Physical symptoms, somatization, and dissociation in women survivors of childhood sexual assault

Sexual violence affects adolescents' health and prosocial behaviour beyond other violence exposure

Background: Sexual violence is a public health issue among adolescents globally but remains understudied in Sub-Saharan Africa.Objective: The present study focused on the association of cumulative exposure to different types of sexual violence with mental and physical health problems and prosocial behaviour.Method: We conducted a survey with a regionally representative sample of both in-school and out-of-school adolescents, aged 13-17 years, living in south-western Nigeria. Self-reported exposure to sexual violence, behavioural problems, physical complaints, and prosocial behaviour were assessed.Results: About three quarters of the participants reported the experience of sexual violence (74.6%). Multiple regression models revealed that the more types of sexual violence an individual reported, the more mental and physical health problems, and the fewer prosocial behaviours they reported when controlling for other forms of violence exposure. Latent class analysis revealed three severity classes of sexual violence. Symptoms of mental and physical health indicators were significantly higher as exposure increased by group whereas prosocial behaviours were non-significantly fewer in the opposite direction.Conclusion: This study revealed a consistent and unique relation between sexual violence exposure and negative health outcomes among adolescents. Further research on sexual violence in Sub-Saharan Africa and its associations is needed.

Somatic symptoms following sexual assault in adolescents: a prospective longitudinal study

Adults and young people with somatoform disorders and somatic symptoms retrospectively report high rates of sexual abuse. We aimed to assess somatic symptoms in young people in the aftermath of a sexual assault and to document links with assault characteristics, with psychopathology and with related functional impairment. This was a prospective cohort study of adolescents seen in specialized clinics in London in the first 6 weeks following a sexual assault and at 4-5 months follow-up. We enquired about somatic symptoms (headaches, abdominal pain and sickness) pre and post assault, and we assessed psychiatric disorders and functional impairment at follow-up using validated scales. Information was obtained on 94 females (mean age 15.6, SD 1.3). There was a statistically significant increase in the number of adolescents reporting somatic symptoms at 4-5-month follow-up (65/94, 69%) (p = 0.035), compared with estimated pre-assault rates (52/94, 55%) and a significant increase in somatic symptoms at follow-up among the victims of violent sexual abuse (p < .001). Subjects with somatic symptoms at follow-up had significant higher rates of psychiatric disorders - especially generalised anxiety disorder, panic disorder and major depressive disorders - as well as lower psychosocial functioning (p < 0.01), than those without somatic symptoms.

Women’s Experiences of Nature as a Pathway to Recovery From Sexual Assault

Given the serious challenges faced by female survivors of sexual assault, an understanding of how they heal after such an experience is vital. Yet little is known about how being in nature may be helpful in this regard. The purpose of this qualitative study was to develop an in-depth understanding of how nature helps women heal from sexual assault. A narrative analysis of semi-structured interview data provided by four female sexual assault survivors generated four main themes. These themes point to how nature served as a source of emotion regulation and spiritual connection, as well as how it facilitated greater acceptance and reduced dissociation. Themes also indicated reduced negative thinking and rumination, and increased attention to the here and now. Findings are contextualized within the existing literature on sexual assault, and implications for counselling and psychotherapeutic practice with survivors are provided.

Sexual Violence as a Key Contributor to Poor Mental Health Among Japanese Women Subjected to Intimate Partner Violence

OBJECTIVES

The aim of this study was to examine the impact of sexual intimate partner violence (IPV) on mental health among Japanese women and to explore to what extent sexual IPV is an important contributor to the severity of mental health problems in comparison with physical and psychological IPV.

MATERIALS AND METHODS

A cross-sectional analysis was conducted of the medical records of participants during psychiatric consultation at the Institute of Women's Health, Tokyo Women's Medical University, including 62 women who experienced IPV without sexual violence and 83 women who experienced IPV with sexual violence. Mental health problems were compared, including anxiety, depression, suicidality, post-traumatic stress disorder (PTSD), and dissociative experiences.

RESULTS

The results demonstrated a higher incidence and severity of somatic symptoms, insomnia, social dysfunction, severe depression and suicidality, PTSD, and dissociative experiences among women in the sexual IPV group than in the women who experienced IPV without sexual violence. In analyzing the relative contribution of sexual, physical, and psychological violence to the severity of mental health problems of the survivors, results indicated that sexual violence was an independent predictor of both PTSD and dissociative experiences.

