Editorial Medical Symptoms, Health Risk, and History of Childhood Sexual Abuse
first sexual intercourse and greater total number of sexual partners, more adolescent pregnancies, and a greater tendency to avoid regular Papanicolaou smear testing, than did the women with no history of abuse. Research on the lasting sequelae of childhood sexual abuse Etiology.-As indicated by Springs and Friedrich, why indicates that such victimization is associated with a wide victims of childhood sexual abuse would be more likely than variety of later psychologic difficulties, including symptoms others to have medical difficulties during adulthood is not of anxiety and depression, interpersonal problems, substance entirely clear. Some investigators have hypothesized that abuse, dissociation, sexual disturbance, and suicidal be- health risk behaviors arise from the abused victim's attempts havior.P Probably as a result, the incidence of childhood to decrease chronic abuse-related distress, such as anxiety or sexual abuse among mental health outpatients and inpatients depression, through the use of anesthetizing (but ultimately often exceeds 50%.2 Even though such psychologic se- injurious) substances or involvement in distracting or soothquelae are common, childhood sexual trauma also affects ing (but potentially self-destructive) activities." Similarly, subsequent somatic and health-related aspects of human . delay in seeking timely medical care may reflect the known functioning. tendency of many victims of abuse to engage in avoidMedical Se9uelae.-Perhaps the first analysis of the spe- ance behaviors when confronted with potentially stressful cific relationship between somatic distress and childhood events.'! Another speculation is that functional medical sexual abuse was reported by Gross and colleagues' in 1981. symptoms represent the symbolic transformation of psychoThose investigators found that of 25 gynecologic patients logic trauma into physical dysfunction; although the actual with chronic pelvic pain, 9 (36%) had self-reported child- mechanism of this transformation remains unclear. Finally, hood histories of incest. Since that time, other studies have as presented by Springs and Friedrich, the association besubstantiated a relationship between sexual abuse and tween childhood abuse and actual organic symptoms may chronic pelvic pain,' gastrointestinal distress.V premenstrual include the lasting sequelae of abuse-related physical trauma difficulties," somatic complaints such as fatigue, headaches, (for example, scarring or nerve damage), the effects of susmuscle pain, and sleep disturbances.Y" and somatization tained posttraumatic autonomic arousal on the various organ disorder per se.'? systems, and the influence of chronic stress on immunologic In the current issue of the Mayo Clinic Proceedings response. Because of the complexity of both abuse trauma(pages 527 to 532), Springs and Friedrich extend the general togenesis and human psychobiology, considerably more inunderstanding of the various somatic sequelae of childhood vestigation will most likely be necessary before the linkage sexual abuse, and they suggest a relationship between such between childhood sexual abuse and subsequent medical victimization and several behaviors known to endanger sequelae can be fully explicated. physical health. A sample of more than 500 women who had Implications.-Although somewhat limited by the abrecently received care from a rural family practice clinic was sence of actual data from medical records (only subjects' surveyed for self-reported medical symptoms, health risk questionnaire responses were analyzed), the findings refactors, and a history of childhood sexual abuse. The 113 ported by Springs and Friedrich strongly suggest that some women who reported sexual abuse had, among other condi- significant proportion of the somatic (especially gynecotions, more pelvic pain, pelvic inflammatory disease, yeast logic) complaints of female medical outpatients may be at infections, complications of pregnancy, breast disease, blad- least partially attributable to childhood sexual trauma. Furder infections, and obesity, as well as higher scores on a thermore, behaviors known to be risk factors for (at ministandardized measure of somatization, than did the 398 mum) complications of pregnancy, cervical cancer, liver and women who denied childhood sexual abuse. The sexually lung disease, and sexually transmitted disease seem to be abused women also reported more health risk indicators, correlated with a history of sexual abuse. The implications such as early and extensive cigarette smoking, more con- of these relationships for medical care and public health cerns about their consumption of alcohol, younger age at policy are several. For example, knowledge of abuse-related psychologic dynamics underlying a specific medical probAddress reprint requests to Dr.JohnBriere, Department of Psychia- lem may enable the medical practitioner to intervene in ways try and Behavioral Sciences, USCSchool of Medicine, 1934 Hos- that otherwise might not be apparent. Most obviously, psychotherapy might be indicated to decrease the psychologic pital Place, Los Angeles, CA 90033. Mayo Clin Proc 67:603-604, 1992
603
604
EDITORIAL
Mayo elin Proc, June 1992, Vol 67
