Research Watch

Physical punishment as childhood adversity is associated with adult psychopathology according to study

Year of Publication
Reviewed By
Geneviève Pagé

Afifi, T.O., Brownridge, D.A., Cox, B.J., & Sareen, J. (2006). Physical punishment, childhood abuse and psychiatric disorders. Child Abuse & Neglect, 30, 1093-1103.


There is controversy over whether physical punishment used to discipline a child is associated with negative outcomes in adulthood. Using data from a nationally representative survey on mental health (the National Comorbidity Survey or NCS) conducted in the early 1990s, this study investigated three categories of increasing severity of childhood adversity (no physical punishment or abuse, physical punishment only, and child abuse) to examine whether the childhood experience of physical punishment alone was associated with adult psychopathology. The prevalence of psychiatric disorders, as well as the prevalence of low parental warmth and protectiveness, progressively increased as the severity of childhood adversity increased. Also, after adjusting for sociodemographic variables (age, gender, education, income, marital status, and ethnicity), and parental bonding (on three scales: perceived parental warmth, protectiveness and authoritarianism), physical punishment was associated with an increased likelihood of major depression, alcohol abuse or dependence, and externalizing problems in adulthood, though these outcomes were less likely for children who experienced physical punishment only rather than child abuse. Finally, further analyses showed that having one or more psychiatric disorders was significantly associated with having experienced either physical punishment or child abuse.

Methodological Notes

This study used the entire sample of the NCS (5,838 respondents aged between 15 and 54), where 35.5% experienced no physical punishment or child abuse (reference group), 48% experienced physical punishment only and 16.5% experienced child abuse (physical and/or sexual). The Conflict Tactic Scales (CTS) was used to distinguish these three groups. Physical punishment was measured by the minor physical assault or physical punishment items from the CTS, which include: having something thrown at you, being pushed, grabbed, shoved, and being slapped or spanked. Child abuse was measured by the following items of the CTS: being kicked, bit, hit with a fist or an object, being beat up, choked, burned or scalded. Respondents indicating that a parent did one or more of these actions often, sometimes or rarely were included in the relevant childhood adversity group. Respondents indicating they had been raped or sexually molested at age 18 or younger were also included in the group having experienced child abuse. The Parental Bonding Index (PBI) was used to assess respondents' perceptions of maternal and paternal bonding experiences. Trained interviewers administered the Composite International Diagnostic Interview 1.1 (CIDI) to assess the presence of psychiatric disorders based on the criteria of the Diagnostic and Statistical Manual 3rd edition (DSM-III-R). Psychiatric disorders were divided into four groups: 1) major depression, 2) any anxiety disorder (including generalized anxiety disorder, simple phobia, social phobia, panic disorder, post traumatic stress disorder, and agoraphobia), 3) alcohol abuse or dependence, and 4) one or more externalizing problems (including drug abuse or dependence, conduct disorder and antisocial personality disorder). Descriptive statistics were used to understand the sample and prevalence of childhood adversity, parental bonding and psychiatric disorders. Binary logistic regressions were used to determine the association between the experience of childhood adversity and psychiatric disorders in adulthood. Multinomial logistic regressions were conducted to investigate the association between childhood adversity and number of psychiatric disorders.