Exploring Traumatic Influences

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WAMT1092-67711545-083XJournal of Aggression, Maltreatment & Trauma, Vol. 19, No. 2, January 2010: pp. 0–0Journal of Aggression, Maltreatment & Trauma

LITERATURE REVIEW

Childhood Emotional Maltreatment and Later Intimate Relationships: Themes from the Empirical Literature

Emotional Maltreatment and Intimate RelationshipsN. Dodge Reyome

NANCY DODGE REYOME State University of New York at Potsdam, Potsdam, New York, USA

Within the last three decades, researchers have begun to investigate the long-term consequences of childhood emotional maltreatment on interpersonal and intrapersonal functioning. These investiga- tions have led to the realization that survivors of childhood emo- tional maltreatment suffer from myriad psychological and social difficulties. These difficulties influence the quality and nature of intimate relationships formed by emotional abuse survivors. The empirical literature looking at the effect of childhood emotional maltreatment on intimate relationships is summarized and dis- cussed. Implications of the current body of research for future research and clinical practice are addressed.

KEYWORDS child abuse, emotional maltreatment, intimate relationships, relational problems

Emotional maltreatment is a commonly occurring form of child maltreatment. In a recent comprehensive national telephone survey conducted in the United States, 2,030 children and adolescents were asked questions regard- ing the types of victimization they had experienced. Finkelhor, Ormrod, Turner, and Hamby (2005) found that of the different forms of child mal- treatment assessed, psychological and emotional forms of maltreatment were the most frequently reported by the children and youth surveyed.

Submitted 13 October 2009; revised 6 December 2009; accepted 7 December 2009. Address correspondence to Nancy Dodge Reyome, Psychology Department, State University

of New York at Potsdam, Potsdam, NY 13676. E-mail: [email protected]

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Scher, Forde, McQuaid, and Stein (2004) found similar results after conduct- ing a telephone survey of 967 men and women in a major metropolitan area in Tennessee. In their study, emotional abuse was one of the most common forms of childhood trauma reported by the adult participants. Although emotional maltreatment has been recognized and documented as a com- monly occurring form of childhood maltreatment, research on the short- and long-term effects has lagged behind other forms of child maltreatment.

Garbarino, Eckenrode, and Bolger (1997) considered emotional maltreat- ment to be “an elusive crime.” In their estimation, it is too often overlooked, difficult to demonstrate, and is clearly not studied as frequently as other forms of maltreatment. Emotional maltreatment is comprised of parental behaviors that often ignore a child’s emotional and psychological needs (Garbarino et al., 1997; Hart & Brassard, 1987; McGee & Wolfe, 1991). These actions might involve isolation, rejection, exploitation, terrorization, or outright neglect of the child who is the target of these parental actions. Glaser (2002) proposed a framework comprised of five categories to encom- pass parental behaviors that constitute emotional maltreatment: (a) emotional unavailability, unresponsiveness, and neglect; (b) negative attributions or misattributions to the child; (c) developmentally inappropriate or inconsis- tent interactions with the child; (d) failure to recognize or acknowledge the child’s individuality and psychological boundary; and (e) failing to promote the child’s social adaptation. As with other forms of maltreatment, an iso- lated incident of emotional maltreatment is not thought to have lasting developmental implications, however, a repeated and chronic pattern of exposure to psychologically and emotionally abusive actions is considered to be especially deleterious to the growing child’s psychological, social, and emotional well-being (Hart & Brassard, 1987; McGee & Wolfe, 1991; Teicher, Samson, Polcari, & McGreenery, 2006).

Harter (1998) argued that child abuse in general and emotionally abu- sive parenting in particular has a harmful effect on the child’s emerging sense of self. She explains that child abuse leads to multiple self-system impairments including impairments in self-awareness, agency, self-continuity, and self-coherence. According to Harter, children who experience child abuse struggle with low self-esteem and a “profound sense of inner badness,” which often leads the child to engage in behavior that is not congruent with the true self. Harter pointed out that guilt, depression, shame, and anger are among the negative emotional problems experienced by abused children.

