Healing From Childhood Trauma: What is the Difference Between Abuse and Emotional Neglect?

When clients begin trauma therapy, a common question they ask involves understanding the exact difference between childhood abuse and neglect. Many adults carry deep emotional wounds but feel hesitant to seek help because they believe their past "wasn't bad enough."

Emotional neglect is fundamentally passive—it is an act of omission defined by the essential emotional support, validation, and connection that a child did not receive.

However, both forms of developmental trauma leave lasting imprints on the adult nervous system. Understanding how they differ—and how they frequently overlap—is the first step toward true recovery. (To learn more about the therapeutic journey, see my article: How Trauma Therapy Can Help You to Overcome Unresolved Trauma).

What is the Difference Between Abuse and Neglect?

The main difference between childhood abuse and neglect comes down to an act of commission versus an act of omission, as well as the behavior and presence of the caregiver.

• Childhood Abuse (Act of Commission): Abuse is an active, intentional, or reckless effort to harm, threaten, or injure a child. It involves premeditated or volatile behaviors that inflict active damage. Examples include physical harm, emotional abuse, verbal assault, and sexual abuse.
• Emotional Neglect (Act of Omission): Neglect is fundamentally passive. It occurs when a caregiver fails to provide a child's basic physical needs (food, shelter, medical care) or essential emotional nurturance. This lack of emotional support includes a systemic absence of validation, empathy, and the secure emotional connection required for healthy child development.

Clinical Vignettes: Seeing the Structural Differences

The following clinical examples illustrate how childhood abuse and emotional neglect manifest differently in real lives. All identifying details have been completely changed to protect client confidentiality.

An Example of Active Abuse: Sara

When Sara was a young child, her father would frequently come home intoxicated, inflicting physical abuse on Sara, her siblings, and their mother. The household lived in a constant state of hypervigilance. While her father often forgot his volatile behavior by the next day, the chronic threat response remained wired into the children.

The abuse finally stopped when Sara’s maternal uncle moved into the home, physically restrained the father during an episode, and contacted local law enforcement. Following multiple police interventions, the father was court-mandated to an alcohol treatment facility, and the family was connected with mental health services through a local community health center.

An Example of Passive Neglect: Tom

Tom's childhood was characterized by profound emotional neglect from both parents. His mother was entirely consumed by building her design business; she never attended Tom's school plays, sports, or milestones, frequently placing him in front of a television while she entertained corporate clients. His father traveled constantly for work, and when he was home, he isolated himself in his den. Tom spent his childhood entirely alone in his bedroom.

The profound isolation was mitigated only when a young family moved next door. The neighbor mother, noticing Tom's loneliness, consistently invited him over to play, offering the warmth, compassion, and validation he was missing at home.

The Hidden Trauma of Childhood Emotional Neglect

While both abuse and neglect are profoundly traumatic, clinical studies show that emotional neglect can sometimes be even more insidious and damaging than active abuse over the long term.

• Emotional Neglect is Completely Invisible: Because neglect is characterized by what didn't happen (a lack of love, attention, or safety), it leaves no physical scars or overt markers. It is often entirely overlooked by teachers, doctors, and even the extended family.
• Children Internalize the Omission: While an abused child can often point to the abuser as the source of harm, an emotionally neglected child has no external target. They internalize the structural absence of love, concluding that they are fundamentally flawed, broken, or unlovable. (Explore this deeper in my article: Overcoming the Emotional Pain of Feeling Unlovable).
• Impacts on Brain Development: Chronic and severe neglect starves the developing brain of necessary relational stimuli. This structural deprivation can lead to severe cognitive, emotional, and language deficits during key developmental windows.

What Are the Long-Term Effects of Childhood Abuse and Neglect?

Adult survivors of both developmental environments frequently navigate complex, compounding psychological challenges, including:

• Mental Health Conditions: High rates of chronic anxiety, clinical depression, complex post-traumatic stress disorder (C-PTSD), and panic conditions.
• Relational Barriers: Pervasive difficulties establishing deep interpersonal trust, an intense fear of vulnerability, or a subconscious habit of self-abandonment. (See my article: What is Self Abandonment?).
• Emotional Dysregulation: Severe difficulties with identifying, processing, soothing, and healthily expressing core emotions.

