Sexual and physical abuse and gastrointestinal illness. Review and recommendations.
OBJECTIVE
To summarize the existing data on abuse history and gastrointestinal illness, suggest a conceptual scheme to explain these associations, suggest ways to identify patients at risk, and provide information about mental health referral.


METHODS
Review of the pertinent literature by clinicians and investigators at referral centers who are involved in the care of patients with complex gastrointestinal illness and who have experience in the diagnosis and care of patients with abuse history in these settings.


METHODS
All research articles and observational data that addressed abuse history in gastroenterologic settings. Articles were identified through a MEDLINE search.


METHODS
Independent extraction by multiple observers.


RESULTS
On the basis of literature review and consensus, it was determined that abuse history is associated with gastrointestinal illness and psychological disturbance; appears more often among women, patients with functional gastrointestinal disorders, and patients seen in referral settings; is not usually known by the physician; and is associated with poorer adjustment to illness and adverse health outcome. Although the mechanisms for this association are unknown, psychological factors (somatization, response bias, reinforcement of abnormal illness behavior) and physiologic factors (psychophysiologic response, enhanced visceral sensitivity) probably contribute. On the basis of these data, recommendations are made on how to identify patients at risk, how to obtain this information, and, if needed, how to make appropriate referrals.


CONCLUSIONS
The authors agree with existing data on the association between abuse history and gastrointestinal illness. Physicians should ask patients with severe or refractory illness about abuse history. Appropriate referral to a mental health professional may improve the clinical outcome.
Drossman
D A
DA
University of North Carolina, Chapel Hill, USA.
Talley
N J
NJ
Leserman
J
J
Olden
K W
KW
Barreiro
M A
MA
D017579:Domestic Violence / Q000517:prevention & control / Q000523:psychology; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology*; D006801:Humans; D008297:Male; D008487:Medical History Taking; D008603:Mental Health; D012017:Referral and Consultation; D012307:Risk Factors; D012657:Self-Help Groups; D012742:Sex Offenses / Q000517:prevention & control / Q000523:psychology