Consistent with Harter’s concerns, a childhood history of emotional maltreatment has been linked with myriad psychosocial problems. Repeat- edly, empirical investigations have discovered that survivors of childhood emotional abuse suffer from both internalizing and externalizing symptoms. A childhood history of emotional maltreatment has been found to be associ- ated with low self-worth, anxiety, depression, anger, dissociation, somatization, heightened self-criticism, and intense feelings of shame (Briere & Runtz,

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1988; Chapman et al., 2004; Dodge Reyome, Ward, & Witkiewitz, 2010; Kim & Cicchetti, 2006; Sachs-Ericsson, Verona, Joiner, & Preacher, 2006; Schneider, Rosa, Graham, & Zielinski, 2005; Showers, Ziegler-Hill, & Limke, 2006; Spertus, Yehuda, Wong, Halligan, & Seremetis, 2003; Teicher et al., 2006; Uhrlass & Gibb, 2007; Webb, Heisler, Call, Chickering, & Colburn, 2007). Given the psychological and emotional problems reported by survivors of emotional maltreatment, it is not surprising that research indicates that individuals with childhood histories of emotional maltreatment often report suffering from eating disorders, substance abuse, and posttraumatic stress disorder (Moran, Vuchinich, & Hall, 2004; Schneider, Baumrind, & Kimberling, 2007; Witkiewitz & Dodge Reyome, 2000).

These early impairments in self-development and the resulting psycho- social aftereffects often translate into poor interpersonal relationships as the individual grows and develops (Berzenski & Yates, 2010; Dodge Reyome et al., 2010; Riggs, 2010; Taussig & Culhane, 2010). In fact, the experience of any form of maltreatment has been shown to set off a vulnerability toward poor peer relationships. In an early influential study of maltreated toddlers’ social interactions with other toddlers and adults, George and Main (1979) found that the young maltreated children in their study were more likely to verbally and physically assault peers and adults than the children who had not experienced maltreatment. These researchers also found that the maltreated toddlers were more likely to respond to positive social inter- actions with avoidance or a mixture of approach-avoidance behaviors. By the preschool and elementary school years, maltreated children have been found to be rated as more disliked, more physically and verbally aggressive, and more socially withdrawn than nonmaltreated children (Anthonysamy & Zimmer-Gembeck, 2007; Bolger & Patterson, 2001; Darwish, Esquivel, Houtz, & Alfonso, 2001; Shonk & Cicchetti, 2001). Duncan (1999) found that children who have experienced parental maltreatment are not only more likely to bully others, but are also likely to be the victims of peer bullying. Although these studies did not focus exclusively on emotional maltreatment, researchers have identified similar developmental outcomes regarding peer relationships in emotionally maltreated children (Egeland, 2009).

Although many studies have documented the long-term effects of physical and sexual abuse (or childhood maltreatment in general) on peer and intimate relationships, the emerging literature has only begun to examine the nature and quality of intimate relationships for adolescents and adults who have a history of childhood emotional maltreatment. This article intends to review the current literature that has been published on the long-term consequences of childhood emotional maltreatment for intimate relationships in adolescence and adult- hood. The studies considered in the review fall into three areas or themes of relationship functioning and difficulties: (a) intimacy and relationship quality, (b) codependency, and (c) intimate partner violence. This review is not intended to be exhaustive of the published literature in each area, but is meant

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to be illustrative of the current state of knowledge regarding this expanding topic of inquiry in the field of child maltreatment. Following this review, sug- gestions are made for future research on the connection between childhood emotional maltreatment and relationship functioning. Brief remarks on the practice implications of these research findings are made as well.

As mentioned previously, emotional maltreatment can include a multitude of emotionally abusive and neglectful behaviors and because of this, it has been not been clearly defined in the literature and researchers often use differ- ent criteria in defining emotional maltreatment across studies. Due to the lack of consistency in the research, this review uses a broad definition for emotional maltreatment and considers a range of studies to summarize the research that has been conducted on this specific area of study. To provide clarification of what emotionally abusive behaviors are being classified as emotional maltreat- ment in each study, the assessment tool used to measure emotional mal- treatment is presented for each study reviewed. Finally, because emotional maltreatment and psychological maltreatment are terms that are both used to describe the emotional abusive behaviors that are intended to be captured in this review, they are both considered to be interchangeable in this article.