Ultimately, while they are distinct clinical concepts, abuse and neglect regularly coexist within dysfunctional family systems.

Moving Forward: Healing Through Modern Trauma Therapy

Relying on sheer willpower or intellectual analysis is rarely enough to resolve early developmental wounds. Because childhood trauma alters our underlying neurobiology, healing requires specialized, experiential therapeutic interventions. (Learn more in my article: Why is Experiential Therapy More Effective at Resolving Trauma Than Talk Therapy?).

Highly effective modalities utilized by trauma specialists include:

• EMDR Therapy (Eye Movement Desensitization and Reprocessing)
• Somatic Experiencing (Body-centered trauma release)
• AEDP (Accelerated Experiential Dynamic Psychotherapy)
• Parts Work (Internal Family Systems and Ego State Therapy)

Working with a trained professional can help you unburden the historical survival defenses stored within your nervous system, allowing you to build a safe, grounded, and deeply fulfilling present life.

About Josephine Ferraro, LCSW

I am a licensed New York psychotherapist, hypnotherapist, and Certified Sex Therapist with over 25 years of clinical experience helping individual adults and couples recover from complex trauma, restore relational intimacy, and heal mind-body distress. 

My advanced therapeutic trainings include EMDR, AEDP, EFT for couples, IFS and Somatic Experiencing.

Take the Next Step

I offer a complimentary 15 minute phone call before setting up an appointment.

I see clients in person in my office in Greenwich Village, NY (10011) and online.

Contact Information

• Website: Visit Josephine Ferraro, LCSW - NYC Psychotherapist to learn more about my practice.

• Email: Reach out confidentially via email at josephineferraro@iCloud.com.

• Phone: Call me directly at (917) 742-2624 during standard business hours.

What is Toxic Stress?

Stress is a common response to daily experiences in life--both positive and negative.  It can be beneficial when it motivates you to make positive changes in your life.  

What is Toxic Stress?

However, when stress is chronic and overwhelming and you don't have internal resources or emotional support to deal with stress, it can become toxic stress (see my article: Responding Instead of Reacting to Stress).

This article will focus on the connection between toxic and trauma as it begins in early childhood and continues into adulthood (see my article: Stress Management: Taking Time For Self Care).

What Are the Different Types of Stress?

• Positive Stress: Positive stress is also known as eustress. Positive stress responses are normal responses to infrequent, short lived and mild stressful experiences. During childhood, if a child is given emotional support to deal with positive stress, the child develops motivation and resilience.  Over time, as a child develops skills to deal with positive stressors, the child also develops self confidence.  Examples of positive stress for children include:

• Meeting new people
• Learning a new task
• Learning a new game or hobby

• Tolerable Stress: Tolerable stress is more frequent, sustained and severe.  Tolerable stress has more of an impact on the mind and body as compared to positive stress. With emotional support, once the tolerable stress is removed, a child's mind and body usually return to their normal level of functioning.  Examples of tolerable stress for children include:

• Parental divorce
• Death of a loved one

• Toxic Stress: Toxic stress often begins in childhood where prolonged exposure to stress has a damaging effect on a child's mind and body. When children are exposed to unrelenting stress without emotional support, the mind and body are often unable to recover. Toxic stress is related to adverse childhood experiences (see below) also known as ACEs. Examples of toxic stress include:

• Abuse
• Emotional neglect
  
• Poverty
• Food scarcity
• Poor health
• Violence
• family dysfunction including, but not limited to, caregivers with substance abuse or mental health conditions

What Are Adverse Childhood Experiences (ACEs)?

Adverse childhood experiences (ACEs) are potentially traumatic events, as mentioned above, that occur in childhood (ages 0-17 years) that can result in toxic stress.

Toxic stress related to ACEs can result in health and mental health problems especially if these experiences are unmitigated by emotional support from loved ones.

