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Psychological Encyclopedia

Childhood Emotional Abuse: What It Is, Examples, and Long-Term Effects

6 days ago
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Author: Ukrainian Psychological Hub · Published: September 22, 2026 · Editorial Policy


Childhood emotional abuse is a form of child maltreatment in which a parent, caregiver, or another person in a position of responsibility, trust, or power uses behaviors that harm, or create a serious risk of harm to, a child’s emotional well-being, self-worth, development, or sense of safety. The Centers for Disease Control and Prevention gives examples such as name-calling, shaming, rejecting, and withholding love. The World Health Organization places emotional ill-treatment within the broader category of child maltreatment.


The term is sometimes used interchangeably with psychological abuse or psychological maltreatment. Research also frequently combines emotional abuse with emotional neglect under the broader label childhood emotional maltreatment. These terms overlap, but they are not perfectly identical across studies, clinical literature, child-protection systems, and jurisdictions. That variation matters when comparing research findings.


Childhood emotional abuse is an exposure or experience, not a psychiatric diagnosis. Experiencing it does not mean that a child or adult will inevitably develop post-traumatic stress disorder (PTSD), complex PTSD (CPTSD), depression, anxiety, an insecure attachment pattern, dissociation, relationship problems, or any other clinical condition. Research consistently finds elevated risks for several later difficulties at the group level, while individual outcomes vary substantially.


What Is Childhood Emotional Abuse?


The CDC defines emotional abuse as behavior that harms a child’s self-worth or emotional well-being. WHO defines child maltreatment more broadly as physical or emotional ill-treatment, sexual abuse, neglect, negligence, or exploitation that results in actual or potential harm to a child’s health, survival, development, or dignity within a relationship of responsibility, trust, or power.


The American Academy of Pediatrics uses the broader term psychological maltreatment. Its clinical report on psychological maltreatment, reaffirmed in 2023, describes harmful caregiver behavior as potentially involving acts of commission or omission, verbal or nonverbal behavior, and active or passive conduct. This is one reason definitions in the scientific literature do not always draw a perfectly sharp line between emotional abuse and emotional neglect.


In practice, the concept is best understood through the interaction of several features:


• the content of the behavior;


• its frequency, persistence, or severity;


• the child’s developmental stage and dependence on the adult;


• the power relationship between the adult and child;


• whether the behavior communicates rejection, humiliation, worthlessness, fear, or conditional belonging;


• the broader relational environment in which it occurs; and


• the actual or potential impact on the child’s emotional security and development.


A single tense interaction, an impatient remark, a disagreement, or an imperfect parenting moment is not equivalent to a sustained pattern of psychological maltreatment. At the same time, professional definitions can include especially severe incidents even when a long pattern is not established. Context, severity, threat, power, developmental appropriateness, and repetition all matter.


Examples of Childhood Emotional Abuse


Emotional abuse can take many forms. The examples below describe patterns that appear in public-health, pediatric, and child-maltreatment frameworks. They are examples rather than a self-diagnostic checklist.


Persistent humiliation or degradation


A child may be repeatedly insulted, mocked, ridiculed, demeaned, or treated as inherently defective. The message can be direct—“you are worthless,” “you ruin everything,” “no one could love you”—or communicated through recurring contempt and humiliation.


The harm is not simply that criticism occurred. Children need correction, limits, and feedback. The concern is a pattern in which the child’s basic worth, dignity, lovability, intelligence, or right to belong is attacked rather than a specific behavior being addressed.


Rejection and conditional belonging


Rejection can involve repeatedly communicating that a child is unwanted, burdensome, unlovable, or undeserving of care. The CDC includes rejecting and withholding love among examples of emotional abuse.


This differs from a caregiver taking a short break during conflict or temporarily reducing privileges. The central issue is using emotional belonging, affection, or acceptance as a weapon against the child or persistently communicating that the child has no secure place in the relationship.


Terrorizing, threatening, or creating chronic fear


Psychological maltreatment can include credible threats of abandonment, severe punishment, harm, loss of important relationships, or other frightening consequences used to control a child. A child may also be placed in a persistently threatening emotional environment even when physical violence does not occur.


Ordinary limit-setting often includes predictable consequences. Terrorizing involves a qualitatively different use of fear, threat, or intimidation.


