Background: There have been many studies documenting adverse psychiatric consequences for people who have experienced childhood and adult sexual and physical abuse. These include posttraumatic stress disorder, anxiety, depression, substance abuse, eating disorders and probably some personality disorders or trait abnormalities. Much less is known about the links between abuse and physical/psychosomatic conditions in adult life. Hints of causal links are evident in the literature discussing headache, lower back pain, pelvic pain and irritable bowel syndrome. These studies are not definitive as they use clinic-based samples. Methods: This study used interview data with a random community sample of New Zealand women, half of whom reported childhood sexual abuse and half who did not. Details about childhood physical abuse and adult abuse were also collected in a two-phase study. Results: Complex relationships were found, as abuses tended to co-occur. Seven of 18 potentially relevant medical conditions emerged as significantly increased in women with one or more types of abuse. These were chronic fatigue, bladder problems, headache including migraine, asthma, diabetes and heart problems. Several of these associations with abuse are previously unreported. Conclusions: In this random community sample, a number of chronic physical conditions were found more often in women who reported different types of sexual and physical abuse, both in childhood and in adult life. The causal relationships cannot be studied in a cross-sectional retrospective design, but immature coping strategies and increased rates of dissociation appeared important only in chronic fatigue and headache, suggesting that these are not part of the causal pathway between abuse experiences and the other later physical health problems. This finding and the low co-occurrence of the identified physical conditions suggest relative specificity rather than a general vulnerability to psychosomatic conditions in women who have suffered abuses. Each condition may require separate further study.

Romans SE, Mullen PE: Childhood sexual abuse: Concerns and consequences. Med J Aust 1997;166:59–60.
Arnold R, Rogers D, Cook D: Medical problems of adults who were sexually abused in childhood. BMJ 1990;300:705–708.
Felitti VJ: Long-term medical consequences of incest, rape, and molestation. South Med J 1991;84:328–331.
Fry R: Adult physical illness and childhood sexual abuse. J Psychosom Res 1993;37:89–103.
Kinzl JF, Traweger C, Biebl W: Family background and sexual abuse associated with somatization. Psychother Psychosom 1995;64:82–87.
Berkowitz CD: Medical consequences of child sexual abuse. Child Abuse Negl 1998;22:541–550, discussion 551–544.
Walker E, Katon W, Harrop-Griffiths J, Holm L, Russo J, Hickok LR: Relationship of chronic pelvic pain to psychiatric diagnoses and childhood sexual abuse. Am J Psychiatry 1988;145:75–80.
Reiter RC, Gambone J: Demographic and historic variables in women with idiopathic chronic pelvic pain. Obstet Gynecol 1990;75:428–432.
Reiter RC, Shakerin LR, Gambone JC, Milburn AK: Correlation between sexual abuse and somatization in women with somatic and nonsomatic chronic pelvic pain. Am J Obstet Gynecol 1991;165:104–109.
Toomey TC, Hernandez JT, Gittelman DF, Hulka JF: Relationship of sexual and physical abuse to pain and psychological assessment variables in chronic pelvic pain patients. Pain 1993;53:105–109.
Bergant AM, Widschwendter M: Chronic pelvic pain (CPP) – Gynaecological and psychosocial factors. Arch Womens Ment Health 1998;1:103–108.
Drossman DA, Leserman J, Nachman G, Zhiming L, Gluck H, Toomey TC, Mitchell CM: Sexual and physical abuse in women with functional or organic gastrointestinal disorders. Ann Intern Med 1990;113:828–833.
Fry RP, Crisp AH, Beard RW: Sociopsychological factors in chronic pelvic pain: A review. J Psychosom Res 1997;42:1–15.
Walling MK, Reiter RC, O’Hara MW, Milburn AK, Lilly G, Vincent SD: Abuse history and chronic pain in women. 1. Prevalences of sexual abuse and physical abuse. Obstet Gynecol 1994;84:193–199.