CHILDHOOD EMOTIONAL MALTREATMENT, INTIMACY, AND RELATIONSHIP QUALITY

Given the chronic nature of emotional maltreatment and the effect this form of trauma has on self-development and psychosocial well-being, researchers have sought to understand the influence of childhood emotional maltreat- ment on beliefs about relationships, relationship quality, and satisfaction. Repeatedly, investigators have arrived at the conclusion that a history of childhood emotional maltreatment is strongly associated with serious diffi- culties in interpersonal relationships in adolescence and adulthood.

Childhood psychological maltreatment has been found to be signifi- cantly associated with lower relationship quality, greater fear of intimacy, and distance in interpersonal relationships. Davis, Petretic-Jackson, and Ting (2001) conducted a study looking at the impact of various child abuse experiences on functioning in partner relationships. Davis and his colleagues measured psychological maltreatment using a scale that incorporated Briere and Runtz’s (1990) Scale of Psychological Maltreat- ment and items reflecting Hart and Brassard’s (1987) definition of psy- chological abuse. In this study, a childhood history of psychological maltreatment accounted for more variance in predicting quality of cur- rent interpersonal relationships than either a history of childhood sexual abuse or physical abuse. Of the child abuse variables measured in their study, only a history of psychological abuse or multiple abuse experiences were related to a greater fear of intimacy (see Paradis & Boucher, 2010).

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Similarly, Drapeau and Perry (2004) looked at how different forms of childhood trauma influence adult relationship patterns. These researchers used vignettes to elicit narratives concerning wishes, needs, motivations, and intentions in interpersonal relationships. Childhood trauma history was measured using a modified version of the Traumatic Antecedents Interview Scale (Herman, Perry, & Van der Kolk, 1989). They found that those partici- pants with a history of verbal abuse during childhood reported “more desire to be distant from others” than those who had not experienced trauma. They also experienced others as “less strong,” and they were more likely to react by “not being open” in interpersonal interactions. Those with a history of emotional neglect had “less desire to avoid conflicts” and “more of a wish to be distant from others” than those who had not experienced trauma. In a study looking at the long-term effects of parental physical abuse, verbal abuse (as measured by Straus’s [1979] Conflict Tactics Scale), and emotional neglect (as measured by Parker’s [1979] Caring Subscale of the Parental Bonding Instrument), Loos and Alexander (1997) found that undergraduates who reported a history of emotional neglect had the highest rates of loneli- ness and social isolation in their sample. The researchers underscore this finding by pointing out that the association between parental emotional neglect and high rates of loneliness and social isolation among their college student sample was the strongest relationship uncovered in their research. Finally, in a community sample, Mullen, Martin, Anderson, Romans, and Herbison (1996) found emotional abuse survivors, as determined by scores on Parker’s (1979) Parental Bonding Instrument, were more likely to report their current partner as uncaring and overintrusive and more frequently reported marital dissolution than a nonabused comparison group.

The extent to which a childhood history of emotional maltreatment is recognized and acknowledged also appears to be associated with the quality of later intimate relationships. Varia and Abidin (1999) discovered that psy- chological maltreatment survivors who minimize their maltreatment history report higher quality relationships than those who actively acknowledge their abuse history. Using the Psychological Maltreatment Scale (Briere & Runtz, 1988), they identified three groups of participants in their study: those who had no history of psychological abuse (nonabused), those who reported a history of psychological abuse and acknowledged the abuse (acknowledgers), and those who reported a history of psychological abuse experiences but did not label themselves as psychologically abused as a child (minimizers). They found the acknowledgers had the lowest quality of adult relationships and the nonabused group had the highest quality rela- tionships. The minimizers fell in between these two groups on measures of relationship quality. Acknowledgers reported less spousal support and more spousal conflict than either of the other two groups and were least likely to report having securely attached adult relationships. Interestingly, minimizers tended to report higher levels of overall maternal care than acknowledgers

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and the researchers reported that it was possible that this level of maternal care moderated the effects of childhood emotional and psychological mal- treatment on the quality of adult interpersonal relationships.