Scapegoating and chronic blaming


A child can become the family member who is repeatedly blamed for conflict, adult emotions, family problems, or events outside the child’s control. Over time, the child may receive a persistent message that they are the cause of other people’s distress or responsible for keeping the household emotionally stable.


Not every instance of blame is abuse. The concern is a recurring, developmentally inappropriate pattern in which responsibility is distorted and the child’s identity becomes organized around being “the problem.”


Extreme or degrading control


Some emotionally abusive environments involve excessive control of age-appropriate expression, relationships, preferences, or autonomy, especially when control is maintained through humiliation, fear, threats, or rejection.


Parental supervision and rules are developmentally necessary. The relevant distinction is whether control is proportionate, protective, and responsive to the child’s developmental needs, or whether it becomes coercive and psychologically degrading.


Isolation from supportive relationships


Intentionally cutting a child off from safe, developmentally appropriate relationships or sources of support may form part of psychological maltreatment. The context matters: temporary restrictions imposed for safety are different from isolation used to make the child dependent, punish the child, or eliminate access to support.


Manipulation of a child’s perception or emotional reality


Some caregivers repeatedly deny events, distort responsibility, or insist that the child’s perceptions and emotions are inherently false or illegitimate. This may overlap with what people now call parental gaslighting, but gaslighting is not a synonym for emotional abuse.


The English Psychology Hub has a separate guide to gaslighting by parents, which owns the narrower search intent around gaslighting as a manipulation pattern.


Emotional Abuse Is Not the Same as Emotional Neglect


Emotional abuse and emotional neglect can coexist, and many studies group them together as psychological or emotional maltreatment. They still describe different emphases.


Emotional abuse usually refers to harmful actions or communications directed toward a child: humiliating, rejecting, terrorizing, degrading, or persistently attacking the child’s emotional security or worth.


Emotional neglect usually emphasizes what is missing: adequate emotional responsiveness, comfort, attention, validation, protection, or support. The CDC defines neglect as failure to meet a child’s basic physical and emotional needs, including appropriately responding to feelings.


The boundary is not absolute. The American Academy of Pediatrics notes that psychological maltreatment can involve both acts of commission and omission. Research instruments also operationalize the constructs differently. For a more focused discussion of omission, responsiveness, adult correlates, and measurement limits, see Childhood Emotional Neglect: Signs, Adult Effects, and What Research Shows.


Emotional Abuse, Childhood Trauma, and ACEs Are Related but Different Concepts


Childhood emotional abuse can be psychologically traumatic, but emotional abuse and childhood trauma are not interchangeable terms.


Childhood emotional abuse describes a type of maltreatment exposure. Trauma, in clinical and psychological use, concerns exposure and the person’s response to an event or set of circumstances. People exposed to similar forms of maltreatment can have very different psychological responses and later outcomes.


The Hub’s pillar article Childhood Trauma: Types, Effects, Adult Outcomes, and Recovery explains the broader trauma construct and its limits.


Adverse childhood experiences, or ACEs, are another related framework. The CDC describes ACEs as potentially traumatic events occurring from ages 0 through 17, including violence, abuse, and neglect as well as household and environmental adversities. Emotional abuse can therefore fall within ACE frameworks, but ACEs are a public-health and research construct, not a diagnosis.


An ACE count is not a measure of how “damaged” or “traumatized” a person is. It is not a clinical severity scale and does not predict an individual person’s future with certainty. The distinctions are covered in ACEs vs Childhood Trauma: What Is the Difference? and ACE Score: What It Means, What It Does Not Predict, and Why It Is Not a Diagnosis.


Emotional Abuse Is Also Not a Diagnosis of PTSD or Complex PTSD


Emotional abuse can be associated with post-traumatic symptoms, PTSD, and CPTSD, but exposure alone does not establish any of those diagnoses.


A large 2026 systematic review and multilevel meta-analysis of 62 studies found a positive association between childhood emotional maltreatment and PTSD/CPTSD outcomes. In 57 studies contributing to the meta-analysis, the pooled association was moderate, but heterogeneity was substantial, and the 95% prediction interval crossed zero. The authors also judged the underlying study quality as generally fair and emphasized the need for longitudinal and cross-cultural research to clarify causal pathways (Hashim et al., 2026).


That evidence supports a group-level association. It does not mean that emotional abuse automatically produces PTSD or CPTSD, and it does not permit diagnosis from a history of maltreatment alone.


