title: Childhood sexual abuse and adult psychiatric and substance use disorders in women: an epidemiological and cotwin control analysis.
abstract: BACKGROUND
  Women who report childhood sexual abuse (CSA) are at increased risk for developing psychiatric disorders in adulthood. What is the diagnostic specificity and cause of this association?
  
  
  METHODS
  In a population-based sample of 1411 female adult twins, 3 levels of CSA were assessed by self-report and cotwin report: nongenital, genital, and intercourse. Interviews with twins and parents assessed family background and diagnoses of psychiatric and substance dependence disorders. Odds ratios (ORs) were calculated by logistic regression.
  
  
  RESULTS
  By self-report, 30.4% reported any CSA and 8.4% reported intercourse. Self-reported CSA was positively associated with all disorders, the highest ORs being seen with bulimia and alcohol and other drug dependence. The ORs were modest and often nonsignificant with nongenital CSA and increased with genital CSA and especially intercourse, where most ORs exceeded 3.0. A similar pattern of findings was seen with CSA as reported by the cotwin, although many ORs were smaller. Controlling for family background factors and parental psychopathology produced a small to modest reduction in ORs. In twin pairs discordant for CSA, the exposed twin was at consistently higher risk of illness.
  
  
  CONCLUSIONS
  Women with CSA have a substantially increased risk for developing a wide range of psychopathology. Most of this association is due to more severe forms of CSA and cannot be explained by background familial factors. Although other biases cannot be ruled out, these results are consistent with the hypothesis that CSA is causally related to an increased risk for psychiatric and substance abuse disorders.
authors.affiliation: Department of Psychiatry, Medical College of Virginia/Virginia Commonwealth University, PO Box 980126, Richmond, VA 23298-0126, USA.
authors.forename: K S
authors.initials: KS
authors.lastname: Kendler
authors.forename: C M
authors.initials: CM
authors.lastname: Bulik
authors.forename: J
authors.initials: J
authors.lastname: Silberg
authors.forename: J M
authors.initials: JM
authors.lastname: Hettema
authors.forename: J
authors.initials: J
authors.lastname: Myers
authors.forename: C A
authors.initials: CA
authors.lastname: Prescott
mesh_terms: D000328:Adult; D002648:Child; D002650:Child Abuse, Sexual / Q000523:psychology / Q000706:statistics & numerical data*; D017831:Diagnosis, Dual (Psychiatry); D004200:Diseases in Twins / Q000175:diagnosis / Q000453:epidemiology; D005195:Family Relations; D005260:Female; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000235:genetics; D016017:Odds Ratio; D010290:Parents / Q000523:psychology; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012044:Regression Analysis; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000235:genetics; D011795:Surveys and Questionnaires