CONCLUSIONS

The present research showed that significant adverse effects on mental health were observed among women who experienced IPV with sexual violence compared with the ones without. These findings provide important implications for considering the specific approaches to meet the needs of those women experiencing sexual IPV and the need for timely and effective interventions, including healthcare, social services, and primary prevention.

Predicting a dissociative disorder from type of childhood maltreatment and abuser-abused relational tie

We investigate the types of childhood maltreatment and abuser-abused relational ties that best predict a dissociative disorder (DD). Psychiatric inpatients (n = 116; mean age = 35; F:M = 1.28:1) completed measures of dissociation and trauma. Abuse type and abuser-abused relational ties were recorded in the Traumatic Experiences Questionnaire. Multidisciplinary team clinical diagnosis or administration of the SCID-D-R to high dissociators confirmed DD diagnoses. Logit models described the relationships between abuser-abused relational tie and the diagnostic grouping of patients, DD present (n = 16) or DD absent (n = 100). Fisher's exact tests measured the relative contribution of specific abuse types. There was a positive relationship between abuse frequency and the presence of DD. DD patients experienced more abuse than patients without DDs. Two combinations of abuse type and relational tie predicted a DD: childhood emotional neglect by biological parents/siblings and later emotional abuse by intimate partners. These findings support the early childhood etiology of DDs and subsequent maladaptive cycles of adult abuse. Enquiries about childhood maltreatment should include a history of emotional neglect by biological parents/siblings. Adult emotional abuse by intimate partners should assist in screening for DDs.

Prostitution in Five Countries: Violence and Post-Traumatic Stress Disorder

We initiated this research in order to address some of the issues that have arisen in discussions about the nature of prostitution. In particular: is prostitution just a job or is it a violation of human rights? From the authors' perspective, prostitution is an act of violence against women; it is an act which is intrinsically traumatizing to the person being prostituted. We interviewed 475 people (including women, men and the transgendered) currently and recently prostituted in five countries (South Africa, Thailand, Turkey, USA, Zambia). In response to questionnaires which inquired about current and lifetime history of physical and sexual violence, what was needed in order to leave prostitution and current symptoms of post-traumatic stress disorder (PTSD) we found that violence marked the lives of these prostituted people. Across countries, 73 percent reported physical assault in prostitution, 62 percent reported having been raped since entering prostitution, 67 percent met criteria for a diagnosis of PTSD. On average, 92 percent stated that they wanted to leave prostitution. We investigated effects of race, and whether the person was prostituted on the street or in a brothel. Despite limitations of sample selection, these findings suggest that the harm of prostitution is not culture-bound. Prostitution is discussed as violence and human rights violation.

Depression and dissociation as predictors of physical health symptoms among female rape survivors with posttraumatic stress disorder

OBJECTIVE

To investigate the relative contributions of depression and dissociation, as well as posttraumatic stress disorder (PTSD), to physical health symptoms and to examine the relationships among somatic symptoms, PTSD, depression, and dissociation in relation to childhood and adult trauma exposure.

METHOD

Cross-sectional data are from 132 female rape survivors with PTSD assessed before engaging in a study of trauma-focused cognitive therapy for PTSD. Measures included the Pennebaker Inventory of Limbic Languidness, Clinician Administered PTSD Scale, Beck Depression Inventory, Trauma Symptom Inventory-Dissociation Subscale, Childhood Sexual Abuse Exposure Questionnaire, and Assessing Environments-III-Physical Punishment Scale.

RESULTS

Hierarchical regression analyses revealed that only dissociative and depression symptoms contributed significantly to physical health symptoms. Similarly, among the subsample of women with either childhood sexual or physical abuse, depression and dissociation were significant predictors of somatic symptoms. However, among women without childhood abuse, only dissociation significantly predicted somatic symptoms.

CONCLUSION

Understanding the psychological and biological mechanisms that link childhood versus adult trauma exposure, PTSD, and comorbid depression or dissociation to physical health symptoms may aid development of individualized treatments for the physical and psychological consequences of trauma. (PsycINFO Database Record

Desire to dissociate: implications for problematic drinking in college students with childhood or adolescent sexual abuse exposure

