Child Abuse & Neglect 27 (2003) 12471258

Childhood emotional abuse and neglect as predictors of

psychological and physical symptoms in women
presenting to a primary care practice
Ilyse L. Spertus a, , Rachel Yehuda b , Cheryl M. Wong c ,
Sarah Halligan d , Stephanie V. Seremetis e
a

Department of Psychiatry, Columbia Presbyterian Medical Center,

180 Fort Washington Avenue (HP-2), New York, NY 10032, USA
b
Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
c
Sall-Myers Medical Associates, Patterson, NJ, USA
d
School of Psychology, University of Reading, Reading, UK
e
BioPharmaceuticals Business Unit, West Princeton, NJ, USA
Received 25 April 2003; received in revised form 7 May 2003; accepted 15 May 2003

Abstract
Objective: There were two aims to this study: first to examine whether emotional abuse and neglect are
significant predictors of psychological and somatic symptoms, and lifetime trauma exposure in women
presenting to a primary care practice, and second to examine the strength of these relationships after
controlling for the effects of other types of childhood abuse and trauma.
Method: Two-hundred and five women completed the Childhood Trauma Questionnaire (Bernstein
et al., 1994), Trauma History Questionnaire (Green, 1996), the Symptom Checklist-revised (Derogatis,
1997), and the Revised Civilian Mississippi Scale for posttraumatic stress disorder (Norris & Perilla,
1996) when presenting to their primary care physician for a visit. Hierarchical multiple regression
analyses were conducted to examine unique contributions of emotional abuse and neglect variables
on symptom measures while controlling for childhood sexual and physical abuse and lifetime trauma
exposure.
Results: A history of emotional abuse and neglect was associated with increased anxiety, depression,
posttraumatic stress and physical symptoms, as well as lifetime trauma exposure. Physical and sexual
abuse and lifetime trauma were also significant predictors of physical and psychological symptoms.
Hierarchical multiple regressions demonstrated that emotional abuse and neglect predicted symptomatology in these women even when controlling for other types of abuse and lifetime trauma exposure.

Corresponding author.

0145-2134/$ see front matter 2003 Elsevier Ltd. All rights reserved.
doi:10.1016/j.chiabu.2003.05.001

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Conclusions: Long-standing behavioral consequences may arise as a result of childhood emotional

abuse and neglect, specifically, poorer emotional and physical functioning, and vulnerability to further
trauma exposure.
2003 Elsevier Ltd. All rights reserved.
Keywords: Emotional abuse; Neglect; Primary care; Anxiety; Somatic

Introduction
Studies have consistently demonstrated childhood sexual and physical abuse to be associated with a broad range of behavioral, psychological and physical problems that persist into
adulthood including increased risk for depression, anxiety, substance abuse, personality disorders, revictimization (for review of the literature, see Yehuda, Spertus, & Golier, 2001), and
increased physical complaints (Moeller, Bachmann, & Moeller, 1993), such as gastrointestinal distress and recurrent headaches (Felitti, 1991). More recently there have been a number
of studies indicating that emotional abuse (i.e., psychological maltreatment and non-physical
aggression) and emotional neglect (i.e., emotional deprivation or the absence of a nurturing
emotional environment) may similarly be associated with adverse outcomes. Emotional abuse
has been associated with increased levels of depression (Briere & Runtz, 1988; Mullen, Martin,
Anderson, Romans, & Herbison, 1996; Rich, Gingerich, & Rosen, 1997), suicidality (Briere &
Runtz, 1988), low self-esteem (Sackett & Saunders, 1999), and personality disorders (Johnson
et al., 2001) in adulthood. In addition, several authors have shown that the combination of multiple types of abuse including emotional abuse and neglect can have devastating effects on the
mental and physical health of such individuals as adults (Briere & Runtz, 1988; Moeller et al.,
1993). However, the effects of emotional abuse and neglect have generally been studied in individuals who have also experienced other types of abuse (i.e., physical and sexual abuse), and
the unique effects of emotional abuse and neglect have not been examined. Thus, it has been
difficult to ascertain whether emotional abuse and neglect might have significant long-term
effects independent from other forms of abuse.
The use of statistical methods to examine the impact of emotional abuse as it occurs independently from other types of abuse is certainly one way to begin to examine unique contributions
to psychological and physical health. Meston, Heiman, and Trapnell (1999) reported that emotional abuse is associated with poor body image and sexual dysfunction in male college students
independent of other forms of abuse. In another study, Briere and Runtz (1988) reported the
shared effects of multiple types of abuse in a sample of university women. However, they also
showed that even when the shared effects of other forms of abuse were statistically accounted
for, paternal psychological abuse remained a significant predictor of anxiety, depression, interpersonal sensitivity, and dissociation in these women. These results lend support to Hart
and Brassards (1987) proposition that psychological maltreatment may be at the core of
child maltreatment and therefore a greater understanding of the consequences of such abuse
is needed.
Addressing the relationship between emotional abuse and neglect, and subsequent psychopathology ultimately requires the evaluation of a wide range of samples. In the current

