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1.
BackgroundEmotional abuse is a form of maltreatment that most strongly predicts adult depressive symptoms in community samples. Introject theories suggest that some depressive symptoms stem from survivors having learned to treat themselves the way they were treated by their perpetrators.ObjectiveMalevolent introjects may undermine self-compassion, which may subsequently maintain feelings of shame. Thus, we hypothesized that self-compassion and shame would mediate the path from retrospective reports of maltreatment to concurrent depressive symptoms in adulthood.Participants and SettingParticipants were 244 adult community members and college students living in a Southwestern American metroplex.MethodWe ran a multiple mediator path model with emotional abuse as the independent variable. We specified four covariates: physical abuse, sexual abuse, physical neglect, and emotional neglect, and held constant the variance they explained in self-compassion, shame, and depression.ResultsOur final model accounted for 53.1% of the variance in adult depressive symptoms. A significant indirect effect from emotional abuse passed through both mediators and ended in adult depressive symptoms. We also found an indirect path from emotional neglect to depression passing through both mediators.ConclusionsIt appears emotional abuse and emotional neglect can undermine the formation of self-compassion. Low self-compassion predicts greater shame and depressive symptoms. Our model suggests self-compassion may be a particularly effective intervention point for survivors of emotional maltreatment.  相似文献   

2.

Objectives

Childhood maltreatment is a robust risk factor for poor physical and mental health. Child welfare youths represent a high-risk group, given the greater likelihood of severe or multiple types of maltreatment. This study examined the relationship between childhood maltreatment and self-compassion – a concept of positive acceptance of self. While not applied previously to a child welfare sample, self-compassion may be of value in understanding impairment among maltreatment victims. This may be most pertinent in adolescence and young adulthood, when self-identity is a focal developmental process.

Methods

The present sample was drawn from the Maltreatment and Adolescent Pathways (MAP) Longitudinal Study, which followed randomly selected adolescents receiving child protection services across two years within an urban catchment area. Child maltreatment was assessed at baseline using the Childhood Trauma Questionnaire ( [Bernstein et al., 1994] and [Bernstein et al., 2003] ). Mental health, substance and alcohol use problems, suicide attempt, and self-compassion were assessed at the two-year follow-up point. There were 117 youths, aged 16–20 years (45.3% males) who completed the self-compassion scale (Neff, 2003). Bivariate correlations were computed between adolescent self-compassion and each form of self-reported maltreatment (physical abuse, sexual abuse, emotional abuse, emotional neglect, and physical neglect). Finally, hierarchical, stepwise regression was used to examine unique contributions of child maltreatment subtypes in predicting adolescent self-compassion, as well as maltreatment-related impairment.

Results

Higher childhood emotional abuse, emotional neglect, and physical abuse were associated with lower self-compassion. Controlling for age and gender, emotional abuse was significantly associated with reduced self-compassion, even when the effects of emotional neglect and physical abuse were taken into account. Youths with low self-compassion were more likely to have psychological distress, problem alcohol use, and report a serious suicide attempt, as compared with those with high self-compassion. A number of maltreatment-related areas of impairment, identified by screening instruments, were significantly associated with lower self-compassion.

Conclusion

Self-compassion may be a fruitful aspect of research to pursue in an effort to better understand the impact of childhood emotional abuse on adolescent functioning, particularly considering the under-researched group of those receiving child protective services.  相似文献   

3.
Criminal thinking styles were examined as mediational links between different forms of child maltreatment (i.e., sexual abuse, physical abuse, and physical neglect) and adult criminal behaviors in 338 recently adjudicated men. Analyses revealed positive associations between child sexual abuse and sexual offenses as an adult, and between child physical abuse/neglect and endorsing proactive and reactive criminal thinking styles. Mediation analyses showed that associations between overall maltreatment history and adult criminal behaviors were accounted for by general criminal thinking styles and both proactive and reactive criminal thinking. These findings suggest a potential psychological pathway to criminal behavior associated with child maltreatment. Limitations of the study as well as research and clinical implications of the results are discussed.  相似文献   

