Does a History of Sexual Abuse in Childhood Play a Role in Women's Medical Problems? A Review

Sexual Assault History and Health-Related Outcomes in a National Sample of Women

This study examined correlates of past-year chronic medical conditions and lifetime contact with health care professionals for mental health and substance abuse problems in women with differing histories of sexual victimization ( N = 627) identified from the National Comorbidity Survey (e.g., assault in childhood, adulthood, or both life phases). Posttraumatic stress disorder (PTSD) and stressful life events were associated with greater odds of chronic medical conditions among women sexually assaulted in childhood only. Additional traumatic events were associated with greater odds of chronic medical conditions among victims of adult sexual assault. Older age and being married were associated with greater odds of lifetime health care professional contact for mental health/substance abuse issues among certain victim subgroups. Stressful life events were related to greater help-seeking for child victims, and traumatic events were related to greater help-seeking in adult victims. Alcohol dependence symptoms and PTSD were each associated with greater odds of lifetime health care professional contact among women victimized in both life phases, whereas depression was related to greater odds of help-seeking for women victimized in one life phase only. Psychosocial factors may play unique roles in health outcomes for women with different sexual assault histories.

Sexual Assault History and Women's Reproductive and Sexual Health

Associations of sexual assault history with reproductive and sexual symptoms were evaluated in 3,419 women randomly selected from two communities. Sexual assault was associated with excessive menstrual bleeding, genital burning, and painful intercourse (whether or not attributable to disease or injury), medically explained missing two menstrual periods, and medically unexplained dysmenorrhea, menstrual irregularity, and lack of sexual pleasure. Physically violent assaults and those committed by strangers were most strongly related to reproductive symptoms. Multiple assaults, assaults accomplished by persuasion, spouse assault, and completed intercourse were most strongly related to sexual symptoms. Assault was occasionally associated more strongly with reproductive symptoms among women with lower income or less education, possibly because of economic stress or differences in assault circumstances. Associations with unexplained menstrual irregularity were strongest among African American women; ethnic differences in reported circumstances of assault appeared to account for these differences.

Sexual abuse in bariatric surgery candidates: impact on weight loss after surgery: a systematic review

Bariatric surgery is becoming more and more influential as efficient weight loss therapy for the morbidly obese. As many studies propose a relationship between sexual abuse and obesity in general, but especially with regard to weight regain after successful weight loss, sexual abuse might also have a crucial impact on the outcome of the surgical procedures. This review examines the literature comparing weight loss after bariatric surgery in sexually abused and non-abused individuals. We conducted a systematic electronic literature search covering PubMed/Medline, ScienceDirect, PsychInfo and Web of Science. While 13 studies examined prevalence rates of sexual abuse among bariatric patients, eight studies explicitly investigated the effect of sexual abuse on surgery outcome. We hypothesized that individuals with a history of sexual abuse lose less weight compared to individuals with no such abuse history. At first glance, only three out of eight studies demonstrated significantly reduced weight loss in the sexually abused patients. However, a closer investigation of all studies revealed that patients with abuse experiences may indeed tend to lose less weight initially. Still, this sub-population apparently benefits from the surgical procedure, as revealed by increased weight loss over time. Reasons for these mixed results are discussed, as well as the clinical implications that can be drawn from these studies.

Child sexual abuse: is it a risk factor for pregnancy?

AIM

This paper is a report of a study of the relationship of post-traumatic stress symptoms, depression, and health status to high risk pregnancy status in survivors of childhood sexual abuse.

BACKGROUND

Studies examining the long-term effects of childhood sexual abuse have delineated diverse psychological, cognitive, and social difficulties in adult survivors that often manifest somatically.

METHODS

A random sample of 1835 mid-pregnant Jewish women was recruited in Israel over an 18-month period in 2005-2007. Participants were divided into three sub-groups consisting of the different combinations between pregnancy at risk (yes/no), childhood sexual abuse (yes/no), other than childhood sexual abuse trauma (yes no), and no trauma (yes/no). They completed a self-administered questionnaire consisting of five scales: a demographic variables scale, the Post-traumatic Stress Disorder Symptom Scale, Center for Epidemiologic Studies Depression Scale, Traumatic Events Questionnaire, and Childhood Sexual Experiences Scale.

