Mental health problems and medically unexplained physical symptoms in adult survivors of childhood sexual abuse: an integrative literature review

People sexually abused in childhood are at higher risk than non-abused people of medically unexplained symptoms such as irritable bowel syndrome or chronic pain, with mental ill health and high healthcare use. Friction and frustration, with high, unproductive healthcare costs, can often develop between these patients and health-care professionals such as general practitioners and nursing staff. The aim of this integrative literature review was to seek a sound evidence base from which to develop helpful interventions, improve relationships and identify gaps in knowledge. It found some theories about interconnections among childhood sexual abuse mental health and medically unexplained symptoms, such as 'somatization' or 'secondary gain', were used prejudicially, stigmatizing survivors. Conflicting theories make more difficult the search for effective interventions. Researchers rarely collaborated with sexual abuse specialists. Emphasis on identifying key risk factors, rather than providing support or alleviating distress, and lack of studies where survivors voiced their own experiences, meant very few targeted interventions for this group were proposed. Recommendations to enable effective interventions include making abuse survivors the prime study focus; qualitative research with survivors, to assist doctors and nursing staff with sensitive care; case histories using medical records; prospective studies with sexually abused children; support for the growing field of neurobiological research.     

Post-traumatic stress disorder in primary care practice

PURPOSE: To provide clinicians in primary care settings with guidelines on evaluation, diagnosis, and management of post-traumatic stress disorder (PTSD). DATA SOURCES: Research-based articles in the medical and psychiatric literature, review articles, and diagnostic criteria. CONCLUSIONS: PTSD is a disorder where psychological and physiological reactions are closely related. Populations at risk include survivors of motor vehicle accidents, natural and man-made disasters, torture, and childhood sexual abuse, as well as combat veterans. IMPLICATIONS FOR PRACTICE: Patients with a history of recent trauma should be targeted for early screening and intervention. Effective treatment of PTSD is a three-stage process consisting of stabilization of symptoms, processing of traumatic perceptions, and integration of trauma into the patient's world- and self-view.     

PSYCHOTHERAPY APPROACHES FOR ADULT SURVIVORS OF CHILDHOOD SEXUAL ABUSE: AN INTEGRATIVE REVIEW OF OUTCOMES RESEARCH

This review synthesized results of 26 outcomes research studies and two meta-analyses that evaluated abuse-focused psychotherapy techniques for survivors of childhood sexual abuse. Different therapeutic approaches delivered in individual, group, or combination formats were evaluated with pre/post test, quasi-experimental, or randomized control designs. Accumulated research findings suggest that abuse-focused psychotherapy for adults sexually abused as children is generally beneficial in reducing psychiatric distress, depression, and trauma-specific symptoms. No one therapeutic approach was demonstrated to be superior. There was little evidence about the effectiveness of individual versus group therapy or the optimal treatment duration.     

Psychotherapy approaches for adult survivors of childhood sexual abuse: an integrative review of outcomes research

This review synthesized results of 26 outcomes research studies and two meta-analyses that evaluated abuse-focused psychotherapy techniques for survivors of childhood sexual abuse. Different therapeutic approaches delivered in individual, group, or combination formats were evaluated with pre/post test, quasi-experimental, or randomized control designs. Accumulated research findings suggest that abuse-focused psychotherapy for adults sexually abused as children is generally beneficial in reducing psychiatric distress, depression, and trauma-specific symptoms. No one therapeutic approach was demonstrated to be superior. There was little evidence about the effectiveness of individual versus group therapy or the optimal treatment duration.     

Relationship of abuse history to functional gastrointestinal disorders and symptoms: some possible mediating mechanisms

The primary goals of this article are to review the evidence that links sexual and physical abuse and intimate partner violence (IPV) with functional gastrointestinal (GI) symptoms and disorders and to explore physiological mechanisms that might mediate these health effects. The literature cited in this review has shown strong and consistent relationships of sexual and physical abuse history and IPV with functional GI symptoms and disorders. Among patients with these disorders, abuse history is associated with worse health-related quality of life, more health care utilization, and more pain. Although research has not determined what mechanisms might account for these associations, alterations in psychophysiological and cortico-limbic pain modulatory systems have been suggested. Given the high prevalence of abuse and long-lasting health consequences, referral for psychiatric and psychological treatment makes sense for many patients with abuse history seen within medical settings.     

