Dissociation Edward

in Women

A. Walker, Ron

M.D.,

With J. Katon,

Wayne

P. Jemelka,

Ph.D.,

and Donna

Kathryn

Massoth,

Pain

Neraas,

M.D.,

Ph.D.

chronic pelvic than women

Method: during

a university women’s they had at any time

The subjects were recruited a 1 -month period. Twenty-two experienced

in the study,

pelvic along

pain

with

The 43 women were self-report measures.

nearly

to amplify severe

physical

childhood

every

day

selected

who attended reported that

for a period women

ofat

without

least

6 months

a history

mechanism, to experience

symptoms. sexual

They

abuse.

In the

pain are sigwithout pain.

were

ofchronic

given structured sexual assault interviews and completed Results: The women with chronic pain were significantly

sexual abuse had significantly tion, and dissociation and Conclusions: The and pain symptoms (Am J Psychiatry

from women women who

21 randomly

use dissociation as a coping selves as medically disabled,

clinic in their included

pelvic

pain.

psychological more likely

to

to show current psychological distress, to see themvocational and social decrements in function, and

were

also

total

study

significantly group,

higher scores on measures viewed their physical health

more women

hmonic pelvic pain is a frequently encountered prob1cm in primary cane. Although the exact prevalence is unknown, our recent survey of 650 women attending two ambulatory came clinics found that 38% reported pelvic pain persisting for more than 6 months at some time in their lives and 12% stated it was the chief complaint for the clinic visit (1). Studies comparing women with and without chronic pelvic pain have shown that women with pain are significantly more likely to have histories of recurrent major depression, somatization, sexual and physical abuse, and chronic psychological distress (2-4), factors that have been shown to predispose to greater use of medical care services (3, 5). Childhood sexual and physical abuse have also been shown to lead to subsequent somatization, anxiety, and depression (6, 7), and the intensity of these sequelac appears to be correlated with the dumation and severity of the abuse (3). Patients who have experienced childhood physical

May 1, 1991; revision received Aug. 26, 1991; accepted 1991. From the Department of Psychiatry and Behavioral Sciences, Division of Consultation-Liaison, University of Washington, Seattle. Address reprint requests to Dr. Walker, Department of Psychiatry and Behavioral Sciences, Division of Consultation-Liaison, University of Washington, Seattle, WA 98195. The authors thank Peter Roy-Byrne, M.D., for his assistance in reviewing this manuscript before submission. Copyright © 1 992 American Psychiatric Association.

likely with

to have

experienced

a childhood

ofpsychological and functioning

authors discuss a model for the development in victims of early sexual abuse. 1992; 149:534-537)

C

534

M.D.,

Pelvic

Objective: The authors’ goal was to determine if women with nificantly more likely to use dissociation as a coping mechanism

lives

Received Sept. 30,

Chronic

history

distress, as more

ofsomatization,

of

somatizaimpaired. dissociation,

and sexual abuse have also been found to use dissociation as a coping mechanism more often than patients without a history of this abuse (8, 9). As defined by DSM-III-R, dissociation is a disturbance or alteration in the normally integrative functions of identity, memory, or consciousness. Since chronic pelvic pain and dissociation have both been independently associated with childhood physical and sexual abuse, we hypothesized that women with chronic pelvic pain would have higher scones on measumes of dissociation and would be more likely to use dissociative defenses.

METhOD The subjects were recruited from women attending a university women’s clinic during a 1-month period. All of the women who came to the clinic during this time were given a written invitation to participate in the study by the two medically trained interviewers (K.N. and D.M). The letter stated that we were interested in speaking briefly with women who had at any time in their lives experienced pelvic pain nearly every day for a period of at least 6 months. Twenty-two women met the inclusion criteria for mcdically unexplained chronic pelvic pain persisting for more than 6 months and provided informed consent. These

Am

J

Psychiatry

I 49:4,

April

1992

WALKER,

TABLE

1. Psychological

Self-Report

Test Scores of Women Women

With

Chronic

Pain

With and Without

Chronic

Pelvic Pain

Women

Without

Chronic Pain (N=21)

(N=22) Test General Health Questionnaire Barsky Amplification Scale Dissociative Experiences Scale Medical Outcomes Surveya Health perception Physical function Rote function Social function Mental health aLower

scores

are

associated

with

less

t

df

p

7.4 6.7 14.9

3.9 15.6 4.8

4.7 7.3 3.8

3.89 2.93 4.22

39 39 41