FINDINGS

Pregnant survivors of childhood sexual abuse suffered higher distress levels which heightened poor health, hence increasing the probability of high risk pregnancy compared to women who had had other than sexual abuse trauma or reported no trauma. Post traumatic stress symptoms and avoidance (a sub-category) were found to explain chronic illnesses, whereas depression was found to explain gynecological problems in pregnant sexually-abused survivors.

CONCLUSION

Healthcare workers need to recognize and address the psychological state of pregnant child sexual abuse survivors. Screening of pregnant women for child sexual abuse is needed to assess survivors' psychological well-being and recognize their unique concerns during pregnancy monitoring.

The health care experiences of adult survivors of child sexual abuse: a systematic review of evidence on sensitive practice

This systematic review analyzes empirically based medical literature relevant to the experiences of adult survivors of sexual abuse in the health care setting and what is known about providing sensitive care to this population. Effects of this trauma may impact the adult survivor's experience of care, health behaviors, and outcomes. The 10 articles reviewed in this study provide patient-based information on the experience of child sexual abuse and its impact on health and health care for patients. Suggestions are made for health care providers in two main areas: facilitation of communication and disclosure issues, and improving the experience of the health care encounter for survivors. Specific strategies are offered to assist in providing nonthreatening care encounters for adults who have been affected by childhood sexual trauma. Implications for research, practice, and policy for patients, health care providers, and social workers in the health care setting are discussed.

Childhood maltreatment and mental and physical health in Haitian adults

PURPOSE

To describe the prevalence of childhood maltreatment among Haitian adults and to examine its relationship to depression, general physical health, and quality of life.

DESIGN

Descriptive exploratory. Participants were men and women 18 years of age or older who were seated in the waiting area of a hospital-based medical clinic in a medium-sized city in Haiti. The author collected these data while on a Fulbright fellowship to Haiti in 2003.

METHODS

Two hundred fifty-eight participants completed the Childhood Trauma Questionnaire, Cohen-Hoberman Inventory of Physical Symptoms, Center for Epidemiologic Study-Depression Scale, and a visual analogue quality of life scale. Data were analyzed using descriptive statistics, Pearson's correlation, multiple regression, and Student's t test.

FINDINGS

Over half (60%) of the women and 85.7% of the men reported at least one type of childhood maltreatment at the moderate to severe level. Of the total sample, 53.9% had scores indicative of major depression and 43.9% reported an average score of "somewhat bothered" by 37 physical symptoms. Childhood maltreatment (each of five types) was related to physical symptoms and depression.

CONCLUSIONS

Rates of childhood maltreatment were high in this sample of Haitian adults, and their childhood maltreatment was related to physical and mental health symptoms in adulthood.

Childhood abuse and neglect histories in low-income women: prevalence in a menopausal population

OBJECTIVES

To examine the prevalence of self-reported childhood abuse and neglect in a primary care population of menopausal women.

DESIGN

A cross-sectional questionnaire-based study.

RESULTS

Three of four women (119/160, 74%) reported histories of childhood abuse and neglect. The prevalence of emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect were 43%, 35%, 33%, 49%, and 44%, respectively. Eleven percent of the sample reported maltreatment in all five categories of trauma. Fifteen percent of women studied met criteria for severe-extreme levels of maltreatment, usually in more than one category.

CONCLUSIONS

A high prevalence of self-reported childhood trauma was detected in our low-income population of menopausal women attending primary care clinics. Because of the potential impact of childhood trauma on physical and mental health, clinicians need to inquire about childhood maltreatment in women of menopausal age and appropriately refer women to mental health intervention and treatment.

The long-term health outcomes of childhood abuse. An overview and a call to action

While the association between abuse in childhood and adverse adult health outcomes is well established, this link is infrequently acknowledged in the general medical literature. This paper has 2 purposes: (1) to provide a broad overview of the research on the long-term effects of child abuse on mental and physical health including some of the potential pathways, and (2) to call for collaborative action among clinicians, psychosocial and biomedical researchers, social service agencies, criminal justice systems, insurance companies, and public policy makers to take a comprehensive approach to both preventing and dealing with the sequelae of childhood abuse.

