June 21, 2006

Childhood Emotional Abuse, Emotional Neglect and Schizophrenia

As we noted in our June 16th article on child abuse and schizophrenia - while the claim that some psychologists are making that child abuse is the leading cause of schizophrenia is unsupported by any rigorous studies, there seems to be an increasing level of belief among psychology and psychiatry researchers that different types of child abuse -- including emotional abuse and emotional neglect - are likely to be contributing factors in the development of mental illnesses, including schizophrenia (especially for children genetically or biologically predisposed).

Additionally, research supports the idea that a warm, sensitive, loving, low-stress, and emotionally responsive environment will result in a child that is more resilient and less likely to develop mental health issues later in life. (see social stress and schizophrenia, isolation and schizophrenia)

A new article in the June issue of Psychiatric Times - a publication that is written for psychologists and psychiatrists - titled "Emotional Maltreatment of Children: Relationship to Psychopathology" covers the issue of emotional abuse of children, including what it is and how it impacts children.

The take home message here is that if you want to have resilient children with a minimum number of mental health problems, research suggests that you want to practice warm, involved, supportive, emotionally intelligent parenting. The good news is that research done over the past 30 years has gone a long way in identifying the behaviors and environments that seriously harm children (physical and sexual abuse, in addition to the emotional abuse list below) - and parents should work to minimize children's exposure to these harmful factors (while providing a warm, gentle, supportive and empathetic environment) to significantly improve their children's mental health and maximize resilience. Children are extremely sensitive to their environment - so parents must be careful to create a safe, secure and responsive environment for the children in order for them to grow up mentally resilient and healthy. (for more reading on this topic, read about the causes of schizophrenia).

The article covers two main types of emotional maltreatment:

One type, emotional abuse, the more obvious analog to physical or sexual abuse, is easier to identify and to measure. The other type, emotional neglect, is more subtle yet pervasive and possibly more damaging than emotional abuse, and poses even more challenging barriers to definition and study. Emotional neglect is often better recognized via comparison with its opposite—warm and involved parenting. ...

Despite the relatively sparse research literature [on emotional abuse] compared with that for other types of childhood maltreatment, emotional maltreatment has been shown to be associated with a wide range of Axis I and II psychiatric disorders. ...

The association of emotional abuse to numerous negative adult outcomes (eg, adolescent pregnancy, sexual problems, low self esteem, overall psychiatric diagnoses, eating disorders, depression, suicide attempts, and psychiatric hospitalization) was almost as strong as that for sexual abuse and stronger than that for physical abuse. ...

In adults with schizophrenia, dissociative symptoms have been found to be associated with a history of emotional abuse as well as physical abuse. Similarly, emotional abuse was found to be associated with substance use in patients with schizophrenia. Emotional abuse and neglect, along with other childhood traumas, represent a risk factor for suicide attempts in patients with schizophrenia.

Its important to note that typically child abuse is not out of willful decisions on the part of bad people, but rather the result of situations where a person was him or herself brought up in an environment that resulted in maltreatment (people tend to parent in the same way that they have been parented, unless they make a serious effort to study, learn and practice good parenting skills - which science has identified during the past 20 years), or due to a parent having a mental illness or brain disorder (for example depression or anxiety) that causes them to parent in a way that is not conducive to healthy functioning for the child - this is one of the reasons why its so important for parents to be successfully treated for any mental illness if they have children. And of course, maltreatment of children can come from any number of sources - including baby sitters, neighbors, extended family, day care workers, teachers and parents.

One recent study that supports the idea that unintended child abuse contributes to schizophrenia is a paper published in the February, 2004 issue of the British Journal of Psychiatry a study looked at adopted children from families that have a history of schizophrenia. The paper stated:

"The information suggests the protective effect of being reared in a healthy adoptive family, with the risk for these high-genetic-risk adoptees developing schizophrenia in healthy families at 1.49% compared with 13% for those reared in "dysfunctional" families. This lends significant support to the stress and hereditary predisposition model of the cause of schizophrenia, in which environmental stressors have a particularly harmful impact only on individuals with a genetic vulnerability." Source: British Journal of Psychiatry

Following are the common classifications of different types of emotional abuse that researchers have identified, and which may be evident in "dysfunctional families":

Types of Child Emotional maltreatment

Denying emotional responsiveness - General unresponsiveness to child’s attempts at interaction, and absence of warm physical contact and empathic conversation. Being psychologically unavailable and failing to respond to the child’s behavior. Behaviors that communicate or constitute abandonment of the child, such as a refusal to show affection.