How Common Are Adverse Childhood Experiences (ACEs)?

Unfortunately, ACEs are common.

Adverse Childhood Experiences and Toxic Stress

Approximately 64% of adults reported they had at least one experience with ACEs and about 17.3% of adults reported having four or more experiences as children with ACEs. 

All children are potentially at risk for ACEs, but ACEs are more likely to occur with girls, racial minorities and in families where adults are unemployed or unable to work.

What is the Effect of ACEs and Toxic Stress?

Without emotional support ACEs and toxic stress can result in one or more of the following problems:

• Permanent damaging effects to brain architecture

• Epigenetic change alteration (modifications to DNA which determine whether genes are turned on or off)

• Long term health consequences, including

• Immune dysregulation
• Persistent inflammatory state and health conditions related to inflammation
• Increased risk for cancer and heart disease
• Other chronic health problems

• Long term mental health consequences, including:

• Anxiety
  
• Depression
• Emotional dysregulation
• Other mental health problems

How Do ACEs and Toxic Stress Effect Adults?

Adults who grew up exposed to ACEs without emotional support are more likely to get into unhealthy relationships.

Toxic Stress and Adult Relationship Problems

Without emotional and mental health support, this can have a traumatic intergenerational traumatic impact where one generation after the next form unstable relationships.

Adults who experienced ACEs as children have an increased risk for having an unstable work history, financial problems, debt and other related problems.

How to Reduce the Risk of ACEs and Toxic Stress

Adverse childhood experiences (ACEs) are preventable.  

The Centers for Disease Control and Prevention (CDC) is the national public health agency for the U.S.  It is a federal agency under the Health and Human Services Department.

The CDC recommends the following steps to prevent ACEs:

• Strengthening family financial security
• Implementing family-friendly work policies
• Promoting public education campaigns to educate people about ACEs
• Promoting legislative approaches to reduce corporal punishment
• Promoting bystander approaches
• Promoting men and boys as allies in prevention
• Implementing early childhood programs to ensure a strong start for children
• Implementing high quality child care
• Promoting preschool enrichment with family involvement
• Teaching social-emotional learning
• Teaching safe dating and relationship skills
• Teaching parenting and healthy family relationship skills
• Developing mentor programs
• Developing after school programs
• Developing enhanced primary care
• Developing victim-centered services
• Developing treatment approaches to reduce the harm of ACEs
• Developing treatment to prevent problem behavior and future involvement in violence
• Developing family-centered treatment for substance abuse

Getting Help in Therapy

As an adult, if you have been impacted by toxic stress, you could benefit from seeking help in therapy.

Getting Help in Therapy

Working with a skilled psychotherapist, who has an expertise with toxic stress and trauma, can help you to overcome the damaging effects of toxic stress.

Rather than struggling on your own, seek help from a qualified mental health professional.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and Sex Therapist.

As a trauma therapist, I have helped many individual adults and couples overcome the impact of toxic stress and trauma.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

    

Developmental Trauma: Living in the Present As If It Were the Past

My prior articles about psychological trauma discussed how unresolved childhood trauma, also known as developmental trauma, affects traumatized individuals as adults (see my article: Overcoming Trauma: When the Past is in the Present).  In this article, I'm focusing specifically on how developmental trauma often affects clients' relationship with their psychotherapist, especially during the early stage of psychotherapy.

Developmental Trauma: Living in the Present As If It Were the Past

In his paper, Developmental Trauma Disorder, trauma expert Bessel van der Kolk, MD indicated that developmental trauma, which includes abuse and neglect, is probably this country's biggest public health challenge.

He estimated that approximately 3,000,000 children are reported as being abused or neglected per year--and these are only the cases that are reported.  Many cases go unreported, so that number is probably much higher.

According to Dr. van der Kolk, approximately 80% of these cases are the result of abuse and neglect by the children's own parents.  As a result, developmental trauma is a significant problem in this country, and much remains to be done.

Since untreated trauma does not simply go away when children become adults, it's important to understand the impact of trauma (see my article: Untreated Trauma is a Serious Issue With Negative Consequences).