How Can Emotional Abuse Affect a Child?


Children can respond to emotionally abusive environments in many ways. Some become withdrawn or anxious. Some become highly vigilant to adult moods. Some show irritability, aggression, school difficulties, sleep problems, somatic complaints, low self-worth, or changes in behavior. Some appear outwardly high-functioning. Some have few obvious symptoms.


None of these signs is specific to emotional abuse. The same behaviors can occur in response to many forms of stress, developmental transitions, neurodevelopmental differences, mood or anxiety disorders, family disruption, bullying, physical illness, sleep problems, or other circumstances.


The American Academy of Pediatrics has emphasized that behavioral manifestations of maltreatment require clinical context rather than inference from one symptom (Sege & Amaya-Jackson, 2017). The WHO clinical handbook likewise treats recognition as a professional assessment process that includes safe communication with children and caregivers and an appropriate response to suspected maltreatment.


A child’s behavior can be a reason to pay attention, ask careful questions, and seek professional help. It is not proof of abuse by itself.


What Does Research Show About Long-Term Effects?


The strongest scientific conclusion is that childhood emotional abuse is associated with increased risk of several adverse outcomes later in life. The evidence does not support a single inevitable “emotional abuse syndrome,” and it does not justify attributing every adult difficulty to childhood.


Depression and anxiety


A systematic review and meta-analysis of 96 studies found that emotional abuse was associated with depressive disorders. The pooled odds ratio for depressive disorders was 2.35, although estimates differed across studies (Gardner, Thomas, & Erskine, 2019). Earlier meta-analytic work also reported associations between emotional abuse and depression and anxiety, alongside substantial variation in designs, measures, populations, and confounding control (Norman et al., 2012).


A broader systematic review and meta-analysis of 90 studies examining childhood emotional abuse and emotional neglect found associations with multiple adult mental-health outcomes, including depression, anxiety, substance-use problems, suicidal thoughts or attempts, eating disorders, personality pathology, and other psychological symptoms (Xiao et al., 2023).


These are population-level associations. They do not mean that a particular adult’s depression or anxiety was caused by childhood emotional abuse, nor that an emotionally abused child will develop a disorder. Depression and anxiety arise through multiple interacting biological, psychological, relational, and social pathways.



Trauma-related symptoms


The 2026 meta-analysis by Hashim and colleagues found that childhood emotional maltreatment was associated with PTSD/CPTSD outcomes, while also showing substantial between-study heterogeneity. Emotional abuse showed a somewhat larger pooled association than emotional neglect in that review, but the evidence does not establish a uniform pathway from emotional abuse to a trauma disorder.


A history of emotional abuse can therefore be clinically relevant when someone has trauma symptoms. It is not, by itself, a PTSD or CPTSD diagnosis.


Adult relationships


A 2022 multilevel meta-analysis of 23 reports and 201 effect sizes found that childhood emotional maltreatment was modestly associated with lower adult romantic relationship well-being (r = -.143). The association was smaller in studies with greater methodological rigor (Cao et al., 2022).


This is a useful example of why causal language matters. A statistical association between childhood emotional maltreatment and later relationship well-being does not mean that survivors are destined to have unhealthy relationships. Adult relationships are shaped by many later experiences, partners, social environments, learned skills, mental-health factors, attachment-related processes, and opportunities for corrective relationships.



Education, functioning, and quality of life


Longitudinal evidence can strengthen confidence that childhood maltreatment precedes later outcomes, although it still does not eliminate every alternative explanation.


A review integrating findings from the Mater-University of Queensland Study of Pregnancy, a longitudinal birth cohort, reported that substantiated psychological maltreatment was associated with a range of later psychological, educational, health, and quality-of-life outcomes. Emotional abuse frequently co-occurred with other forms of maltreatment, which complicates attempts to identify a unique effect of one subtype (Strathearn et al., 2020).


This co-occurrence is important. A person exposed to emotional abuse may also have experienced neglect, physical violence, household instability, poverty, caregiver mental-health problems, peer victimization, or other adversities. Statistical adjustment can reduce some confounding, but it cannot reconstruct every feature of a childhood environment.


