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Sexual and Physical Abuse History in Gastroenterology Practice: How Types of Abuse Impact Health Status

Leserman, Jane PhD; Drossman, Douglas A. MD; Li, Zhiming MD; Toomey, Timothy C. PhD; Nachman, Ginette MD; Glogau, Louise BA

Original Article

Objective: There is an increasing amount of literature pointing to a relationship between sexual and/or physical abuse history and poor health status, although few studies provide evidence concerning which aspects of abuse may impact on health. In female patients with gastrointestinal (GI) disorders, the present study examined the effects on health status of: 1) history of sexual abuse and physical abuse, 2) invasiveness or seriousness of sexual abuse and physical abuse, and 3) age at first sexual and physical abuse. Method: The sample included 239 female patients from a referral gastroenterology clinic who were interviewed to assess sexual and physical abuse history. Results: We found the following: 1) 66.5% of patients experienced some type of sexual and/or physical abuse; 2) women with sexual abuse history had more pain, non-GI somatic symptoms, bed disability days, lifetime surgeries, psychological distress, and functional disability compared to those without sexual abuse; 3) women with physical abuse also had worse health outcome on most health status indicators; 4) rape (intercourse) and life-threatening physical abuse seem to have worse health effects than less serious physical violence, and sexual abuse involving attempts and touch; and 5) those with first abuse in childhood did not appear to differ on health from those whose first abuse was as adults. Conclusions: The authors conclude that asking about abuse should be integrated into history taking within referral-based gastroenterology practices.

From the Department of Psychiatry (J.L., D.A.D., T.C.T.), and Division of Digestive Diseases, Department of Medicine (J.L., D.A.D., Z.L., G.N., L.G.), University of North Carolina School of Medicine, Chapel Hill, North Carolina

Address reprint requests to: Jane Leserman, PhD, Departments of Psychiatry and Medicine, CB #7160, University of North Carolina, Chapel Hill, NC 27599-7160.

Received for publication March 17, 1995; revision received May 16, 1995.

Copyright © 1996 by American Psychosomatic Society
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