Homeopathy in survivors of childhood sexual abuse

The objective of this review was to ascertain the incidence of childhood sexual abuse: to ascertain the long-term effects of childhood sexual abuse and to collate the experiences of homeopaths in caring for survivors. Childhood sexual abuse (CSA) is common with a high percentage of homeopathic patients giving a positive history. It is associated with many common clinical conditions, particularly pelvic pain. Survivors are more likely to present for medical help and to be hospitalised. Homeopaths have found work with such patients to be difficult, with cases being complex and multi-layered. New models for case-analysis have been developed.     

Childhood sexual abuse: help make it 'Safe to Say'

Childhood sexual abuse remains a taboo subject and requires sensitive handling by committed and caring services (Scottish Executive, 2004). By introducing a training programme, Safe to Say, the Scottish Association of Mental Health aims to improve the confidence and competence of healthcare workers when faced with the sensitive disclosure of childhood abuse. This article aims to explore the effects of childhood sexual abuse and the attitudes of health professionals when faced with adult survivors disclosing such abuse. Despite Government strategies, there still appears to be a lack of suitable services for adult survivors of childhood sexual abuse, even though health professionals have an essential role in supporting disclosure and promoting recovery (Read et al, 2005).     

The health care experiences of adult survivors of child sexual abuse: a systematic review of evidence on sensitive practice

This systematic review analyzes empirically based medical literature relevant to the experiences of adult survivors of sexual abuse in the health care setting and what is known about providing sensitive care to this population. Effects of this trauma may impact the adult survivor's experience of care, health behaviors, and outcomes. The 10 articles reviewed in this study provide patient-based information on the experience of child sexual abuse and its impact on health and health care for patients. Suggestions are made for health care providers in two main areas: facilitation of communication and disclosure issues, and improving the experience of the health care encounter for survivors. Specific strategies are offered to assist in providing nonthreatening care encounters for adults who have been affected by childhood sexual trauma. Implications for research, practice, and policy for patients, health care providers, and social workers in the health care setting are discussed.     

The Relationship Between Childhood Abuse,Psychological Symptoms and Subsequent Sex Offending

Background Childhood sexual and physical abuse has been related to subsequent offending behaviour in non‐disabled individuals as well as people with intellectual disabilities, but there is a dearth of research examining the link between these two characteristics and psychological, behavioural and psychiatric symptoms amongst sex offenders with intellectual disabilities. The aim of this study was to examine the relationship between childhood abuse, history of psychological and psychiatric symptoms, and patterns of violence in later offending. Methods Twenty sex offenders with intellectual disabilities were compared with 20 non‐disabled sex offenders. The Kaufman Brief Intelligence Test, the Vineland Adaptive Behavior Scales, and a structured clinical interview were administered to participants. Results Offenders with ID were more likely to report that they had been the victim of physical abuse during childhood; aggressive behaviour during adulthood was related to a history of having been the victim of childhood physical abuse, or exposure to family violence. Participants in the ID group were more likely to be diagnosed with depression, post‐traumatic stress disorder and aggressive behaviour. A history of childhood exposure to violence was related to the development of later symptoms, for both ID and non‐disabled offenders. Perpetrators with ID who had been physically abused during their developmental years were significantly more likely to threaten or use violence during the offence. Conclusions The study suggests that childhood abuse may be related to severity of the crime, and to the development of later psychological and psychiatric symptoms. Longitudinal research in this area and a larger sample size are needed to clarify and extend the present findings.     

Childhood Physical and Sexual Abuse: Their Relationship with Depressive Symptoms in Adulthood

The purposes of this study were to determine the prevalence of childhood physical and sexual abuse among 206 low-income single mothers and to examine the relationship of childhood abuse to current maternal depressive symptoms. Severe physical abuse was reported by 36 percent of the women. The prevalence of sexual abuse was 22 percent; more than one-half of these women were violently abused. High depressive symptoms were reported by 51 percent of the mothers. Both severe physical abuse and sexual abuse in childhood were associated with high depressive symptoms. Women who experienced violent sexual abuse were almost four and one-half times more likely to report high depressive symptoms, compared to the women who were not sexually abused. These findings provide further evidence that childhood abuse may have long-term consequences for women's mental health .     