Walling MK, O’Hara MW, Reiter RC, Milburn AK, Lilly G, Vincent SD: Abuse history and chronic pain in women. 2. A multivariate analysis of abuse and psychological morbidity. Obstet Gynecol 1994;84:200–206.
Talley NJ, Boyce PM, Jones M: Is the association between irritable bowel syndrome and abuse explained by neuroticism? A population based study. Gut 1998;42:47–53.
Plichta S: The effects of woman abuse on health care utilization and health status: A literature review. Womens Health Issues 1992;2:154–163.
Schofferman J, Anderson D, Hines R, Smith G, Keane G: Childhood psychological trauma and chronic refractory low-back pain. Clin J Pain 1993;9:260–265.
Bowman ES, Markand ON: Psychodynamics and psychiatric diagnoses of pseudoseizure subjects. Am J Psychiatry 1996;153:57–63.
Trief PM: Childhood abuse and chronic pain. J Repr J Interpersonal Violence 1996;11:599–608.
Linton SJ: A population-based study of the relationship between sexual abuse and back pain: Establishing a link. Pain 1997;73:47–53.
Goldberg RT: Childhood abuse, depression, and chronic pain. Clin J Pain 1994;10:277–281.
Green CR, Flowe-Valencia H, Rosenblum L, Tait AR: Do physical and sexual abuse differentially affect chronic pain states in women? J Pain Symptom Manage 1999;18:420–426.
Finestone HM, Stenn P, Davies F, Stalker C, Fry R, Koumanis J: Chronic pain and health care utilization in women with a history of childhood sexual abuse. Child Abuse Negl 2000;24:547–556.
Gill JR, Stein HJ: More on sexual abuse and headaches (letter). Headache 1988;28:138.
Shuper A, Zeharia Z, Mimouni M: Migraine headaches induced by sexual abuse (letter). Headache 1994;34:237.
Kendall-Tackett KA, Marshall R: Victimization and diabetes: An exploratory study. Child Abuse Negl 1999;23:593–596.
Rapkin AJ, Kames LD, Darke LL, Stampler FM, Naliboff BD: History of physical and sexual abuse in women with chronic pelvic pain. Obstet Gynecol 1990;76:92–96.
Laws A: Sexual abuse history and women’s medical problems. J Gen Intern Med 1993;8:441–443.
Salmon P, Calderbank S: The relationship of childhood physical and sexual abuse to adult illness behavior. J Psychosom Res 1996;40:329–336.
Farley M, Keaney JC: Physical symptoms, somatization, and dissociation in women survivors of childhood sexual assault presented at the 11th International Conference on Dissociative States, November 4, 1994, Chicago, IL. Women Health 1997;25:33–45.
Stein MB, Yehuda R, Koverola C, Hanna C: Enhanced dexamethasone suppression of plasma cortisol in adult women traumatised by childhood sexual abuse. Biol Psychiatry 1997;42:680–686.
Heim C, Newport DJ, Heit S, Graham YP, Wilcox M, Bonsall R, Miller AH, Nemoroff CB: Pituitary-adrenal and autonomic responses to stress in women after sexual and physical abuse in childhood. JAMA 2000;284:592–597.
Weiss EL, Longhurst JG, Mazure CM: Childhood sexual abuse as a risk factor for depression in women: Psychosocial and neurobiological correlates. Am J Psychiatry 1999;156:816–828.
Romans SE, Martin JL, Morris E, Herbison GP: Psychological defense styles in women who report childhood sexual abuse: A controlled community study. Am J Psychiatry 1999;156:1080–1085.
Anderson J, Martin J, Mullen P, Romans S, Herbison P: The prevalence of childhood sexual experiences in a community sample of women. J Am Acad Child Adolesc Psychiatry 1993;32:911–919.
Mullen PE, Martin JL, Anderson JC, Romans SE, Herbison GP: Child sexual abuse and mental health in adult life. Br J Psychiatry 1993;163:721–732.
Martin J, Morris EM, Romans S: Stability of retrospective reporting of child sexual abuse by adult women. 12th Int Conf Child Abuse Neglect, Auckland, 1998.
