Physical Punishment Linked to Increased Long-Term Mental Health Disorders

David Harari, UVM Medical Student

by David Harari

(Editor Note – I am very pleased to have one of our UVM medical students, David Harari, contribute this well written piece on an important topic.  For those interested in learning more about corporal punishment, however, I suggest not doing an internet search on “spanking.”  You were warned – DCR)

While it is well established that overt child maltreatment  is associated with an array of mental disorders, less is known about the link between harsh physical punishment (i.e., pushing, grabbing, shoving, slapping, hitting)—in the absence of more severe child maltreatment—and psychiatric disorders.

A new study, however, found that children who experienced harsh physical punishment in the absence of severe maltreatment were also more likely to develop long-term psychiatric problems including depression, anxiety, mania, drug and alcohol abuse/dependence, and various personality disorders.

The study, recently published in the August 2012 journal Pediatrics (published online on July 2, 2012), surveyed between 2004 and 2005 a nationally representative sample of 34,653 individuals involved with the National Epidemiologic Survey on Alcohol and Related Conditions. Researchers found that approximately 6% of respondents reported harsh physical punishment in the absence of frank abuse before the age of 18.

Even after adjusting for sociodemographic variables and a family history of dysfunction, a significant link emerged between harsh physical punishment and long-term psychiatric disorders. Approximately 2% to 5% of Axis I disorders and 4% to 7% of Axis II disorders were attributable to harsh physical punishment. Among the mental health disorders most associated with physical harsh punishment in childhood were schizotypal personality disorders (7.2% more likely), antisocial personality disorder (5.5% more likely), mania (5.2% more likely), narcissistic personality disorder (4.7% more likely), borderline personality disorder (4.6% more likely), alcohol abuse or dependence (3.4% more likely), and drug use or dependence (3% more likely).

The parent or caregiver’s right to use physical punishment as a means of discipline remains a matter of dispute. Indeed, the right to use physical punishment has been abolished in 32 countries. With the continued use of physical discipline in this country, the authors argue that their findings should stimulate a stronger position by health care professionals against the practice. While the American Academy of Pediatrics has already opposed the striking of a child for any reason, the authors suggest that a more explicit position statement (physical punishment of any sort should not be used with children of any age) might prove beneficial. In addition, improvement is needed in developing more widespread education and resources that encourage more positive approaches and strategies to disciplining children. From a public health perspective, the authors conclude, “reducing physical punishment may help to decrease the prevalence of mental disorders in the general population.”


Afifi, TO, Mota NP, et al. Physical punishment and mental disorders: Results from a nationally representative US sample.  Pediatrics 2012;130:1-9.

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