Related to the findings that individuals with a childhood history of emotional maltreatment report lower quality relationships marred by loneli- ness, isolation, and mistrust, survivors of childhood emotional maltreatment also report higher rates of interpersonal conflict in intimate relationships than individuals without a history of emotional maltreatment. Using the psy- chological abuse scale from the Computer Assisted Maltreatment Inventory (DiLillo et al., 2006), Messman-Moore and Coates (2007) found that a child- hood history of psychological abuse was directly correlated with adult inter- personal conflict. They also discovered that the relationship between a history of childhood emotional abuse and adult interpersonal conflict is mediated by an individual’s beliefs about the self and interpersonal relationships. Messman-Moore and Coates referred to these beliefs as early maladaptive schemas. According to these researchers, the early maladaptive schemas, which guide the interpersonal relationships of psychological abuse survivors, involve mistrust, abandonment, deprivation, and defectiveness (see Riggs, 2010, for a discussion of the development of internal working models in emotional abuse survivors). In their research, they found that the relationship between child- hood history of psychological abuse and adult interpersonal conflict was fully mediated by the mistrust or abuse and abandonment schema and partially mediated by the defectiveness or shame schema. The demonstration of media- tion indicates that certain rigid interpersonal beliefs about the self in relation to others accounted for the connection between a childhood history of psycholog- ical maltreatment and interpersonal conflict in adulthood.

As time unfolds, the interpersonal difficulties of childhood emotional abuse survivors can impact marital relationship quality and satisfaction. Belt and Abidin (1996) looked at quality of parenting history and the nature of childhood abuse experiences in a sample of married couples with children. In this study, verbal abuse was measured using a verbal maltreatment scale adapted from Berger and Knutson (1984) and Briere and Runtz (1988). Belt and Abidin discovered that the quality of family-of-origin functioning and childhood abuse experiences (physical and sexual maltreatment were also measured) were more consistently associated with the quality of the marital relationship for women than men. For men, neither the quality of childhood parenting nor the extent of childhood abuse predicted the depth or the level of supportiveness of their current marital relationship. The extent of childhood care was a significant predictor of the depth of women’s marital relationships. Also for women, verbal abuse during childhood significantly predicted conflict in the marital relationship.

In a recent prospective study that also considered gender differences in childhood maltreatment and marital functioning, DiLillo et al. (2009) assessed marital functioning at three points over a 2-year period in 202 recently

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married couples. They measured childhood history of psychological maltreat- ment using the Computer Assisted Maltreatment Inventory (DiLillo et al., 2006) and the Childhood Trauma Questionnaire (Bernstein & Fink, 1998). In contrast to Belt and Abidin (1996), DiLillo and his colleagues found that a history of childhood psychological abuse was related to lower marital satis- faction at the first point of measurement for husbands but not for wives. Husbands with histories of psychological maltreatment had declining marital satisfaction throughout the study. Overall, these researchers found that husbands with psychological maltreatment histories reported far more prob- lems with marital relationships than did wives with similar histories.

Finally, Perry, DiLillo, and Peugh (2007) investigated the role of psycholog- ical difficulties as possible mediators of the relationship between childhood his- tory of psychological maltreatment and marital satisfaction in a sample of newly married couples. The Childhood Trauma Questionnaire was employed in this study to measure both history of emotional abuse and history of emotional neglect (Bernstein & Fink, 1998). As with previous studies, Perry et al. (2007) found a significant negative association between having a history of childhood emotional maltreatment and marital satisfaction for the entire sample. Further- more, for the entire sample of male and female participants, these researchers found the association between a childhood history of emotional abuse and emotional neglect and marital satisfaction and quality was completely mediated by psychological distress, hostility, and depression (see Riggs & Kaminski, 2010, for a discussion of the connection between childhood emotional abuse and depression). When looking at gender differences in mediation, Perry et al. found the association between childhood emotional abuse and marital quality in males was mediated by psychological distress and paranoia. In females, psychological distress, hostility, and obsessive-compulsive tendencies served to mediate the relationship between childhood emotional abuse and emotional neglect and marital satisfaction and quality.

In summary, childhood emotional abuse survivors report a greater fear of intimacy, a need for interpersonal distance in relationships, and a general lack of trust in others. At the same time, they report feeling lonely, discon- nected, and socially isolated. Many individuals who have experienced emo- tional abuse during childhood possess maladaptive beliefs about themselves and others (e.g., “other people can’t be trusted”) that negatively influence their interpersonal relationships. A history of childhood emotional abuse tends to be related to lower quality marital relationships, lower marital satis- faction, and marital dissolution. A few researchers have found that there are gender differences in the impact of childhood emotional maltreatment on marital relationships, however, these findings are mixed and warrant further investigation. Finally, there is emerging evidence that particular psychological and social variables such as psychological distress and depression can account for the connection between childhood emotional abuse and the quality of later relationships.