What is Developmental Trauma?
Before going into more clinical material, let's define "developmental trauma."

Developmental trauma occurs in childhood. It causes overwhelming stress for the child, especially when the stress is not alleviated by the parents.  This includes:

• physical abuse
• emotional abuse
• sexual abuse
• physical neglect
• emotional neglect

The dysfunction in the home can include, among other things:

• mental illness
• substance abuse
• domestic violence
• an incarcerated relative
• divorce

Developmental trauma is also called Adverse Childhood Experiences (ACE) and has serious long term health and mental health implications (see ACE Childhood Study).

Since adults, who experienced Adverse Childhood Experiences, were unable to trust their parents, who were supposed to love and protect them as children, it makes sense that they often have problems trusting people in their adult relationships, including their psychotherapist (see my article: Adults Who Were Neglected or Abused as Children Often Have Problems With Trust).

What Are the Clinical Implications in Therapy For Adults With Developmental Trauma?
For adults, who experienced developmental trauma as children, it takes a lot of courage to come to therapy to be emotionally vulnerable enough to work through their trauma (see my article: Starting Therapy to Overcome Untreated Trauma and Developing the Courage to Change).

It's not surprising that these adults often come to therapy with a great deal of ambivalence and mistrust (see my article: Starting Psychotherapy: It's Not Unusual to Feel Anxious or Ambivalent).

Since most trauma-informed psychotherapists recognize these dynamics, they are aware of the importance of trying to establish a trusting relationship with these clients.

It's not unusual for these individuals to go from one psychotherapist to the next as soon as they feel emotionally vulnerable in therapy--especially since they often come to therapy unconsciously anticipating that the therapist will fail them in the same way that their parents failed them.

Their unconscious anticipatory fear that the psychotherapist will fail them in much the same way that their parents failed them usually indicates that they are living in the present as if it were the past.

The following fictional clinical vignette, which represents a common scenario for adults with developmental trauma, illustrates these points:

Fictional Clinical Vignette: Living in the Present As If It Were the Past
Nina

Nina, who was in her mid-30s, began therapy after her relationship with John ended six months after they started dating.

John ended the relationship because of Nina's jealous accusations.  John vehemently denied that he was cheating, but Nina didn't believe him.

Developmental Trauma: Living in the Present As If It Were the Past

Although they got along well during their first three months together, Nina began to suspect that John was cheating after their relationship became more emotionally intimate in their fourth month together.

Even though she saw no direct signs of John's infidelity, her suspicions alone were enough for her to assume that he was cheating, and she was relentless in her accusations.

When she came for her first session with her therapist, Nina expressed regret that she had destroyed her relationship with John with no objective evidence that he was cheating.  In hindsight, she understood her mistake and why John got fed up.

She also explained to her therapist that this was her pattern in relationships--she always assumed that her boyfriend at the time was cheating, even when there were no objective signs of infidelity.

When she came to therapy the following week for her second session, Nina had a completely different take on why her relationship with John ended.

She told her therapist, "All men cheat and since all men cheat, I know that John was cheating on me.  He ended the relationship because I called him on it and he didn't like it."

When her therapist attempted to explore Nina's feelings about the relationship in the current therapy session versus what Nina said in the first session, Nina acknowledged that she had initially said that  she had made a mistake with John.  But she maintained that she was wrong in her first session and what she felt today was the truth, "Men can't be trusted."

Her therapist realized that, although Nina did a 180 degree turnaround from her first therapy session to her second session a week later, she knew that Nina did not meet the clinical criteria for multiple personality disorder or, as it is now called, Dissociative Identity Disorder (DID).

She recognized Nina's turnaround as a matter of shifting self states, which is a dissociative process, but not as dissociative as DID (see my article: How Shifting Self States Can Affect You For Better or Worse).

And, while everyone has shifting self states to some degree, people who are not traumatized usually have barely perceptible shifts as compared to people with unresolved trauma.

So the fact that Nina had a completely different view about the demise of her relationship when she returned to therapy on the second week was understandable considering her history of childhood trauma.

