Sexual Abuse Survivors and Psychiatric Hospitalization after Bariatric Surgery

Background Some investigators have postulated that a history of being the victim of childhood sexual abuse may impact outcome of bariatric surgery. Methods In this retrospective chart review, we examined the electronic medical records of 152 adults with morbid obesity who underwent Roux-en-Y gastric bypass and who had a weight recorded in their medical record or reported in a follow-up surgery at 2 years after the RYGBP. The purpose of this retrospective chart review was to examine the relationship between psychosocial factors assessed preoperatively and the percent of excess weight lost (%EWL) at 2 years after bariatric surgery. Results We found a high prevalence of being the victim of childhood sexual abuse (27%), adult sexual trauma (9%), and/or physical abuse (19%) at the initial evaluation. There was no association between these factors and %EWL at 2 years. However, when we examined participants’ medical records for post-operative psychiatric hospitalizations at our medical center, 8 of 11 hospitalized patients reported a history of childhood sexual abuse (73%). Conclusions History of being the victim of childhood sexual abuse is reported frequently by patients seeking bariatric surgery. Our finding that having been the victim of childhood sexual abuse may be associated with increased risk of psychiatric hospitalization after RYGBP has several clinical implications. First, we recommend that clinicians assess carefully for a history of sexual or physical abuse, and secondly, abuse survivors may need to be told that there is an increased risk of psychiatric morbidity after bariatric surgery. Finally, perhaps close monitoring of these patients may prevent psychiatric difficulties after surgery. Further research to verify these preliminary findings is clearly needed.     

Group treatment of adult male inpatients abused as children

Recent research indicates that childhood abuse experiences characterize a large subset of psychiatric inpatients. This paper presents a time-limited pilot group developed for adult male abuse survivors in an inpatient setting using: (1) techniques adapted from the existing literature on treatment of abuse survivors; and (2) approaches deriving from the interface of theory and current manifestations of distress. The eclectic therapeutic approach incorporated psychoeducational, cognitive, behavioral, and art therapy techniques presented below in a session-by-session format.A version of this paper was presented at the Eighth Annual Meeting of the International Society for Traumatic Stress Studies, Los Angeles, CA, October 22, 1991.     

The Effects of Multiple Interpersonal Traumas on Psychological Maladjustment of Sexually Abused Children in Korea

The purpose of the present study was to explore the effects of multiple interpersonal traumas on psychiatric diagnosis and behavior problems of sexually abused children in Korea. With 495 children (ages 4–13 years) referred to a public counseling center for sexual abuse in Korea, we found significant differences in the rate of psychiatric diagnoses (r = .23) and severity of behavioral problems (internalizing d = 0.49, externalizing d = 0.40, total d = 0.52) between children who were victims of sexual abuse only (n = 362) and youth who were victims of interpersonal trauma experiences in addition to sexual abuse (n = 133). The effects of multiple interpersonal trauma experiences on single versus multiple diagnoses remained significant in the logistic regression analysis where demographic variables, family environmental factors, sexual abuse characteristics, and postincident factors were considered together, odds ratio (OR) = 0.44, 95% confidence interval (CI) = [0.25, 0.77], p < .01. Similarly, multiple regression analyses revealed a significant effect of multiple interpersonal trauma experiences on severity of behavioral problems above and beyond all aforementioned variables (internalizing β =.12, p = .019, externalizing β = .11, p = .036, total β = .14, p =.008). The results suggested that children with multiple interpersonal traumas are clearly at a greater risk for negative consequences following sexual abuse.     

Cumulative trauma: The impact of child sexual abuse,adult sexual assault,and spouse abuse

The present study investigated the relationship between trauma symptoms and a history of child sexual abuse, adult sexual assault, and physical abuse by a partner as an adult. While there has been some research examining the correlation between individual victimization experiences and traumatic stress, the cumulative impact of multiple victimization experiences has not been addressed. Subjects were recruited from psychological clinics and community advocacy agencies. Additionally, a nonclinical undergraduate student sample was evaluated. The results of this study indicate not only that victimization and revictimization experiences are frequent, but also that the level of trauma specific symptoms are significantly related to the number of different types of reported victimization experiences. The research and clinical implications of these findings are discussed.     

Recent Victimization in Women and Men with Severe Mental Illness: Prevalence and Correlates

The problem of violence against individuals with severe mental illness (SMI) has received relatively little notice, despite several studies suggesting an exceptionally high prevalence of victimization in this population. This paper describes the results of an investigation of the prevalence and correlates of past year physical and sexual assault among a large sample of women and men with SMI drawn from inpatient and outpatient settings across 4 states. Results confirmed preliminary findings of a high prevalence of victimization in this population (with sexual abuse more prevalent for women and physical abuse more prevalent for men), and indicated the existence of a range of correlates of recent victimization, including demographic factors and living circumstances, history of childhood abuse, and psychiatric illness severity and substance abuse. The research and clinical implications of these findings are discussed.     