Andrews G, Singh M, Bond M: The Defense Style Questionnaire. J Nerv Ment Dis 1993;181:246–256.
Bernstein EM, Putnam FW: Development, reliability and validity of a dissociation scale. J Nerv Ment Dis 1986;174:727–735.
Carlson EB, Putnam FW: An update on the Dissociative Experiences Scale. Dissociation 1993;4:16–27.
Wing JK, Cooper JE, Sartorius N: The Measurement and Classification of Psychiatric Symptoms. London, Cambridge University Press, 1974.
Wing JK, Nixon JM, Mann SA, Leff JP: Reliability of the PSE used in a population study. Psychol Med 1977;7:505–516.
Altman DG: Practical Statistics for Medical Research, ed 1. London, Chapman and Hall/CRC, 1997.
White PD, Thomas JM, Amess J, Crawford DH, Grover SA, Kangro HO, Clare AW: Incidence, risk and prognosis of acute and chronic fatigue syndromes and psychiatric disorders after glandular fever. Br J Psychiatry 1998;173:475–481.
Price RK, North CS, Wessely S, Fraser VJ: Estimating the prevalence of chronic fatigue syndrome and associated symptoms in the community. Public Health Rep 1992;107:514–522.
Wessely S, Chalder T, Hirsch S, Wallace P, Wright D: The prevalence and morbidity of chronic fatigue and chronic fatigue syndrome: A prospective primary care study. Am J Public Health 1997;87:1449–1455.
Wessely S: Old wine in new bottles: Neurasthenia and ‘ME’. Psychol Med 1990;20:35–53.
Sharpe M, Hawton K, Simkin S, Surawy C, Hackmann A, Klimes I, Peto T, Warrell D, Seagroatt V: Cognitive behaviour therapy for the chronic fatigue syndrome: A randomized controlled trial. BMJ 1996;312:22–26.
Deale A, Chalder T, Marks I, Wessely S: Cognitive behavior therapy for chronic fatigue syndrome: A randomized controlled trial. Am J Psychiatry 1997;154:408–414.
Price JR, Couper J: Cognitive behaviour therapy for adults with chronic fatigue syndrome. Cochrane Database Syst Rev 2000, CD001027.
Hudson A, Jones LR, Weber MT: Adult survivors of childhood sexual abuse as patients: Two case studies. J Wound Ostomy Continence Nurs 1999;26:60–66.
Nazareth I, King MB: The urethral syndrome: A controlled evaluation. J Psychosom Res 1993;37:737–743.
Elliott BA, Johnson MM: Domestic violence in a primary care setting: Patterns and prevalence. Arch Fam Med 1995;4:113–119.
Coker AL, Smith PH, Bethea L, King MR, McKeown RE: Physical health consequences of physical and psychological intimate partner violence. Arch Fam Med 2000;9:451–457.
Sixsmith DM, Weissman L, Constant F: Telephone follow-up for case finding of domestic violence in an emergency department. Acad Emerg Med 1997;4:301–304.
Kendall-Tackett KA, Williams LM, Finkelhor F: Impact of sexual abuse on children: A review and synthesis of recent empirical studies. Psychol Bull 1993;113:164–180.
Fava GA, Sonino N: Psychosomatic Medicine. Psychother Psychosom 2000;69:184–197.
Sivik T: Psychosomatic medicine. Psychother Psychosom 2000;69:178–180.
Ryff CD, Singer BH: Biopsychosocial challenges of the new millennium. Psychother Psychosom 2000;69:170–177.
Porcelli P, De Carne M, Fava GA: Assessing somatization in functional gastrointestinal disorders. Psychother Psychosom 2000;69:198–204.
Grandi S, Fabbri S, Tossani E, Mangelli L, Branzi A, Magelli C: Psychological evaluation after cardiac transplantation. Psychother Psychosom 2001;70:176–183.
Fava GA, Mangelli L, Ruini C: Assessment of psychological distress in the setting of medical disease. Psychother Psychosom 2001;70:171–175.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.