Working with suffering

The past century has shown that human beings are capable of genocidal destruction of millions of other humans based on ethnicity or race. Clinicians today are likely to encounter patients who are survivors of inflicted atrocities and abuse. People fleeing horrendous circumstances bring persisting memories that produce symptoms even for the next generation. Families carry the knowledge-personal, cultural, familial, and sometimes individual-of the depths of destruction that human beings can do to one another. Suffering derives from the memory, both physical and mental, of what other persons inflicted; it has multiple dimensions that patients may not express explicitly; instead they may frame their experience of suffering in terms of pain. Diagnostic labels such as post-traumatic stress disorder or somatization are inadequate to convey human comprehension of suffering. Clinicians around the world need to be willing and able to acknowledge and witness the profound sources of experiential pain in the lives of their patients.

Posttraumatic stress disorder in women: assessment and treatment in primary care

The focus of this article is to provide primary care clinicians with a better understanding of women who have undergone sexual trauma and have related post-traumatic stress disorder. Victimization has adverse physical and mental health effects and affects a woman's clinical presentation, her coping skills, and the primary care intervention strategies needed to treat her. The article reviews issues of victimization and related PTSD among women, including the prevalence and sequel of victimization, and provides a theoretical framework for primary care intervention, treatment, and referral.

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.

The relationship between trauma, PTSD, and medical utilization in three high risk medical populations

OBJECTIVE

Increased use of medical and psychiatric services has been reported as a correlate of exposure to trauma. Recent studies suggest that: 1) physical and sexual abuse traumas are particularly associated with increased utilization and 2) posttraumatic stress disorder (PTSD), a common sequela of abuse, mediates the relationship between trauma exposure andelevated utilization. The goal of this study was to explore the relationships between trauma, abuse, PTSD, and medical utilization in three medical help seeking groups reported to be at high risk for trauma exposure.

METHOD

One hundred and seven patients receiving care at a university-affiliated medical center were surveyed for trauma history and PTSD using the Trauma History Questionnaire (THQ) and the PTSD Checklist (PCL). The sample included: forty-eight gynecologic outpatients, thirty-five inpatients with seizure disorders, and twenty-four psychiatric inpatients with non-PTSD admitting diagnoses. Medical utilization data were obtained from a computerized medical center data base.

RESULTS

Ninety-six patients reported a trauma history. Of these patients, sixty-six reported abuse and forty-five qualified for PTSD diagnoses. Total number of traumas and reported sexual and physical abuse correlated significantly with elevated medical utilization and PTSD prevalence. PTSD diagnosis was not significantly correlated with utilization, but the five highest utilizers received PTSD diagnoses.

CONCLUSIONS

Study results supported hypotheses regarding the relation of trauma exposure to medical utilization, but were less clear about the mediating role of PTSD. These findings suggest that routine screening of high-risk patient groups might promote timely identification of trauma history and PTSD, and subsequently impact health care utilization.

Psychosocial aspects of Crohn's disease

In clinical practice, significant discrepancies occur between disease activity and severity, and the patient's symptom experience and behavior. Discrepancies cannot be explained by biologic or morphologic findings, and usually are considered to be related to psychosocial factors. Recent advances in the scientific understanding of the relationship between environmental stress and the neural, endocrine, and immune systems, combined with new methodologies in clinical research, provide a challenging opportunity for clinicians and researchers to establish a more comprehensive understanding of Crohn's disease. This article reviews the important relationship of psychosocial factors, pathogenesis, clinical expression, response to treatment, and outcome of Crohn's disease, and presents a comprehensive model of illness, disease, and ways to integrate psychosocial factors with diagnosis and patient care.

Sexual assault and physical health: findings from a population-based study of older adults

OBJECTIVE

Prior reports have pointed to an adverse effect of sexual assault on subsequent health, particularly depression and obesity, in women. The objective of this study was to determine whether there is an association between self-reported sexual assault history and objective parameters of physical health in a sample of older men and women.

