Walker E A, Katon W J, Hansom J, Harrop-Griffiths J, Holm L, Jones M L, Hickok L, Jemelka R P
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle 98195.
Psychosom Med. 1992 Nov-Dec;54(6):658-64. doi: 10.1097/00006842-199211000-00005.
Although there is increasing awareness of the short-term psychological and social adaptations to childhood sexual abuse, little is known about the long-term effects of such abuse, particularly its effect on subsequent medical utilization and the experience and reporting of physical symptoms. We re-analyzed data from a previous study of 100 women scheduled for diagnostic laparoscopy (50 for chronic pain, 50 for tubal ligation or infertility evaluation) who received structured, physician-administered psychiatric and sexual abuse interviews. Women were regrouped by severity of childhood sexual abuse, and we compared the groups with respect to lifetime psychiatric diagnoses and medically unexplained symptom patterns. Unadjusted odds ratios showed that risk for lifetime diagnoses of major depression, panic disorder, phobia, somatization disorder and drug abuse, and current diagnoses of major depression and somatoform pain disorder were significantly higher in the severely abused group compared with women with no abuse or less severe abuse. Logistic regression analysis demonstrated that number of somatization symptoms, lifetime panic disorder and drug dependence were predictive of a prior history of severe childhood sexual abuse. Psychiatric disorders and medical symptoms, particularly chronic pelvic pain, are common in women with histories of severe childhood sexual abuse. Clinicians should inquire about childhood sexual and physical abuse experiences in patients with multiple medical and psychiatric symptoms, particularly patients with chronic pelvic pain.
尽管人们越来越意识到儿童期性虐待的短期心理和社会适应问题，但对于此类虐待的长期影响却知之甚少，尤其是其对后续医疗利用以及身体症状的体验和报告的影响。我们重新分析了之前一项研究的数据，该研究涉及100名计划接受诊断性腹腔镜检查的女性（50名因慢性疼痛，50名因输卵管结扎或不孕症评估），她们接受了由医生进行的结构化精神病学和性虐待访谈。根据儿童期性虐待的严重程度对女性进行重新分组，我们比较了各小组在终生精神病诊断和医学上无法解释的症状模式方面的情况。未经调整的优势比显示，与未受虐待或受虐待程度较轻的女性相比，受严重虐待组终生诊断为重度抑郁症、惊恐障碍、恐惧症、躯体化障碍和药物滥用的风险，以及当前诊断为重度抑郁症和躯体形式疼痛障碍的风险显著更高。逻辑回归分析表明，躯体化症状的数量、终生惊恐障碍和药物依赖可预测严重儿童期性虐待的既往史。精神疾病和医学症状，尤其是慢性盆腔疼痛，在有严重儿童期性虐待史的女性中很常见。临床医生应该询问有多种医学和精神症状的患者，特别是有慢性盆腔疼痛的患者的儿童期性虐待和身体虐待经历。