History of sexual abuse among bariatric surgery candidates.

BACKGROUND: A history of sexual abuse is associated with a range of psychosocial difficulties and health risk behaviors in the general population. Sexual abuse also appears to be a risk factor for the development of obesity. Little is known, however, about the prevalence and psychosocial correlates of sexual abuse among persons with extreme obesity who seek bariatric surgery. METHODS: Questionnaire data were collected from 567 individuals with extreme obesity who presented for bariatric surgery. Those with and without a self-reported history of sexual abuse were compared on several psychosocial variables. RESULTS: Sixteen percent of the surgery candidates (17.0% of women and 11.5% of men) reported a history of sexual abuse. Those who reported a history of sexual abuse were more likely to report previous emotional difficulties, as well as a personal and family history of substance abuse. They also were significantly more likely to meet the criteria for binge eating disorder, as determined from self-report responses to the Questionnaire on Eating and Weight Patterns, compared with those without a self-reported history of sexual abuse. In addition, those who reported a history of sexual abuse were more likely to report both current and previous psychiatric treatment than were those who denied a history of abuse. CONCLUSION: A significant minority of bariatric surgery candidates reported a history of sexual abuse. Among these individuals, a history of sexual abuse was associated with both current and past psychiatric problems and treatment. The relationship of these variables to postoperative outcomes, however, is unknown.     

Childhood maltreatment in subjects with male-to-female gender identity disorder

Childhood maltreatment (CM) is quite common and constitutes a nonspecific risk factor for a range of different psychiatric symptoms during lifespan. It has been demonstrated that sexual minorities are at higher risk of maltreatment and abuse, and a high proportion of transsexual subjects report CM. The aim of this study is to evaluate the prevalence of reported CM in a clinical sample of patients with male-to-female Gender Identity Disorder (MtF GID), and to explore the relationship between these early life events, body image and different psychopathological and clinical variables. A consecutive series of 162 patients with male genotype was evaluated from July 2008 to May 2010. A total of 109 subjects (mean age 36 ± 10 years) meeting the criteria for MtF GID and giving their informed consent were considered. The occurrence of CM experiences was evaluated through a face-to-face clinical interview. Patients were asked to complete the Body Uneasiness Test and Symptom Checklist-90 Revised. More than one-fourth of patients reported CM. Maltreated subjects reported a higher body dissatisfaction and display a worse lifetime mental health. The presence of reported CM in these patients has relevant psychopathological implications, and therefore should be carefully investigated.     

Sexual abuse in adolescents--data from a psychiatric treatment centre for adolescents.

OBJECTIVES: To determine the prevalence of sexual abuse in a large sample of adolescent psychiatric patients and to compare sexually abused patients with non sexually abused patients, the latter category including non-sexual physically abused and non-abused patients. DESIGN: A retrospective analysis of the patient records at the William Slater Centre for Adolescents, University of Cape Town Medical School/Groote Schuur Hospital. SETTING: The William Slater Centre (WSC) is an outpatient psychiatric treatment centre for adolescents with emotional and behavioural problems. SUBJECTS: Nine hundred and thirty-four adolescent and young adult patients referred to the WSC in Cape Town from February 1990 to April 1997. METHODS: The WSC Assessment form, a semi-structured interview schedule, was used to focus on depressive symptoms, suicidal ideation and parasuicide, eating disorders, substance abuse, psychosexual history, sexual abuse and physical abuse, and Diagnostic and Statistical Manual i.v. diagnosis. RESULTS: One-third of all patients admitted to the centre from February 1990 to April 1997 reported some form of sexual abuse. More sexually abused patients than expected received a diagnosis of depression. On average sexually abused patients scored higher on depression rating scales than non sexually abused patients. Logistic regression showed that the presence of suicidal symptoms and alcohol use are to some extent independently associated with sexual abuse. CONCLUSION: The problem of sexual abuse among South African youth is confirmed by this study. The association between sexual abuse and depression, suicidal symptoms and alcohol use is supported. The country's dwindling psychiatric services therefore face an increasingly challenging future.     

Sexual and physical abuse histories among child and adolescent psychiatric outpatients

Despite linkages between physical and sexual abuse experienced by children and adolescents and subsequent emotional, behavioral and mental disorders, no prior studies have examined the sexual or physical abuse histories occurring among young clients receiving outpatient mental health services. In the present chart review study, a high prevalence of documented and suspected abuse histories were found, with significant differences among male and female, and black and white outpatients, with respect to types of abuse experienced. Recommendations regarding further investigations in this area are discussed.     