Physical health


Research on child maltreatment has reported associations with later physical-health outcomes, but the evidence is more difficult to interpret causally than popular “trauma causes disease” narratives suggest. Some studies rely on retrospective reports; maltreatment categories frequently co-occur; socioeconomic conditions and health behaviors can confound or mediate associations; and physical illnesses have multiple causes.


A history of emotional abuse can be medically relevant context. It is not evidence that a particular chronic disease was caused by emotional abuse. Individual medical symptoms still require ordinary medical assessment.


Why Outcomes Differ So Much


There is no single adult profile produced by childhood emotional abuse. Several factors can influence outcomes.


Severity, chronicity, and developmental timing


Repeated humiliation across many years is not the same exposure as a brief period of harsh behavior. The developmental stage at which maltreatment occurs may matter, as may the degree of dependence on the abusive caregiver and whether the child had any reliable source of safety.


Research often struggles to capture these dimensions precisely. Many studies reduce complex histories to yes/no exposure categories or questionnaire totals.


Co-occurring adversity


Emotional abuse often occurs alongside other maltreatment or household adversity. That makes it difficult to isolate one exposure statistically and can magnify cumulative stress.


At the same time, counting adversities does not produce a linear scale of human damage. Two people with the same number of adversities can have very different experiences, resources, meanings, symptoms, and outcomes.


Protective relationships and environments


Safe, stable, nurturing relationships can protect development and help reduce the effects of violence. The CDC identifies safety, stability, and nurturing as central protective conditions.


Support may come from a non-abusive caregiver, grandparent, sibling, teacher, coach, friend, clinician, community, or another reliable relationship. Protective factors also include material stability, access to health care, educational opportunity, community safety, and timely intervention.


These factors do not “erase” maltreatment. They can alter developmental pathways and help explain why risk is probabilistic rather than deterministic.



Later experiences


Childhood matters, but development continues. Later relationships, education, therapy, work, community, financial security, health, discrimination, loss, illness, and new stressors can all influence adult functioning.


A childhood history can be an important part of a person’s story without being a complete explanation of the person.


What Mechanisms Might Link Emotional Abuse to Later Mental Health?


Researchers have proposed several psychological and developmental pathways. They are best treated as candidate mechanisms rather than universal explanations.


Self-beliefs and cognitive patterns


Repeated rejection or degradation may contribute to persistent negative beliefs about worth, safety, competence, or relationships. A systematic review of psychological mediators in the emotional abuse–depression literature identified recurring research on maladaptive schemas, hopelessness, negative cognitive styles, rumination, and related cognitive-personality variables (Li, Luyten, & Midgley, 2020).


The review also emphasized major methodological limitations. Many mediation studies were cross-sectional, and comparatively few adequately isolated emotional abuse from other maltreatment. A statistical mediator is not automatically a demonstrated causal mechanism.


Emotion regulation


Emotion-regulation difficulties are another frequently studied pathway. A 2026 systematic review of mediation studies found consistent indirect associations involving emotion dysregulation in studies of emotional abuse, while also noting the limitations of the mediation literature (Schaumburg & Nimtz, 2026).


This does not mean emotional abuse “damages the nervous system” in a fixed way or leaves every person permanently dysregulated. Emotion regulation is influenced by temperament, development, learning, relationships, current stress, mental-health conditions, sleep, physical health, and many other factors.


Interpersonal learning


Children learn what to expect from close relationships. Repeated humiliation, rejection, or coercion may shape expectations about trust, conflict, closeness, criticism, and self-protection. Those expectations can be one pathway among many linking childhood experiences with adult relationship patterns.


They should not be converted into deterministic attachment claims. Adult attachment dimensions are measured constructs, not diagnoses, and insecure attachment cannot be inferred solely from a history of emotional abuse. See Childhood Trauma and Attachment: What Research Supports and What It Does Not.


Stress-related adaptation


Chronic threat or unpredictability can influence how people attend to danger, interpret social cues, and respond to stress. Biological stress systems are also studied in maltreatment research. Findings are generally group-level and vary by sample, developmental stage, measurement, timing, and co-occurring adversity.


It is therefore more accurate to discuss altered probabilities and stress-related adaptations than to say that emotional abuse universally “rewires the brain,” permanently “damages the nervous system,” or keeps everyone in continuous fight-or-flight.


How Childhood Emotional Abuse Is Measured in Research


One reason estimates vary is that childhood emotional abuse is measured in different ways.