METHODS

We conducted a cross-sectional study of white, middle to upper middle class, older (median age 75 years) men (N = 533) and women (N = 826) within a defined community setting. Sex-specific, age-adjusted risks were calculated for 11 common chronic medical conditions (10 for each sex: coronary heart disease, hypertension, diabetes, osteoporosis, obesity, asthma, migraine, thyroid disease, and arthritis in all subjects; breast cancer in women; and prostate cancer in men) and confirmed by physical or laboratory examination or review of medical records.

RESULTS

Sexual assault was reported by 5.4% of men and 12.7% of women; repeated exposure was reported by 10.3 and 21.9% of sexually assaulted men and women, respectively. In women, a history of sexual assault was associated with an increased risk of 2 of 10 conditions: arthritis (OR = 1.76, 95% CI = 1.13-2.76) and breast cancer (OR = 2.21, 95% CI = 1.12-4.33). A "dose-response" effect was observed: Multiple episodes of sexual assault carried a two- to three-fold increased risk of these diseases compared with a single episode. In men, the only statistically significant association was between sexual assault and thyroid disease (OR = 4.68, 95% CI = 1.08-20.3).

CONCLUSIONS

These data partially replicate findings from other studies of adverse effects of sexual trauma on health, although the specific diseases are different. Causal mechanisms cannot be inferred from these data. Studies in other cohorts are warranted.

Prevalence of sexual abuse history in a sample of women seeking treatment for premenstrual syndrome

This study evaluated the prevalence and correlates of sexual abuse history among women seeking treatment for severe premenstrual syndrome (PMS). Of 77 women participating in a randomized clinical trial of non-pharmacological treatments for severe PMS, 42 were interviewed regarding their sexual abuse history. The interviewed women were a mean of 38 years old, and most were of European ancestry, heterosexual, married, employed and well-educated. At least one attempted or completed sexual abuse event was reported by 95% of the women, with 81% reporting completed penetration against their will and 85% of these sustaining physical threat or harm. Compared to prior studies of sexually abused women in general populations, these women were abused earlier in life, more frequently and by similar types of offenders. Most of the abused women (65%) were estimated to have post-traumatic stress disorder (PTSD). Most abused women (83%) had never disclosed the abuse to a health practitioner. The findings suggest that a history of sexual abuse, particularly in childhood or adolescence, may be extremely common among women seeking treatment for severe PMS, and that substantial undiagnosed PTSD may also be present in this population. Implications for patient screening and treatment are discussed.

Chronic pain and health care utilization in women with a history of childhood sexual abuse

OBJECTIVE

This cross-sectional controlled study investigated the association between chronic pain, health care utilization and a history of childhood sexual abuse.

SUBJECTS

Three groups, constituting 80 women in total, were studied (1) attendees at group therapy for individuals who had experienced childhood sexual abuse (n = 26); (2) Two control groups consisting of nonabused (a) psychiatric outpatients (n = 33); and (b) nurses (n = 21).

SETTING

The setting was a university affiliated community and tertiary care hospital in London. Ontario.

OUTCOME MEASURES

Each subject voluntarily completed questionnaires documenting history of childhood abuse, pain, psychological symptomatology and medical and surgical history.

RESULTS

Sixty-nine percent of the women who had experienced childhood sexual abuse reported a chronic painful condition lasting more than three months, compared to 43% of the combined control groups (p = .026). Women who had experienced childhood sexual abuse reported a greater number of painful body areas (p = .003), more diffuse pain and more diagnoses of fibromyalgia (p = .013). They had more surgeries (p = .037), hospitalizations (p = .0004) and family physician visits (p = .046).

CONCLUSIONS

Women with a history of childhood sexual abuse reported more chronic pain symptoms and utilized more health care resources compared to nonabused control subjects. Identification of such a history in the patient experiencing persisting pain may be the first step toward a successful combination of medical and psychosocial interventions.

The effects of daily stressors on physical health in women with and without a childhood history of sexual abuse

OBJECTIVE

The primary purpose of the present study was to examine the relationship between daily stressors and physical symptoms in college-age women with a childhood history of sexual abuse and women without a history of childhood sexual abuse. It was hypothesized that women with a history of childhood sexual abuse would be particularly susceptible to the effects of daily stressors on physical symptoms, and would show more covariation between daily stressors and physical symptoms, compared to women without a history of childhood sexual abuse.

