Drossman D A
Dept. of Medicine, University of North Carolina at Chapel Hill 27599-7080, USA.
Scand J Gastroenterol Suppl. 1995;208:90-6. doi: 10.3109/00365529509107768.
Clinicians are becoming aware of the increased attention paid to the occurrence of sexual and physical abuse in our society and its consequences. However, only recently has attention been paid to their association with medical and particularly gastrointestinal illnesses.
Recently, we investigated the frequency of sexual or physical abuse among female patients in our gastroenterology clinic, and their association with health status. Of 206 women, 89 (44%) reported some type of sexual or physical abuse in their lifetime. We also found that patients diagnosed with functional GI disorders when compared with those with organic diagnoses reported a significantly greater frequency of sexual (53% versus 37%) and physical abuse (13% versus 2%). Of these, 59% had never discussed the abuse experience outside their families, a third had never told anyone, and only 17% of their GI physicians were aware of this history. We also found that abuse history led to a poorer health outcome: more severe GI pain and a higher frequency of pelvic pain (16% versus 6%), more non-GI symptoms (7.1 versus 5.8), more physician visits in the previous six months (4.2 versus 3.3) and more lifetime operations (2.8 versus 2.0).
In a GI referral practice, abuse history is a hidden factor that is associated with poorer adjustment to illness, greater symptom severity and higher health care use rates. Since the publication of these data, several groups have supported our findings and obtained additional new data on associating factors and possible mechanisms of symptom generation. This paper will: (i) review this epidemiologic data, (ii) propose hypotheses about their association, (iii) offer suggestions to identify this information in a sensitive and supportive manner, and (iv) discuss how to initiate referral for ancillary psychosocial care.
临床医生越来越意识到社会对性虐待和身体虐待事件及其后果的关注度日益提高。然而，直到最近，人们才开始关注它们与医学疾病尤其是胃肠道疾病的关联。
最近，我们调查了消化内科门诊女性患者中性虐待或身体虐待的发生率及其与健康状况的关系。在206名女性中，89名（44%）报告在其一生中曾遭受某种形式的性虐待或身体虐待。我们还发现，与患有器质性疾病的患者相比，被诊断为功能性胃肠疾病的患者报告的性虐待（53%对37%）和身体虐待（13%对2%）发生率显著更高。其中，59%的人从未在家庭之外讨论过虐待经历，三分之一的人从未告诉过任何人，只有17%的胃肠科医生知晓这一病史。我们还发现，虐待史导致了更差的健康结果：更严重的胃肠道疼痛和更高的盆腔疼痛发生率（16%对6%）、更多的非胃肠道症状（7.1对5.8）、在过去六个月中更多的就诊次数（4.2对3.3）以及更多的终生手术次数（2.8对2.0）。
在胃肠病转诊实践中，虐待史是一个隐藏因素，它与较差的疾病适应能力、更严重的症状以及更高的医疗使用率相关。自这些数据发表以来，多个研究团队支持了我们的发现，并获得了关于相关因素和症状产生可能机制的更多新数据。本文将：（i）回顾这些流行病学数据，（ii）提出关于它们之间关联的假设，（iii）提供以敏感且支持性的方式识别此类信息的建议，以及（iv）讨论如何启动辅助心理社会护理的转诊。