4.
BackgroundChild maltreatment is a global public health issue that encompasses physical abuse, sexual abuse, emotional abuse, neglect, and exposure to intimate partner violence (IPV). This systematic review and meta-analysis summarises the association between these five forms of child maltreatment and depressive and anxiety disorders.MethodsPublished cohort and case-control studies were included if they reported associations between any form of child maltreatment (and/or a combination of), and depressive and anxiety disorders. A total of 604 studies were assessed for eligibility, 106 met inclusion criteria, and 96 were included in meta-analyses. The data were pooled in random effects meta-analyses, giving odds ratios (ORs) with corresponding 95% confidence intervals (CIs) for each form of child maltreatment.ResultsAll forms of child maltreatment were associated with depressive disorders (any child maltreatment [OR = 2.48, 2.14–2.87]; sexual abuse [OR = 2.11, 1.83–2.44]; physical abuse [OR = 1.78, 1.57–2.01]; emotional abuse [OR = 2.35, 1.74–3.18]; neglect [OR = 1.65, 1.35–2.02]; and exposure to IPV [OR = 1.68, 1.34–2.10]). Several forms of child maltreatment were significantly associated with anxiety disorders (‘any child maltreatment’ [OR = 1.68, 1.33–2.4]; sexual abuse [OR = 1.90, 1.6–2.25]; physical abuse [OR = 1.56, 1.39–1.76]; and neglect [OR = 1.34, 1.09–1.65]). Significant associations were also found between several forms of child maltreatment and post-traumatic stress disorder (PTSD).ConclusionsThere is a robust association between five forms of child maltreatment and the development of mental disorders. The Global Burden of Disease Study (GBD) includes only sexual abuse as a risk factor for depressive and anxiety disorders. These findings support the inclusion of additional forms of child maltreatment as risk factors in GBD.  相似文献   

5.

Objectives

The current study investigates the moderating effect of perceived social support on associations between child maltreatment severity and adult trauma symptoms. We extend the existing literature by examining the roles of severity of multiple maltreatment types (i.e., sexual, physical, and emotional abuse; physical and emotional neglect) and gender in this process.

Methods

The sample included 372 newlywed individuals recruited from marriage license records. Participants completed a number of self-report questionnaires measuring the nature and severity of child maltreatment history, perceived social support from friends and family, and trauma-related symptoms. These questionnaires were part of a larger study, investigating marital and intrapersonal functioning. We conducted separate, two-step hierarchical multiple regression models for perceived social support from family and perceived social support from friends. In each of these models, total trauma symptomatology was predicted from each child maltreatment severity variable, perceived social support, and the product of the two variables. In order to examine the role of gender, we conducted separate analyses for women and men.

Results

As hypothesized, increased severity of several maltreatment types (sexual abuse, emotional abuse, emotional neglect, and physical neglect) predicted greater trauma symptoms for both women and men, and increased physical abuse severity predicted greater trauma symptoms for women. Perceived social support from both family and friends predicted lower trauma symptoms across all levels of maltreatment for men. For women, greater perceived social support from friends, but not from family, predicted decreased trauma symptoms. Finally, among women, perceived social support from family interacted with child maltreatment such that, as the severity of maltreatment (physical and emotional abuse, emotional neglect) increased, the buffering effect of perceived social support from family on trauma symptoms diminished.

Conclusions

The results of the current study shed new light on the potential for social support to shield individuals against long-term trauma symptoms, and suggest the importance of strengthening perceptions of available social support when working with adult survivors of child maltreatment.  相似文献   

6.
The impact of individual forms of childhood maltreatment on health behavior   总被引:2,自引:0,他引:2  
OBJECTIVE: This study examines the unique contribution of five types of maltreatment (sexual abuse, physical abuse, emotional abuse, physical neglect, emotional neglect) to adult health behaviors as well as the additive impact of exposure to different types of childhood maltreatment. METHOD: Two hundred and twenty-one women recruited from a VA primary care clinic completed questionnaires assessing exposure to childhood trauma and adult health behaviors. Regression models were used to test the relationship between childhood maltreatment and adult health behaviors. RESULTS: Sexual and physical abuse appear to predict a number of adverse outcomes; when other types of maltreatment are controlled, however, sexual abuse and physical abuse do not predict as many poor outcomes. In addition, sexual, physical, and emotional abuse and emotional neglect in childhood were all related to different adult health behaviors. The more types of childhood maltreatment participants were exposed to the more likely they were to have problems with substance use and risky sexual behaviors in adulthood. IMPLICATIONS: The results indicate that it is important to assess a broad maltreatment history rather than trying to relate specific types of abuse to particular adverse health behaviors or health outcomes.  相似文献   