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CHILDHOOD EMOTIONAL MALTREATMENT AND CODEPENDENCY

The literature linking childhood emotional maltreatment with codependency in later relationships is conceptually similar to the Messman-Moore and Coates (2007) study that found maladaptive schemas of self-sacrifice and mistrust underlie the connection between childhood emotional maltreatment and later relationship problems. Noriega, Ramos, Medina-Mora, and Villa (2008) referred to codependency as a “relational problem” characterized by a ten- dency to remain within stressful, abusive, and unhealthy relationships. Codependents tend to engage in self-sacrificing, self-defeating, controlling, and rigid behavior in an attempt to control and change their partner (Dear, Roberts, & Lange, 2005; Dodge Reyome & Ward, 2007; Dodge Reyome et al., 2010). Originally, codependency was believed to emerge from a family con- text of substance abuse, especially alcoholism (Beattie, 1987; Mellody, Miller, & Miller, 1989). As investigations into the link between substance abuse and codependency progressed and only a weak relationship between familial substance abuse and codependency emerged, researchers broad- ened their focus to look at the influence of different family and parenting environments and the influence of other forms of childhood trauma on the development of codependent tendencies in intimate relationships. Eventually, investigators began to consider child abuse and neglect history as a possible precursor of codependency in adulthood.

Early studies examining the link between childhood abuse history and codependency focused on physical and sexual abuse. These studies are mixed in regard to whether or not there is a relationship between childhood physical abuse or sexual abuse and codependency in adulthood. For instance, in a study looking at the relationship between different forms of childhood trauma, Irwin (1995) found that codependency in adulthood was not predicted by either childhood sexual abuse or physical abuse. Similarly, Cullen and Carr (1999) found that individuals labeled as high codependency were no more likely to have childhood histories of physical abuse or sexual abuse than those in the low codependency group. However, F. Parker, Faulk, and LoBello (2003) did find a positive association between codepen- dency and both childhood physical abuse and sexual abuse.

Unlike physical abuse and sexual abuse, researchers have consistently found a direct relationship between childhood emotional abuse and code- pendency in late adolescence and adulthood. Carson and Baker (1994) were perhaps the earliest researchers to report on the strong connection between emotional and psychological forms of abuse and codependency. They found that individuals in their sample with histories of emotional abuse tended to score high in codependency. Although Cullen and Carr (1999) focused their study on other forms of maltreatment, they did note that family environments that lacked warmth and appropriate emotional

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expression tended to be associated with codependency. Investigations into parenting styles and practices and codependency tend to support this overall conclusion that emotional maltreatment is linked with codependency. Crothers and Warren (1996) found that codependency was positively associated with coercive, controlling, and nonnurturing forms of parenting. Related to this finding, Fischer and Crawford (1992) found paternal authoritarian parenting was linked with high codependency scores.

Dodge Reyome and Ward (2007) conducted a comprehensive study to investigate the link between childhood abuse history and codependency by looking at all five major forms of childhood maltreatment and looking at the association of each form with codependency. Childhood abuse history was measured using the Childhood Trauma Questionnaire (Bernstein et al., 1994), which has emotional abuse and emotional neglect subscales. Additionally, childhood psychological maltreatment was assessed using the Psychological Maltreatment Inventory (Engels & Moisan, 1994). They found that although all forms of child abuse and neglect measured in the study were significantly positively associated with codependency, the most robust relationships were between emotional abuse and emotional neglect and codependency (see Dodge Reyome et al., 2010, for further exploration of the link between child- hood emotional maltreatment and codependency). In a sample of young women seeking primary health care in Mexico, Noriega et al. (2008) found that women who reported a history of familial emotional maltreatment (measured by a three-item scale) were more than two times more likely to be codependent than other young women without a childhood history of emotional abuse and neglect. Interestingly, in this same study, neither child- hood physical nor sexual abuse was found to be significantly associated with codependence in this sample of young women.

In summary, for some time, researchers and theoreticians believed that family-of-origin alcohol and substance abuse was the primary familial context of codependency in adult relationships. However, investigations looking at the relationship between exposure to substance and alcohol abuse and codependency found only a weak association. Studies looking at other forms of childhood trauma and codependency in adulthood have consistently found a moderate to strong relationship between childhood emotional mal- treatment and codependency. Further research is needed to look at explan- atory mechanisms for the connection between emotional maltreatment and codependency.

