Childhood verbal abuse has lasting mental health effects similar to physical abuse

Experiencing childhood verbal abuse shows a similar impact to adult mental health as physical abuse, suggests a large intergenerational study, published in the open access journal BMJ Open.

While often not immediately obvious, the effects of verbal abuse may be no less damaging or protracted, the findings indicate. This large retrospective study of more than 20,000 participants examining birth cohorts from the 1950s onwards showed reductions in childhood physical abuse but increases in childhood verbal abuse.

Globally, an estimated 1 in 6 children endures physical abuse from family and caregivers. As well as the immediate physical trauma, physical abuse can exert lifelong effects on mental and physical health and wellbeing, note the researchers. 

This can manifest as higher levels of anxiety and depression, problematic alcohol and drug use, other 'risky' behaviours, violence towards others, and serious health issues, such as cardiovascular disease and diabetes, they explain.

Like physical abuse, verbal abuse is a source of toxic stress, which may affect the neurobiological development of children. It is thought that around one in three children around the globe is subjected to it, they add.

But despite its high prevalence, policies and initiatives to prevent violence against children have tended to focus on physical abuse, often overlooking the potential impact of verbal abuse, they point out.

To better glean the long-term effects on adult mental health of childhood physical and verbal abuse, separately and combined, the researchers pooled the data from 7 relevant studies, involving 20,687 adults from England and Wales, and published between 2012 and 2024.

The studies had all involved questions on childhood physical and verbal abuse using the validated Adverse Childhood Experiences (ACE) tool, and the short Warwick-Edinburgh Mental Wellbeing Scale to measure individual and combined components of adult mental wellbeing.

The survey asked participants how often over the past 2 weeks they had been: feeling optimistic about the future; feeling useful; feeling relaxed; dealing with problems well; thinking clearly; feeling close to other people; and able to make up their own mind about things.

Responses were scored from 1 (none of the time) to 5 (all of the time), and added up. Low mental wellbeing was considered as being more than one standard deviation below average scores (equivalent to around 1 in 6 of the sample).

Analysis of all the data showed that experience of either physical or verbal abuse as a child was independently associated with a similar significant increase (52% and 64%, respectively) in the likelihood of low mental wellbeing as an adult.

And experience of both abuse types more than doubled this likelihood compared with no exposure to either type. 

Even when physical abuse was part of a person's childhood experiences, those who had also experienced verbal abuse as a child faced an additional risk, with the prevalence of low mental wellbeing rising from 16% with no abuse to 22.5% (physical abuse only), 24% (verbal abuse only) and 29% (both physical and verbal abuse). 

Individual components of mental wellbeing also showed similar associations, with the prevalence of never or rarely having felt close to people in the preceding fortnight rising from 8% for neither abuse type, to 10% for physical abuse alone, to just over 13.5% for verbal abuse alone, and to just over 18% for both types, after adjusting for potentially influential factors. 

Those born in or after 2000 had higher likelihoods of all individual poor mental wellbeing components as well as overall low mental wellbeing. And men were more likely to report never or rarely feeling optimistic, useful, or close to other people, while women were more likely to report never or rarely feeling relaxed.

The prevalence of child physical abuse halved from around 20% among those born between 1950 and 1979 to 10% among those born in 2000 or later. But the reverse was true of the prevalence of verbal abuse, which rose from 12% among those born before 1950 to around 20% among those born in 2000 or later.

Reported physical and verbal abuse were both highest among those who lived in areas of greatest deprivation.

This is an observational study, and as such, can't establish cause and effect. The researchers also acknowledge that the study relied on the retrospective recall and report of verbal and physical abuse, so inaccuracies may have crept in. 

Nor were they able to measure the severity of either type of abuse, the age at which it had occurred, or how long it had gone on for, all of which might be highly influential, they suggest.

But they nevertheless conclude: "Verbal abuse may not immediately manifest in ways that catch the attention of bystanders, clinicians, or others in supporting services with a responsibility for safeguarding children. However, as suggested here, some impacts may be no less harmful or protracted. 

"In an increasing range of countries, parents, caregivers, teachers, and others are in roles where legislation now prevents the physical abuse of children, regardless of whether the intent would previously have been considered abusive, punitive, or educational. This leaves a potential void which should be filled with instructional advice and support on appropriate parenting, discipline, and control of children.

"Without such support, and in an absence of public knowledge of the damages caused by child verbal abuse, measures to reduce the physical punishment of children risk simply swapping one type of harmful abuse for another, with equally long-term consequences."