Paeds Vivas · child-safety-and-social-paediatrics
Psychological and emotional abuse — branching viva
Branching viva on psychological and emotional abuse: Glaser's conceptual framework and the APSAC categories, the toxic-stress cascade and ACE dose-response mechanism, recognising the relational and developmental pattern, excluding concurrent maltreatment, the stepped trauma-informed safeguarding pathway, the fabricated-or-induced-illness overlap, a diagnostic-overshadowing challenge in a disabled child, and a suicide-risk interrupt.
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Target exams
Station 1 — Opening presentation (set the frame)
A six-year-old is brought for bedwetting. Her mother calls her "evil, stupid, a waste of space" in front of you and locks her in her room for hours. The child sits frozen, eyes on her mother. What is going on, and what is your framework? [2]
Expected answer: Recognise psychological and emotional abuse (psychological maltreatment) — not "behaviour problems." Apply Glaser's framework: a repeated pattern of caregiver behaviour conveying the child is worthless, unloved, endangered, or valued only in meeting another's needs, with three features — pattern, caregiver relationship, and harm or likely harm to development. The absence of a mark does not exclude abuse. [2] [4]
Station 2 — Classification: the categories
Which APSAC/Glaser categories are present here, and what is the abuse-versus-neglect distinction? [4]
Expected answer: Spurning (degrading, shaming), terrorizing (the confinement and unpredictability), and denying emotional responsiveness (the cold, contemptuous ignoring). Distinguish acts of commission (emotional abuse) from acts of omission (emotional neglect — failing to provide affection, stimulation, comfort, mental-health care); a child usually experiences both. Add witnessing intimate-partner violence as a recognised form. [2] [4]
Station 3 — Mechanism: why is it as harmful as physical abuse?
A colleague says "words don't hurt." Correct them with the mechanism. [5]
Expected answer: The toxic-stress cascade: a sustained, unpredictable threat from a caregiver, delivered without a buffering relationship, produces chronic HPA-axis activation, amygdala sensitisation and brain-structure change (Shonkoff; Glaser brain review). Vachon shows emotional maltreatment predicts psychiatric harm as strongly as physical or sexual abuse; the ACE dose-response (Felitti, Hughes) links accumulated adversity to mental illness, self-harm and chronic disease. There is no safe form of child maltreatment. [5] [8]
You have read the opening of this viva. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.
References6Show ledgerHide ledger
- [2]Glaser D Emotional abuse and neglect (psychological maltreatment): a conceptual framework. Child Abuse & Neglect, 2002.PMID 12201163
- [4]Hibbard R; Barlow J; Macmillan H; Committee on Child Abuse and Neglect; et al Psychological maltreatment. Pediatrics, 2012.PMID 22848125
- [5]Shonkoff JP; Garner AS; Committee on Psychosocial Aspects of Child and Family Health; et al The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 2012.PMID 22201156
- [7]Norman RE; Byambaa M; De R; Butchart A; et al The long-term health consequences of child physical abuse, emotional abuse, and neglect: a systematic review and meta-analysis. PLoS Medicine, 2012.PMID 23209385
- [8]Vachon DD; Krueger RF; Rogosch FA; Cicchetti D Assessment of the harmful psychiatric and behavioral effects of different forms of child maltreatment. JAMA Psychiatry, 2015.PMID 26465073
- [12]DeJong M; Wilkinson S; Apostu C; Glaser D Emotional abuse and neglect in a clinical setting: challenges for mental health professionals. BJPsych Bulletin, 2022.PMID 34544522