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1249

study we evaluated the impact of childhood emotional abuse and neglect in women presenting
to a primary care practice who are highly educated, gainfully employed, and have not received
treatment for psychiatric illness. We believed that the use of a non-clinical rather than a psychiatric sample would provide an opportunity to examine the effects of emotional abuse and
neglect independent of other types of childhood abuse, since we expected a relatively low rate
of physical and sexual abuse.
We also set out to determine the impact of early emotional abuse and neglect in the context of
subsequent trauma exposure. Childhood physical and sexual abuse have been associated with
higher risk of exposure to further traumatic events in adulthood (Cloitre, Scarvalone, & Difede,
1997; Cloitre, Tardiff, Marzuk, Leon, & Portera, 1996; Merrill et al., 1999; Schaaf & McCanne,
1998) and such exposure to traumatic events (e.g., combat, assault, accidents) is associated
with subsequent psychopathology. Thus, maladaptive childhood experiences may influence
subsequent psychological symptoms indirectly, by virtue of being associated with higher rates
of exposure to traumatic events in adult life, as well causing symptoms directly or elevating
the likelihood that symptoms occur following trauma exposure. As far as we are aware, no
prior research has addressed the question of whether childhood emotional abuse and neglect
elevate the risk for subsequent trauma exposure. We sought to examine whether childhood
emotional abuse and neglect predict lifetime exposure to trauma, and also whether emotional
abuse and neglect predicted adult symptoms above and beyond the effects of trauma exposure.
In sum, the current study aimed to examine the impact of childhood emotional abuse and
neglect on psychological and somatic symptoms in a primary care sample of adult women. We
further sought to investigate the extent to which emotional abuse and neglect are associated with
lifetime exposure to trauma. We assessed physical complaints and psychological symptoms of
depression, anxiety and posttraumatic stress disorder (PTSD). Although PTSD has been shown
to be a consequence of childhood sexual and physical abuse (for review see Yehuda, Spertus,
et al., 2001), emotional abuse and neglect have generally not been considered in the etiology
of PTSD. However, given the evidence that emotional abuse and neglect are associated with
psychopathology in adulthood and more specifically, previous reports have shown emotional
abuse as a predictor of PTSD severity (Yehuda, Halligan, & Grossman, 2001), we examined
whether a history of emotional abuse and neglect are also associated with symptoms of PTSD.

Method
Subjects
Participants were 205 female patients, aged 1982 years (mean 44.5, SD = 14 years), who
presented to a hospital-based womens primary care practice in New York City. Eighty percent
of participants were White, and 43% were married. Sixty-five percent classified themselves
as working full-time, 80% reported 16 or more years of education, and 59% reported a family
income level equal to or above $50,000. Forty-percent (n = 81) of the sample reported that they
were coming to the center for a regular checkup, 11% (n = 23) for a regular gynecological
checkup and 49% (n = 100) were coming to the center for other reasons. Other reasons
listed included general tests and follow-up appointments, allergies, pain complaints, emotional