7.
Child maltreatment can have a lasting impact, which is why it is important to understand factors that may exacerbate or mitigate self-esteem difficulties in adulthood. Although there is tremendous benefit that can come from religion and spirituality, few studies examine religious views after child maltreatment. Subsequent interpersonal difficulties may also affect self-esteem in maltreatment survivors. This study sought to examine interpersonal problems and religiosity as mediators in the link between childhood maltreatment and self-esteem in adulthood. The study recruited 718 women (M = 19.53 years) from a large public university. Participants completed questionnaires related to child abuse and neglect, interpersonal problems, religiosity, and self-esteem. Results demonstrated that all forms of maltreatment were associated with negative views of God and with more interpersonal difficulties. Viewing God as a punishing figure mediated the relationship between childhood emotional abuse and low adult self-esteem, along with several areas associated with interpersonal problems. Further, for both child emotional neglect and physical abuse, viewing God as less supportive mediated the relationship between child maltreatment and low adult self-esteem. The results may help in intervention for child maltreatment survivors by increasing awareness of the importance of religiosity in treatment to self-esteem issues in both childhood and adulthood.  相似文献   

8.
This article compares multiple types of child maltreatment among Puerto Rican youth. We seek to expand the limited knowledge of the effects of multiple types of maltreatment on depressive symptoms in a specific Latino population as emerging studies indicate that children who are exposed to one type of maltreatment are often exposed to other types. This study examines the predictive strength of different and multiple types of lifetime child maltreatment (i.e., physical, sexual, and emotional abuse; and neglect), and the effect of youth support from parents, youth coping, youth self-esteem, and place of residence on depressive symptoms among Puerto Rican youth. Secondary data analyses were performed using three annual waves (2000–2004) of data from the Boricua Youth Study. The analytic sample consists of 1041 10–13 year old Puerto Rican youth living in New York and Puerto Rico. Results indicate that: (1) youth who experienced ‘sexual abuse only’, ‘multiple maltreatment’ (2 or more types of maltreatment), ‘physical abuse only’ have a significant increase in depressive symptoms (75.1%, 61.6%, and 40.5% respectively) compared to those without maltreatment; and (2) place of residence, exposure to violence, and mental disorders were significant risk factors. When developing psychosocial interventions, professionals should particularly focus on youth who report past lifetime experience with child maltreatment. Particular attention should be given to children living in the Bronx, New York and similar urban low-income areas who report past lifetime experience with multiple types of child maltreatment and who present symptoms or a diagnosis of co-occurring mental health problems.  相似文献   

9.
Child maltreatment has been associated with sexual risk behaviors. Previous investigators have typically studied only one form of maltreatment, preventing them from exploring interrelations between forms of maltreatment and their impact on sexual risk behaviors. Thus, this study aims to examine the unique, cumulative, and interactive effects of four maltreatment forms (sexual abuse, physical abuse, neglect, and witnessing interparental violence) on sexual risk behaviors. The sample comprised 1940 sexually active adolescents (Mage = 15.6; 60.8% girls) attending Quebec (Canada) high schools. Regression results showed that all maltreatment forms were associated with having a higher number of sexual partners, casual sexual behavior, and a younger age at first consensual intercourse. Physical abuse and witnessing interparental violence were associated with inconsistent condom use, and physical abuse was associated with sexually transmitted infections. After controlling for all forms of maltreatment (unique effects), analyses showed that sexual abuse, physical abuse, neglect or witnessing interparental violence remained statistically associated depending on the sexual risk behavior. A greater number of forms of maltreatment was associated with more sexual risk behaviors (cumulative effect). When sexual abuse was not experienced, neglect was associated with a higher number of sexual partners (interactive effects). In general, associations between maltreatment and sexual risk behaviors were similar for both genders. The magnitude of the relationship between a specific form of child maltreatment and sexual risk behaviors may be inaccurately estimated when not controlling for other forms of maltreatment.  相似文献   