Studies may use:


• retrospective adult questionnaires;


• structured or semi-structured interviews;


• child-protection or clinical records;


• prospective cohort assessments;


• caregiver or child reports; or


• broader maltreatment scales that combine emotional abuse and neglect.


Each method has advantages and limitations.


Retrospective self-report can capture experiences that were never officially detected, which is important because emotional abuse is often hidden. It can also be influenced by memory, interpretation, current mood, wording, and the thresholds used by a questionnaire.


Administrative records have different limitations. They tend to capture only events known to systems, can reflect reporting and service-access differences, and may miss emotional maltreatment that never reaches official attention.


Prospective studies establish temporal ordering more clearly, but they can still face confounding, attrition, incomplete measurement, and co-occurring adversity.


The Xiao et al. meta-analysis specifically notes continuing challenges in the definition and detection of emotional abuse and emotional neglect. Those challenges are a reason to interpret precise effect estimates as research summaries rather than universal constants.


Can You Tell From Adult Traits That Emotional Abuse Happened?


No single adult trait proves a history of childhood emotional abuse.


Low self-esteem, perfectionism, people pleasing, conflict avoidance, difficulty trusting, emotional numbness, anger, anxiety, depression, dissociation, memory gaps, fear of rejection, or relationship problems can occur in people with many different histories. Some survivors of emotional abuse have some of these difficulties; others do not.


These traits are therefore poor reverse-diagnostic tools. “I people-please, therefore I must have been emotionally abused” is not a valid clinical inference. The same is true of attachment labels, online trauma checklists, dreams, bodily sensations, or a feeling that something must have happened.


The most defensible question is narrower: what experiences can you actually remember or document, how did those experiences affect you, what symptoms or difficulties exist now, and what support would be useful regardless of whether every historical question can be resolved?


What If You Are Unsure Whether Your Childhood “Counts” as Emotional Abuse?


People often look for a single threshold that will settle the question. Research and clinical practice are less tidy.


You can examine concrete behavior without forcing an immediate global label. Questions that may help organize reflection include:


• What was actually said or done?


• Was it recurring, severe, threatening, degrading, rejecting, or developmentally inappropriate?


• Was affection or belonging used as punishment or leverage?


• Were you made responsible for adult emotions or repeatedly blamed for problems outside your control?


• Did you have access to a safe adult who could challenge the message or protect you?


• How old were you, and how dependent were you on the person involved?


• Are there current symptoms or relationship difficulties that deserve attention in their own right?


These questions are prompts for reflection, not diagnostic criteria. A self-checklist cannot determine whether maltreatment legally occurred, prove a trauma disorder, or establish the cause of an adult mental-health condition.


If uncertainty itself is causing significant distress, a licensed clinician can help separate remembered experiences, present-day symptoms, meanings, and treatment needs without requiring a single simplistic score.


If a Child May Be Experiencing Emotional Abuse Now


When concern involves a current child, the priority is safety rather than retrospective labeling.


The WHO clinical handbook for responding to child maltreatment emphasizes careful recognition, safe communication with children and caregivers, first-line support, and appropriate reporting considerations. Procedures differ by jurisdiction and professional role.


If you are a caregiver, teacher, clinician, relative, neighbor, or another trusted adult and you are concerned about a child:


• take disclosures seriously;


• avoid interrogating the child or pressuring them to produce details;


• do not promise secrecy you may be unable to keep;


• document concrete observations rather than assumptions when appropriate;


• consult qualified child-protection, health, school, or safeguarding professionals; and


• if the child appears to be in immediate danger, contact local emergency or child-protection services.


The goal is to increase safety while minimizing additional distress.


Recovery and Support in Adulthood


There is no rule that every adult who experienced childhood emotional abuse needs trauma-focused psychotherapy. Treatment should be based on the person’s current difficulties, goals, functioning, preferences, and any diagnosable conditions.


Someone with PTSD may benefit from evidence-based PTSD treatment. Someone with depression may need depression-focused care. Another person may want psychotherapy for shame, relationship patterns, self-criticism, grief, or boundary difficulties without meeting criteria for a trauma disorder.


The Hub separates these intents deliberately. For the broader recovery question, see Healing From Childhood Trauma: What Recovery Can Mean and What Treatments Have Evidence. For treatment modalities and evidence by clinical population, see Therapy for Childhood Trauma in Adults: Evidence-Based Approaches and How They Differ.