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and behavioral problems (e.g., diet, eating, anxiety and depressive disorders), gynecological
problems, and infections. Eighty-three percent of participants reported that they have never
received treatment for a psychiatric illness.
Measures
Childhood Trauma Questionnaire. The Childhood Trauma Questionnaire is a 25-item selfreport measure that assesses childhood trauma in the following areas: physical, sexual and emotional abuse, and physical and emotional neglect (Bernstein et al., 1994). Each of the CTQ subscales is comprised of 5 items, beginning with the phrase When I was growing up, and rated
on a 5-point Likert scale from Never true to Very often true. The factor scales showed moderate to high internal consistency and test-retest correlations from .80 to .83 (Bernstein & Fink,
1998; Bernstein et al., 1994). In the present study, the Emotional Abuse (EA; e.g., I thought
my parents wished I had never been born) and Emotional Neglect (EN; reverse-scored items,
e.g., I felt loved) subscales were used to assess the overall perception of emotional abuse
and neglect as a child. The Physical Abuse (PA; e.g., I was punished with a belt, a board, a
cord, or some other hard object) and Sexual Abuse (SA; e.g., Someone tried to make me
do sexual things or watch sexual things) scales were used to assess subjects perception of
physical and sexual abuse during childhood.
Trauma History Questionnaire (THQ). The THQ is designed to assess a wide range of traumatic events, and was based on the high magnitude stressor questionnaire used in the
DSM-IV field trials for Posttraumatic Stress Disorder (Green, 1996). A 21-item version of
the THQ was used in this study. For each item, the subject indicates whether or not they
experienced the event, and if so, the number of times and approximate age(s) of occurrence.
Test-retest analysis in a previous study demonstrated that reporting events (yes vs. no) was
consistent across administrations with correlations ranging from .47 to 1.00. The items that
tended to have the lowest reliability were those that did not specify an event; these were not
used in our analyses.
In the present study, items were combined to form the following categories: crime related
events (e.g., mugging), sexual assault (e.g., sexual abuse and or assault), physical assault (e.g.,
assaulted with a weapon, beaten as a child), accident, car accident, witnessing someone injured
or killed, natural disaster, man-made disaster, engaging in combat, and seeing or handling dead
bodies. Items were combined in order to prevent events from being counted twice. A subject
was coded 1 in a category if that event had occurred at some point in their life and coded 0
if it had not. Categories were summed to compute a lifetime total trauma score (TRAUMA).
Thus, the total trauma score reflects how many types of trauma the subject had experienced
during their lifetime.
Symptom Checklist-90R (SCL-90R). The Somatic (SOM), Anxiety (ANX), and Depression
(DEP) scales of the SCL-90R were used to assess physical complaints and symptoms of anxiety
and depression, respectively. Internal consistency and test-retest reliability for all scales of the
SCL-90R have been good across a range of patient groups and test-retest intervals (Derogatis,
1992).

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1251

Revised Civilian Mississippi Scale for PTSD. This scale was developed to assess posttraumatic
stress symptomatology in combat veterans (Keane, Caddell, & Taylor, 1998) and was later
modified to identify such symptoms in civilians. This measure has shown good reliability and
validity (Norris & Perilla, 1996). The total score (PTS) was calculated by summing all items
of the scale and reflected a continuous score of posttraumatic stress symptoms.
Procedure
Surveys were distributed by the receptionist to consecutive patients appearing for appointments at a private womens primary care practice that serves a highly educated urban professional community on the upper east side of Manhattan. Questionnaires were distributed at a
weekly clinic, for random and non-consecutive weeks over a 4-month period. The questionnaires included a cover sheet, which explained the investigators interest in understanding the
impact of trauma on mental health of women and that completing the questionnaire was voluntary and would not impact their treatment. The questionnaires were kept anonymous unless the
participant was interested in participating in further research and wrote her name and contact
information. Clinic staff were unable to keep records of patients who refused participation in
the study; however, they reported that refusal rates among the women, who generally spent
time waiting for their appointment, were negligible. The study was approved by the Mount
Sinai School of Medicine Institutional Review Board.
Data analysis. Our goals were first to determine whether emotional abuse and neglect were
related to general anxiety, depression, physical symptoms, posttraumatic stress symptoms,
and lifetime trauma. Our second goal was to determine whether emotional abuse and neglect
predicted adult symptomatology even after controlling for the effect of the other types of childhood abuse and lifetime trauma. To accomplish our objectives, zero-order correlations were
conducted to examine whether childhood emotional abuse and neglect (CTQ) were significant predictors of general anxiety, depression, physical symptoms (assessed using the relevant
subscales of the SCL-90R), posttraumatic stress symptoms (Civilian Mississippi) and lifetime
trauma (Trauma History Questionnaire). Where zero-order correlations showed that other
childhood trauma or lifetime trauma variables were also significant predictors, hierarchical
multiple regressions were conducted with other childhood abuse and trauma variables entered
on the first step and emotional abuse and neglect on the second. Demographic variables were
assessed as possible variables that would account for differences in the dependent variables.
Age was correlated with ANX (.15, p < .05) and not the other dependent variables. Therefore, age was entered as a covariate in the multiple regression with ANX as the dependent
variable.