10.
Child maltreatment is a public health concern with well-established sequelae. However, compared to research on physical and sexual abuse, far less is known about the long-term impact of emotional maltreatment on mental health. The overall purpose of this study was to examine the association of emotional abuse, emotional neglect, and both emotional abuse and neglect with other types of child maltreatment, a family history of dysfunction, and lifetime diagnoses of several Axis I and Axis II mental disorders. Data were from the National Epidemiological Survey on Alcohol and Related Conditions collected in 2004 and 2005 (n = 34,653). The most prevalent form of emotional maltreatment was emotional neglect only (6.2%), followed by emotional abuse only (4.8%), and then both emotional abuse and neglect (3.1%). All categories of emotional maltreatment were strongly related to other forms of child maltreatment (odds ratios [ORs] ranged from 2.1 to 68.0) and a history of family dysfunction (ORs ranged from 2.2 to 8.3). In models adjusting for sociodemographic characteristics, all categories of emotional maltreatment were associated with increased odds of almost every mental disorder assessed in this study (adjusted ORs ranged from 1.2 to 7.4). Many relationships remained significant independent of experiencing other forms of child maltreatment and a family history of dysfunction (adjusted ORs ranged from 1.2 to 3.0). The effects appeared to be greater for active (i.e., emotional abuse) relative to passive (i.e., emotional neglect) forms of emotional maltreatment. Childhood emotional maltreatment, particularly emotionally abusive acts, is associated with increased odds of lifetime diagnoses of several Axis I and Axis II mental disorders.  相似文献   

11.
This study systematically reviews research on child maltreatment and risk of gambling problems in adulthood. It also reviews adult problem gamblers’ risk of abusing or neglecting their own children. Multiple database searches were conducted using pre-defined search terms related to gambling and child abuse and neglect. We identified 601 unique references and excluded studies if they did not report original research, or did not specifically measure child maltreatment or gambling. Twelve studies that included multivariable analysis of childhood maltreatment exposure and problem gambling were identified. Six of seven studies examining childhood sexual abuse and four of five examining physical abuse showed a significant positive association between abuse and later gambling problems (odds ratios for sexual abuse 2.01–3.65; physical abuse 2.3–2.8). Both studies examining psychological maltreatment and two of three examining neglect identified positive associations with problem gambling. In most studies, risks were reduced or eliminated when controlling for other mental health disorders. The three studies measuring risk of child abuse and neglect among current problem gamblers suggest an increased risk for child physical abuse and medical conditions indicative of neglect although there is a considerable amount of variation among studies. Child abuse is associated with increased risk of gambling problems – gambling treatment providers should ask about maltreatment history as part of their clinical assessment. Problem gamblers may be more likely to physically abuse or neglect their children, but data here are more limited. Child welfare professionals should consider asking questions about parental gambling when assessing family risk.  相似文献   

12.
OBJECTIVE: The aim of this study was to examine the differential effects of multi-types of maltreatment in an adolescent sample. Different combinations of maltreatment (emotional, sexual, physical, neglect) were examined in relation to both negative affect and externalizing symptoms in male and female youth. METHOD: One thousand four hundred fifty-two middle and high school youth were recruited from urban schools and a mandated early warning truancy program. Youth completed an anonymous survey that included measures of child maltreatment, depression, suicide proneness, hopelessness, delinquency, hostility, substance use, and promiscuity. Respondents were categorized into groups of different combinations of maltreatment by their reports of sexual abuse, physical abuse, neglect (emotional and physical), and emotional abuse. RESULTS: Nearly two-thirds of boys and girls reported some form of maltreatment, and multi-type maltreatment was common (e.g., 13% reported experiencing both physical and sexual abuse and neglect). Individuals with maltreatment histories were more depressed (F=52.78, p<.0001), suicide prone (F=24.29, p<.001), and hopeless (F=32.07, p<.0001) than non-abused individuals. Maltreated adolescents were also more hostile (F=35.03, p<.0001), and they engaged in more delinquent behavior (F=26.76, p<.0001), promiscuity (F=8.54, p<.0001), and drug and alcohol use (F=9.61, p<.0001). Individuals experiencing multi-type maltreatment were the most symptomatic, particularly youth with histories of physical abuse, sexual abuse, and neglect. In general, gender differences in effects were not observed. CONCLUSIONS: The results highlight the importance of studying combined types of maltreatment, as well as understanding the particularly deleterious effects of neglect and emotional abuse. The results are generally consistent with an additive model of maltreatment effects.  相似文献   