Alcohol use to replace inadequate dissociative capabilities, or chemical dissociation, has been linked to college students with childhood or adolescent sexual abuse (CASA). Insofar as CASA-exposed persons experience a restricted range of dissociative capabilities, what remains relatively unclear is whether some desire to achieve greater dissociative experiences. Nonclinical levels of dissociative tendencies have positively predicted alcohol-related blackouts in CASA-exposed students, and dissociation mediated the relations between CASA and intoxication frequency. Although alcohol (similar to dissociation) can reduce physiological and psychological responses to stress, alcohol consumption may be prompted by a desire to dissociate rather than inadequate dissociative tendencies alone. To investigate this interpretation of the chemical dissociation phenomenon, researchers examined the mediating potential of dissociative tendencies using the Dissociative Experiences Scale-II (DES-II) as well as the desire to dissociate concept (ie, a modified version of the DES-II) on the relations between CASA exposure and problematic alcohol use in college students (N = 298). Results indicated that dissociation scores did not replicate previous mediation findings whereas desire to dissociate scores fully mediated CASA exposure and problematic alcohol use. Implications of the results are discussed including possible reasons why prior mediation results were not replicated as well as links to experiential avoidance.

Mental health problems and medically unexplained physical symptoms in adult survivors of childhood sexual abuse: an integrative literature review

People sexually abused in childhood are at higher risk than non-abused people of medically unexplained symptoms such as irritable bowel syndrome or chronic pain, with mental ill health and high healthcare use. Friction and frustration, with high, unproductive healthcare costs, can often develop between these patients and health-care professionals such as general practitioners and nursing staff. The aim of this integrative literature review was to seek a sound evidence base from which to develop helpful interventions, improve relationships and identify gaps in knowledge. It found some theories about interconnections among childhood sexual abuse mental health and medically unexplained symptoms, such as 'somatization' or 'secondary gain', were used prejudicially, stigmatizing survivors. Conflicting theories make more difficult the search for effective interventions. Researchers rarely collaborated with sexual abuse specialists. Emphasis on identifying key risk factors, rather than providing support or alleviating distress, and lack of studies where survivors voiced their own experiences, meant very few targeted interventions for this group were proposed. Recommendations to enable effective interventions include making abuse survivors the prime study focus; qualitative research with survivors, to assist doctors and nursing staff with sensitive care; case histories using medical records; prospective studies with sexually abused children; support for the growing field of neurobiological research.

A prospective study of child maltreatment and self-injurious behavior in a community sample

In conjunction with prospective ratings of child maltreatment (i.e., sexual abuse, physical abuse, and physical neglect) and measures of dissociation and somatization, this study examined prospective pathways between child maltreatment and nonsuicidal, direct self-injurious behavior (SIB; e.g., cutting, burning, self-hitting). Ongoing participants in the Minnesota Longitudinal Study of Parents and Children (N = 164; 83 males, 81 females) completed a semistructured interview about SIB when they were 26 years old. SIB emerged as a heterogeneous and prominent phenomenon in this low-income, mixed-gender, community sample. Child sexual abuse predicted recurrent injuring (i.e., three or more events; n = 13), whereas child physical abuse appeared more salient for intermittent injuring (i.e., one to two events; n = 13). Moreover, these relations appeared largely independent of risk factors that have been associated with child maltreatment and/or SIB, including child cognitive ability, socioeconomic status, maternal life stress, familial disruption, and childhood exposure to partner violence. Dissociation and somatization were related to SIB and, to a lesser degree, child maltreatment. However, only dissociation emerged as a significant mediator of the observed relation between child sexual abuse and recurrent SIB. The findings are discussed within a developmental psychopathology framework in which SIB is viewed as a compensatory regulatory strategy in posttraumatic adaptation.

Psychometric evaluation and comparison of three retrospective, multi-item measures of childhood sexual abuse

OBJECTIVE

To evaluate and compare the psychometric qualities of three retrospective, multi-item measures of childhood sexual abuse (CSA): the CSA Frequency Scale, CSA Count Index, and CSA Multiple Characteristics Index.

METHODS

Two samples of women 20-50 years old who experienced CSA were recruited from a family practice clinic (N=132) and the community (N=19). The measures were designed to represent the three most commonly used approaches for multi-item measurement of past CSA, as determined by a review of literature. Items were derived from a self-administered instrument from a larger study. The CSA Frequency Scale was evaluated for test-retest reliability, internal consistency, and criterion-related validity. The CSA Count and CSA Multiple Characteristics Indexes were evaluated for content specification, indicator specification, indicator collinearity, external validity, criterion-related validity, and test-retest reliability. Criterion-related validity variables were (a) physical and psychosocial symptomatology and (b) depression.

RESULTS

Upon evaluation, all three measures met criteria for satisfactory quality, with one exception: external validity for both indexes. When compared across test-retest reliability and criterion-related validity results, none of the measures proved superior. Intraclass correlation coefficients for test-retest reliability ranged from .92 to .94; correlations with the criterion-related validity variables ranged from r=.36 to .41.

