title: Reported sexual abuse predicts impaired functioning but a good response to psychological treatments in patients with severe irritable bowel syndrome.
abstract: OBJECTIVE
  We assessed the effect of reported sexual abuse on symptom severity and health-related quality of life in patients with severe irritable bowel syndrome (IBS) undergoing psychological treatments.
  
  
  METHODS
  IBS patients entering a treatment trial who reported prior sexual abuse were compared with the remainder in terms of symptom severity and health-related quality of life (SF-36) at trial entry and 15 months later. Analyses used ANCOVA with age, sex, marital status, and treatment group as covariates. We assessed possible mediators using multiple regression analysis.
  
  
  RESULTS
  Of 257 patients with severe IBS, 31 (12.1%) reported a history of rape and 28 (10.9%) reported forced, unwanted touching. People who reported abuse were more impaired than the remainder on the SF-36 scales for pain (adjusted p = .023) and physical function (p = .029); these relationships followed a "dose-response" relationship and were mediated by SCL-90 somatization score. At 15 months follow-up, the associations between reported abuse and SF-36 scores were lost because people with reported abuse, especially rape, improved more than the remainder when treated with psychotherapy or paroxetine (selective serotonin reuptake inhibitor antidepressant); this improvement was mediated by change in SCL-90 somatization score.
  
  
  CONCLUSIONS
  In severe IBS, the association between self-reported sexual abuse and impaired functioning is mediated by a general tendency to report numerous bodily symptoms. A reported history of abuse is associated with a marked improvement following psychological treatment.
authors.affiliation: School of Psychiatry and Behavioural Science, University of Manchester, Manchester, UK. francis.creed@manchester.ac.uk
authors.forename: Francis
authors.initials: F
authors.lastname: Creed
authors.forename: Elspeth
authors.initials: E
authors.lastname: Guthrie
authors.forename: Joy
authors.initials: J
authors.lastname: Ratcliffe
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Fernandes
authors.forename: Christine
authors.initials: C
authors.lastname: Rigby
authors.forename: Barbara
authors.initials: B
authors.lastname: Tomenson
authors.forename: Nicholas
authors.initials: N
authors.lastname: Read
authors.forename: David G
authors.initials: DG
authors.lastname: Thompson
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000503:physiopathology / Q000523:psychology*; D008297:Male; D001523:Mental Disorders / Q000628:therapy; D008875:Middle Aged; D011580:Psychological Techniques; D011788:Quality of Life; D012720:Severity of Illness Index; D012742:Sex Offenses / Q000523:psychology*; D014342:Truth Disclosure