13.
OBJECTIVE: To examine trends by year in reports of victims of child maltreatment in the US Army Central Registry (ACR) during the period 1975-97. We report the rates/1,000 children of Army families of initial substantiated cases from 1988-97 and the number of cases of maltreatment as a percentage of total victims for each year from 1975-97. Army data are compared to published reports from military service child abuse registries. METHODS: Numbers of cases of child maltreatment for each year were obtained from the ACR for major, minor, and total physical abuse, sexual abuse, emotional abuse, and neglect. Population figures for numbers of children were obtained from the Defense Manpower Data Center. RESULTS: The rates/1,000 for neglect have decreased by 24% from 1991-97, although the decrease has not been steady. The rates/1,000 of minor physical abuse declined 28% from 1993-97. The rates/1,000 of major physical abuse were basically unchanged from 1988-96, although the highest rate was recorded in 1997. The rates/1,000 of sexual abuse were also basically unchanged with the exception of increases in 1992-94 after which time the rates/1,000 returned to the pre-1992 levels. The rates/1,000 of emotional abuse cases more than doubled from 1988-97. CONCLUSIONS: While minor physical abuse and neglect have shown decreases over the past decade, major physical abuse has remained virtually unchanged and sexual and emotional abuse have shown fluctuations. All these forms of maltreatment are challenges to the Army Family Advocacy Program.  相似文献   

14.
PURPOSE: This study had two aims: (1) to determine the prevalence of five categories of retrospectively reported childhood maltreatment in an adult community sample and (2) to examine relationships between three theoretically and practically chosen demographic variables and childhood maltreatment. METHOD: Participants were a representative sample of 967 adult men and women in the metropolitan Memphis, Tennessee area. They completed a telephone survey that included a reliable, valid questionnaire assessing five types of childhood maltreatment (i.e., emotional abuse, emotional neglect, physical abuse, physical neglect, and sexual abuse) and demographic questions. Simultaneous logistic regression analyses were used to identify demographic correlates of specific trauma types. RESULTS: Prevalence of childhood maltreatment ranged from approximately 30% for women to over 40% for men. Approximately 13% of participants reported multiple forms of maltreatment. The most common forms of trauma for both men and women were physical abuse, physical neglect, and emotional abuse, all of which were highly likely to co-occur. Race, sex, and current educational level were each associated with an increased likelihood of childhood maltreatment; differential relationships with particular maltreatment types were also observed. IMPLICATIONS: These findings highlight the importance of research on the prevalence of and risks for multiple types of childhood maltreatment, particularly in the somewhat neglected area of emotional abuse and neglect. These findings can be used to highlight the need for preventive interventions aimed at the negative sequelae of childhood maltreatment and to tailor preventive interventions to the needs and expectations of those at high risk.  相似文献   

15.
The increasing rate of child abuse and neglect is a special concern for educators who are legally mandated reporters of suspected maltreatment, are often the first to identify and refer children who have been harmed, are in contact with parents and are aware of the family conditions contributing to child maltreatment, and who must often work closely with other professionals in their efforts to support child victims and prevent further abuse. Moreover, children's emotional or behavioral problems, learning disabilities, or other difficulties often reflect broader problems that are associated with abuse or neglect. Consequently, understanding the causes and consequences of child maltreatment, and contemporary child protection efforts, is essential to educators in their efforts to assist victimized children. This article surveys current research on child maltreatment with particular attention to the challenges of child protection, the multidimensionality of child maltreatment (distinguishing physical abuse, physical neglect, sexual abuse, and psychological maltreatment), and hopeful new avenues for prevention. The implications of this research for educational professionals are emphasized.  相似文献   

16.
Child maltreatment negatively affects children's development and wellbeing. This study investigated the associations between child maltreatment (i.e., emotional neglect, emotional abuse, and physical abuse) and interpersonal functioning, including parent–child relationship, teacher–student relationship, and peer relationships among children with oppositional defiant disorder (ODD). A total of 256 children with ODD and their parents and class master teachers from Mainland China completed questionnaires. Results showed a negative correlation between emotional abuse (parent-reported) and children's interpersonal relationships with parents, teachers, and peers. Emotional neglect and physical abuse were related to poor parent–child relationships. Latent profile analysis revealed three profiles of child maltreatment among children with ODD. ODD children with more severe levels of one type of maltreatment were also more likely to have experienced severe levels of other types of maltreatment. Children with ODD who were in the group of high maltreatment had the poorest quality of interpersonal relationships. Our findings highlight the urgent need to prevent child maltreatment and promote more positive parenting in families with ODD children.  相似文献   