CHILDHOOD EMOTIONAL MALTREATMENT AND INTIMATE PARTNER VIOLENCE

Initially, researchers looking at the association between child maltreatment and intimate partner violence focused on a history of physical child abuse

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or witnessing domestic violence as possible antecedents of relationship vio- lence in adulthood (Rich, Gidycz, Warkentin, Loh, & Weiland, 2005). Some investigators also linked child sexual abuse with a high likelihood of sexual victimization in adult relationships (Arata & Lindman, 2002). Only recently have researchers turned their attention to the role of childhood emotional maltreatment in the experience of intimate violence in partner relation- ships during late adolescence and adulthood (see Berzenki & Yates, 2010; Zurbriggen, Gobin, & Freyd, 2010).

Childhood emotional maltreatment has been found to be associated with intimate partner violence in marital relationships. In an early study looking at childhood emotional maltreatment among battered married women, Cascardi, O’Leary, Lawrence, and Schlee (1995) compared three groups of women on a variety of psychosocial and family history measures. Child abuse history including childhood history of emotional abuse was measured using the Child Abuse Assessment (Neidig, 1989). Cascardi et al. (1995) uti- lized three groups of women in their study: abused women, unhappily married nonabused women, and martially content women. They found that rates of childhood physical abuse and sexual abuse did not differ significantly across groups. However, the abused women and the unhappily married women reported significantly higher rates of childhood emotional abuse than did the women who were content in their marriage. Further, the abused women reported the highest rate of childhood emotional maltreatment of all three groups in the study.

In a telephone survey of 637 women in the Memphis, Tennessee area, Seedat, Stein, and Ford (2005) examined the association between childhood maltreatment history (as measured by the Childhood Trauma Questionnaire), substance misuse, posttraumatic stress disorder (PTSD), suicidal behavior, and intimate partner violence victimization. Approximately half of the women surveyed in their study were married or cohabitating and the aver- age age of the participants was 37 years for those who reported intimate partner violence and 40 years for those reporting no history of intimate part- ner violence. Using a simultaneous regression model, childhood emotional abuse (among other variables) significantly predicted experiencing intimate partner violence. Stepwise regression analysis revealed that childhood emo- tional abuse along with childhood sexual abuse and low educational attainment were the only significant predictors of intimate partner violence victimization in their study.

Studies also indicate that a history of childhood emotional abuse is strongly associated with dating violence. Sappington, Pharr, Tunstall, and Rickert (1997) looked at the relationship among a history of child abuse, dating violence, and psychological problems in a sample of 133 female undergraduates. Verbal abuse was assessed in this study using a measure designed by the researchers called the Experiences Questionnaire. These researchers found that a reported history of parental verbal abuse was

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strongly associated with being forced to have sex on a date, being physi- cally abused by a date, being verbally abused by a date, and verbally abus- ing a date. In essence, Sappington et al. found a strong association between having a history of parental verbal abuse and reported dating violence vic- timization and perpetration. Similarly, in a college student sample, Rich et al. (2005) looked at the link between childhood victimization experiences and college-age victimization experiences, including dating violence. In this study, verbal aggression between parent and child was measured using Straus’s (1979) Conflict Tactics Scale. Sixty-seven percent of the college-age women in this study reported a history of paternal verbal abuse with close to 50% reporting severe paternal verbal abuse. Eighty percent reported maternal verbal abuse and almost 54% of the sample reported severe verbal abuse from their mothers. In this sample, a reported history of maternal and paternal verbal abuse was significantly related to dating violence victimization during late adolescence. In fact, the only forms of childhood victimization (physical abuse and sexual abuse were also measured) that predicted expe- riencing dating violence during adolescence were maternal and paternal verbal abuse during childhood.