CONCLUSIONS

The results support the continued use of established scales similar to the CSA Frequency scale. In addition, the results suggest further development and standardization of indexes similar to the CSA Count and Multiple Characteristics Indexes is warranted.

Consequences of childhood sexual abuse experiences on dental care

OBJECTIVE

Around 20% of female patients seeking dental care may have experienced childhood sexual abuse (CSA). Several similarities between abuse situations and dental treatment lead to dental fear. Since dental fear hampers oral health, the long-term effects of CSA on dental care and the specific factors that lead to increased stress during dental treatment have been investigated in women exposed to CSA.

METHODS

A self-administered questionnaire, which was developed to investigate the objectives of the study, was distributed to 111 women recruited from support centers for women with CSA experiences. CSA was explored with a modified version of the questionnaire developed by Wyatt. Data from 85 women with CSA experiences were used for comparison to the data of 170 matching control women recruited, who were mothers of children attending kindergarten.

RESULTS

Compared to controls, women exposed to CSA exhibited several long-term effects on dental care in terms of major psychological strain during dental treatment (36.5%/18.8%; P<.005), a lower number of prophylactic controls (72.9%/89.4%; P<.005), and preference for a female dentist to a male dentist (29.4%/8.2%; P<.0001). Women with CSA experiences considered four of five defined stressors associated with dental treatment as more intense. Of these women, 28% suffered from memories of their original abuse situations during dental treatment, and 29.4% believed that the dentist should have known about their history of abuse.

CONCLUSION

CSA experiences may increase psychological strain during dental treatment. To improve dental care for women exposed to CSA, dentists should adjust their treatment plans to the specific needs of these patients.

Psychosomatic Pain: New Insights and Management Strategies

At least 40 to 60 percent of women and at least 20 percent of men with chronic pain disorders report a history of being abused during childhood and/or adulthood. This incidence of abuse is two to four times higher than in the general population. Patients with more severe or frequent abuse, usually during childhood and worse if sexual in nature. often develop specific syndromes or combinations of syndromes. These syndromes include posttraumatic stress disorder, fibromyalgia, and other conditions characterized by repression, somatization, and increased utilization of medical care. Psychosomatic symptoms and dysfunctional behaviors may emerge as these patients seek attention and validation of their suffering, while paradoxically repressing painful memories of trauma. Behavioral observations and key features of the physical examination may greatly help the clinician identify both the presence and severity of psychosomatic disease. In addition, it is very interesting that various studies document physiologic changes in the brains of patients with a history of abuse and in patients with a diagnosis of fibromyalgia. These studies suggest that abuse may physiologically and developmentally increase a person's susceptibility to pain and that some organic changes may be associated with psychogenic disease. Diagnosis and treatment of even the most challenging patients with chronic pain is much more effective if it includes (a) careful inquiry about any history of past or present abuse or other severe trauma, (b) empathy and constructive validation of disease and suffering, (c) recognition of dysfunctional pain behaviors and personality traits, (d) documentation of nonanatomic as well as anatomic features on examination, (e) multidisciplinary treatments including psychotherapy whenever indicated, and (f) noninvasive procedures and alternatives to potentially habit-forming medications whenever possible and appropriate. Furthermore, it has been shown that helping patients gain insight about the relationship between abuse and their current symptoms leads to decreased health care utilization. Practical guidelines are provided for identifying psychopathology, communicating effectively, and achieving better treatment outcomes for these unfortunate patients.

Different traumatic experiences are associated with different pathologies

We tested the hypothesis that different traumatic experiences will contribute in variable degree to different mental pathologies. A total of 223 young adult non-patients were assessed with the help of self-reports. The role of six different trauma experiences (broken home, dysfunctional family, family violence, child sexual abuse, child severe sexual abuse and adult sexual abuse) in six different conditions/pathologies (alexithymia, depression, somatization, borderline, overall physical health and overall mental health) was tested in a series of multivariate analyses of variance and of Roy-Bargmann stepdown analyses. The hypothesis was confirmed: Individual traumatic experiences were indeed associated with different pathologies. Specifically, sexual abuse predicted borderline pathology, severe child sexual abuse somatization, and dysfunctional or broken family depression. Family violence was associated with worse overall mental health and alexithymia, whereas no trauma variable could be identified to be associated with overall physical health. Most of these individual relationships were reported in the literature, based on results obtained in different clinical samples. Our results were won in a sample of young non-patients controlling for overlap between pathologies.

