We often say that words can hurt, but do we really take that seriously? In research, the harms of verbal abuse remain less well understood than those of physical abuse (Bellis et al, 2025), and policy and child protection efforts tend to focus more on reducing physical abuse, for example through restrictions on corporal punishment (Dube et al, 2023).
Globally, around one in six children experience physical abuse (Whitten et al, 2024). Verbal abuse, however, may affect as many as one in three (Stoltenborgh et al, 2012), making it even more widespread. While physical abuse appears to be declining, verbal abuse may be on the rise (Dube et al, 2023). This raises questions about how well the harms of verbal abuse are understood by the public.
This also resonates with everyday life. In my own experience, in daily conversations, and in counselling practice, I have often seen that while physical injuries may heal, the effects of verbal abuse can linger much longer. These harms are often less visible, less likely to be recognised, and therefore less likely to be addressed.
This blog summarises findings from a study by Bellis et al (2025), which directly compares the impacts of verbal and physical abuse on mental well-being.
We often say that words can hurt, but do we really take that seriously? This paper explored the phenomenon of verbal abuse, which is far less understood than physical abuse.
Methods
The study analysed survey data from seven studies, covering 20,687 adults in England and Wales.
These data included three types of information:
- Childhood experiences of abuse – physical, verbal, both, or neither
- Current mental well-being – based on seven aspects: how often over the past two weeks people felt optimistic about the future, relaxed, close to others, useful, able to think clearly, able to deal with problems well, and able to make up their own minds
- Background characteristics – year of birth, sex, ethnicity, and level of deprivation.
The analysis focused on:
- How different types of abuse relate to mental well-being
- How background factors are related to both reported abuse and mental well-being
- How patterns of abuse vary across birth cohorts.
Results
Both verbal and physical abuse are linked to poorer mental well-being
Verbal and physical abuse in childhood are each linked to a higher likelihood of low mental well-being later in life. For example,
- 16% of those exposed to neither type of abuse reported low mental well-being,
- compared with 22.4% of those who experienced physical abuse (AOR 1.52),
- 23.8% of those who experienced verbal abuse (AOR 1.64), and
- 29.1% among those who experienced both (AOR 2.15).
Across the seven aspects of mental well-being, four (feeling optimistic about the future, relaxed, close to others, and useful) show similar patterns: verbal and physical abuse are each associated with poorer outcomes than no abuse, with the worst outcomes among those exposed to both types of abuse. Verbal abuse is specifically linked to poorer outcomes in dealing with problems well, while physical abuse is linked to poorer outcomes in thinking clearly.
Physical abuse has declined, while verbal abuse has increased across generations
In terms of reported abuse, physical abuse became less common across generations, declining with each decade from those born in the 1970s onwards (from around 20% among those born in the 1970s to 10% among those born since 2000). By contrast, verbal abuse increased across generations, from those born before the 1950s to those born in the 1970s (rising from around 12% to 21%).
In terms of mental well-being, those born since 2000 showed poorer outcomes in both overall mental well-being and most individual aspects, compared with earlier generations.
Patterns of abuse and mental well-being differed by ethnicity
Ethnicity was grouped into three categories: White, Asian, and Other. Compared with White individuals, the Other group reported higher levels of physical abuse, with no clear difference in verbal abuse, while Asian individuals reported the lowest levels of both types of abuse. White individuals reported the lowest levels of mental well-being.
Both verbal abuse and physical abuse were linked to poor mental wellbeing, and reports of verbal abuse have increased across generations.
Conclusions
Overall, both verbal and physical abuse are associated with around a 50% higher likelihood of having poor mental well-being. This suggests that verbal abuse, often less visible or recognised, can be as harmful as physical abuse.
Patterns across generations show a decline in physical abuse and a rise in verbal abuse, suggesting shifts in how abuse is carried out over time. Notably, these changes have not been matched by better mental well-being, with those born since 2000 reporting poorer outcomes than earlier generations; a pattern worth exploring further.
This survey study found that verbal abuse, although often less visible or recognised, can be as harmful as physical abuse in relation to mental health.
Strengths and limitations
This study has several strengths. It draws on a large sample of over 20,000 participants from seven datasets, which increases the reliability of the findings. Relevant factors included in the analysis, along with variation across datasets, are accounted for, helping to address potential confounding.
There are also some limitations to consider. As the study relies on retrospective self-reports, verbal and physical abuse may not be interpreted or remembered in the same way. This may lead to differences in how likely different forms of abuse are to be reported, potentially affecting the comparison between the two. The study does not account for whether individuals have received mental health support, which can play an important role in current mental wellbeing. In addition, focusing on mental wellbeing captures only part of the impacts of abuse, which may extend beyond the psychological to physical health, education, and employment.
