In February 2019, a five-minute video of a mother forcing her 13-year-old son to climb the wall of their building in order to reach the balcony went viral on social media. The boy had misplaced the key to their apartment. While he screamed in fear, his mother continued to beat and push him, pulling him back only when he was near falling (Daily News Egypt). In October of the same year, a 4-year-old girl died in hospital after being tortured by her grandmother and raped by her uncle (Ahram Online). These incidents, among many others, shed light on the social problem of violence against children in Egypt, a lower-middle income (LMIC) Middle Eastern country that sits in the north of the African continent.
In this article, I first shed light on the cultural context that increases the prevalence of child maltreatment (CM) in Egypt. Second, I summarize the existing research on CM and its consequences in adulthood. I then justify the importance of studying emerging adulthood and choice of college students as a sample. Finally, I offer an overview of the present study, along with its findings, limitations and implications.
Shedding light on the Egyptian culture
The Arab culture is characterized by its collectivist nature, which gives precedence to the welfare of the group (i.e., family) over the welfare of the individual [2]. The family is the basic unit of social structure in traditional and contemporary Arab society [3]. The family structure is subject to a set of traditional norms, including protecting the family’s privacy and protecting its reputation amongst the community, which may prevent family members from contacting welfare and health authorities for assistance [4]. Children are consequently raised to be obedient to certain authority figures, particularly those in the family unit. Furthermore, disciplining one’s child by resorting to physical abuse is generally accepted in Egyptian society and because the reputation of the family is prioritized over individual good, children are expected to make sacrifices for the benefit of the family [3]. I argue that collectivism contributes to how individuals and communities justify forms of violence, especially that shame is fueled by the urge to avoid exposure.
Contextualizing child maltreatment
The WHO’s 2014 global status report on violence prevention shows that 36% of Egyptian children were emotionally abused, 23% have been physically abused, 18% of girls and 8% of boys have been sexually abused, and 16% have experienced neglect. Although Egyptian law prohibits the emotional, physical, and sexual exploitation of children [5], exploitation remains prevalent. According to Elghossain et al. [6], Egypt had the highest rate of CM in the Arab region (91%). The deep-rooted cultural model of parental discipline, which includes physically chastising and yelling, legitimizes the use of violence against children [7]. According to the latest nationally representative population survey in Egypt, 93% of children between ages 1 and 14 were exposed to violent disciplinary practices at some point during their childhood. Among the sample (N = 19.474; age range = 15–49), 63% reported “calling the child dumb, lazy or a similar term” at least once during the month before the interview. As for physical punishment, 41.2% reported using severe physical punishment against their children, specifically “hitting or slapping the child on the face, head or ears,” and 11.1% reported “hitting the child over and over and as hard as one can” at least once during the month preceding the interview (Ministry of Health and Population, [8]).
Repercussions of child maltreatment in adulthood
The WHO defines CM as the abuse and neglect of individuals under the age of 18. This includes all forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligence, and exploitation—commercially or otherwise—in the context of a relationship of responsibility, trust, or power that results in actual or potential harm to the child’s health, survival, development, or dignity. Four types of CM are generally recognized: emotional abuse, physical abuse, sexual abuse, and neglect. CM disrupts the caregiver-child bond that is necessary for children’s emotional development [9]. As maltreated children grow up, forming and maintaining bonds could become challenging; they are likely to deal with future emotional connections in a manner that mimics the style of attachment they grew up to learn through their relationship with those who maltreated them, increasing their chance of developing symptoms of psychopathology. Among the deleterious effects in adulthood, a history of antipathy (i.e., emotional abuse), physical and sexual abuse, and/or neglect is linked to risks of posttraumatic stress disorder (PTSD) [10], depression [11], lower satisfaction with life [12], and lower resilience [13]. One possible link between CM, PTSD, depression, life satisfaction, and resilience is difficulty in emotion regulation [14].
CM leaves children feeling terrorized [10], which potentially impairs the integration of the CM experience into memory, resulting in PTSD [15]. Although all forms of CM are associated with PTSD, effects are stronger for antipathy and sexual abuse [10]. The link between sexual abuse and PTSD has long been documented, having been demonstrated in a 30-year longitudinal study by Fergusson et al. [16]. Relating to negative evaluation by an attachment figure, antipathy is potent in causing emotion dysregulation and negative emotions, including shame, which can explain the link between antipathy and PTSD [17]. Antipathy negatively affects children’s attachment style, which shapes individuals’ internal working models [9]. Such negative working models, in turn, anticipate depression [11]. Sexual abuse disrupts children’s sense of trust, which is also associated with depression [18] as well as their world view [19]. The current investigation suggests that sexual abuse is the strongest correlate to depression when compared to other forms of CM [10]. To summarize, both antipathy and sexual abuse, in comparison to physical abuse and neglect, are more strongly associated with PTSD and depression.