METHOD

Female college students (n = 491) were screened for histories of childhood (before age 15) and adulthood (after age 15) contact sexual abuse. Of these participants, 18 women with only a history of childhood sexual abuse were assigned to the SA group, and 27 women with no history of childhood or adulthood sexual abuse were assigned to the NA group. These women filled out self-report measures of daily hassles and physical symptoms for 28 consecutive days.

RESULTS

During the 5 days preceding a highly stressful day, women in the SA group reported significantly more physical symptoms than during the 5 days preceding a day of low stress. For the NA group, there were no significant differences in reported physical symptoms between high- and low-stress days.

CONCLUSIONS

The pattern of results for physical symptoms suggests that women with a history of childhood sexual abuse may be particularly susceptible to the effects of heightened daily stress, and may display this susceptibility in the report of physical symptoms. Possible explanations for these findings are discussed.

Victimization of women and its impact on assessment and treatment in the psychiatric emergency setting

An understanding of victimization is critical to the practice of emergency psychiatry. Victimization histories are disturbingly common among women presenting to the PES, particularly among frequent service users. The sequelae of victimization are both psychological and physical and often impair health and functioning across numerous domains. PTSD, BPD, and substance-use disorders are often seen among women with victimization histories, which can be particularly challenging for PES providers. Screening for trauma on PES presentation or history should not be overlooked in any person, including severely mentally ill, homeless, disabled, or elderly women. PES clinicians should remember to ask about victimization and pose questions privately in a direct and an open-ended format while conveying empathic validation. Clinical assessment of women with victimization histories in the PES should be guided by the principles of standard emergency psychiatry and be informed by an understanding of trauma. This includes a working knowledge of trauma dynamics, adherence to sound professional boundaries, and care not to retraumatize patients or re-enact perpetrator-victim dynamics. Voyeurism and regression should be avoided, particularly when eliciting trauma history. The PES should be a place for screening and acute intervention, not for conducting intensive trauma therapy. In the PES, the focus should remain on triage and treatment priorities, those of safety and stabilization, and carefully evaluating for substance use and psychosis. The PES ideally provides a "holding environment" that affords a balance of nurturing, limits, consistency, and communication. A basic knowledge of cognitive-behavioral interventions affording "crisis survival strategies," such as DBT, can be particularly useful to PES clinicians. Clinicians also need to monitor issues of countertransference and the potential to be dismissive to these women with complex, comorbid, and chronic problems and diseases. The role for the use of psychotropic medication in PES cohorts with victimization histories should target acute symptoms. Involving regular providers of these decisions is advised to coordinate care and minimize splitting and risks of polypharmacy. Although the SSRIs are effective in symptom management of disorders related to victimization, patients must be reminded of the side-effect profile, particularly sexual dysfunction and withdrawal and discontinuation syndromes.

Childhood sexual abuse, psychological distress, and medical use among women

OBJECTIVE

This study examined the relationships between reported history of childhood sexual abuse (CSA), psychological distress, and medical utilization among women in a health maintenance organization (HMO) setting.

METHODS

Participants were 206 women aged 20 to 63 years who were recruited from an HMO primary care clinic waiting area. Participants were classified, using screening questionnaires and the revised Symptom Checklist 90, as 1) CSA-distressed, 2) distressed only, 3) CSA only, or 4) control participants. Medical utilization rates were generated from the computerized database of the HMO for 1) nonpsychiatric outpatient, 2) psychiatric outpatient, 3) emergency room (ER), and 4) inpatient admissions.

RESULTS

CSA-distressed and distressed only groups both used significantly more nonpsychiatric outpatient visits than CSA only and control participants but were not different from one another. CSA only and control participants did not differ on nonpsychiatric outpatient utilization. CSA-distressed participants used significantly more ER visits and were more likely to visit the ER for pain-related complaints than other participants. Among CSA-distressed participants, those who met criteria for physical abuse had significantly more ER visits than those who did not. There were no differences among the four groups in inpatient utilization rates.

