Adolescent Abuse: Risk for Psychiatric Disorders

To the Editor: In their recent article, Sandra J. Kaplan, M.D., and colleagues (1) have made a scholarly effort to study whether physical abuse functions as an additional risk factor for adolescent psychopathology. However, several important questions that may limit the contribution of this well-designed and clearly written article to the literature remain partially or fully unanswered. First, what is the impact of age at onset, frequency, and chronicity versus acuity of physical abuse on the development of psychopathology? Second, what is the relative contribution of the emotional abuse that commonly accompanies physical abuse (i.e., insults, slurs) to the development of psychopathology? Third, is the sexual behavior criterion used in this study—“with an adult at least 5 years older”—too lenient? This excludes sexual abuse by peers and siblings.