A further limitation concerns the cultural applicability of the measures used. For example, in some Asian cultural contexts where physical punishment is normative, or verbal criticism is framed as care or guidance, individuals may be less likely to interpret certain experiences as abuse. In cultures that emphasise parental authority and filial piety, there may be higher thresholds for reporting such experiences. Lower reported rates of abuse among Asian participants may therefore reflect differences in how experiences are understood, rather than actual prevalence.
Similar concerns apply to measuring mental wellbeing. The concepts and measures are often shaped by Western frameworks and may not fully capture how distress is experienced and expressed in other cultural contexts (Kohrt et al, 2014). For instance, distress in some cultures may be more often expressed through somatic symptoms, silence, or in relational or collective ways (Al Busaidi, 2010; Nichter, 1981). Lower reported mental wellbeing among White participants may simply reflect that these measures make their experiences more visible, rather than genuinely poorer mental well-being.
What counts as abuse, and how its harm is experienced, is highly subjective and shaped by culture.
Implications for practice
Policy
Current child protection policy tends to focus on physical abuse, for example through legislation on corporal punishment. The findings of this study suggest that this focus needs rebalancing. Failing to recognise verbal abuse as equally harmful risks sending the message that it is less serious, or worse, that replacing physical abuse with verbal abuse could be seen as an improvement. Policy should reflect the comparable harm of verbal abuse, through both legislation and investment in public awareness. This could include helping people recognise what verbal abuse looks like, understand its impacts, and access guidance on appropriate parenting and discipline. Clearer reporting mechanisms would also make verbal abuse easier to identify and respond to.
Clinical assessment
Since verbal abuse can be as damaging to mental wellbeing as physical abuse, it deserves equal attention in clinical assessment. Clinicians may need to actively create space for verbal abuse and its impacts to be surfaced and explored, especially where service users may not have recognised those experiences as harmful, or may never have had the language to name them at all. It is therefore important to explore how service users themselves understand and make sense of what happened to them, rather than relying on clinical criteria alone.
Repair
Recognising the harm of verbal abuse and working to reduce it is important. But so is what happens afterwards. People make mistakes, and parents, caregivers, and teachers are no exception. This is not to excuse abuse, but to highlight that harm will sometimes occur, and that unlike physical injuries, the harm caused by verbal abuse can easily be missed, dismissed, or left unaddressed. Yet it is equally in need of repair. For those who care for and work with children, being aware that this kind of repair is possible, and matters, may be as important as prevention itself.
Unlike physical injuries, the harm caused by verbal abuse is often missed or dismissed, yet it needs repair just as much. For those who care for and work with children, recognising that repair is both possible and essential may be as important as prevention.
Statement of interests
Min (Xiaomin Lai) has a background in counselling and an interest in trauma-informed care and the cultural applicability of research. These perspectives inform their reflections in this blog. They have no conflicts of interest to declare. AI was used to tighten sentences and refine word choice.
Edited by
Dr Laura Hemming.
Links
Primary paper
Mark Bellis, Karen Hughes, Kat Ford, Zara Quigg, Nadia Butler, Charley Wilson (2025). Comparative relationships between physical and verbal abuse of children, life course mental well-being and trends in exposure: a multi-study secondary analysis of cross-sectional surveys in England and Wales. BMJ open, 15(8), e098412.
Other references
Al Busaidi ZQ. (2010) The concept of somatisation: A cross-cultural perspective (PDF). Sultan Qaboos University Medical Journal 10(2) 180–186.
Dube SR, Li ET, Fiorini G, Lin C, Singh N, Khamisa K, McGowan J, Fonagy P. et al (2023) Childhood verbal abuse as a child maltreatment subtype: A systematic review of the current evidence (PDF). Child Abuse & Neglect 144 106394.
Kohrt BA, Rasmussen A, Kaiser BN, Haroz EE, Maharjan SM, Mutamba BB, de Jong JTVM, Hinton DE. et al (2014) Cultural concepts of distress and psychiatric disorders: Literature review and research recommendations for global mental health epidemiology. International Journal of Epidemiology 43(2) 365–406. (Abstract)
Nichter M. (1981) Idioms of distress: Alternatives in the expression of psychosocial distress: A case study from South India. Culture, Medicine and Psychiatry 5(4) 379–408. (Abstract)
Stoltenborgh M, Bakermans-Kranenburg MJ, Alink LRA. et al (2012) The Universality of Childhood Emotional Abuse: A Meta-Analysis of Worldwide Prevalence (PDF). Journal of Aggression, Maltreatment & Trauma 21 870–890.
Whitten T, Tzoumakis S, Green MJ. et al (2024) Global Prevalence of Childhood Exposure to Physical Violence within Domestic and Family Relationships in the General Population: A Systematic Review and Proportional Meta-Analysis (PDF). Trauma, Violence, & Abuse 25 1411–1430.
