping your kid with a rolled up newspaper on a few occasions isn't the same as routine and repeated beatings either. But we could call them both 'hitting,' and there are lots of popular media headlines about hitting kids being bad for them. Are those not equally problematic?

Didn't say it was on the original authors. They specifically state that the limitations in defining what CVA is. That said, based on a quick read of the original material I do question the utility of differentiating CVA from the larger category of emotional abuse.

According the NY Post article yelling apparently only occurs when wagging an index finger at your kid, maybe we need to study the utility of not using your index finger.

 

[borne_before]

Ok sure, but how about this alternative "would-you-rather" scenario:

1) Your alcoholic father wakes you out of a sound sleep at midnight to scream at you about how worthless you are, several nights per week for your entire childhood. Never lays a hand on you

2) Your otherwise generally loving and consistent father whacks you with a shoe, as punishment for specific transgressions, on 3 separate occasions over the course of your childhood

Which one would you pick? Which one do you think is more likely to lead to long term psychopathology?

What about La chancla?

 

[Sanman]

What about La chancla?

 

[Fan_of_Meehl]

I think the problem is not that people can suffer lasting effects from maltreatment in childhood as much as the message that being yelled at is automatically abusive and that it is “trauma”. There are a lot more factors that go into emotional abuse and the headline is missing that. I actually think that appropriate expressions of anger from caregivers can be helpful for emotional development and that if we continue to move toward protecting all kids from any potential adverse experiences that are within the range of normal, then we are actually not helping them. I grew up in a time when adults could hit you if you misbehaved, and they definitely could yell at you, not always sure that was a bad thing.

I think that things like an 'invalidating' environment (as described by Linehan) can be extremely damaging, over time. It's just a real challenge to isolate/measure this as a variable (especially an independent/causal variable separate from everything else, including the phenomenon of reciprocal causality over time).

 

[tr]

I think that things like an 'invalidating' environment (as described by Linehan) can be extremely damaging, over time. It's just a real challenge to isolate/measure this as a variable (especially an independent/causal variable separate from everything else, including the phenomenon of reciprocal causality over time).

Yes definitely. I think the invalidating environment issue is even trickier to define and measure than verbal abuse.

An environment of exposure to chronic verbal abuse I imagine would predispose to psychopathology in all but the most resilient.

The 'invalidating environment' thing really seems to apply to people who have some kind of predisposition to be extremely interpersonally sensitive. I'm not very interpersonally sensitive and I can sometimes feel my eyes rolling on the inside at some of the things that patients with Axis II issues find 'invalidating.' (I work very hard at suppressing this unhelpful response and maintaining unconditional positive regard. Can't promise I'm always 100% successful from the patient's point of view.)

I guess there is this ratchet effect where an interpersonally sensitive child in an environment that is not extremely supportive becomes further sensitized to see invalidation everywhere.

 

[borne_before]

Just to add another point on the demand for data that disentangle inherited from environmental influences, there are some human cross-fostering data available as well, using samples of children conceived with assistive reproductive technology (IVF with own egg vs donor egg). Obviously these are tricky samples to recruit so it's a much more limited literature than the animal cross-fostering literature.

But here, for example, is one showing a robust association between maternal antisocial behavior and child conduct problems regardless of whether the mother used her own egg or a donor egg. Note that the negative association of child conduct disorder with breastfeeding is evident only in the related group, which is completely consistent with what we already know about breastfeeding being essentially a proxy for better psychosocial functioning in mothers, which accounts for essentially all differences observed in the long term between children who were vs were not breastfed as infants. However, the positive association of child conduct disorder with maternal antisocial behavior is equally evident in the unrelated group, indicating that it is not an inherited effect.

Using a genetically informative design to examine the relationship between breastfeeding and childhood conduct problems - European Child & Adolescent Psychiatry

A number of public health interventions aimed at increasing the uptake of breastfeeding are in place in the United States and other Western countries. While the physical health and nutritional benefits of breastfeeding for the mother and child are relatively well established, the evidence for...

link.springer.com

View attachment 377421

My wife is in this field and works with egg donors. The egg donors are not randomly sampled from the population, there could be a characterization of young female donors that are tight on funds. That alone would bias the sample to people who are pre-disposed to impulsivity, lack of foresight, etc. All donors go through psych evals, but I’m not sure what those evals looks like, but I assume they’re mostly screening out blatant personality disorders, delusional thinking, and psychosis. As an aside, sperm donors (in the US) do not have to go through psych evals, which I thought was interesting.