Spurning - Verbal battering that includes rejection and hostile degradation

Terrorizing - Threatening severe or sinister punishment, or deliberately creating a climate of fear or threat. Verbal threat to inflict major physical or psychological injury to a child who disobeys

Isolating - Active isolation of a child, ranging from locking in a confined space to limitation of appropriate social and peer interaction. Preventing the child from participating in normal opportunities for social interactions.

Exploiting/corrupting - Modeling of antisocial acts and condoning of deviant standards and behaviors. Behaving so as to encourage the child to develop social values that reinforce antisocial or deviant behavior, such as aggression, criminal acts, or substance abuse.

Read the entire article here:Emotional Maltreatment of Children: Relationship to Psychopathology

Books on how you can create a positive home environment that results in more resilient children.

More information on Social Stress and Schizophrenia

Google Scholar Search (Recent scientific reseach on): Schizophrenia and Emotional Abuse


I don't believe that it is just child abuse. My theory based off of my experiences, and the things I've read, have led me to believe that SZ can develop from any type of physical, mental, or emotional abuse including any type of intense or traumatic experience.

I theorize that there is something in the brain, like a fuse, that burns out or gets turned off by anything too intense, and is especially sensitive to extreme amounts of stress. It is probably some type of mechanism involving Cortisol and a set of nerve fibers between the limbic system and PFC, probably involving language neurons. For some reason, people genetically predisposed to SZ probably have a more sensitive "fuse" in their brain that is more easily triggered. So theoretically SZ is something that everyone could potentially develop in an intense enough situation. This might also have something to do with PTSD.

When the fuse burns out, it prevents certain parts of the brain from communcating with other parts, which results in the cognitive disabilities often seen in SZ. Emotions are felt through many different systems in the brain going off at once, and without them being able to communicate, emotional connections are no longer experienced like they once were. The brain also loses the ability to properly regulate the balance of neurotransmitters, resulting in cells dieing due to overstimulation, understimulation, or some type of programmed cell death that is accidentially overactive. A lot of the incoming sensory data and internal stimuli are not able to reach their intended destination because the fuse is broken, so there is all of this brain activity that has nowhere to go and possibly is rerouted to a different part of the brain, resulting in hallucinations, voices, and a general inability to "test reality" to understand what is real and what is not.

The medications available today help these different parts of the brain function more properly and communicate better by controlling overactive dopamine, increasing underactive dopamine, and stabilizing serotonin. But if these parts of the brain still had the "fuse" then they would probably be able to communicate and regulate these systems just fine, resulting in normal functioning. The problem is that this "fuse" might be a set of nerve fibers, or a type of genetic expression, or an enzyme that inhibits a certain type of gene activity, or alters receptor activity. Weather or not this fuse is able to be "reset" is something I've yet to determine.

I would also like to note that the fuse is exactly that, a fuse, which is in place for a type of security measure, and is triggered to prevent further, or more detrimental, damage to the brain. If the PFC is malfunctioning, then the easiest thing our brain can do is shut it down and stop communicating with it. This helps quarantine the problem and probably increases our chance of long term survival and long term cognitive abilities.

This is all ONLY A THEORY of mine that I've been researching over the last year or so. Feel free to e-mail me if you have any more information or would like to comment on my theory.

Posted by: Cory Schulz at June 22, 2006 11:38 AM

I strongly agree abuse and almost 100% with this article. I am not a doctor but was always my theory. It totally confirms my beliefs. I feel that people who are born in stable warm enviroments are less likely to develop SZ. I beleive to much stress on the mind of a child or at any age for long periods will trigger this Illness. I believe anybody born normal if enough physical and verbal abuse, and Isolation from social supporting enviroments will cause SZ. I think your articles are very logical with exellent real research. I also believe gentics play a part to a degree. Some people are weaker than others. Some people can handle abuse better than others. I also beleive some people are born this way and always will be. Unfortunatley once these poor souls are diagnosed and on medication. Ignorant people claim it is genetic. Very unlikely!!! but possible. SZ I believe is reversable with lots of the right possitive emotional support,over a long time. Unfortunatley the scars are always there.

