What’s Worse for a Child, Abuse or Neglect?
Do the mental and emotional effects of neglect differ from those of abuse?
Posted February 13, 2019
Based on my 40 years of experience doing therapy, I’d wager that most people would say that child abuse is worse, or more serious, than neglect. The very fact that, as generally understood, abuse is active, an act of commission, and neglect is passive, an act of omission, lends credence to the idea that abuse is the more reprehensible of these two forms or child maltreatment.
Still, are we to judge these transgressions by their apparent motives, or by the psychological harm they cause the child victimized by negative attention—or by alarming inattention? Before exploring this key question of child maltreatment, let me describe child neglect in more detail, particularly as it can be viewed as distinct from child abuse.
Although child neglect embodies many variations, all pertain to caretakers’ failing to provide a child with age-appropriate care. In short, the child is deprived of the basic necessities that would enable them to thrive. And this denial can be either intentional or indicative of “reckless disregard” for the child’s welfare. Note that neither of these two accounts imply that neglect is any more innocent than straight-out abuse.
As some researchers have suggested, this sub-optimal care falls into five different (though overlapping) categories—physical, emotional, medical, mental, and educational. According to United States Department of Health and Human Services tracking, more children suffer from neglect than from physical and sexual abuse combined. Yet neglect has received substantially less attention than other forms of abuse. Or, as I might somewhat hyperbolically put it, neglect has, relatively speaking, been subject to neglect.
In several respects, neglect can be more difficult to spot than abuse. If a child is being denied love, affection, or comfort by their caregivers, it’s not as though he or she wears a placard signaling this void. More often than not, neglect isn’t as public, direct, or blatant as abuse. So it usually appears less blameworthy. Still, consider how neglect can manifest itself when a child receives deficient care. For children so deprived can be recognized by:
- being excessively thin, through malnutrition;
- getting sick all the time or frequently having to visit the school infirmary;
- performing poorly in school, or often being absent;
- displaying delinquent behavior that, even when parents are informed, continues unabated;
- looking, or sounding, depressed or apathetic;
- being unable to grasp certain social customs or conventional behaviors, suggesting they’ve received little or no guidance or supervision from caretakers that would assist them in recognizing what’s appropriate in relating to others;
- not getting adequate medical/dental care—such as inoculations, check-ups, teeth x-rays and cleanings;
- showing poor hygiene, and being generally unkempt;
- constantly exhibiting (infected) cuts or rashes, with no indication that their parents are attending to them—or doing anything to prevent them;
- wearing threadbare clothes or not being dressed properly for different weather conditions;
- various situations intimating that the child is experiencing some type of abandonment (e.g., being left alone at home, or showing otherwise unexplainable signs of social withdrawal, isolation, or diffuse anxiety).
Doubtless, these signs of parental dereliction, however troubling, would still seem less severe (or sadistic) than the more dramatic pointers of physical abuse—such as bruises all over the child’s body, burns, fractures, head injuries, and the like. And these jarring signs are typically, as The American Humane Association (AHA) characterizes them, the outcome of the child’s being non-accidentally shoved and slammed, punched, beaten, kicked, bitten, burned, or otherwise attacked by their own parent.
Unquestionably, such (presumably) more calculated forms of maltreatment help account for the circumstance that neglect has received less attention than more flagrant signs of abuse. And it hardly matters that sometimes the abuse may have been undertaken “benignly”—as a grossly misguided or inappropriate attempt to "civilize" the child, or discipline them for their mistakes. Regardless of intention, continuing harsh punishment can be understood as traumatizing. It can eventuate in lasting and—without professional intervention—irreparable damage to their self-image, relationships, and state of well-being.
On the contrary, as many writers have observed, most (though certainly not all) parents guilty of child neglect are viewed as harboring less malign intentions than abusers:
Many neglectful parents, for example, were themselves neglected or abused as children. Also, very young or inexperienced parents might not fully understand how to care for a baby, or what can reasonably be expected of children at different stages of development. Circumstances that place families under extraordinary stress, such as poverty, divorce, sickness, or disability, sometimes lead to the neglect or mistreatment of children. And parents who abuse alcohol or other drugs are more likely to abuse or neglect their children.
All the same, child abuse and neglect are hardly discrete or mutually exclusive, though unfortunately this is what much of the literature implies. For one thing, they both have serious repercussions for the healthy development of the child, who in both cases may experience what’s now commonly designated complex trauma, signifying that the maltreatment is ongoing—vs. a single, isolated, emotionally overwhelming incident. And neglect itself can be nothing short of fatal—such as a caretaker’s naively, or absent-mindedly, leaving a baby or toddler alone in a locked car with windows closed in 100-degree heat. But that’s merely the most dramatic instance of the seriously detrimental ways that children can be affected by what might be seen as an almost “criminal” lack of awareness.
Abuse may also result from neglect, and whether we refer to maltreatment of a child as constituting an act of commission or omission, the child may be similarly programmed to keep their distance from others because of having been conditioned to distrust people generally—and, every bit as important, themselves as well.
