Self-reported medical problems of adult female survivors of childhood sexual abuse
Background. Childhood sexual abuse has been established as an antecedent to specific psychological disorders in adulthood. Only recently have researchers begun to consider the effects of this early trauma on subsequent physical health status. The current study sought to explore the relationship between a history of childhood sexual abuse in female adults and subsequent self-reported medical compliants.
Methods. This consecutive sample study used a questionnaire to distinguish subjects with a sexual abuse history and those without such a history. Subjects were female patients over 18 years of age at a primary care health center.
Results. Twenty-six percent of the 523 subjects who completed the entire questionnaire acknowledged a history of sexual abuse in childhood. This percentage is consistent with estimates for the population at large. The abuse group reported more problems in respiratory, gastrointestinal, musculoskeletal, neurological, and gynecological functions. Statistically significant discriminating variables for those who had been abused were (1) total medical complaints reported, (2) previous mental health treatment, and (3) age of first sexual intercourse. Among the abused group, only 5.1% had ever disclosed information about their sexual abuse experiences to a physician.
Conclusions. At least one in four women are survivors of childhood sexual abuse. These women rarely spontaneously reveal this history to a physician, yet they are more likely than nonabused patients to report multisystemic medical complaints. To avoid misdiagnosis and misuse of medical services, physicians should routinely obtain a thorough sexual history, particularly when the patient has multisystem complaints.
General medical settings represent a primary entrance point into the health care system for persons with mental and psychosocial problems.[1,2] These patients often present complicated clinical pictures that defy accurate medical diagnosis.
Childhood trauma (physical and sexual), occurring during a time of immature psychological and central nervous system development, has been suspected by clinicians as antecedent to the development of a variety of psychophysiological problems in adulthood.[3-5] Prevalency studies[6,7] indicate that the percentage of women in the United States who report having had an experience of sexual abuse before the age of 18 years is between 12% and 38%.
Recent studies have focused primarily on the psychological trauma caused by the abuse.[3,8] A number of these studies have included somatization disorder, or in a less structured manner, a "tendency to somatize," as an outcome variable. These studies have invariably involved distinctly psychiatric samples.[9-12]
Several other studies have investigated the relationship of sexual abuse history to specific medical problems (eg, gynecologic) in nonpsychiatric clinical samples.[13,14] Still others have used specific groups such as college students. These studies all used control groups and documented significantly increased levels of self-reported physical complaints or measurable disease entities or both. A notable recent study documented significantly more health risk behaviors in these women.
The present study focused on the self-reported physical health status and childhood sexual abuse history of women in a primary care setting. The study was designed to further explore the relationship of self-perceived health status and childhood sexual abuse history, and to discuss the implications of this relationship...