Experiences of women healing from childhood sexual abuse

Childhood sexual abuse has affected the lives of countless survivors who seek help within the health care system. Despite extensive research and clinical work, many survivors do not receive adequate help. This research aimed to add to the body of clinical knowledge by reporting on the experiences of childhood sexual abuse survivors who have achieved a measure of healing. Findings from a naturalistic study of 14 female survivors of childhood sexual abuse are presented. The character of healing, the relationship of context with healing, what facilitated healing, and what impeded healing are discussed.     

Understanding the need for personal space boundary restoration in women-client survivors of intrafamilial childhood sexual abuse

A large volume of literature exists on childhood sexual abuse (CSA) and nursing literature on this topic continues to develop. However, discussion of boundaries in relation to intrafamilial childhood sexual abuse (ICSA) and to its significance in terms of personal space boundary (PSB) violation, is lacking. This is important, as PSB violation creates difficulties for adult survivors of ICSA and for nurses who care for these people as clients. As all experiences of CSA cannot be addressed, discussion focuses on women who are clients of mental health services and who have experienced ICSA. Using Scott's work on boundaries and her diagrammatic conceptualization of PSBs, links are created between ICSA boundary violation, resultant PSB regulation difficulties and principles to guide nursing practice. Discussion centres on understanding the need for PSB restoration in women-client survivors of ICSA.     

Primary Health Care of Survivors of Childhood Sexual Abuse: How Can Psychiatric Nurses Be Helpful?

Researchers have demonstrated that 15% to 30% of all women were sexually abused as children. Although information on the emotional, behavioral, cognitive, and medical sequelae of this abuse has been available to mental health professionals, problems that abuse survivors experience during routine primary care are less well known. This article discusses the primary care needs of adult survivors of childhood sexual abuse and suggests ways that psychiatric nurses can be helpful in making sure that survivors receive adequate and sensitive primary health care services. (J Am Psychiatr Nurses Assoc [2000]. 6, 191-195.)     

Sexual revictimization: a review of the empirical literature

This article reviews the literature on sexual revictimization, covering approximately 90 empirical studies and includes a discussion of prevalence, risk factors, and correlates of sexual revictimization. Research suggests that two of three individuals who are sexually victimized will be revictimized. The occurrence of childhood sexual abuse and its severity are the best documented and researched predictors of sexual revictimization. Multiple traumas, especially childhood physical abuse, and recency of sexual victimization are also associated with higher risk. There is preliminary evidence that membership in some ethnic groups or coming from a dysfunctional family places an individual at a greater risk. Revictimization is associated with higher distress and certain psychiatric disorders. People who were revictimized show difficulty in interpersonal relationships, coping, self-representations, and affect regulation and exhibit greater self-blame and shame. Existing research on prevention efforts and treatment is discussed. More longitudinal studies on sexual revictimization are needed.     

Sudden Gains During Patient-Directed Expressive Writing Treatment Predicts Depression Reduction in Women with History of Childhood Sexual Abuse: Results from a Randomized Clinical Trial

Sudden gains are large reductions in symptoms measured in a single between-session interval and are positively associated with long-term treatment outcomes. To date, sudden gains have mostly been observed in therapist-directed psychotherapies. There are currently mixed findings surrounding the mechanisms underlying sudden gains, with some support for a cognitive mechanism and some support for therapist characteristics such as the therapeutic alliance. In this study of 77 female survivors of childhood sexual abuse, sudden gains in trauma symptoms were found in a randomized clinical trial of a patient-directed expressive writing intervention. Women in the active treatment condition (who wrote about their beliefs related to sexuality or trauma) exhibiting sudden gains in trauma symptoms showed larger improvements in depression than those in the control condition (who merely wrote about their daily needs). The extension of sudden gains from psychotherapy to a client-directed treatment refines our understanding of the mechanisms underlying these gains, and supports the hypothesis that cognitive change is a likely mechanism underlying sudden gains.     

