Psychological violence and psychological harm: how to prove the invisible when there are no physical injuries

⚖️🧠 Forensic psychiatry · Psychological violence · Psychological harm · Causal link

By Dr. Marc Agraz — Forensic psychiatry and psychiatric expert assessments · Lleida and online.

We are talking about psychological violence: control, humiliation, threats, isolation, fear, blackmail, degradation, pathological jealousy, surveillance, manipulation, intimidation, the gradual undermining of autonomy, and loss of an internal sense of safety.

And a key question arises for lawyers, victims, families, and courts:

How do you prove harm that cannot always be seen?

The answer is not simple. But it is clear: through method, chronology, documentation, rigorous clinical assessment, and a well-constructed psychiatric expert assessment.

1) Why this topic is particularly relevant now

In April 2026, Spain’s Supreme Court issued judgment STS 308/2026, summarized by Mujeres Juristas Themis as a significant ruling on gender-based violence, sexual violence, the assessment of evidence, and judicial perspective. Among the highlighted criteria, the judgment recalls that gender-based violence should not be analyzed as a sum of isolated episodes, but within a context of domination, control, and inequality.

The forensic implications are substantial: if psychological violence, control, or humiliation form part of the pattern of abuse, the report cannot simply ask:
“Was there a blow?”. It must reconstruct a pattern, a context, and a sequence of psychological deterioration.

2) The major mistake: believing that no physical injuries means no harm

Many victims of psychological violence seek help late because they doubt their own suffering.

• “He did not hit me.”
• “I have no evidence.”
• “They were just arguments.”
• “Maybe I am exaggerating.”
• “He told me I was crazy.”
• “I find it hard to explain what happened.”
• “From the outside, it seemed like a normal relationship.”

This is one of the most pernicious effects of psychological violence: it undermines confidence in one’s own perceptions.

Possible effects include:

The question is not whether the harm “can be seen.” The question is whether it can be assessed, documented, and causally connected to a pattern of violence.

3) What a psychiatric expert assessment contributes in psychological violence

A psychiatric expert report should not be a letter of emotional support. Nor should it become an accusation dressed in medical language.

It must provide expert evidence.

Psychological violence and psychological harm: key clinical and forensic points

4) It is not “believing” the victim: it is an expert assessment of harm

In gender-based violence and sexual violence, much is said about the victim’s testimony. And careful distinctions matter.

Spain’s Supreme Court has recently recalled that the victim’s testimony can have evidentiary value, and that the absence of a psychological expert assessment of credibility does not necessarily preclude a conviction; it is the court that assesses the evidence with procedural safeguards, reasoned decisions, and the opportunity to challenge it.

What an expert can do—and this is very important—is assess:

• psychological harm;
• clinical compatibility between symptoms and reported events;
• the course of the condition;
• lasting effects;
• the need for treatment;
• functional impact;
• vulnerability factors;
• the risk of revictimization;
• the impact on children;
• the causal relationship between the pattern described and the psychopathological condition.

An expert assessment should not attempt to “prove everything.” It should contribute what only a clinical and forensic expert can contribute.

5) Psychological violence: what often goes undocumented

The problem with psychological violence is that it is often normalized for years.

It can start with phrases such as:

• “You are crazy.”
• “No one will believe you.”
• “You are nothing without me.”
• “Your friends manipulate you.”
• “Your family puts ideas in your head.”
• “If you leave me, you will regret it.”
• “The children will find out who you really are.”
• “You will lose everything.”
• “You are a bad mother.”
• “I control you because I love you.”

And, over time, it can become a pattern:

According to Themis’s summary, Spain’s Supreme Court recalls that psychological violence, control, jealousy, threats, humiliation, and isolation form part of the dynamics of gender-based violence. It also emphasizes that continuing the relationship or living together does not rule out violence.

6) What documentation strengthens a case

In psychological violence, the account matters, but it should not stand alone. An expert case is strengthened by clinical, social, employment, family, or judicial documentation that allows the sequence to be reconstructed.

Spain’s Crime Victims’ Statute recognizes rights to protection, information, support, assistance, and care, and provides for an individual assessment of victims to determine special protection needs. Its implementing regulations recall that this assessment must consider personal characteristics, the nature of the offense, the seriousness of the harm, and the risk of recurrence, with attention to particularly vulnerable victims.