Abuse, dissociation, and somatization in irritable bowel syndrome: towards an explanatory model

This study tested a preliminary model of the role of dissociation and somatization in linking abuse to irritable bowel syndrome (IBS). Outpatients with IBS (N = 64) or bowel symptoms explained by physical disease (N = 61) completed questionnaires to assess recollections of abuse as children or adults and current dissociation, somatization, and emotional distress. By comparison with physically diseased patients, patients with IBS recalled more sexual abuse as children and adults, more physical abuse as children, and more psychological abuse as adults. They were more anxious and depressed, and somatized and dissociated more. Analyses indicated a causal chain linking, in turn, abuse, dissociation, somatization, and IBS. The results are consistent with a model in which childhood abuse is linked to IBS because it causes a tendency to dissociate, and because dissociation causes a general increase in physical symptoms. Future research should identify factors that explain why a generally increased level of physical symptoms should, in some patients, lead specifically to IBS.

Childhood trauma and adult somatic preoccupation by body area among women in an internal medicine setting: a pilot study

OBJECTIVE

This study was designed to explore the relationship between three types of abuse in childhood and their relationship to somatic preoccupation, in general and by body area, in adulthood.

METHOD

Eighty-five women in an internal medicine clinic completed self-report measures of childhood sexual, physical, and emotional abuse as well as the Bradford Somatic Inventory.

RESULTS

Using simple correlations, all three types of abuse were positively related to current somatic preoccupation. Using multiple regression analysis that included demographic variables (education and age) and the three forms of childhood abuse, only the demographic variables and sexual abuse were uniquely predictive of somatic preoccupation. To determine the relationship between childhood abuse and somatic symptoms based on body area (head, chest, stomach, throat) and fatigue, a series of multiple regression analyses were performed. The chest and throat areas were significant, but no abuse variable was uniquely predictive.

CONCLUSIONS

Among females in adulthood, all studied forms of abuse in childhood appear to contribute to general somatic preoccupation, as well as specific somatic symptoms in the chest and throat areas. Sexual abuse, specifically, is a unique predictor for general somatic preoccupation, but not necessarily specific body areas.

Systematic review of the comorbidity of irritable bowel syndrome with other disorders: what are the causes and implications?

BACKGROUND & AIMS

Comorbid or extraintestinal symptoms occur frequently with irritable bowel syndrome and account for up to three fourths of excess health care visits. This challenges the assumption that irritable bowel is a distinct disorder. The aims of this study were to (1) assess comorbidity in 3 areas: gastrointestinal disorders, psychiatric disorders, and nongastrointestinal somatic disorders; and (2) evaluate explanatory hypotheses.

METHODS

The scientific literature since 1966 in all languages cited in Medline was systematically reviewed.

RESULTS

Comorbidity with other functional gastrointestinal disorders is high and may be caused by shared pathophysiological mechanisms such as visceral hypersensitivity. Psychiatric disorders, especially major depression, anxiety, and somatoform disorders, occur in up to 94%. The nongastrointestinal nonpsychiatric disorders with the best-documented association are fibromyalgia (median of 49% have IBS), chronic fatigue syndrome (51%), temporomandibular joint disorder (64%), and chronic pelvic pain (50%).

CONCLUSIONS

Multivariate statistical analyses suggest that these are distinct disorders and not manifestations of a common somatization disorder, but their strong comorbidity suggests a common feature important to their expression, which is most likely psychological. Some models explain the comorbidity of irritable bowel with other disorders by suggesting that each disorder is the manifestation of varying combinations of interacting physiological and psychological factors. An alternative hypothesis is that the irritable bowel diagnosis is applied to a heterogeneous group of patients, some of whom have a predominantly psychological etiology, whereas others have a predominantly biological etiology, and that the presence of multiple comorbid disorders is a marker for psychological influences on etiology.

Physical symptoms, posttraumatic stress disorder, and healthcare utilization of women with and without childhood physical and sexual abuse

For four groups of women: no abuse, physical abuse alone, combined sexual and physical abuse, and unclear about memories of abuse, we examined the associations between childhood sexual and physical abuse, chronic physical symptoms in adulthood, PTSD, and health care utilization. Of a randomly selected sample of 600 adult femalc members of a health maintenance organization, 86 (14%) chose to participate. Women with a history of physical and sexual abuse in childhood reported significantly more cardiovascular, immune, musculoskeletal, neurologic, and reproductive symptoms than those without this history. While the Sexual/Physical Abuse group had the most chronic physical symptoms, medical visits, emergency room visits, prescriptions, and severe PTSD, the Unclear Memory group consistently ranked second on these same measures--higher than either Controls or the Physical Abuse group. Findings underscore the importance of screening for trauma history among patients seen in medical clinics, and the importance for psychotherapists of attending to patients' physical as well as psychological symptoms of childhood trauma.