CONCLUSIONS

Psychological distress is associated with higher outpatient medical utilization, independent of CSA history. History of CSA with concomitant psychological distress is associated with significantly higher ER visits, particularly for those with a history of physical abuse. History of CSA without distress is not associated with elevated rates of medical utilization. Screening for psychological distress, CSA, and physical abuse may help to identify distinct subgroups with unique utilization patterns.

Sexual assault history and headache: five general population studies

Headache is a common and disabling symptom. Although it is known that sexual assault is associated with a wide range of physical symptoms, little research has addressed its association with headache. The present study evaluated this association in five independent samples of randomly selected household residents (pooled N = 7502). The weighted mean odds ratio (OR) linking sexual assault and headache, controlling age and education, was 1.70 (95% confidence interval [CI] = 1.40, 2.07). Odds ratios were homogeneous across studies, and were similar regardless of participants' gender or ethnicity. Persons sexually assaulted in childhood consistently had greater odds of headache than those first assaulted in adulthood (OR = 1.89, 95% CI = 1.19, 2.99). These results indicate that sexual assault, particularly in childhood, is associated with headache.

How multiple types of stressors impact on health

OBJECTIVE

Although many studies have focused on the relationship between stress and health, few have examined the impact of multiple types of stressors. The current study investigated the health impact of four stressors: sexual and physical abuse history, lifetime losses and traumas, turmoil in childhood family, and recent stressful life events.

METHOD

The sample included 239 female patients from a referral-based gastroenterology clinic.

RESULTS

We found that the four stressors (abuse history, lifetime traumas, turmoil in childhood family, and recent stressful life events) were related to poor health status (eg, more pain, symptoms, bed disability days, physician visits, functional disability, and psychological distress); together, these stressors accounted for 32% of the variance in overall current health. Furthermore, women who scored high on one type of stressor also tended to have experienced other types. Unlike many previous studies, we did not find that social support buffered the effects of stress.

CONCLUSIONS

This study provides evidence that many different types of stressors independently contribute to poor health outcome. Such findings suggest that health practitioners and researchers should question patients about histories of traumatic events, in addition to the examination of the biological aspects of illness, inasmuch as both may have notable effects on health status.

Impact of sexual and physical abuse dimensions on health status: development of an abuse severity measure

OBJECTIVE

Despite the abundant literature showing a relationship of sexual and/or physical abuse history with poor health status, few studies provide evidence about which dimensions of abuse may have a worse impact on health. In female patients with gastrointestinal (GI) disorders, the present study aims to identify which dimensions of abuse history (eg, number of perpetrators, injury) might predict poor current health status, in order to develop an empirically based severity of abuse measure.

METHODS

Of a sample of 239 female patients from a referral gastroenterology clinic, this paper primarily focuses on 121 women with a past history of contact sexual abuse (N = 99), and/or life threatening physical abuse (N = 68).

RESULTS

Among those with a sexual abuse history, 24% of current health status was explained by serious injury during abuse (p = .0006), victimization by multiple perpetrators (p = .03), and being raped (p = .09). Among the physically abused, rape (in addition to life threat) (p = .0001), and multiple life-threatening incidents (p = .002) explained 39% of the variance in overall health. Among the women with a sexual and/or physical abuse history, the experience of rape, serious injury during sexual abuse, and multiple life-threatening incidents explained one fourth of the variance in current health status. Based on these three dimensions of abuse, we created an abuse severity measure which explained about one fourth of the variance in health status among the subgroup with abuse history, and among the entire clinic sample.

CONCLUSIONS

Given the high prevalence of abuse in referral practice, and the potential health impact of previous abuse, it is important that history taking include details concerning the abuse experience. The severity of abuse measure developed in this paper should prove useful for both research and clinical practice.

Traumatic events and physical health in a community sample

The relationship of traumatic events to physical health was examined in a randomized community survey (N = 2,364) of Los Angeles residents, 16% of whom had experienced a lifetime traumatic event. This study tested hypotheses that individuals experiencing traumatic events have poorer physical health and that the negative impact of traumatic events on physical health is greater among disadvantaged sociodemographic groups. Regression analyses showed that respondents with a traumatic event history indicated poorer perceptions of their physical health, more chronic limitations in physical functioning, and more chronic medical conditions compared with respondents without such a history, while controlling for demographics, psychiatric history, and other stressful life events. The association of traumatic events with poorer physical health among vulnerable sociodemographic groups was partially supported.