Needless to say, such pervasive doubts and cynicism carry enormous implications for their future relationships in terms of being willing to open up and feel “safely vulnerable” with others. Such vulnerability, dependent on an inner security that safeguards them in taking certain interpersonal risks, is a key prerequisite for the intimate relationship that (however secretly) they crave in order to begin healing the painful psychological wounds they suffered growing up.
The Asia Pacific Network of Science and Technology (APSAC) defines child abuse as “spurning, terrorizing, isolating, exploiting, corrupting, denying emotional responsiveness, or neglect” or “a repeated pattern of caregiver behavior or extreme incident(s) that [and this is what’s crucial here] convey to children that they are worthless, flawed, unloved, unwanted, endangered, or only of value in meeting another’s needs.” Note that the first set of descriptors are sufficiently broad as to apply to both abuse and neglect, while the second set—relating to its tragic results—are similarly applicable to both types of child maltreatment.
So, without considerable psychotherapy or adult mentoring, odds are —unless those so afflicted are especially resilient, so-called “dandelion children”—that the harm done to them will last indefinitely, creating multiple problems in confronting the various challenges they’re bound to face as adults, particularly in establishing and maintaining fulfilling relationships. For they’ve developed powerful defense mechanisms to shield themselves from feeling anywhere as emotionally threatened as they constantly experienced growing up.
The intriguing compare-and-contrast website differencebetween.net also attempts to distinguish between neglect and abuse. But as in other writings I’ve examined, it regards them as overlapping—at times, indistinguishable. For example, it states that although “abuse and neglect...have different meanings, [they’re both] associated with the emotional and physical well-being of a person.” Additionally, whereas the literature on this topic sees neglect as generally inadvertent or unintentional, this site’s portrayal of neglect goes so far as to view it as “the deliberate act of forgetting and not caring.”
Admittedly, such a viewpoint overstates its case. But when this site discusses abuse as harming another and neglect as not preventing the occurrence of such harm (through the very act of not acting) once again the actual disparity between the two behaviors seems almost academic—something like committing a crime vs. being complicit in its commission. For, after all, no effort was actually made to avert it. In both instances, then, there’s culpability. Finally, further obscuring the traditional differentiation between abuse and neglect, the article concludes by stating: “A person who has neglecting behavior can also be abusive at the same time.”
Another author, Mandy Trouten, comes to almost exactly the same conclusion. As she puts it: "In practice, neglect is usually an act of abuse.” And as regards whether neglect or abuse is worse, she opines that such a verdict depends on the motive. But to me the purpose of the perpetrator is ultimately less important than the injury their behavior (whether directly or indirectly) has caused. For regardless of how intentional it may be, the maltreatment can result in serious harm to the person’s core sense of self. In any particular instance, an act of abuse could do more—or less—damage than an act of neglect.
Finally, it might be beneficial to talk about abuse and neglect without somehow implying that their effects are essentially different. For they’re not. In light of their quite similar impact on the child, perhaps we should start employing the compound term abuse/neglect to emphasize how they can be opposite sides of the same offensive coin. So returning to my earlier example of a very young child’s dying from hyperthermia in a scorchingly overheated car, in the end it doesn’t much matter whether the injury done to the child was intentional or not. Either way the child has lost its life. The repercussions of neglect can be no less catastrophic than willfully malicious acts of abuse. So it’s erroneous to assume, as I believe most laypeople do, that abuse is inherently worse than seemingly less shameful neglect.
In addition, writers on this topic generally fail to grasp the paradoxical idea of unconscious intent. Consider, for example, that a passive-aggressive act can be just as dangerous, or damaging, as a straightforwardly aggressive one. And although the distinction that the former is somehow less odious because it’s less overt, still passive-aggressive acts may be every bit as vengefully motivated as more transparent acts of hostility.
The inevitable ambiguity of all this can’t be denied. The World Health Organization (WHO) defines child abuse and child maltreatment as "all forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child’s health, survival, development or dignity." The federal Centers for Disease Control and Prevention (CDC) employs the term maltreatment “to refer to both acts of commission (abuse)...and acts of omission (neglect).” Finally, fusing even more these two complementary forms of injuring children, this source notes that “child abuse can cause a range of emotional effects. Children who are constantly ignored [i.e., neglected], shamed, terrorized or humiliated [i.e., abused] suffer at least as much, if not more, than if they are physically assaulted.”
More sophisticated laypeople seem to be developing an awareness of the fundamental “sameness” of these two overlapping manifestations of child maltreatment. And it might be fitting to end this piece by quoting a couple of them as they’ve expressed their views on this topic in quora.com. One respondent notes that “the view of most legal systems is, neglect is abuse,” adding “I don’t think you can say one or the other is worse when all are abuse and all have serious effects. They are simply all bad.”
A second commenter, describing her own agonizing trauma of never feeling wanted or cared about by her mother—that is, growing up feeling emotionally abandoned by her—remarks on the devastating damage done by such desertion. Stating it as frankly, and forcefully, as anyone could, she reflects:
I’ve never been physically abused, but when your own parent treats you like you don’t even exist, seems to me that must be the worst kind of abuse there is.
© 2019 Leon F. Seltzer, Ph.D. All Rights Reserved.