Medical and psychiatric symptoms in female gastroenterology clinic patients with histories of sexual victimization.
Several recent retrospective reports have associated prior sexual victimization and long-term medical sequelae such as increased medical clinic utilization and reports of physical symptoms. However, methodological constraints have limited the generalizability of these findings. Our study was designed using structured interviews with a sequential sample of 89 female gastroenterology clinic patients, who were classified by severity of sexual trauma and studied for differences in lifetime psychiatric diagnoses, physical abuse, and medically unexplained symptom patterns. Compared with the 46 women who had experienced less severe or no prior sexual trauma, the 43 patients with severe victimization had significantly higher life-time and current rates of several selected psychiatric disorders as well as significantly higher mean numbers of lifetime psychiatric disorders, medically unexplained physical and anxiety symptoms, greater harm avoidance and dissociation scores, and increased functional disability. A logistic regression showed that the main predictors of a history of severe sexual abuse were the number of medically unexplained symptoms, adult physical abuse, and lifetime dysthymic disorder. We concluded that women with prior severe sexual trauma episodes may express medically unexplained physical symptoms as part of the long-term adaptation to their victimization.
Walker
E A
EA
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle 98195, USA.
Gelfand
A N
AN
Gelfand
M D
MD
Koss
M P
MP
Katon
W J
WJ
D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology; D002648:Child; D002649:Child Abuse / Q000145:classification / Q000523:psychology; D002650:Child Abuse, Sexual / Q000145:classification / Q000523:psychology*; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis / Q000523:psychology*; D008875:Middle Aged; D010348:Patient Care Team; D010552:Personality Assessment; D011602:Psychophysiologic Disorders / Q000175:diagnosis / Q000523:psychology*; D012803:Sick Role; D013001:Somatoform Disorders / Q000175:diagnosis / Q000523:psychology*