Sexual and physical abuse history and medical practice

Reassessing the Ecology of Medical Care in Japan

Studies on ecology of medical care can provide valuable information on how people seek healthcare in a specific geographic area. The objective of this study was to update a 2003 report on the ecology of medical care in Japan, identifying relevant changes in healthcare patterns. We collected information based on a prospective health diary recorded for a month in 2013 (n = 4548; 3787 adults and 797 children) using a population-weighted random sample from a nationally representative panel. We compared our overall and stratified findings with a similar study conducted in 2003. During a one-month period, per 1000 adults and children living in Japan, we estimated that 794 report at least one symptom, 447 use an over-the-counter (OTC) drug, 265 visit a physician's office, 117 seek help from a professional provider of complementary or alternative medicine (CAM), 70 visit a hospital outpatient clinic (60 community-based and 10 university-based), 6 are hospitalized, and 4 visit a hospital emergency department. After adjusting for demographic variables, we found that healthcare seeking behaviors were influenced by age, gender and area of living. Compared with the 2003 study, participants in this study had fewer symptoms, fewer physician and emergency room visits, and less OTC use, but reported higher frequency of CAM use (p < .01 for all). Compared with 2003, reported symptoms, physician visits and OTC use has decreased, while CAM use has increased. Our findings may be useful to policymakers in Japan in a context where healthcare expenditure and a rapidly aging population are two challenging issues.

Cumulative abuse: do things add up? An evaluation of the conceptualization, operationalization, and methodological approaches in the study of the phenomenon of cumulative abuse

For women, any one type of abuse rarely occurs in isolation of other types, and a single abusive experience is often the exception rather than the norm. The importance of this concept of the cumulative nature of abuse and its negative impact on health has been well recognized within the empirical literature, however there has been little consensus on what to call this phenomenon or how to study it. For the most part researchers have operated on the premise that it is the sheer number of different types of cumulating abuse experiences that is primarily responsible for worse health outcomes among women. And although this simplistic 'more is worse' approach to conceptualizing and operationalizing cumulative abuse has proven to be a powerful predictor of poorer health, it contradicts growing empirical evidence that suggests not all victimizations are created equal and that some victimizations may have a more deleterious effect on health than others. Embedded in abuse histories are individual and abuse characteristics as well as other life adversities that need to be considered in order to fully understand the spectrum and magnitude of cumulative abuse and its impact on women's health. Furthermore, given the long-term and persistent effects of abuse on health it becomes imperative to not only evaluate recent abusive experiences, but rather all abuse experiences occurring across the lifespan. This review highlights and evaluates the conceptual, operational, and methodological challenges posed by our current methods of studying and understanding the phenomenon of cumulative abuse and suggests that this phenomenon and its relationship to health is much more complex than research is currently portraying. This paper calls for the urgent need for interdisciplinary collaboration in order to more effectively and innovatively study the phenomenon of cumulative abuse.

Somatic symptom reporting in women and men

Women report more intense, more numerous, and more frequent bodily symptoms than men. This difference appears in samples of medical patients and in community samples, whether or not gynecologic and reproductive symptoms are excluded, and whether all bodily symptoms or only those which are medically unexplained are examined. More limited, but suggestive, literature on experimental pain, symptom reporting in childhood, and pain thresholds in animals are compatible with these findings in adults. A number of contributory factors have been implicated, supported by varying degrees of evidence. These include innate differences in somatic and visceral perception; differences in symptom labeling, description, and reporting; the socialization process, which leads to differences in the readiness to acknowledge and disclose discomfort; a sex differential in the incidence of abuse and violence; sex differences in the prevalence of anxiety and depressive disorders; and gender bias in research and in clinical practice. General internists need to keep these factors in mind in obtaining the clinical history, understanding the meaning and significance that symptoms hold for each patient, and providing symptom relief.

Somatic symptom reporting in women and men

Women report more intense, more numerous, and more frequent bodily symptoms than men. This difference appears in samples of medical patients and in community samples, whether or not gynecologic and reproductive symptoms are excluded, and whether all bodily symptoms or only those which are medically unexplained are examined. More limited, but suggestive, literature on experimental pain, symptom reporting in childhood, and pain thresholds in animals are compatible with these findings in adults. A number of contributory factors have been implicated, supported by varying degrees of evidence. These include innate differences in somatic and visceral perception; differences in symptom labeling, description, and reporting; the socialization process, which leads to differences in the readiness to acknowledge and disclose discomfort; a sex differential in the incidence of abuse and violence; sex differences in the prevalence of anxiety and depressive disorders; and gender bias in research and in clinical practice. General internists need to keep these factors in mind in obtaining the clinical history, understanding the meaning and significance that symptoms hold for each patient, and providing symptom relief.

Child abuse and severity of disturbance among adult psychiatric inpatients

OBJECTIVE

The aim of this study was to determine whether childhood abuse is related to severity of psychological disturbance in adulthood, even within an extremely disturbed, predominantly psychotic, population.

METHODOLOGY

The medical records of 100 consecutive admissions to an adult psychiatric inpatient unit were examined. Documentation of physical or sexual abuse as a child was recorded together with several measures of severity of pathology including: suicidality, length of current admission, age at first admission and use of Intensive Care Unit and Mental Health Act.

RESULTS

The study revealed relationships between childhood sexual or physical abuse and suicidality, duration of hospitalization, and age at first admission. Several gender differences in these relationships were found. These included the finding that sexually abused males, but not sexually abused females, were significantly more suicidal than their nonabused counterparts.

CONCLUSIONS

The theoretical and clinical implications of further evidence that child abuse is related to the most severe levels of dysfunction in adulthood, including psychosis, are discussed. The need for routine child abuse inquiry in inpatient settings is reiterated.

The status of alexithymia as a risk factor in medically unexplained physical symptoms

Some decennia ago, the concept of alexithymia was developed from the clinical experience of psychosomaticians who at the time were largely working within a psychoanalytic frame of reference. Alexithymia can briefly be described as a cognitive-affective disturbance characterized by difficulties in differentiating one's feelings and expressing them in words. Clinicians who treat patients with medically unexplained physical symptoms may often recognize alexithymic features in their patients. It is supposed that alexithymia could be a predisposing factor for the development or persistence of medically unexplained physical symptoms. In this review, the concept of alexithymia as well as paradigmatic shifts in psychoanalysis and psychosomatics are discussed to place the concept of alexithymia in its epistemiological context. Furthermore, the empirical literature on the association between alexithymia and medically unexplained physical symptoms is reviewed. The main conclusions are that alexithymia appears to be a theoretically important and clinically appealing concept, but that so far the empirical evidence that alexithymia predisposes to the development or persistence of medically unexplained physical symptoms is imperfect. This is mainly because of the cross-sectional design of most studies and is due to other methodological shortcomings, such as the lack of allowance for depression and anxiety as possible confounding factors. Suggestions for future research are made.