Of all the forms of child abuse, emotional abuse is the most poorly understood and the least well researched; despite a growing awareness of the harmful outcomes it can have in later life [1]. It may have many causative factors, including negative learned behaviours, unsatisfied emotional needs, and mental disorders on the part of parents, and/or a variety of social circumstances both within the family and its wider environment [2,3]. Although emotional abuse tends to accompany other forms of abuse, such as physical and sexual abuse, and neglect, it may also occur on its own, in which case it is especially difficult to detect [4]. In isolation it can be hard to identify as an event or to establish causal links to the victim’s psychological condition [5].

Emotional abuse can be placed into six categories. These are as follows: 1) Rejection, which may take the form of continual criticism or undermining a child’s self-esteem. 2) Isolation, so that the child is kept from seeing family and friends from child. 3) Ignoring, which may involve not responding a child’s efforts to seek attention or failing to acknowledge achievements etc. 4) Terrorizing, such as threatening to harm a child or abandon them. 5) Corruption, especially involving a child in crime. 6) Exploitation, such as forcing a child to work to provide family income and look after siblings [6].

There are indications that emotional abuse may be the most harmful type of abuse because the perpetrator is, in many cases, the parent or guardian – i.e. the individual with the greatest responsibility for raising the child and nourishing them emotionally and developmentally [7]. Research has shown that such abuse is linked to a broad spectrum of detrimental outcomes, among which are anxiety, depression, aggression, dissociation, borderline personality disorder, and symptoms akin to those of post-traumatic stress disorder [8-10].

The bulk of data on emotional abuse, as it pertains to young people who receive assistance from child welfare authorities, comes from countries that have well-established child protection services. Research into the prevalence of child emotional abuse in these countries, including the UK, indicates that cases of such abuse that are on child protection registers amount to only a small fraction of all children who are actually victims of this form of maltreatment [11]. A further difficulty is that the majority of studies do not isolate the particular impact of emotional abuse but instead treat it, and its consequences, together with other types of maltreatment [12].

Saudi Arabia is a country with only embryonic child protection services. The problem of child abuse in general, and the need to address it at a nationwide level, has only been recognized at a governmental level with the past 25 years or so. The research presented here is an effort to discover what, if anything, is known about the prevalence and nature of emotional abuse in Saudi Arabia, and what steps are being taken, and should be taken in the future, to address the issue.

The central aim of this study is to carry out a comprehensive review of published literature bearing on the subject of child emotional abuse in Saudi Arabia in order to establish what is known about the nature and extent of the problem.

The researcher will then use the findings as a basis for making recommendations for further research, more effective practice by social workers, and improving protection against child abuse through improved programs and policies. Additional goals of the study are: 1) To establish any changes in reported incidence of child emotional abuse in Saudi Arabia; 2) To gauge the extent to which researchers and social workers are now ready to address this problem; and 3) To identify the programs and policies being adopted by the government to meet the challenge of child emotional abuse.

The method employed in this study is a systematic review. This began by determining the selection criteria for inclusion and exclusion based on the central aim of the research, i.e., to establish what is known about the nature and extent of the problem, and secondary aims, including to ascertain what official steps have been taken to address the issue. The selection criteria used by the researcher are shown in Table 1.

Table 1: Selection criteria.

The search for publications was confined to 1990–2016, which covers the entire period during which social science researchers and health care professionals have been reporting data on child abuse in Saudi Arabia. Unpublished dissertations and theses were included in the search, but other material excluded unless it appeared in peerreviewed journals. Key terms used for the search were: “Saudi Arabia”, “child abuse”, “emotional child abuse”, and “child protection”.

General search engines were used initially as a result of which a number of specific online databases and journal indexes were identified. Were the researchers have used a number of search engines such as Hail University Library, Cross Search, Science Direct (Elsevier), Social Sciences Citation Index (New ISI XML), SDL Saudi Digital Library, The resources included in the website of the library of King Fahd, In addition, the researchers will hand search key journals, such as Child Maltreatment, Child Abuse & Neglect: The International Journal, Child Welfare, Child Development etc. Following the application of the inclusion and exclusion criteria, four articles and two reports as following in Table 2 were found to be relevant to the present study.

Table 2: Papers, theses, and other documents identified from main search.