Anyways, those effect sizes aren’t that remarkable.

 

[tr]

My wife is in this field and works with egg donors. The egg donors are not randomly sampled from the population, there could be a characterization of young female donors that are tight on funds. That alone would bias the sample to people who are pre-disposed to impulsivity, lack of foresight, etc. All donors go through psych evals, but I’m not sure what those evals looks like, but I assume they’re mostly screening out blatant personality disorders, delusional thinking, and psychosis. As an aside, sperm donors (in the US) do not have to go through psych evals, which I thought was interesting.

Anyways, those effect sizes aren’t that remarkable.

Wait what? You are saying that egg donors are more likely to have conduct-disordered offspring because they are financially tight? Or less likely because they are screened psychiatrically?

Either way that makes no sense. What you suggest would result in (either increased or decreased? depending on what you are saying?) rates of conduct disorder in children of donor eggs across the board. But this does not seem to be true. Not in this paper, but published elsewhere and referred to here, this group separately established overall similar behavioral profiles between children of own-egg ART vs donor-egg ART.

https://journals.sagepub.com/doi/abs/10.1177/0165025409338444

Furthermore, your argument implies that (increased?) genetically caused conduct disorder in donor offspring would be noncausally associated with (increased) antisocial behavior in the intended mothers, meaning the apparent association in the unrelated group was caused by confounding - but in such a way as to mirror a (supposedly) genetically caused association in the related group? What third factor would this be that is present only in the unrelated group? The whole argument is too convoluted to make sense. Occam's razor says it's the maternal behavior.

Also, I've also done psych evals for individuals seeking ART. I'm not sure why reproductive endocrinology asks for this, it seems like a meaningless exercise, mostly intended to cover them in case any untoward psychosocial events happen down the line and somebody tries to sue them.

 

[borne_before]

Wait what? You are saying that egg donors are more likely to have conduct-disordered offspring because they are financially tight? Or less likely because they are screened psychiatrically?

Either way that makes no sense. What you suggest would result in (either increased or decreased? depending on what you are saying?) rates of conduct disorder in children of donor eggs across the board. But this does not seem to be true. Not in this paper, but published elsewhere and referred to here, this group separately established overall similar behavioral profiles between children of own-egg ART vs donor-egg ART.

https://journals.sagepub.com/doi/abs/10.1177/0165025409338444

View attachment 377466


Furthermore, your argument implies that (increased?) genetically caused conduct disorder in donor offspring would be noncausally associated with (increased) antisocial behavior in the intended mothers, meaning the apparent association in the unrelated group was caused by confounding - but in such a way as to mirror a (supposedly) genetically caused association in the related group? What third factor would this be that is present only in the unrelated group? The whole argument is too convoluted to make sense. Occam's razor says it's the maternal behavior.

Also, I've also done psych evals for individuals seeking ART. I'm not sure why reproductive endocrinology asks for this, it seems like a meaningless exercise, mostly intended to cover them in case any untoward psychosocial events happen down the line and somebody tries to sue them.

I think youre making some good points, I have some thoughts but I'm unsure if it's cool to make in public forum. Let me think for a bit. BTW - you've done psych evals on families going through IVF? Like their RE required them to do a psych eval before they receive IVF, ICSI, donor sperm/egg?

 

[Ollie123]

Interesting, had never heard of a psych eval for IVF. I know some clinics now have embedded psychologists/social workers for managing distress related to the process, but have never heard of the treatment being conditioned on a psych eval.

Unless maybe in the case of donors/surrogacy by unknown 3rd parties? I could see an eval being requested in those cases, though how much utility it would have I don't know.

 

[borne_before]

Interesting, had never heard of a psych eval for IVF. I know some clinics now have embedded psychologists/social workers for managing distress related to the process, but have never heard of the treatment being conditioned on a psych eval.

