By Chris Emery, Contributing Writer, MedPage Today
Published: August 19, 2009
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.
Sexual abuse is associated with an increased risk of somatic disorders, in which patients report physical symptoms or complaints with no clear underlying cause, a review of nearly two dozen studies concluded.
Patients with a history of sexual abuse, as children or adults, were more likely to experience gastrointestinal disorders (OR 2.43; 95% CI 1.36 to 4.31), nonspecific chronic pain (OR 2.20; 95% CI 1.54 to 3.15), psychogenic seizures (OR 2.96; 95% CI 1.12 to 4.69) and chronic pelvic pain (OR 2.73; 95% CI 1.73 to 4.30), according the report in the August 5 Journal of the American Medical Association.
"Building greater awareness of the association between sexual abuse and somatic disorders may lead to improved health care delivery and outcomes for sexual abuse survivors," Ali Zirakzadeh, MD, of the Mayo Clinic, and colleagues wrote. "As a group, survivors of abuse have higher medical care use and incur greater costs compared with the general patient population."
Surveys have determined that the incidence of sexual violence in the United States is 2.5% for women and 0.9% for men, according to the review, and researchers have estimated that one in 15 adults has experience forced sexual intercourse. Studies have also estimated that 16% of men and 25% of women in the United States are survivors of childhood sexual abuse.
"To date, research on the long-term effects of sexual abuse has primarily focused on mental health outcomes," wrote Zirakzadeh and his coauthors. "Strong evidence supports a link between childhood sexual abuse and multiple psychiatric sequelae. However, studies investigating the association between sexual abuse and somatic outcomes have been less definitive."
The authors conducted a systematic literature search of electronic databases from January 1980 to December 2008, identifying 23 longitudinal studies that reported somatic outcomes in 4,640 people with and without history of sexual abuse.
The researchers categorized sexual abuse into two major groups. "Rape" was defined as penetration with a body part or foreign object, while "All forms of sexual abuse" captured the wide variety of definitions used to characterize sexual violence.
While analysis from the data in the studies indicated a relationship between sexual abuse and some somatic disorders, the researchers found no significant association between sexual abuse and a lifetime diagnosis of fibromyalgia, obesity or headache.
However, when they restricted the analysis to rape victims, they found a higher risk of fibromyalgia diagnosis (OR 3.35; 95% CI, 1.51 to 7.46). Like those classified under "all forms of sexual abuse," rape victims were also more prone to chronic pelvic pain (OR 3.27; 95% CI 1.02 to 1.53) and functional gastrointestinal disorders (OR 4.01; 95% CI 1.88 to 8.57).
The principal limitation of the study, according to the authors, was the inclusion of data susceptible to bias. Only two of 23 studies met at least 8 of the 10 maximum points of the Newcastle-Ottawa criteria for study quality. They also noted that their findings may not apply to men, since sixteen of the 23 studies in the review included only female subjects.
However, they also noted that the review used an exhaustive and reproducible search strategy and attempted to avoid bias by careful selection and extraction of data.
They also pointed out that sexual abuse remains prevalent and that doctors commonly encounter survivors in general medical practice.
They speculated that sexual abuse may be an early inciting environmental factor in a multistep process that culminates in physical dysfunction, and that the neuroendocrine system may mediate the connection between sexual abuse and the development of somatic dysfunction.
"Increasingly, it has been shown that survivors of sexual abuse face a spectrum of often challenging health concerns, resulting in greater health care use and cost and significant morbidity," they wrote. "Recognition of this association may have important clinical implications for patients coping with these disorders and their clinicians."
The authors reported no financial conflicts of interest.
No funding source for the study was reported.
Primary source: Journal of the American Medical Association
Zirakzadeh A, et al. "Sexual Abuse and Lifetime Diagnosis of Somatic Disorders" JAMA 2009; 5: 550-61.
The application of this information to pregnancy and birth for women who have been abused in childhood is well known to midwives. This information underscores the importance for women to feel in control and autonomous in their pregnancies and births.
Great to see this information becoming 'mainstream'.