When Nina talked about her childhood, she vacillated between idealizing and denigrating her mother.

When she idealized her mother, Nina thought that her mother could do no wrong.  But when she denigrated her mother, she blamed her mother for not leaving the father, who had a long history of cheating on the mother.  Once again, her therapist understood these shifts as being part of Nina's shifting self states which were emotionally unintegrated.

Nina also had a long history of aborting therapy.  She explained to her current therapist that she had seen 10 therapists in the last two years, and she left each one when she felt that she couldn't trust the therapist (see my article: When Clients Leave Psychotherapy Prematurely).

Based on what Nina told her, her current therapist could see that Nina's pattern was that she left therapy as soon as the therapeutic work intensified and she felt too vulnerable.  Before that, Nina tended to idealize her therapists.  But once the work progressed and came close to her core traumatic issues, Nina became fearful, she developed a mistrust for the therapist and left therapy abruptly.

Forewarned of Nina's pattern in therapy, her therapist knew that there was a real possibility that Nina might abort the current therapy--even if it seemed like she developed a trusting relationship with the therapist before they processed Nina's traumatic experiences.

During most of her therapy sessions, Nina made it clear to her therapist that she understood that her traumatic childhood, including her father's infidelity, impacted her ability to have lasting relationships with men.

Most of the time, she expressed regret for her mistrust and wanted to "...hurry up and get over my trauma, since I'm not getting any younger and I'd like to get married and have children."

Nina sought therapy with her current therapist because the therapist specialized in working with trauma using EMDR Therapy.  Nina wanted to try EMDR therapy because she heard that it tends to work faster than regular talk therapy.

On the days when Nina acknowledged how her childhood history affected her adult relationships, she was in a hurry to get relief from her traumatic symptoms.

But on the days when she came to therapy blaming "all men for being dogs," she disavowed any connection between her childhood history and the demise of her relationships.  Once again, her shifting perspective was due to her shifting self states.

As part of the therapeutic process, Nina's therapist was the "container" for these different self states (see my article: The Holding Environment in Psychotherapy).

She knew that, even when Nina was in a hurry to process her childhood trauma, Nina wasn't ready.  Nina needed to develop internal resources and a greater sense of emotional integration before she would be ready to process her childhood trauma--otherwise, she would be flooded with anxiety and completely overwhelmed by the trauma therapy.

Her therapist also helped Nina to recognize her different self states by doing Ego States therapy (also known as Parts Work therapy) with Nina.  In this type of therapy, the therapist helps the client to get to know each of her shifting self states in order to foster greater emotional integration.

Nina understood most of the time that the internal resourcing and the Ego States therapy was preparation to eventually process her traumatic memories.  But there were times when she came to therapy feeling angry with her therapist for "dragging out the process and not helping me to get over my trauma."

During those times, Nina was ambivalent about her therapist and about the therapy.  Nina feared that she was being "duped" by the therapist and that she shouldn't trust the therapist.  She threatened to leave therapy and accused her therapist of being "no better than all the other therapists that I've had before."

But Nina and her therapist weathered these storms and, most of the time, Nina was able to see that her doubts and mistrust were the result of a particular self state that got triggered when she became anxious about the therapy (see my article: Coping With Trauma: Becoming Aware of Your Emotional Triggers and Expanding Your Window of Tolerance in Therapy).

She could see that what she was experiencing was the result of her traumatic past which she was living out in the present with her therapist.

Along the way, there was enactments in therapy, as there often are with clients who have been traumatized:  There were several sessions in a row where Nina "forgot" to bring a check to pay her therapist, she "forgot" to come to her sessions, and she was annoyed when her therapist held her accountable for her broken appointments.

All of these enactments were unconscious on Nina's part and were part of her dissociative shifting self states.

Most of the time, her therapist did not get caught up in these enactments but, being human, there was one time when she found herself right in the middle of an enactment with Nina: Nina's therapist had to take a couple of weeks off for a medical procedure.  She made a conscious decision not to disclose her medical problem, which was not serious, to Nina because she assessed that Nina was not ready emotionally to handle this disclosure.  She also wanted to preserve her right to privacy by not disclosing her medical problem.

