Sexual abuse and lifetime diagnosis of somatic disorders: a systematic review and meta-analysis.
BACKGROUND
Many patients presenting for general medical care have a history of sexual abuse. The literature suggests an association between a history of sexual abuse and somatic sequelae.


OBJECTIVE
To systematically assess the association between sexual abuse and a lifetime diagnosis of somatic disorders. Data Sources and Extraction A systematic literature search of electronic databases from January 1980 to December 2008. Pairs of reviewers extracted descriptive, quality, and outcome data from included studies. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled across studies by using the random-effects model. The I(2) statistic was used to assess heterogeneity.


METHODS
Eligible studies were longitudinal (case-control and cohort) and reported somatic outcomes in persons with and without history of sexual abuse.


RESULTS
The search identified 23 eligible studies describing 4640 subjects. There was a significant association between a history of sexual abuse and lifetime diagnosis of functional gastrointestinal disorders (OR, 2.43; 95% CI, 1.36-4.31; I(2) = 82%; 5 studies), nonspecific chronic pain (OR, 2.20; 95% CI, 1.54-3.15; 1 study), psychogenic seizures (OR, 2.96; 95% CI, 1.12-4.69, I(2) = 0%; 3 studies), and chronic pelvic pain (OR, 2.73; 95% CI, 1.73-4.30, I(2) = 40%; 10 studies). There was no statistically significant association between sexual abuse and a lifetime diagnosis of fibromyalgia (OR, 1.61; 95% CI, 0.85-3.07, I(2) = 0%; 4 studies), obesity (OR, 1.47; 95% CI, 0.88-2.46; I(2) = 71%; 2 studies), or headache (OR, 1.49; 95% CI, 0.96-2.31; 1 study). We found no studies that assessed syncope. When analysis was restricted to studies in which sexual abuse was defined as rape, significant associations were observed between rape and a lifetime diagnosis of fibromyalgia (OR, 3.35; 95% CI, 1.51-7.46), chronic pelvic pain (OR, 3.27; 95% CI, 1.02-10.53), and functional gastrointestinal disorders (OR, 4.01; 95% CI, 1.88-8.57).


CONCLUSIONS
Evidence suggests a history of sexual abuse is associated with lifetime diagnosis of multiple somatic disorders.
Paras
Molly L
ML
Mayo Clinic College of Medicine, Rochester, MN 55906, USA.
Murad
Mohammad Hassan
MH
Chen
Laura P
LP
Goranson
Erin N
EN
Sattler
Amelia L
AL
Colbenson
Kristina M
KM
Elamin
Mohamed B
MB
Seime
Richard J
RJ
Prokop
Larry J
LJ
Zirakzadeh
Ali
A
D006801:Humans; D012742:Sex Offenses / Q000523:psychology* / Q000706:statistics & numerical data; D013001:Somatoform Disorders / Q000453:epidemiology / Q000209:etiology*; D017741:Survivors / Q000523:psychology