Sexual and physical abuse history in gastroenterology practice: how types of abuse impact health status

OBJECTIVE

There is an increasing amount of literature pointing to a relationship between sexual and/or physical abuse history and poor health status, although few studies provide evidence concerning which aspects of abuse may impact on health. In female patients with gastrointestinal (GI) disorders, the present study examined the effects on health status of: 1) history of sexual abuse and physical abuse, 2) invasiveness or seriousness of sexual abuse and physical abuse, and 3) age at first sexual and physical abuse.

METHOD

The sample included 239 female patients from a referral gastroenterology clinic who were interviewed to assess sexual and physical abuse history.

RESULTS

We found the following: 1) 66.5% of patients experienced some type of sexual and/or physical abuse; 2) women with sexual abuse history had more pain, non-GI somatic symptoms, bed disability days, lifetime surgeries, psychological distress, and functional disability compared to those without sexual abuse; 3) women with physical abuse also had worse health outcome on most health status indicators; 4) rape (intercourse) and life-threatening physical abuse seem to have worse health effects than less serious physical violence, and sexual abuse involving attempts and touch; and 5) those with first abuse in childhood did not appear to differ on health from those whose first abuse was as adults.

CONCLUSIONS

The authors conclude that asking about abuse should be integrated into history taking within referral-based gastroenterology practices.

Sexual and physical abuse and gastrointestinal illness

BACKGROUND

Clinicians are becoming aware of the increased attention paid to the occurrence of sexual and physical abuse in our society and its consequences. However, only recently has attention been paid to their association with medical and particularly gastrointestinal illnesses.

METHODS AND RESULTS

Recently, we investigated the frequency of sexual or physical abuse among female patients in our gastroenterology clinic, and their association with health status. Of 206 women, 89 (44%) reported some type of sexual or physical abuse in their lifetime. We also found that patients diagnosed with functional GI disorders when compared with those with organic diagnoses reported a significantly greater frequency of sexual (53% versus 37%) and physical abuse (13% versus 2%). Of these, 59% had never discussed the abuse experience outside their families, a third had never told anyone, and only 17% of their GI physicians were aware of this history. We also found that abuse history led to a poorer health outcome: more severe GI pain and a higher frequency of pelvic pain (16% versus 6%), more non-GI symptoms (7.1 versus 5.8), more physician visits in the previous six months (4.2 versus 3.3) and more lifetime operations (2.8 versus 2.0).

CONCLUSIONS

In a GI referral practice, abuse history is a hidden factor that is associated with poorer adjustment to illness, greater symptom severity and higher health care use rates. Since the publication of these data, several groups have supported our findings and obtained additional new data on associating factors and possible mechanisms of symptom generation. This paper will: (i) review this epidemiologic data, (ii) propose hypotheses about their association, (iii) offer suggestions to identify this information in a sensitive and supportive manner, and (iv) discuss how to initiate referral for ancillary psychosocial care.

The reliability and validity of a sexual and physical abuse history questionnaire in female patients with gastrointestinal disorders

Although the literature on the psychological and medical sequelae of sexual and physical abuse has been growing, researchers have made few attempts to standardize the measurement of abuse history. The authors of this article report the first standardization of a screening instrument to identify sexual and physical abuse in a medical population. Reliability was assessed using test-retest methodology, and validity was supported by comparison with an interview (criterion validity). The sample included 139 female patients in a gastroenterology clinic. Data indicate acceptable test-retest reliability of the sexual abuse instrument (81%) and 81% overall agreement between the questionnaire and the interview on any sexual abuse. In comparison, the authors found 77% agreement in test-retest reliability of the physical abuse questionnaire and 70% agreement between the questionnaire and the interview on physical abuse. From their analyses, they concluded that the sexual abuse questionnaire and, to a lesser extent, the physical abuse instrument have acceptable levels of reliability and validity. As a screening tool, the abuse measures could be used to identify women in clinic settings for further study.