7) Child witnesses: harm that is not always noticed in time

One of the most sensitive issues concerns children who witness violence.

A child who sees, hears, or experiences violence between significant adults can develop symptoms of their own:

• anxiety;
• nighttime fear;
• regression;
• bedwetting;
• nightmares;
• school problems;
• irritability;
• hyperalertness;
• guilt;
• withdrawal;
• aggressive behavior;
• fear of separation from the safe caregiver;
• attachment difficulties;
• posttraumatic symptoms.

The recently reported case in Madrid starkly illustrates this reality: the judgment includes a conviction related to psychological harm and the exposure of a girl under three to violence against her mother. Beyond that specific case, the forensic lesson is clear:
witnessing violence can also cause psychological harm of one’s own.

8) When criminal proceedings have been dismissed: is that the end?

Not always.

The absence of a criminal conviction does not automatically mean that there was no violence or psychological harm. It depends on the proceedings, the standard of proof, and the legal issue at stake.

A recent example is the High Court of Justice of Murcia, which recognized entitlement to a widow’s pension in a case without a conviction or protection order. The chamber considered together a police complaint of abuse, medical reports describing anxiety and depression linked to possible psychological abuse, and the context of the marital breakdown.

9) What a good expert report must avoid

In this field, a poor report can cause harm.

• asserting facts it cannot prove;
• confusing a clinical account with a judicially established fact;
• presenting nonspecific symptoms as direct proof of violence;
• using tests without interpreting the context;
• acting as a “credibility expert” without methodological limits;
• ignoring previous psychiatric history;
• omitting alternative factors;
• overdiagnosing PTSD without clear criteria;
• failing to distinguish current harm from lasting effects;
• failing to assess malingering, exaggeration, or inconsistencies when appropriate;
• using activist language instead of technical language;
• forgetting the gender perspective or using it to remove safeguards.

10) Why some cases fail despite real suffering

Many proceedings are weakened not because the victim has not suffered, but because the case is poorly structured.

11) When to request a psychiatric expert assessment

An expert report can be particularly useful when:

• there is psychological violence without obvious physical injuries;
• there is anxiety, depression, PTSD, or insomnia after an abusive relationship;
• there are questions about lasting psychological effects;
• compensation for psychological harm is being claimed;
• there are children exposed to violence;
• protection or civil measures are being considered;
• the victim delayed reporting and the dynamics of fear or dependence need to be explained;
• the risk of revictimization needs to be assessed;
• there are related criminal, civil, employment, or Spanish Social Security proceedings;
• the lawyer needs to distinguish a treatment report from an expert report;
• expert testimony in court is requested.

It can also be useful for the defense, in a very different way, when mental impairment, capacity for criminal responsibility, impulsivity, substance use, psychiatric disorders, or grounds for exemption or mitigation are in dispute. But even then the report must be rigorous: a psychopathological explanation cannot become an automatic excuse or erase the victim’s harm.

12) What a psychiatric expert report on psychological violence should contain

13) What a lawyer needs from an expert in these cases

A lawyer does not just need a “sensitive” report. A lawyer needs a useful report.

14) The invisible can also be proved, but it takes expertise

Psychological violence does not always leave visible marks. But it can leave deep traces: fear, insomnia, hypervigilance, depression, paralysis, guilt, loss of autonomy, and deterioration of identity.

The forensic challenge is neither to “simply believe” nor to “systematically doubt.”

The challenge is to assess well: with clinical and legal perspectives, a gender perspective when appropriate, safeguards, and method.

SEO FAQ

15) If the case depends on psychological harm, describing suffering is not enough: it must be proved methodically

Are you a lawyer who needs a psychiatric expert report in a case involving psychological violence, gender-based violence, psychological harm, or children exposed to violence? Have you experienced psychological abuse and need an expert assessment explaining the harm, lasting effects, and causal link?

Dr. Marc Agraz prepares independent and technically reasoned psychiatric expert reports on psychological harm, psychological violence, traumatic effects, anxiety, depression, PTSD, children exposed to violence, causal link, functional impact, clinical risk assessment, and expert testimony in court when the case requires it.

16) Sources and further reading