Results
Frequencies of types of childhood trauma based on the cut-offs recommended by Bernstein
and Fink (1998) are presented in Table 1. Means and standard deviations of subscale scores
are presented in Table 2. Several of the scales used in the analyses had distributions that were

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Table 1
Frequency of types of childhood trauma using the Childhood Trauma Questionnaire (CTQ)
Type of abuse

None or
minimal, n (%)

Low to
moderate, n (%)

Moderate to
severe, n (%)

Severe to
extreme, n (%)

Physical abuse
Sexual abuse
Emotional abuse
Emotional neglect

181 (88.3)
162 (79.0)
119 (58.0)
116 (56.6)

11 (5.4)
18 (8.9)
40 (19.5)
46 (22.4)

4 (2.0)
8 (3.9)
20 (9.8)
23 (11.2)

9 (4.4)
15 (7.4)
26 (12.7)
20 (9.8)

substantially skewed and kurtotic, most notably the physical and sexual abuse subscales of the
CTQ, and to a lesser extent the subscales of the SCL-90R (ANX, DEP, SOM). We chose not
to report analyses conducted using transformations of these variables since the distributions
were indicative of a relative low prevalence of physical and sexual abuse and psychological
symptoms. This observation was entirely consistent with our expectations of this primary
care sample, and we, therefore, believed the non-transformed scores to be more clinically
meaningful. However, in order to examine whether transforming the data attenuated any of
the effects, all reported analyses were also carried out using square root transformed scales as
the dependent variables. None of the analyses with transformed variables provided significant
differences in the results.
Childhood trauma
Frequencies of types of childhood trauma were based on the cut-offs recommended by
Bernstein and Fink (1998). Twelve percent of participants reported low to extreme physical
abuse, 21% reported low to extreme sexual abuse, while 42% reported low to extreme emotional
abuse and 43% reported low to extreme emotional neglect. Further breakdown of frequencies
based on the recommended cut-offs appear in Table 1.
Table 2
Means and standard deviations of subscale scores
Subscale
Symptom Checklist 90-revised (SCL-90R)
Somatic (SOM)
Depression (DEP)
Anxiety (ANX)
Childhood Trauma Questionnaire (CTQ)
Emotional abuse (EA)
Emotional neglect (EN)
Physical abuse (PA)
Sexual abuse (SA)
Revised Civilian Mississippi Scale for PTSD
Total score (PTS)

Mean (SD)
.52 (.51)
.70 (.69)
.41 (.52)
9.2 (4.8)
10.1 (5.0)
6.0 (2.5)
6.2 (3.2)
68.2 (16.5)

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1253

Table 3
Zero-order correlation matrix

EN
SA
PA
EA
TRAUMA
PTS
SOM
DEP
ANX

EN

SA

PA

EA

TRAUMA

PTS

SOM

DEP

ANX

.32
.32
.72
.21
.41
.27
.30
.31

.38
.33
.28
.38
.17
.18
.20

.41
.22
.25
.21
.15
.15

.30
.40
.35
.38
.39

.19
.28
.17
.21

.60
.75
.67

.69
.66

.78

Note: EN, emotional neglect (CTQ); SA, sexual abuse (CTQ); PA, physical abuse (CTQ); EA, emotional abuse
(CTQ); TRAUMA, lifetime trauma exposure (THQ); PTS, posttraumatic stress symptoms (Mississippi-Civilian);
SOM, somatic symptom scale (SCL-90R); DEP, depression symptom scale (SCL-90R); ANX, anxiety symptom
scale (SCL-90R).

p < .05.

p < .01.

Lifetime trauma
Seven percent of participants reported that they had never experienced a traumatic event
in their lifetime, while 18% reported experiencing one event, 27% two events, and 47% three
or more events. Seventy-one percent of the participants reported experiencing a criminal act,
36% physical abuse or an assault, 33% sexual abuse or assault, 25% natural disaster. Other
events experienced consisted of a motor vehicle accident, witnessing a trauma, and other types
of accidents.
Zero-order correlations
Zero-order correlations are reported in Table 3. In accordance with predictions, emotional
abuse and neglect were significantly positively correlated with DEP, ANX, SOM, and PTS,
and also with trauma exposure. Consistent with prior research, physical and sexual abuse
also showed significant associations with each of these dependent variables, and there were
significant intercorrelations between each of the dimensions of childhood trauma.
Multiple regressions
To examine whether emotional abuse and neglect predicted TRAUMA over and above physical and sexual abuse, a hierarchical multiple regression was conducted by entering childhood
physical and sexual abuse on the first step and emotional abuse and neglect on the second.
This analysis revealed that emotional abuse and neglect significantly predicted TRAUMA [F
change (2, 200) = 4.57, p < .05] over and above physical and sexual abuse.
Hierarchical multiple regressions were conducted to examine whether emotional abuse and
neglect predicted DEP, ANX, SOM, and PTS over and above physical and sexual abuse, and