Recently, investigators have begun to look at potential mediators of the relationship between a history of childhood emotional abuse and intimate partner violence victimization and perpetration. As with the connection between childhood emotional maltreatment and interpersonal conflict in adult relationships, early maladaptive schemas have been found to be one of the possible links explaining the association between having a history of childhood emotional abuse and later experiencing intimate violence in ado- lescence and adulthood. Using a sample of college males and females, Crawford and Wright (2007) studied the relationship between childhood emotional maltreatment and intimate partner violence and the role of early maladaptive schemas in this connection. These researchers utilized the Life- time Experiences Questionnaire to measure childhood emotional abuse and childhood emotional neglect. Similar to other researchers, Crawford and Wright found that childhood emotional maltreatment emerged as a signifi- cant predictor of both victimization and perpetration of intimate partner violence. In addition, they found different schemas mediated the relationship between a history of emotional maltreatment and intimate violence victim- ization and emotional maltreatment and intimate violence perpetration. The schemas of mistrust, self-sacrifice, and emotional inhibition all emerged as full mediators of the relationship between childhood emotional abuse and intimate partner victimization. The schemas of entitlement, emotional inhibition, and insufficient self-control emerged as partial mediators of the relationship between the perpetration of intimate partner violence and a childhood history of emotional abuse.

Other psychological and social mechanisms have been investigated as possible explanatory mechanisms for the established relationship between

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childhood emotional maltreatment and intimate partner violence. Taft, Schumm, Marshall, Pamuzio, and Holzworth-Munroe (2008) considered PTSD and social information processing deficits as potential mediators of the asso- ciation between a history of childhood maltreatment and intimate partner violence in a sample of adult couples who were married or living together. Of the forms of childhood maltreatment (childhood exposure to parental violence and childhood physical abuse were also measured) assessed in the Taft et al. study, only parental rejection emerged as being significantly related to the perpetration of physical and psychological forms of relation- ship violence. Parental rejection in childhood, as measured by the Rejection subscale of the EMBU (Perris, Jacobsson, Lindstrom, von Knorring, & Perris, 1980), was also strongly correlated with posttraumatic stress symptoms and social information processing deficits. Finally, Taft et al. found the associa- tion of parental rejection with the perpetration of intimate partner violence was mediated by posttraumatic stress symptoms and social information pro- cessing deficits.

In a recent study, Wekerle et al. (2009) also looked at PTSD as a mediator of the relationship between a childhood history of emotional maltreatment and dating violence in a sample of adolescents involved with protective services. These researchers gathered information from 402 teenagers receiving child protective services. Most of the teens in their sample had begun dating and between half and two thirds reported some form of dating violence. Two instruments were utilized to measure childhood emotional maltreatment in this study: the Childhood Trauma Questionnaire (Bernstein et al., 1994) and the Childhood Experiences of Victimization Questionnaire (Walsh, MacMillan, Trocme, Jamieson, & Boyle, 2008). Similar to Taft et al. (2008), these research- ers found childhood emotional maltreatment was a significant predictor of PTSD symptoms and intimate partner violence. Interestingly, they found childhood emotional abuse was a significant predictor of both perpetration of violence and victimization in dating relationships among males. In females, only being a victim of dating violence was significantly predicted by a history of childhood emotional abuse. Also, posttraumatic stress symp- toms were found to be a significant mediator of childhood emotional abuse and dating violence perpetration in males and dating violence victimization in females.

In summary, although not as frequently studied as physical abuse, emotional forms of child abuse have been found to be linked with intimate partner violence in adolescent and adult populations in dating and marital relationships. Those individuals with a history of emotional maltreatment are far more likely than those without such a history to be involved in rela- tionship violence perpetration and victimization. Recent studies have begun to look at possible explanations for the link between a history of emotional maltreatment and intimate partner violence in both dating and marital rela- tionships. Some promising explanatory mechanisms for this connection are

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PTSD, maladaptive schemas about the self and others, and social informa- tion processing deficits.

IMPLICATIONS FOR FUTURE RESEARCH AND CLINICAL PRACTICE

Although the research literature on the long-term consequences of child- hood emotional maltreatment is growing, the sheer volume of studies lags behind the amount of empirical research that has been carried out on other forms of child maltreatment. It is especially important that child maltreat- ment researchers continue to shine a light on the effect of childhood emo- tional maltreatment on adolescent and adult interpersonal functioning. Future investigations looking at aspects of adult interpersonal functioning associated with childhood emotional maltreatment could advance this field of inquiry by utilizing diverse samples, exploring protective factors, studying mediators of the relationship, and employing prospective designs.