components of abuse-related somatic disturbance'
first sexual intercourse and greater total number of sexual partners, more adolescent pregnancies, and a greater tendency to avoid regular Papanicolaou smear testing, than did the women with no history of abuse. Research on the lasting sequelae of childhood sexual abuse Etiology.-As indicated by Springs and Friedrich, why indicates that such victimization is associated with a wide victims of childhood sexual abuse would be more likely than variety of later psychologic difficulties, including symptoms others to have medical difficulties during adulthood is not of anxiety and depression, interpersonal problems, substance entirely clear. Some investigators have hypothesized that abuse, dissociation, sexual disturbance, and suicidal be- health risk behaviors arise from the abused victim's attempts havior.P Probably as a result, the incidence of childhood to decrease chronic abuse-related distress, such as anxiety or sexual abuse among mental health outpatients and inpatients depression, through the use of anesthetizing (but ultimately often exceeds 50%.2 Even though such psychologic se- injurious) substances or involvement in distracting or soothquelae are common, childhood sexual trauma also affects ing (but potentially self-destructive) activities." Similarly, subsequent somatic and health-related aspects of human . delay in seeking timely medical care may reflect the known functioning. tendency of many victims of abuse to engage in avoidMedical Se9uelae.-Perhaps the first analysis of the spe- ance behaviors when confronted with potentially stressful cific relationship between somatic distress and childhood events.'! Another speculation is that functional medical sexual abuse was reported by Gross and colleagues' in 1981. symptoms represent the symbolic transformation of psychoThose investigators found that of 25 gynecologic patients logic trauma into physical dysfunction; although the actual with chronic pelvic pain, 9 (36%) had self-reported child- mechanism of this transformation remains unclear. Finally, hood histories of incest. Since that time, other studies have as presented by Springs and Friedrich, the association besubstantiated a relationship between sexual abuse and tween childhood abuse and actual organic symptoms may chronic pelvic pain,' gastrointestinal distress.V premenstrual include the lasting sequelae of abuse-related physical trauma difficulties," somatic complaints such as fatigue, headaches, (for example, scarring or nerve damage), the effects of susmuscle pain, and sleep disturbances.Y" and somatization tained posttraumatic autonomic arousal on the various organ disorder per se.'? systems, and the influence of chronic stress on immunologic In the current issue of the Mayo Clinic Proceedings response. Because of the complexity of both abuse trauma(pages 527 to 532), Springs and Friedrich extend the general togenesis and human psychobiology, considerably more inunderstanding of the various somatic sequelae of childhood vestigation will most likely be necessary before the linkage sexual abuse, and they suggest a relationship between such between childhood sexual abuse and subsequent medical victimization and several behaviors known to endanger sequelae can be fully explicated. physical health. A sample of more than 500 women who had Implications.-Although somewhat limited by the abrecently received care from a rural family practice clinic was sence of actual data from medical records (only subjects' surveyed for self-reported medical symptoms, health risk questionnaire responses were analyzed), the findings refactors, and a history of childhood sexual abuse. The 113 ported by Springs and Friedrich strongly suggest that some women who reported sexual abuse had, among other condi- significant proportion of the somatic (especially gynecotions, more pelvic pain, pelvic inflammatory disease, yeast logic) complaints of female medical outpatients may be at infections, complications of pregnancy, breast disease, blad- least partially attributable to childhood sexual trauma. Furder infections, and obesity, as well as higher scores on a thermore, behaviors known to be risk factors for (at ministandardized measure of somatization, than did the 398 mum) complications of pregnancy, cervical cancer, liver and women who denied childhood sexual abuse. The sexually lung disease, and sexually transmitted disease seem to be abused women also reported more health risk indicators, correlated with a history of sexual abuse. The implications such as early and extensive cigarette smoking, more con- of these relationships for medical care and public health cerns about their consumption of alcohol, younger age at policy are several. For example, knowledge of abuse-related psychologic dynamics underlying a specific medical probAddress reprint requests to Dr.JohnBriere, Department of Psychia- lem may enable the medical practitioner to intervene in ways try and Behavioral Sciences, USCSchool of Medicine, 1934 Hos- that otherwise might not be apparent. Most obviously, psychotherapy might be indicated to decrease the psychologic pital Place, Los Angeles, CA 90033. Mayo Clin Proc 67:603-604, 1992
603
604
EDITORIAL
Mayo elin Proc, June 1992, Vol 67
components of abuse-related somatic disturbance'