CM also affects adult individuals’ subjective life satisfaction [20]. A 19-year longitudinal study by Mosley-Johnson et al. [12] found a negative association between CM and life satisfaction. Fortunately, some who are maltreated as children overcome the adverse consequences and grow up to be resilient [13]. In this context, resilience is the potential to thrive despite having experienced severe stressors. It is therefore best studied longitudinally (e.g., [20]). Individuals with a history of CM tend to be less resilient to stressors later in life. Some traits and skills that contribute to resilience, such as psychological hardiness, ego resilience, and coping efficacy have been measured by self-reporting [21].
Furthermore, CM interferes with the development of the six strategies of emotion regulation abilities, namely acceptance, avoidance, problem solving, reappraisal, rumination, and suppression [22]. Emotion regulation is, in turn, associated with mental health [14]. On the one hand, emotion dysregulation predicts PTSD through thought suppression, avoidance and rumination, and it predicts depression through the inability to regulate affect [23]. Experiencing higher negative emotions due to low reappraisal and rumination [11], in turn, predicts lower life satisfaction [24]. On the other hand, resilient individuals use two emotion regulation strategies [25]: attentional control, to shift focus from negative experiences, and reappraisal, to focus on positive emotions. Since emotion regulation is instrumental for developing resilience—and because it is predicted by CM —[23] emotion regulation is shown to mediate the association between CM and resilience.
The right and duty to produce data about child maltreatment
The international community recognizes violence against children as a public health and human rights problem, both globally and within the 22 countries of the Arab League. Simultaneously, given the political events in the Middle East, Arabs have increasingly become the focus of media attention [26]. Thus, there is a growing need for accurate information regarding Arab culture in order to better aid assessment and treatment of CM in Arab countries. Egypt is currently undergoing political and economic turmoil due to the regime’s implementation of a number of policies which led to unprecedented inflation rates that have reached 23.2% in 2016 compared to 9% in 2011 [27]—that directly impacts social and familial dynamics—which might lead to increased levels of violence, including community violence, and possibly CM. It has been established in the existing literature that economic hardships are associated with adverse changes in the parenting of children, including maternal child abuse and neglect [28]. In this regard, Le Minh et al. [29] argue that high rates of CM in LMICs exist in tandem with high rates of community violence. Evidence that violence increases the chances of developing short- and long-term negative mental health issues has led to calls for greater attention to violence as a determinant of mental health, especially among young people [6].
Most research on CM in Egypt focuses on risk factors [30], external symptoms [31], and socioeconomic predictors [32]. Other studies that investigate the problem of CM focus on data from emergency or clinical departments, criminal records or autopsy reports (e.g., [33]). To the best of our knowledge, only three studies examined CM among Egyptian college students (N = 450; 52% females [34];; N = 1270; 100% females [35];; N = 963; 64% females [36];). While one of the three studies only reported prevalence of sexual abuse [34], Mansour et al. [36] and Mahrous et al. [35] found that CM correlated with negative outcomes using instruments that were only designed for these studies. The lack of use of existing and validated instruments hinders the comparison of findings with other studies. In addition, none of the three studies investigated the relations of interest here, namely the correlation of CM with PTSD, depression, life satisfaction, and resilience, nor did they examine the mediating role of emotion dysregulation. Thus, the existing literature leaves important questions regarding CM unanswered. Most importantly, most research done on CM in Egypt is based on samples from lower socioeconomic statuses (SES) (Mohammad & Samak, 2017), including the three aforementioned studies. While findings refer to low parental education as a positive predictor of CM [37], our research shows that CM transcends social class [38]. Therefore, this study contributes to the body of limited information on CM in emerging adults from middle and higher SES in Egypt. Emerging adulthood is a developmental stage marked by greater independence, exploration, and uncertainty [39]. It is understandably a period of vulnerability for psychopathology. There is a large body of research establishing CM as a risk factor for multiple negative outcomes in both adolescence and adulthood. Yet studies have relatively neglected emerging adulthood [38].
The present study
The present study aimed to replicate findings about associations between CM and PTSD, depression, life satisfaction, and resilience, as well as investigate the mediating role of emotion regulation in a sociocultural context not yet well studied: well-educated emerging adults in Egypt. This study was motivated by two objectives: (1) contributing to the literature on CM in Arab countries and (2) advancing the study of CM in higher SES in Egypt. I hypothesized a positive association between CM and psychopathology (H1) and a negative association between CM, life satisfaction and resilience (H3). Specifically, I hypothesized that antipathy and sexual abuse contributed most to both associations (H2, H4). Second, I aimed at elucidating the mechanisms by which the forms of CM exerted their relative influence on psychopathology and life satisfaction. Specifically, I hypothesized that emotion dysregulation mediates the relationship between each CM form and psychopathology (H5), as well as life satisfaction and resilience (H6).