Recovery does not require proving that every current difficulty came from childhood. It can begin with the problems that are present now.


Scientific Status: What Is Established, What Is Associated, and What Remains Uncertain?


Several conclusions are well supported.


Childhood emotional abuse is recognized by major public-health and pediatric authorities as a form of child maltreatment. Systematic reviews and meta-analyses consistently report associations with later mental-health difficulties, especially depression and broader psychological distress. There is also evidence linking emotional maltreatment with trauma-related outcomes and modestly poorer adult romantic relationship well-being.


Other conclusions require more restraint.


The size of associations varies substantially by study design, measurement, population, co-occurring maltreatment, socioeconomic context, and analytic choices. Much of the literature relies on retrospective reports. Emotional abuse is often correlated with emotional neglect and other adversity. Mediation studies identify plausible psychological pathways, but many do not establish causal mechanisms.


The evidence therefore supports childhood emotional abuse as an important risk exposure. It does not support deterministic individual predictions.


Frequently Asked Questions


Is emotional abuse “real” abuse if there was no physical violence?


Yes. Major public-health and pediatric authorities recognize emotional or psychological abuse as a form of child maltreatment. Physical injury is not required for behavior to qualify as emotional abuse. The relevant issue is harmful or threatening emotional treatment within a relationship of responsibility, trust, or power.


Is yelling at a child emotional abuse?


Yelling by itself is not enough information to classify a relationship. Context, intensity, content, threat, frequency, developmental appropriateness, and the broader relational pattern matter. Repeated degrading, terrorizing, or rejecting verbal behavior is different from an isolated episode of raised voices during conflict.


Is emotional abuse the same as emotional neglect?


No. Emotional abuse generally emphasizes harmful acts or communications; emotional neglect emphasizes failure to meet emotional needs. They can coexist and are often grouped together as psychological or emotional maltreatment in research, so the boundary is not always operationalized the same way.


Can childhood emotional abuse cause depression or anxiety?


Research shows strong and repeated associations with later depression and other mental-health difficulties. Some longitudinal evidence supports temporal relationships, but individual causation is more complicated. Genetics, temperament, co-occurring adversity, socioeconomic conditions, later stress, relationships, health, and many other factors contribute to depression and anxiety. A history of emotional abuse is a risk factor, not an individual diagnostic explanation.


Can emotional abuse cause PTSD or complex PTSD?


It may be associated with PTSD/CPTSD outcomes, and emotional maltreatment can be clinically relevant in trauma assessment. Exposure does not automatically mean a person has PTSD or CPTSD. Diagnosis requires the relevant symptom pattern, duration, impairment, and other diagnostic criteria.


Does emotional abuse always affect adult relationships?


No. Meta-analytic evidence suggests a modest average association between childhood emotional maltreatment and poorer adult romantic relationship well-being. That is a group-level tendency, not a destiny for any individual survivor.


Can emotional abuse cause memory gaps?


Memory gaps have many possible explanations, including ordinary forgetting, childhood amnesia, attention, stress, sleep problems, depression, dissociative symptoms, substance use, medical conditions, and neurological causes. A memory gap does not prove hidden abuse. For the broader evidence, see Childhood Trauma and Memory: Why Recall Can Be Clear, Fragmented, or Incomplete.


Can someone recover from childhood emotional abuse?


Many people improve substantially, and some never develop a clinical disorder. Recovery can involve safer relationships, changes in self-beliefs, better emotion regulation, treatment for specific symptoms, improved boundaries, social support, and changes in current circumstances. There is no single required recovery path.


Do I need therapy if I experienced emotional abuse?


Not automatically. Therapy is appropriate when a person wants help with distress, symptoms, relationships, functioning, or meaning-making. The presence of a childhood adversity by itself does not create a universal treatment requirement.


Related Articles










References


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Centers for Disease Control and Prevention. (2024a). About child abuse and neglect. https://www.cdc.gov/child-abuse-neglect/about/index.html


Centers for Disease Control and Prevention. (2024b). Preventing child abuse and neglect. https://www.cdc.gov/child-abuse-neglect/prevention/index.html


Centers for Disease Control and Prevention. (2026). About adverse childhood experiences. https://www.cdc.gov/aces/about/index.html


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