The Saudi National Family Safety Register for 2011 reported a total of 616 cases of child abuse across the nation between October 2010 and February 2012, of which 76 (12.3%) were emotional abuse (Health Ministry, 2011). These include only children and adolescents who were diagnosed as, or suspected of, having suffered some form of child abuse, and received treatment or sought medical attention at any of the 41 hospital-based Child Protection Centres (CPC). In the same register for 2012, the total of all abused children registered was 202 of which 14 (5.3%) were emotional abuse Health Ministry, 2012). No explanation is offered in the 2012 Family Safety Register as to why the figures are so much smaller than in the previous year, although it is clear, comparing these numbers with data from other countries, such as the UK and US, which have much more comprehensive and long-standing child protection services, that the registered Saudi cases of abuse represent a massive under-reporting of all cases occurring throughout the year. The report does make the important point, however, that “emotional maltreatment diagnosis is often under diagnosed and sometimes overlooked if there is another maltreatment form.” In 2012, parents were identified as being perpetrators of emotional abuse in about 77% of all cases and step-parents in a further 11%.

A self-administered web-based questionnaire was used by Al- Dabaan, Newton, and Asimakopoulou in 2014, to obtain information from dentists about instances of abuse that they suspected among children whom they treated. Of the 122 respondents, 59% reported having come across a case of child abuse in the previous five years of their practice, although no figure was given as to the fraction of these cases that might have involved emotional abuse. It is significant, however, that even where abuse was suspected, there was a reluctance to inform authorities for a variety of reasons, including fear of further punishment of the victim by family members. There was a high percentage of agreement among the respondents about the nature of certain forms of emotional abuse, including verbal humiliation and lack of interest in child’s problems.

Almuneef, Qayad, Aleissa, and Albuhairan in 2014, studied adverse childhood experiences (ACEs) in Saudi Arabia, among which are instances of child emotional abuse, using the ACE-IQ (ACE International Questionnaire) supplemented by further questions on risky health behaviours and chronic disease. This paper analysed the demographics of ACEs and how the ACE-IQ score has changed over time but does not isolate the contribution of emotional abuse to the overall score. Nor does it examine the effects of such abuse on the subsequent lives of victims.

Al-Shail, Hassan, Aldowaish, and Kattan in 2012, pointed out point out the inadequacy of data from Saudi Arabia concerning the extent of child abuse in general and emotional abuse in particular. They speculate that this “probably due to multiple social, cultural, and bureaucratic factors leading to seemingly a broad consensus at community level on unbroken silence regarding child abuse phenomena”. As noted earlier, the great majority of abuse cases have been medically reported and “little is known about the less severe child abuse cases that might have occurred in the community and were perpetrated by parents or relatives, since lack of data does not necessarily imply low or no incidence of child abuse”.

Although Saudi Arabia has taken some steps in implementing intervention and protection programs aimed at safeguarding children from abuse, much remains to be done. In particular, the issue of child emotional abuse remains highly sensitive and one that has been slow to be addressed within the country. Very little literature is available on the subject and such statistical data as there is merely reflects the fact that the phenomenon is massively underreported. The author recommends that more specialist facilities be established, staffed by trained social workers and medical personnel, where suspected victims can be assessed and given counselling. At the same time, there needs to be a greater emphasis on increasing public awareness of the problem and on establishing secure means, such as 24 hour hotlines, by which children can report abuse without fear of repercussions from their families or the authorities.

Child emotional abuse is a worldwide phenomenon about which there is an extensive body of literature. Saudi researchers and social workers are urged to add to this international fund of knowledge through further investigation and reporting of CEA in their own country, thus placing the needs of children at risk above the sensitivities of a conservative culture in which such matters have traditionally been hidden from view.

There is inadequate information on both the incidence and prevalence of child emotional abuse in Saudi Arabia. The literature that is available, as revealed by the search conducted in this study, amounts to a handful of academic papers, theses, and government reports. These publications acknowledge the existence of the problem and that some steps have been taken to address the needs of children in this area, and also provide some rudimentary statistical data. However, these data, such as those provided by the National Family Safety Registry in recent years, simply underscore how few cases have actually come to light at an official level and how much more is needed to expose the full scale of the problem, nationwide, and adequately deal with it. The author has made some general recommendations as to how to proceed, but the initiative now must come at a governmental level. A public awareness program is needed along with the means by which children can securely report abuse, but these steps must coincide with the establishment of new facilities that can provide for the safe assessment and counselling of children who are suspected victims of CEA.