When her therapist told Nina that she had to take a couple of weeks off, Nina exploded.  She was angry because she felt she was being abandoned by her therapist and with only a couple of weeks notice (see my article: Abandonment Issues Can Get Triggered While Your Therapist is Away).

Nina's therapist had little notice from her doctor that she needed this medical procedure, which could not wait, so she couldn't provide Nina with more notice.  But her therapist didn't want to reveal this to Nina because, as previously mentioned, she thought Nina was too emotionally fragile at that point.

Her therapist did the best she could under the circumstances to contain Nina's upset as well as her own feelings of being misunderstood.  But, after two sessions where Nina ranted about the two week break, her therapist told Nina in an angry tone that she would have a backup therapist that could consult during that two week break.

Even though her therapist got caught up in a mutual enactment by talking to Nina in an angry tone, something shifted for Nina where she stopped ranting and realized that she was being unreasonable (see my article: Mutual Enactments in Psychotherapy Between Client and Psychotherapist).

They were able to talk about what had just happened between them, and Nina expressed that, while she didn't like that her therapist spoke to her in an angry tone, she could feel the genuine nature of her therapist's upset and this caused her to "wake up" and see her therapist as a "normal human being" with her own experiences and feelings.  This was a major breakthrough for Nina.

As I mentioned in an earlier article about enactments, there are times when mutual enactments can have a positive effect on the therapy if the therapist is able to repair the rupture between the therapist and client and they come to a new understanding of their therapeutic relationship (see my article: Ruptures and Repairs in Psychotherapy).

Of course, although these enactments can be repaired and advance the therapeutic work, a therapist should never plan an enactment.

Gradually, over time, Nina became much more perceptive of when she was going through a self state shift.  She had developed a much more observing sense of self so that she could step back, even when she was in a mistrustful state, and see, "It's happening again," which made it easier for her to be more objective and shift into a more emotionally balanced state.

Developmental Trauma: Living in the Present As If It Were the Past

As Nina became more emotionally integrated with fewer dramatic self state shifts, she was now ready to process her earlier traumatic experiences using EMDR therapy.

By processing her childhood trauma in therapy, eventually, Nina freed herself from her traumatic history so that she was no longer living in the present as if she were in the past.

Conclusion
Reenacting unresolved childhood trauma is an unconscious process.

These reenactments occur in personal relationships, work relationships, and in the client's relationship with his or her psychotherapist.

There are times when traumatized clients are able to get a glimpse into these reenactments in therapy but, due to the nature of their shifting self states, this new understanding can be tenuous and change back and forth over time until the client becomes more emotionally integrated as a result of the work in therapy.

A skilled trauma-informed psychotherapist understands that clients often go back and forth in their understanding of their problems because the shifting self states are unconscious.

Developing a trusting relationship with a traumatized client is of the utmost importance before any processing of trauma occurs.

The therapist must also help the client to develop the necessary internal resources and coping skills before processing trauma.

Each client is unique as to when he or she feels safe enough in therapy and prepared to do the therapeutic work.

When a client has worked through developmental trauma, s/he is free to live life without constantly reenacting the past.

Getting Help in Therapy
Making the decision to start therapy is an important step which most people don't take lightly, especially people with a history of trauma (see my article: The Benefits of Psychotherapy).

People with developmental trauma often come to therapy after they have had a series of major disappointments or setbacks in their life.

It takes courage to face a painful history of trauma, and most trauma-informed psychotherapists are aware of this and the clinical implications for the client (see my article: How to Choose a Psychotherapist).

If you think you might be living in the present as if it were the past, you owe it to yourself to get help from a licensed trauma-informed mental health professional.

Although the therapeutic work isn't quick or easy, once you have worked through the trauma, you can live a more fulfilling life without the burden of your past.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I have helped many clients to overcome trauma so they could go on to live a more fulfilling life.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 or email me.