Sticks and stones may break my bones,
But names will never hurt me. …

That often repeated children’s rhyme is wrong, according to Harvard University psychiatrists. Scolding, swearing, yelling, blaming, insulting, threatening, ridiculing, demeaning, and criticizing can be as harmful as physical abuse, sexual abuse outside the home, or witnessing physical abuse at home, notes a report in the April issue of the Harvard Mental Health Letter.

The report suggests that, when verbal abuse is constant and severe, it creates a risk of post-traumatic stress disorder, the same type of psychological collapse experienced by combat troops in Iraq. The research on which the report is based points out that children who are the target of frequent verbal mistreatment exhibit higher rates of physical aggression, delinquency, and social problems than other children.

Many studies tie physical and sexual abuse to lasting effects on the brain and behavior, but emotional mistreatment has not received the same focus. “Exposure to verbal aggression has received little attention as a specific form of abuse,” notes Martin Teicher, associate professor of psychiatry at McLean Hospital, a Harvard-affiliated psychiatric facility. “This despite the fact that one national study found that 63 percent of American parents reported one or more instances of verbal aggression, such as swearing at and insulting their child.”

Other researchers have associated childhood verbal abuse with a significantly higher risk of developing unstable, angry personalities, narcissistic behavior, obsessive-compulsive disorders, and paranoia. “Verbal abuse may also have more lasting consequences than other forms of abuse, because it’s often more continuous,” says Teicher. “And in combination with physical abuse and neglect [it] may produce the most dire outcome. However, child protective service agencies, doctors, and lawyers are most concerned about the impact and prevention of physical or sexual abuse.”

This situation prodded Teicher and three colleagues — Jacqueline Samson, Ann Polcari, and Cynthia McGreenery — to do a study comparing the impact of childhood verbal abuse in both the presence and absence of physical and sexual abuse and exposure to family violence.

Badgering vs. battering

They recruited 554 young people, aged 18 to 22 years, who responded to advertisements. About half were women and most were white. They all filled out questionnaires about unhappy childhoods and verbal abuse.

Typical of the respondents was Angela, an 18-year-old college freshman who enrolled in the study after seeing a subway car advertisement for people who had an unhappy childhood. “This is the first time I have thought about these things in years,” she said, “and the first time I have talked about it.”

Verbal abuse, the researchers found, had as great an effect as physical or nondomestic sexual mistreatment. Verbal aggression alone turns out to be a particularly strong risk factor for depression, anger-hostility, and dissociation disorders. The latter involve cutting off a particular mental function from the rest of the mind. In one type of dissociation, the person can’t recall part of his or her personal history. Other types involve hallucinations, feeling unreal or unstable, unconsciously converting painful emotions into physical symptoms, and multiple personalities.

“Our findings raise the possibility that exposure to verbal aggression may affect the development of certain vulnerable brain regions in susceptible individuals,” Teicher’s group warns. “Alternatively, such exposure in childhood may put into force a powerful negative model for interpersonal relationships.” Possible consequences could include insecure attachments to others, negative feelings about oneself in relation to others, poor social functioning, and lowered self-esteem and coping strategies. Worse, says, Teicher, “such possibilities are not mutually exclusive.”

As yet unpublished research by Teicher shows that, indeed, exposure to verbal abuse does affect certain areas of the brain. These areas are associated with changes in verbal IQ and symptoms of depression, dissociation, and anxiety.

Violence at home

The effects of verbal abuse were worse than witnessing serious domestic violence and as serious as sexual abuse outside the home, but not as bad as sexual abuse by a family member. Of 54 people in the study who witnessed domestic violence, 35 saw their mothers being threatened or assaulted. Twenty-three witnessed brothers and sisters being physically mistreated. Thirteen of these attacks involved severe beatings.

It is possible, the team points out, “that exposure to domestic emotional, physical, or sexual abuse is greatest in families with mental illness. Thus, genetic factors could contribute to the higher symptom scores we found in subjects exposed to domestic abuse.”

On the other hand, they note that the overall degree of psychological problems they found is probably lower for their college-educated, mainly upper middle-class subjects than it would be for the population in general.

The take-home message is that occasional harsh or angry words are not going to traumatize a child for life. However, frequent verbal bashing could be as bad as sticks and stones that break their bones.

Ursano: Stopping post-traumatic stress disorder before it happens