Studies looking at relationship functioning have tended to focus on female participants and overlook male participants. This tendency has been especially true in intimate violence studies seeking to understand the background and psychosocial history of victims of intimate violence. The importance of con- ducting studies that include male and female participants is exemplified by studies where gendered relationship patterns have been uncovered. For instance, DiLillo et al. (2009) found that husbands with a history of childhood emotional abuse and emotional neglect reported declining marital satisfaction, whereas wives with similar histories did not. Similarly, Wekerle et al. (2009) found that a history of childhood emotional abuse was predictive of dating vio- lence victimization in females and dating violence perpetration in males.

Whereas the connection between a history of childhood emotional maltreatment and deleterious intimate relationships is clear, it is much less clear what conditions could or do serve as protective factors in this connec- tion. In their research, Varia and Abidin (1999) discovered that individuals with a history of childhood psychological maltreatment who minimize their history report higher quality relationships than individuals who have similar histories of childhood psychological abuse who label themselves as being childhood victims of emotional maltreatment. Besides minimizing the impor- tance of their history of parental psychological abuse, the only other factor Varia and Abidin could identify for ameliorating the effect of the abuse on their adult relationships was the higher level of maternal care that the indi- viduals who minimized their history reported receiving. It will be important for future studies to begin to identify, explore, and understand other protec- tive factors that soften the blow of parental emotional maltreatment on later intimate relationships.

Researchers have begun to identify explanatory mechanisms for the connection between a childhood history of emotional maltreatment and

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later problems in intimate relationships. In marital relationships, Perry et al. (2007) identified psychological distress as a mediator of the relationship between a childhood history of emotional abuse and neglect and marital satisfaction in males and females. Crawford and Wright (2007) found the early maladaptive schemas of mistrust, self-sacrifice, and emotional inhibi- tion were full mediators of the association between childhood emotional abuse and intimate partner victimization. Both Wekerle et al. (2009) and Taft et al. (2008) identified PTSD as a mediator of the relationship between child- hood emotional abuse and partner violence. It is likely that other psychological or contextual variables will be found to serve as pathways between a childhood history of emotional abuse and relationship difficulties in adolescence and adulthood (see Berzenski & Yates, 2010; Dodge Reyome et al., 2010).

The importance of employing prospective research designs in under- standing the consequences of child maltreatment has been addressed in other venues (Widom, Raphael, & DuMont, 2004). One of the greatest advantages of using prospective, longitudinal research designs in looking at the long-term consequences of emotional abuse is the ability to avoid recall bias, which might artificially inflate the relationship between childhood emotional abuse and later relationship problems. At the present time, most of the studies looking at the relationship between childhood emotional mal- treatment and later relationship functioning are retrospective in nature. Short-term prospective designs have been utilized in the research literature on the effect of childhood emotional maltreatment on intimate relationships. For instance, DiLillo et al. (2009) looked at childhood emotional abuse and marital functioning in newlyweds over a 2-year period. However, longer term prospective studies have been carried out looking at the effect of other forms of childhood maltreatment on interpersonal relationships in adoles- cence and adulthood (Colman & Widom, 2004). Similar studies are needed that follow individuals with a history of childhood emotional maltreatment over longer spans of time and measure stage-salient aspects of relationship functioning.

The findings of the current literature looking at the effect of childhood emotional maltreatment history on later intimate relationships hold consid- erable promise for clinical practice. Adult survivors of childhood emotional victimization clearly have lowered opinions of themselves in relationship to others and maladaptive beliefs and expectations of interpersonal relation- ships. These early maladaptive schemas serve to guide their behavior in inti- mate relationships and can result in mistrust, disconnection, and loneliness. Therapeutic approaches that explore and rework these negative self and relationship schemas will assist the individual in adopting new and more constructive ways of thinking about the self and other people (see Carbone, 2010, for further exploration of therapeutic interventions). This cognitive reworking should help the adult survivor form more meaningful, peaceful, and connected relationships with others.

238 N. Dodge Reyome

Moreover, psychological distress and PTSD have been identified as pathways by which a childhood history of emotional maltreatment is linked with lower relationship satisfaction and quality as well as intimate violence in adolescence and adulthood. Exploring and addressing these possible avenues of relationship discord with adult survivors of emotional maltreat- ment and providing targeted therapeutic intervention for these difficulties should prove fruitful in assisting these individuals in finding ways to live more productive and satisfying lives.

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