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CLINICAL CORNER |
From the Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Address correspondence and reprint requests to Jane Leserman, PhD, Professor, Department of Psychiatry, CB 7160, Medical School Wing C, Room 233, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7160. E-mail: JLes{at}med.unc.edu
Objective: Lifetime history of sexual abuse is estimated to range between 15% and 25% in the general female population. People who are sexually abused are at greater risk for a whole host of physical health disorders that may occur many years after the abusive incident(s). Despite the high prevalence of this trauma and its association with poor health status, abuse history often remains hidden within the context of medical care. The aims of this review are to determine which specific health disorders have been associated with sexual abuse in both women and men, to outline the types of sexual abuse associated with the worst health outcome, to discuss some possible explanations and mediators of the abuse/health relationship, to discuss when and how to talk about abuse within a clinical setting, and to present evidence for which psychological treatments have been shown to improve the mental health of patients with past sexual abuse.
Method: To meet these objectives, we have reviewed a wide literature on the topic of sexual abuse.
Results: We demonstrate that abuse appears to be related to greater likelihood of headache and gastrointestinal, gynecologic, and panic-related symptoms; that the poor health effects associated with abuse are also seen in men; that abuse involving penetration and multiple incidents appears to be the most harmful, and that exposure-type therapies with and without cognitive behavioral therapy hold promise for those with abuse history.
Conclusion: We need more research examining psychological treatments that might be efficacious in treating the physical health problems associated with sexual abuse history.
Key Words: sexual abuse • trauma • PTSD • review
Abbreviations: EMDR = eye movement desensitization and reprocessing; HMO = health maintenance organization; HPA = hypothalamic-pituitary-adrenocortical; PTSD = posttraumatic stress disorder.
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