Unless maybe in the case of donors/surrogacy by unknown 3rd parties? I could see an eval being requested in those cases, though how much utility it would have I don't know.

I originally wrote a ****ty reply to @tr being like "OMG that is so UNFAIR, extra hurdle, anything for a buck huh?" But, I decided I was being rash. I called my wife. Who said IVF evals aren't really "Evals" it's more like presurgical before, using my own example, a cochlear implant. It's essential that parents know that the kid wont wake up with the ability to hear and talk fluently, potential complicaitons, ensuring that they can commit to training/speech therapy/wearing the damn thing.

In IVF, my wife said it's super common, especially when donor egg/sperm are used. It's more about making sure that the couple are on the same page, have realistic expectations, and the big one, won't keep the secret of using a donated sperm/egg to conceive from the kiddo.

 

[Ollie123]

Eval seems like the wrong word for this then. That sounds like basic health education as part of treatment consent, I'm not even sure why psych would be the one to do that.

 

[borne_before]

Eval seems like the wrong word for this then. That sounds like basic health education as part of treatment consent, I'm not even sure why psych would be the one to do that.

I think a lot of doctors just trust psychologists to handle stuff and keep them a little more safe. Probably not deeply thinking about it.

 

[tr]

I think youre making some good points, I have some thoughts but I'm unsure if it's cool to make in public forum. Let me think for a bit. BTW - you've done psych evals on families going through IVF? Like their RE required them to do a psych eval before they receive IVF, ICSI, donor sperm/egg?

Yeah my area of expertise is reproductive psychiatry so sometimes I get asked to do these. I agree with you it's a ridiculous extra hurdle. Nobody needs psych clearance to get pregnant the regular way right?

I think it's just a CYA move on the part of RE. They just don't want to be bothered with anything psychosocial.

That said, I have had a couple of cases where there were some good reasons to think twice about ART (think older single parent with mental illness and limited social supports) where RE sent them to me under the pretext of "standard pre-ART psych eval" because they just didn't feel comfortable having that conversation with the patient.

 

[futureapppsy2]

IMO, it's a fool's errand to rank-order traumatic experiences and expect that to hold up for any sort of larger population. We've tried to do it in studies before, and it's so blurry (and often interconnected) that you really can't do it and get meaningful results. I think people in general tend to like the idea of rank ordering trauma because it gives us a clearer metric by which to judge things/people/reactions at a glance, but that just doesn't hold in the broader literature and, at worst, can lead to a lot of victim-blaming and invalidation ("Why are you traumatized by that sexual assault--after all, you had an orgasm/weren't threatened with murder/had been on a date the guy where it happened/were drunk/etc?" or "Sure, he hit you but he didn't break any bones/you weren't hospitalized/you weren't in the ICU, so get over it."). Many studies of IPV survivors have shown that it's fairly common for people to find the emotional abuse in their relationship just as, if not more damaging, long-term than the physical abuse, because emotional abuse is much easier for a preparator to hide/deny/gaslight someone about and because it's much less discrete (e.g., someone can slap/choke/hit you only when they are around but they can lock you up/isolate you/harass you via phone from pretty much anywhere). People's experiences of abuse are going to differ based on context and risk/protective factors.

 

[DynamicDidactic]

Punishment is not a great way to get long term behavior change. Overreliance on threatening, frightening, and intimidating methods - without compensating with care, empathy, and love (without being too sappy) - is likely to be more harmful than helpful., especially to children who are relatively powerless.

Snapping or yelling are probably not what is happening in these studies but more likely consistent, over-the-top, and threatening verbal abuse (again, without anything to make up for it). Is it more/less/same harmful than physical or sexual, to me, is seemingly less important.

Yes, this review has flaws. Yes, a different analysis would be interesting. More controlled studies wold help. But, overall it seems to vibe with my understanding of human behavior.

 

[ClinicalABA]

Punishment is not a great way to get long term behavior change...

But it's a pretty effective way to get short term behavior change, thus it's popularity. It's a tool of the shortsighted, with many harmful and lasting side-effects, as this study clearly shows.

 

[Psychstudent!721]

No wonder why the general public thinks of our field the way it does