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Table 4
Multiple regressions analyses predicting psychological and physical symptoms
R
Somatic symptoms (SOM)
Step 1
.33
TRAUMA
PA
SA
Step 2
.40
EA
EN
Anxiety symptoms (ANX)a
Step 1
.15
AGE
Step 2
.30
TRAUMA
PA
SA
Step 2
.44
EA
EN
Depression symptoms (DEP)
Step 1
.23
TRAUMA
PA
SA
Step 2
.39
EA
EN
Posttraumatic stress symptoms (PTS)
Step 1
.41
TRAUMA
PA
SA
Step 2
.51
EA
EN

R2

F

df

.10

7.91

3,201

.06

6.69

2,199

Partial correlation

.25
.19
.02

4.79

1,203

.09

5.10

3,200

.10

12.82

2,198
.33
.27

.05

3.84

3,201

.10

11.10

2,199
.32
.24

.17

13.15

3,200

.09

11.92

2,198
.28
.31

Note: EN, emotional neglect (CTQ); SA, sexual abuse (CTQ); PA, physical abuse (CTQ); EA, emotional abuse
(CTQ); TRAUMA, lifetime trauma exposure (THQ); PTS, posttraumatic stress symptoms (Mississippi-Civilian);
SOM, somatic symptom scale (SCL-90R); DEP, depression symptom scale (SCL-90R); ANX, anxiety symptom
scale (SCL-90R).
a
Age entered in first step in regression because age was significantly correlated with ANX in preliminary analyses.

p < .05.

p < .01.

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1255

trauma exposure. For each regression, PA, SA and TRAUMA were entered on the first step,
with EA and EN being entered on the second step. Total and partial variances accounted
for by the variables and the models are presented in Table 4. Emotional abuse and neglect
were significant predictors of ANX, SOM, DEP, and PTS when partialling out the variance
accounted for by PA, SA and TRAUMA (all p < .05). Additionally, emotional abuse and
neglect were significant predictors of ANX even after partialling out the variance for AGE.
In addition to completing the psychological scales, participants also estimated the number
of times that they had visited a doctor over the past year (not including the current visit). Three
percent of participants reported no doctors visits over the past year, while 13% reported one
doctors visit, 21% two visits and 63% three or more visits. Hierarchical regression analysis,
as described above, indicated that emotional abuse and neglect were significant predictors of
reported number of visits to a doctor over the past year [F change (2, 199) = 6.84, p < .005]
when partialling out the variance accounted for by PA, SA, and TRAUMA.

Discussion
The findings of this study indicate that, in a primary care sample with relatively low rates
of physical and sexual abuse, childhood emotional abuse and neglect predict emotional and
physical distress as well as lifetime exposure to trauma in adult women presenting to a primary
care practice. Importantly, these strong associations between childhood emotional abuse and
neglect and adult symptoms were present even when partialling out the variance accounted
for by childhood physical and sexual abuse and lifetime trauma exposure, thus highlighting
the strength of the relationship between emotional abuse and neglect with adult emotional and
somatic functioning.
Our findings are consistent with Pitzner and Drummond (1997), who found that psychological/verbal abuse predicted negative mood independent of other negative life events in
community and student samples. We extended their findings by demonstrating that emotional
abuse and neglect predicted adult psychopathology even when statistically partialling out the
effects of other types of abuse. In a sample with low rates of reported physical and sexual
abuse, and using statistical methods to partial out any variance accounted for by these experiences, we continued to find that emotional abuse and neglect were relatively strong predictors
of emotional and physical symptoms in adulthood.
Emotional abuse and neglect do not fulfill the DSM-IV criterion A for PTSD, which require
that the event be life threatening and induce a subjective response of fear, helplessness, or
horror and threat to the physical integrity of self or others (American Psychiatric Press,
1994), yet these experiences did predict PTSD symptoms in our sample. It may be that emotional abuse and neglect are potent risk factors for predicting PTSD and other maladaptive
responses given exposure to subsequent events that do fulfill the A criterion. In this sample,
we did indeed find emotional abuse and neglect to predict higher rates of lifetime trauma exposure. It is also possible that emotional abuse and neglect directly caused PTSD-like symptoms,
even the absence of intervening criterion A events. The use of the Civilian Mississippi to assess
PTSD symptoms in the current study may have contributed to such an effect, as it includes
several items that relate to quite general psychological symptoms.