The relationship of childhood sexual and physical abuse with adulthood disability

ObjectiveThe aim of this study was to examine the association of childhood sexual and physical abuse with disability in adulthood, and to assess how several demographic, physical, behavioral, psychosocial, and psychiatric factors may influence this association.MethodsThis study used nationally representative cross-sectional data from 7403 people aged ≥ 16 years who participated in the 2007 Adult Psychiatric Morbidity Survey. Information on childhood sexual talk, sexual touching, sexual intercourse, and physical abuse occurring before the age of 16, and disability in activities of daily living and instrumental activities of daily living in adulthood were collected. Multivariable logistic regression analyses were conducted.ResultsAfter adjusting for age, sex, and ethnicity, we found a positive association between different types of childhood abuse and adulthood disability: sexual talk (OR 1.54; 95% CI 1.27–1.85); sexual touching (OR 1.82; 95% CI 1.49–2.22); sexual intercourse (OR 2.58; 95% CI 1.75–3.81); physical abuse (OR 2.84; 95% CI 2.20–3.68). Increasing number of types of childhood abuse was associated with increased odds of adulthood disability. The odds of adulthood disability was increased for individuals who experienced all types of childhood abuse versus no childhood abuse (OR 3.59; 95% CI 1.64–7.84). Finally, the association between any childhood abuse and adulthood disability was largely explained by anxiety disorder, number of chronic physical conditions, and loneliness.ConclusionsChildhood abuse is positively associated with adulthood disability in England. Future longitudinal studies are warranted to understand the potentially complex interplay of factors that may increase risk for disability in individuals who experienced childhood abuse.     

Adult ADHD: evaluation and treatment in family medicine

Attention-deficit/hyperactivity disorder (ADHD) affects 30 to 50 percent of adults who had ADHD in childhood. Accurate diagnosis of ADHD in adults is challenging and requires attention to early development and symptoms of inattention, distractibility, impulsivity and emotional lability. Diagnosis is further complicated by the overlap between the symptoms of adult ADHD and the symptoms of other common psychiatric conditions such as depression and substance abuse. While stimulants are a common treatment for adult patients with ADHD, antidepressants may also be effective. Cognitive-behavioral skills training and psychotherapy are useful adjuncts to pharmacotherapy.     

Repressed and silent suffering: consequences of childhood sexual abuse for women’s health and well‐being

Scand J Caring Sci; 2013; 27; 422–432 Repressed and silent suffering: consequences of childhood sexual abuse for women’s health and well‐being Research results indicate that psychological trauma in childhood caused by child sexual abuse can have serious and widespread consequences for health and well‐being. The purpose of this study was to examine the consequences of childhood sexual abuse for women’s health and well‐being. The research methodology was phenomenology. Seven women with a history of childhood sexual abuse were interviewed twice with 1–6 months interval. For all the women, the abuse started when they were between 4 and 5. All of them were repeatedly violated and traumatized ever since then and were even still being victimized at the time of the interviews. The main result of the study is that time does not heal all wounds. All the women described great repressed and silent suffering in all aspects of life, and the abuse is still seriously affecting them and their loved ones. As children, they had learning problems, experienced bullying and had unexplained physical symptoms. In adulthood, they have been suffering multiple physical and psychological symptoms: five of them have fibromyalgia; all of them have been suffering chronic and widespread pain; they have all been dealing with depression and difficulty with close connections, and they all have trouble trusting others. Because they were kids, they have been using the health service to a great extent but without adequate help. It is important for health professionals to know the symptoms and consequences of childhood sexual abuse to be able to respond to adult survivors in a supportive and caring way. More effective therapeutic measures have to be developed to decrease their suffering.     

Dispelling confusion about traumatic dissociative amnesia

How survivors of trauma remember--or forget--their most terrifying experiences lies at the core of one of the most bitter controversies in psychiatry and psychology: the debate regarding repressed memories of childhood sexual abuse. Most experts hold that traumatic events--those experienced as overwhelmingly terrifying and often life-threatening--are remembered very well; however, traumatic dissociative amnesia theorists disagree. Although acknowledging that traumatic events are usually memorable, these theorists nevertheless claim that a sizable minority of survivors are incapable of remembering their trauma. That is, the memory is stored but dissociated (or "repressed") from awareness. However, the evidence that these theorists adduce in support of the concept of traumatic dissociative amnesia is subject to other, more plausible interpretations. The purpose of this review is to dispel confusion regarding the controversial notion of dissociated (or repressed) memory for trauma and to show how people can recall memories of long-forgotten sexual abuse without these memories first having been repressed.