Posted by: New to site at July 6, 2006 08:51 PM

I totally agree my brother developed SZ after being traumatized and abandoned by his father, mother, step father and brother at the age of 18; early marijuana use was also involved.

Posted by: Jim at July 7, 2006 04:58 PM

I think we run into problems when we try to determine one cause. Bear in mind that Eugene Bleuler, the man who coined the term "schizophrenia," originally added an "s" to the end of it in recognition of its multiple forms. I feel there are not only different forms of schizophrenia, there are also different causes.

In regard to the current discussion, my own theory is that some forms of schizophrenia are caused by ego displacement or collapse. I am using the term "ego" here to refer to one's structure of personality. Severe stress can produce ego collapse/displacement, as can trauma, loss, grief, specific spiritual practices, and certain forms of drugs. I don't know if I'd agree that child abuse does cause schizophrenia in later years but I would suggest that if abuse was part of one's past, and if it was unresolved, it's going to come up when the ego collapses.

For the record I have had a schizophrenic break and yes, there was severe emotional and sexual abuse in my past. My schizophrenic break occurred after a serious of multiple losses as accompanied by trauma; what could also be defined as a period of sustained and unrelenting stress. To pick up on a comment of Mr. Schultz's, I certainly did feel burned out. I suspect that if there had been some way to test my adrenal gland function at the time it would have been off the charts.

Reference: How to Produce an Acute Schizophrenic Break

Incidentally, my break occurred four years ago. Because I didn't know that my experience was considered to be an acute schizophrenic break in this culture, I didn't go to the hospital. Because I didn't go to the hospital, I didn't receive any form of psychiatric care or medication. Recovery has been difficult but it has come. I have been working for the past 3.5 years (just part-time to start); my primary relationships have all stabilized (many non-primary relationships were lost); my mental faculties appear to be intact (there was a time when I had difficulty stringing a sentence together), and; I have still not had any form of psychiatric care or medication.

Posted by: spiritual_emergency at August 6, 2006 05:57 PM

I am a clinical psychologist. I need the articles for my research work

Posted by: Nimer Said at January 24, 2007 06:14 AM

I was diagnosed with schizophrenia 12 years ago,I can function perfectly well in day to day encounters but am still struggling with many issues.I liked this article because it confirmed for me something I thought about myself recently.My problems started in my teens.I was brought up in a very loving and caring enviroment by my parents who I love and respect very much.When I was 8 I walked into my parents room one night whilst they were having sex,and when I hit puberty the natural desires for sex I started to have made me feel dirty and guilty.I also became interested in and was baptised a catholic when I was 17 which was probably due to the guilt I was feeling over what I considered at the time 'dirty' thoughts.I didnt lose my virginity until I was 27 and havent had much sexual experience since then.I have suffered constantly with low self esteem and have had periods of self harm,suicide attempts and I smoked cannabis for quite a while in my early twenties(which caused further problems)Even though I would like a relationship Ive never felt able and have never had a proper girlfriend.I agree with the comments above too,I feel that a part of my brain was damaged as an 8 year old due to a stress I didnt understand and could therefore not deal with.I can remember feeling upset with both sets of my grandparents who never responded to me emtionally and there are smaller events in my childhood and teens which I suppose add up to make the original problem worse.Even thogh I now consider sex normal and natural I cant figure out how to resolve the issues an 8 year old was feeling 20 years later and I dont seem able to heal the emotional scars that still affect me today.I would argue that every adults pschological makeup, mental illness or not, is determined entirely by that adults experiences as a child.If a difficult event in childhood is not resolved it will cause problems for that person.

Posted by: james at July 31, 2007 02:37 AM

I am glad that you have gotten help to resolve your issues.

I think that what you have stated about what to you was emotional abuse and trauma (walking in on your parents having sex) is an example of a predisposition to succumb to stress and trauma because it affected you so deeply.

You seem to be a sensitive person. Millions of children walk in on their parents without lasting severe trauma. It just becomes an uncomfortable incident in a lifetime of millions of other incidents.

I know that to some other children, unbearable stress and trauma can be getting a case of poison ivy, or the time they abruptly lost a teacher. A million other kids have the resiliency to cope with things like they are just a blip in their lives, and others simply cannot.

Then there is severe abuse and trauma like being beaten and burned and chained in a closet which is likely to destroy even the most genetically resilient of people - yet not all.

Which again shows that everyone is different. Everyone comes into this world with their own levels of tolerance for stress, trauma, etc.


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