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Many psychological theories of development have delineated the importance of early childhood experiences to be nurturing and supportive in order to achieve normal developmental
milestones. Thus, emotional abuse and neglect may thwart development and over time lead
to a decreased repertoire of adaptive behaviors and poor self-care. In the current study, emotional abuse and neglect in a non-clinical sample accounted for significant unique variance
in psychological and physical symptoms in adult women. These findings demonstrate that it
is not only the more severe and overt forms of abuse that have implications for adult health.
Furthermore, since children exposed to physical and sexual abuse very frequently experience
concomitant emotional abuse and neglect, the latter should not be ignored even when more
severe abuse is present. Emotional abuse and neglect may very directly communicate to the
child a lack self-worth and instill in them a set of negative beliefs regarding themselves and
their efficacy.
Prior research has indicated that childhood sexual and physical abuse are associated with
increased health care utilization (Arnow et al., 1999; Felitti, 1991) and health care costs (Walker
et al., 1999). Although we did not directly examine healthcare utilization in this study, we did
ask subjects to provide an estimate to the number of times they visited a doctor during the past
year. Emotional abuse and neglect were significantly correlated with number of doctors visits,
even after controlling for other forms of child and adult trauma. Thus, we found preliminary
evidence that emotional experiences in childhood may have implications for adult healthcare
utilization, similar to those documented for physical and sexual abuse. Given the strength
of the current findings in a non-clinical, high functioning sample, further investigation about
the impact emotional abuse may have on health care utilization and costs appears warranted.
There are several possible mechanisms by which emotional abuse and neglect may increase
healthcare utilization: directly, by increasing anxiety and other psychological symptoms which
have implications for physical as well as psychological health, and also indirectly, by causing
poor self-care and increased exposure to subsequent adversity, or by reducing the threshold
at which healthcare is sought in response to symptoms. Future research is needed to address
these possibilities.
As attention is increasingly being given to providing comprehensive care to patients presenting to primary care settings, clinicians are learning the importance that childhood maltreatment
may have on adult functioning, physically, emotionally and interpersonally. Our findings indicate the importance that childhood emotional abuse and neglect may have on adult functioning,
and when considered in conjunction with other historical information, can contribute to a better understanding of the complex clinical picture that maltreated individuals often present
(Bernstein & Fink, 1998), particularly within the context of a primary care setting.
Addressing the relationship between emotional abuse and physical neglect, and subsequent
psychopathology ultimately requires the evaluation of a wide range of samples. The current
sample was comprised primarily of highly educated persons in an urban professional community. The extent to which the current findings will generalize to other populations must await
future research. A second limitation of the current research lies with the reliance on a single
method of data collection (i.e., self-report questionnaires). Generally, a multi-modal approach
to assessment is desirable in assessing trauma history and current emotional and physical
functioning. Furthermore, assessments of child and adult trauma exposure were retrospective.
Prospective studies such as those conducted by Widom (1999) may provide more valid infor-

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1257

mation. In this study we cannot establish these relationships to be causally linkedhowever,

prospective studies would address more directly the possibility of causal link and allow for
more detailed exploration of mediators and moderators of these relationships. Finally, although
reports indicated that refusal rates in the current study were very low, in the absence of detailed
information about participants who refused to take part we cannot rule out the possibility that
a response bias contributed to the current findings.
In conclusion, emotional abuse and neglect predicted physical, anxiety and depressive symptoms and lifetime trauma exposure in a sample of high functioning women. These relationships
remained strong even after controlling for the effects of other types of abuse. Thus, emotional
abuse and neglect may be powerful predictors of adult emotional functioning that should not
be overlooked due to the more subtle nature of this form of trauma.

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Rsum/Resumen
French- and Spanish-language abstracts not available at time of publication.