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A curated collection of Books, Videos, Articles and more to educate consumers, caregivers and professionals about Complex Trauma.

Death by a Thousand Cuts: The Insidious Impact of Psychological Maltreatment

Click here to view and download a PDF of the essay


We are pleased to announce the addition of a new core topic on the website: Death by a Thousand Cuts: The Insidious Impact of Psychological Maltreatment. We welcome you to peruse the new content by clicking the hyperlink above and exploring the additional related resources listed below.

A Preview of the New Material

We recognize that many people have grown up in environments that were chronically critical, invalidating, lonely, dismissive, insulting, or all of the above. Emotional wounds stemming from these experiences accumulate over time, and people impacted by such psychological maltreatment may find that navigating life feels like stumbling through the world with invisible cuts and bruises.

The complex trauma exposure known as psychological maltreatment includes multiple, often subtle forms of interpersonal trauma that most frequently occur in relationships with parents, caregivers, and authority figures. The most prominent forms of psychological maltreatment are emotional abuse and emotional neglect, which can have lasting implications for various facets of a survivor’s life.


Dr. Jana Pressley, Senior Training Associate of the Foundation Trust and Director of Clinical Services at Complex Trauma Treatment Center-Boston, took the lead role in developing the content for this new core topic of the website. Elaborating on why it is important to focus attention on this particular type of complex trauma, Dr. Pressley explains: “As a society it is widely accepted that sexual abuse and physical abuse are harmful and traumatic experiences, whereas emotional abuse and neglect often go unrecognized or minimally acknowledged. Because of the invisible nature of the impact, survivors are often left feeling like they don’t have a right to their suffering, or that their painful life experiences “don’t count” in comparison to others. However, these individuals will often struggle with some of the most profound distress, while simultaneously doubting their own perceptions or judging themselves as weak or flawed. It is for this reason that I find it critically important to focus on this category of complex trauma exposure; to give voice to an issue that deeply affects so many.”


This new section of the website can provide guidance and hope for growth and healing to anyone touched by psychological maltreatment, whether survivors, service providers, or friends and loved ones. Our goal is that, through this content, people will better understand the forms psychological maltreatment can take, how it impacts people, and how patterns can affect future relationships.


Dr. Kelly Flanagan, a practicing psychotherapist and author of “Loveable”  (further details in our Recommended Books section) reflects on why it is vital to the success of the lasting adult friendships and intimate relationships of many of the client he encounters in individual and couples therapy to recognize and address experiences of emotional abuse and emotional neglect that occurred earlier in life: “To a child, people aren’t just people, they are also mirrors. We look at the adults in our lives, hoping to find something of ourselves reflected in the way that they see us. When those mirrors are intact, we see an image of the good things we are and the good things we can become. However, when those mirrors are broken—and in the case of chronic psychological maltreatment, the mirrors around us were very, very broken—we can develop only a fractured image of ourselves. This is a painful way to walk through the world as an adult, believing we are broken, never having caught a glimpse of the goodness in us, the goodness which might have been the foundation of our love for ourselves, our people, and our life. This then, is one of the many purposes of mental health treatment, it becomes a mirror through which we can begin to glimpse the good things in us that have been there all along.”


Additional Resources

Accompanying this addition to the website are substantial updates to the Complex Trauma glossary, where definitions and examples for common terms in Complex Trauma and psychological maltreatment can be found.


Additional resources focused on understanding emotional abuse and emotional neglect, evaluating their effects, and guiding effective intervention can be found throughout the website, including, but not limited to, the following:


Journal articlesThe following are featured research articles authored by experts in the trauma field related to the topic of emotional abuse and neglect. They explore various components of psychological maltreatment, including the long-term impact of this form of complex trauma exposure and relevant treatment considerations.


Books: These featured books provide further understanding into the topic of emotional abuse and neglect. The first book listed below, authored by Dr. Christine Courtois, is written for the survivor as a resource to aid in understanding what complex trauma is and how it can have an impact on emotions, behaviors, relationships, and physical symptoms. The second book listed is focused on trauma treatment, outlining an intervention model for psychotherapists engaged in this work.


Complex Trauma Resource Guide for Youth: With significant input from youth, this guide defines various categories of complex trauma exposure, as well as explains some of the most common emotions, behaviors, and relationship struggles that can occur when individuals experience childhood trauma.  The resource supports individuals and their loved ones in learning how to understand their past or current behaviors as survival strategies, while offering suggestions for growth and recovery.


Complex Trauma: Never Give Up Video: Youth and young adults in this poignant video offer language and perspective on how to understand oneself through the lens of complex trauma and seek support to find hope and healing.


Treatment for Adults: Component Based Psychotherapy (CBP)CBP is a new psychotherapy framework specifically designed for adult survivors of childhood emotional abuse and neglect. Recognizing the subtleties of this work, Drs. Frances Grossman, Joseph Spinazzola, and colleagues combined psychoanalytic and relational-cultural models of change with mind-body, narrative, and clinical dissociation based approaches to trauma intervention.


Diagnostic Tools:

  • Traumatic Antecedents Questionnaire (TAQ): This measure gathers information about an individual’s history of exposure to traumatic experiences throughout childhood and adulthood, including emotional abuse and neglect. The questionnaire also explores positive experiences throughout development that have served as protective factors.


  • Developmental Trauma Disorder (DTD): This is a symptom list based on the diagnostic criteria of the proposed Developmental Trauma Disorder diagnosis. DTD names various potential trauma exposures relevant to psychological maltreatment including neglect, emotional and verbal abuse, prolonged separation from caregivers, and disruption in relationship with primary caregivers.


  • International Trauma Questionnaire (ITQ): This questionnaire has been deemed a valid and reliable measure for the new Complex PTSD diagnosis to be listed in the forthcoming ICD-11.


  • Structured Interview for Disorders of Extreme Stress (SIDES): This measure (with both clinical interview and self-report versions) assesses the complex effects of interpersonal trauma on a variety of adult symptoms and life difficulties.