17.
OBJECTIVE: No published studies have examined childhood abuse and neglect in body dysmorphic disorder (BDD). This study examined the prevalence and clinical correlates of abuse and neglect in individuals with this disorder. METHODS: Seventy-five subjects (69.3% female, mean age=35.4+/-12.0) with DSM-IV BDD completed the Childhood Trauma Questionnaire and were interviewed with other reliable and valid measures. RESULTS: Of these subjects, 78.7% reported a history of childhood maltreatment: emotional neglect (68.0%), emotional abuse (56.0%), physical abuse (34.7%), physical neglect (33.3%), and sexual abuse (28.0%). Forty percent of subjects reported severe maltreatment. Among females (n=52), severity of reported abuse and neglect were .32-.57 standard deviation units higher than norms for a health maintenance organization (HMO) sample of women. Severity of sexual abuse was the only type of maltreatment significantly associated with current BDD severity (r=.23, p=.047). However, severity of sexual abuse did not predict current BDD severity in a simultaneous multiple regression analysis with age and current treatment status. There were other significant associations with childhood maltreatment: history of attempted suicide was related to emotional (p=.004), physical (p=.014), and sexual abuse (p=.038). Childhood emotional abuse was associated with a lifetime substance use disorder (r=.26, p=.02), and physical abuse was negatively associated with a lifetime mood disorder (r=-.37, p=.001). CONCLUSIONS: A high proportion of individuals with BDD reported childhood abuse and neglect. Certain types of abuse and neglect appear modestly associated with BDD symptom severity and with gender, suicidality, and certain disorders.  相似文献   

18.
OBJECTIVE: This study examines the association between maternal childhood maltreatment and psychopathology and aggression in intimate relationships during pregnancy and the postpartum period. METHOD: Forty-four pregnant women who were recruited from an obstetric clinic and local advertising periodical completed questionnaires about childhood maltreatment and psychopathology during their first trimester of pregnancy. Approximately 1 year after the birth of the child, 32 of the original participants completed these same questionnaires. Regression models were used to test the relationship between childhood maltreatment and psychopathology and aggression during pregnancy and 1 year postpartum. RESULTS: Sexual abuse and emotional neglect were related to psychopathology during pregnancy, and emotional neglect and physical abuse and neglect predicted poorer maternal outcomes 1 year postpartum. Contrary to expectations, physical abuse was related to less aggression during pregnancy, and emotional abuse was associated with less pathology postpartum. CONCLUSIONS: The results of this study indicate that childhood maltreatment is associated with poorer maternal mental health during pregnancy and 1 year postpartum and points to the need to improve targeting and treatment of psychopathology during this time.  相似文献   

19.
This study used latent growth modeling to investigate longitudinal relationships between self-system processes and depressive symptoms among maltreated (n = 142) and nonmaltreated children (n = 109) aged 6-11 years. On average, self-esteem and self-agency increased and depressive symptoms decreased over time. Multivariate growth modeling indicated that, regardless of gender, physical abuse was negatively related to initial levels of self-esteem, and physical abuse and physical neglect were positively associated with initial levels of depressive symptoms. Emotional maltreatment was predictive of changes in self-esteem and changes in depressive symptoms. Initial levels of self-esteem were negatively associated with initial levels of depressive symptoms. The findings contribute to enhancing our understanding of the developmental processes whereby early maltreatment experiences are linked to later maladjustment.  相似文献   

20.
The impact of early physical and sexual abuse (EPA/SA) occurring in the first 5 years of life was investigated in relation to depressive and internalizing symptomatology and diurnal cortisol regulation. In a summer camp context, school-aged maltreated ( n  =   265) and nonmaltreated ( n  =   288) children provided morning and late afternoon saliva samples on 5 consecutive days. Child self-report and adult observer reports of child internalizing and depressive symptoms were obtained. Children experiencing EPA/SA and high depressive or internalizing symptoms uniquely exhibited an attenuated diurnal decrease in cortisol, indicative of neuroendocrine dysregulation. These results were specific to EPA/SA rather than later onset physical or sexual abuse or early occurring neglect or emotional maltreatment.  相似文献   

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