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Tuesday, 2 June 2015

Emotional abuse: a neglected dimension of partner violence

Volume 376, Issue 9744, 11–17 September 2010, Pages 851–852
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Emotional abuse: a neglected dimension of partner violence


doi:10.1016/S0140-6736(10)61079-3
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Emotional abuse is well recognised as a form of intimate partner violence that is widespread in abusive and dysfunctional relationships. It is often overshadowed by physical and sexual partner violence, which are closely related. The prevalence of exposure to emotional abuse in women can range from 9% to 70%.1, 2, 3, 4, 5, 6, 7 and 8
Ana Ludermir and colleagues9 report in The Lancet today that emotional abuse during pregnancy might be more important than are physical and sexual violence in determining the development of postnatal depression. Today's finding supports a population-based study from Japan, in which women who experienced only emotional abuse had poorer self-reported health status, suicidal ideation, difficulty in daily activities, increased use of health services in the previous month, and symptoms of distress. 10 Such findings suggest that a radical re-evaluation of the importance of emotional abuse in women's mental health is necessary.
Emotional abuse is more diverse than physical and sexual abuse because it takes many different forms, including verbal abuse, threats of violence, engendering fear, humiliation, destruction of property, enforcement of social isolation, taking or withholding earnings, and flaunting other sexual partners. There is variation in acts between different cultures, and the way the victim perceives the emotional abuse also influences the effect of the act. In violent relationships, women often experience pervasive emotional abuse compared with the more discrete acts of physical and sexual violence; at times, emotional abuse might be the only form of abuse. The association of emotional abuse with ill-health has been hard to assess because of strong overlaps with physical and sexual violence, especially in settings with a high overall prevalence of partner violence. Emotional abuse generates fear and anxiety, removes social support, impoverishes, and undermines self-esteem; it is therefore unsurprising that such abuse is important in postnatal depression. Emotional abuse probably has a greater importance in women's mental ill-health than originally thought, and should therefore receive more attention from researchers and health services.
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Ludermir and colleagues' study has important implications for health services. Postnatal depression is an important and prevalent health problem in women worldwide and affects both mother and baby. Today's findings suggest that 10% of postnatal depression could be prevented if partner violence was eliminated, and that a substantial proportion of women at risk of postnatal depression could be identified during antenatal care if midwives or doctors inquired about partner violence, including emotional abuse. Women at risk need psychological support and mental health services, which are often inadequate in low-income and middle-income countries and so compound the problems for female victims.11 The high prevalence of postnatal depression reported in today's report shows the great need for improved mental health care.
Emotional abuse has not been part of many screening recommendations to identify women who experience abuse during prenatal care, such as those from the American Congress of Obstetricians and Gynecologists.12 However, there is mounting evidence that guidelines should include questions about emotional abuse, as well as physical and sexual abuse. Prevention of all forms of intimate partner violence is very important for improving women's health, particularly their mental health.
I declare that I have no conflicts of interest.

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