**4. Psychological abuse**

Psychological abuse (also referred to as psychological aggression or emotional abuse in the literature) is defined as "the use of verbal and non-verbal communication with the intent to harm a partner mentally or emotionally and/or exert control over a partner" [2]. Psychological abuse is by far the most prevalent form of dating violence and is estimated to effect nearly half of all adults [67] and varies across studies from 20% to over 95% among teens [68–70]. Yahner et al. [39], in a largescale cross-sectional study of 7-12th graders from 3 states in the Northeast, found that nearly one third of their sample reported experiences of psychological abuse. More alarmingly, rates of perpetration of psychological abuse may be more prevalent at younger ages. For example, in a study of middle schoolers (grades 6–8) from four large high risk urban cities, 77% of youth reported perpetrating psychological dating abuse [71].

Psychological abuse is not only a significant health concern for U.S. youth, but is it also a worldwide problem. In an international review of teen dating violence in North America and Europe, Leen et al. [72] found similar rates of adolescent victimization internationally with reports as high as 77% of teens reporting psychological abuse in dating relationships. Additionally, similar to patterns in the USA, psychological abuse was the most prevalent form of dating violence among teens.

Current findings around gender differences in perpetration and victimization of psychological abuse among teens are mixed. In some cases, females are more likely than males to report perpetrating psychological abuse [73, 74]. These findings appear to align with earlier research that suggest that males are more likely to be victims of psychological abuse than females [44]. However, Hébert, Blais, and Lavoie [75], in a representative sample of Canadian youth, found that girls were more likely to report being victims of all forms of abuse with psychological abuse being the most prevalent. Similarly, in a recent national Canadian study, psychological abuse was more prevalent among adolescent females and non-binary youth relative to their male counterparts [56]. On the contrary, in an international review of teen dating violence Leen et al. [72] found rates of psychological abuse to be similar among boys and girls, there were no gender differences. Thus, it appears while the relationship between gender and psychological abuse remains unclear, this form of dating violence is a serious international public health concern.

There are many significant ramifications of psychological abuse in dating relationships. Consequences of psychological abuse include psychological distress, relationship anxiety, relationship deterioration, symptoms of depression and anxiety, substance use, suicidal ideation, and an increased risk of further victimization and perpetration of dating violence [69, 76–80]. Specifically, those who experience psychological abuse are more likely to be victims of physical abuse [81] thus perpetuating a cycle of violence and further supporting the need to integrate these behaviors.

While much attention in the IPV literature focuses on physical abuse, it is psychological abuse that may be more deleterious to mental health [69, 78]. In an 8-week study of teen dating violence among high school students, Jouriles et al. [78] found that not only does psychological abuse occur in higher frequency than other forms of violence, but it is also viewed as more unpleasant and intentionally hurtful than physical abuse. These findings are consistent with the adult literature which indicates that women view their partners' psychological abuse as more negative and associate their distress more so to psychological abuse than physical abuse [82, 83].

#### **4.1 Cyber-digital relationship abuse**

Even prior to the COVID-19 pandemic, teens' lives have been dominated by technology use and since the new millennium cell phones and text messaging have been the primary means of communication and social connectedness for teens and emerging adults [84]. In fact, young adults spend more time with technology than any other daily activity [85] and technology use mediates most young adult romantic relationships. This new means of communication has changed the way young adults interact within romantic relationships and has introduced a new form of psychological dating aggression, cyber-digital relationship abuse (CDRA). CDRA (also referred to as cyber dating abuse) [40, 41] or electronic dating violence [86] or technology assisted dating violence and abuse [87] is conceptualized as behaviors where technology serves as a tool to harass, threaten, control, and/or monitor a partner's whereabouts through use of social media (e.g., Facebook and Twitter) and digital means (e.g., texting and e-mail) [88–90].

Prevalence rates of CDRA range across studies from 10–32% for perpetration and up to 51% for victimization [40, 41, 91]. According to the Research Triangle Institute International [92], 31% of 7th graders were victims of some form of CDRA. Smaller rates were found in a cross-sectional study using an ethnic minority sample of 6th graders, where 15% reported to have perpetrated CDRA [93]. It appears that rates of CDRA are even higher among LGB youth and young adults with 38% reporting psychological abuse via CDRA versus 10% of heterosexual youth and young adults [94]. It is important to note that CDRA is more frequent at younger ages [88] thus demonstrating the need for early prevention and intervention efforts.

As CDRA is a relatively new form of dating violence, gender differences are still being revealed. In a large-scale study of youth in the northeast ages 13–18, females reported more CDRA victimization than males [41]. Similarly, in a separate study of 9th graders, females were more likely to report experiences of CDRA [95]. In contrast, Cutbush [96] in a sample of 7th graders found that males were more likely to experience CDRA. This pattern was also found in a separate study by Cutbush [91] in which victimization was more prevalent for boys (42%) than for girls (31%). Ybarra et al. [94] reported equal rates of CDRA victimization by gender. Still other studies found no gender differences to emerge among young adults [88]. Thus, it appears that gender and age may play a unique role in the expression of CDRA and these dynamics need to be further explored. At this time, little is known about the relation between race and CDRA. In one study race was not associated with CDRA among high school students [41] and in another study, Hispanic race/ethnicity was correlated with perpetration of CDRA among middle school students [96]. Like gender, differences in rates of CDRA across race and ethnicity needs further exploration.

Similar to traditional forms of dating violence, CDRA is associated with a number of negative outcomes. For instance, CDRA was associated with depressive symptoms and anxiety among high school students [41, 97, 98]. Additionally, CDRA has been linked with lowered self-esteem and greater emotional distress [99] and is associated with personal and professional harm [94]. In an ethnically diverse sample of youth, CDRA was associated cross-sectionally with mental health and substance use, whereas longitudinal associations between CDRA and substance use were shown [100]. CDRA also increases likelihood of cyberbullying victimization and perpetration [88]. It is important to consider that comparable to patterns identified in traditional forms of IPV, there is a high rate of mutual engagement in CDRA [40, 56]. Essentially, victims and perpetrators are not always distinct from one another. In fact, findings indicated that the victimized often victimize

*An Integrative Exploration of Sexual, Physical, Psychological, and Cyber-Digital Relationship… DOI: http://dx.doi.org/10.5772/intechopen.98233*

via CDRA [87]. Therefore, prevention and intervention must be designed around conceptualizing teens as both perpetrators and victims of CDRA simultaneously.

Interestingly, as compared with other forms of abuse, CDRA may be more difficult to escape due to the permanent presence of technology whether it be the various ways to access the victim or the permanent nature of online posts. Moreover, Borrajo et al. [40] found that victims were repeatably victimized with an average of 23 times in last six months. Given the rise of COVID-19, many more relationships are being formed and maintained through technology, making it all the more imperative that youth and young adults are aware of parameters around healthy technology use and how to use technology to build a foundation of healthy relationship dynamics.