Perceptions of parents' health status and relationship to somatic preoccupation

OBJECTIVES

This study was designed to examine the potential relationship of family factors to somatic preoccupation.

METHOD

A total of 116 internal medicine patients completed research booklets exploring perceptions of parents' health, childhood trauma, borderline personality symptomatology [Personality Diagnostic Questionnaire-Revised (PDQ-R)], and somatic preoccupation (Bradford Somatic Inventory).

RESULTS

Simple correlations revealed that most of the relationships between somatic preoccupation and remaining study variables were statistically significant (e.g., poor parental health status correlated to somatic preoccupation). Using path analysis, poor perception of mother's health demonstrated an indirect effect on somatic preoccupation via borderline personality symptomatology, whereas, poor perception of father's health demonstrated an indirect effect on somatic preoccupation via childhood trauma. Neither parents' health status demonstrated direct effects on somatic preoccupation.

CONCLUSIONS

There appear to be parent gender differences in the mediation of the relationship between poor parental health status and somatic preoccupation in the offspring. The implications of these findings are discussed.

Arriving at readiness to recover emotionally after sexual assault

The purpose of this grounded theory study was to discover behaviors and processes that lead survivors of sexual assault to seek help with emotional recovery. The substantive theory Arriving at Readiness was developed from interviews with 11 women survivors of sexual assault. Eleven categories, each containing several strategies, form the theory. The core variable is arriving at readiness. The findings clarify why survivors often delay obtaining help with emotional recovery. The theory can be used as a tool to make it more likely survivors will be identified and receive help that is responsive to their needs.

Dissociação e transtornos dissociativos: modelos teóricos

A compreensão da experiência dissociativa e das origens dos transtornos dissociativos é difícil devido à complexidade da questão. As contradições da classificação são decorrentes das dificuldades de se construir uma teoria da mente abrangente que unifique neurobiologia e psicodinâmica. Os autores discutem as bases conceituais da dissociação com ênfase na integração entre neurobiologia e fenomenologia. O papel do aprendizado é amplamente discutido, assim como as teorias atuais de neodissociação, trauma e sociocognitivismo para os transtornos dissociativos.

Somatoform dissociation discriminates among diagnostic categories over and above general psychopathology

OBJECTIVE

The primary aim of this study was to investigate the hypothesis that somatoform dissociation would differentiate among specific diagnostic categories after controlling for general psychopathology.

METHOD

The Somatoform Dissociation Questionnaire (SDQ-20), the Dissociative Experiences Scale, and the Symptom Checklist-90-R were completed by patients with DSM-IV diagnoses of dissociative disorders (n = 44), somatoform disorders (n = 47), eating disorders (n = 50), bipolar mood disorder (n = 23), and a group of consecutive psychiatric outpatients with other psychiatric disorders (n = 45), mainly including anxiety disorders, depression, and adjustment disorder.

RESULTS

The SDQ-20 significantly differentiated among diagnostic groups in the hypothesised order of increasing somatoform dissociation, both before and after statistically controlling for general psychopathology. Somatoform dissociation was extreme in dissociative identity disorder, high in dissociative disorder, not otherwise specified, and increased in somatoform disorders, as well as in a subgroup of patients with eating disorders. In contrast with somatoform dissociation, psychological dissociation did not discriminate between bipolar mood disorder and somatoform disorders.

CONCLUSIONS

Somatoform dissociation is a unique construct that discriminates among diagnostic categories. It is highly characteristic of dissociative disorder patients, a core feature in many patients with somatoform disorders, and an important symptom cluster in a subgroup of patients with eating disorders.

Working with childhood sexual abuse survivors during pregnancy, labor, and birth

It is estimated that approximately 27% of women have a history of childhood sexual abuse. Long-term effects of this abuse include physical and psychologic consequences that can affect the pregnant woman during the prenatal, antenatal, and postpartum periods. Careful screening of all pregnant women and specific interventions during examinations and procedures can help survivors of childhood sexual abuse experience childbearing as healing and empowering. Care providers who are survivors of such abuse can better serve their patients by working therapeutically on their own healing.