The Child Behavior Checklist as an indicator of posttraumatic stress disorder and dissociation in normative, psychiatric, and sexually abused children

Expert ratings and confirmatory factor analyses were used to derive a posttraumatic stress disorder (PTSD), dissociation, and a combined PTSD/dissociation scale from the Child Behavior Checklist (CBCL). Validity was established by examining the relationship of these scales to features of sexual abuse thought to relate to severity and chronicity, as well as to self-report scales of PTSD and dissociation. In addition, this study examined differences between normative, psychiatric, and sexually abused children on the new scales. Both the sexual abuse and psychiatric sample differed significantly from the normative sample on all scales, but not from each other. Despite correlations of the dissociation and PTSD/dissociation combined scale with features of trauma and child self-report of PTSD and dissociation, the absence of differences between the clinical groups on the derived scales suggests that the scales measure generic, as opposed to trauma-related, distress.     

The Correlates of Male Adults' Perceptions of Their Early Sexual Experiences

This study investigates the relationship between men's perceptions of their earliest sexual experiences and adult psychosocial functioning. Twenty men who identified themselves as sexual abuse survivors were compared with 20 men who would be classified as sexual abuse survivors by common research definitions, but do not identify themselves as survivors, and to 20 men who reported only noncoercive childhood sexual experiences with peers. Men who self-identified as survivors reported nearly twice the level of psychological distress, and were twice as likely to have utilized mental health services as the other two groups. The current article also examines differences in perpetrator and event characteristics.     

Epidemiology of sexual dysfunction in the male population

Sexual dysfunctions have found an increasing attention in recent epidemiological studies of the ageing male. The purpose of this paper is to review the prevalence of sexual dysfunctions and risk factors based on community samples. Studies have not only demonstrated a strong age-related incline of erectile dysfunction (ED), but also of ejaculatory and orgasmic disorders (particularly a reduced or absent ejaculation). Despite a declining sexual desire, sexual interest remains present in old age. Lower urinary tract symptoms have been identified as strong risk factors for ED along with cardiovascular, metabolic, psychiatric disorders and lifestyle factors. The wide range of prevalence rate estimates is likely because of different definitions and criteria of sexual dysfunctions. More research is needed on other dysfunctions besides ED and on the partner relationship as a major determinant of sexual activity and satisfaction. The interrelationship between risk factors calls for interdisciplinary prevention and treatment approaches. As disability-free life expectancy keeps increasing, the need to identify, adequately assess and treat male sexual dysfunction as an important impediment to quality of life most likely will become even more pressing.     

Multivariate prediction of posttraumatic symptoms in psychiatric inpatients

Based on a conceptual framework for the long-term effects of childhood abuse, this study examined the capacity of childhood family environment (caretaker dysfunction, neglect, perceived social support), violent abuse (physical and sexual), and individual variables (other abuse) to predict adult psychiatric symptoms of PTSD, dissociation, and depression. Complete interview data were obtained from 178 psychiatric inpatients who varied greatly on abuse status and severity. Results of multiple regressions of predictor variables onto the three outcome variables showed that the predictor variables accounted for 15% (for depression) to 42% (for PTSD) of the variance in these symptoms and that violent abuse uniquely accounted for a significant proportion of the variance in outcomes for all three of the symptom groups studied.     

Childhood abuse and intake severity in alcohol disorder patients

In a sample of 336 patients with an alcohol use disorder, this study examined, whether patients with histories of childhood sexual abuse (CSA) and childhood physical abuse (CPA) compared to those without such histories have a greater severity of alcohol and other clinical difficulties. Whether lifetime posttraumatic stress disorder (PTSD) mediates the relationship between childhood abuse and clinical outcomes was explored. Results were that CSA was associated with earlier age of onset for alcohol disorder, greater Axis I comorbidity as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994), more social and psychiatric problems, but lower drinking frequency. Childhood physical abuse was related to greater drinking consequences, social and psychiatric dysfunction, and Axis I comorbidity, but also lower drinking frequency. Posttraumatic stress disorder partially mediated the effect of both CSA and CPA on severity of psychiatric problems.     

Stress and sexual response

Stress may be a source of sexual problems, sex may be a source of stress, or stress may even be a facilitator of sexual response. Sexual dysfunction is often associated with anxiety, and physical illness can impair sexual response. Traumatic experiences of a sexual nature can have important adverse effects, although this is not always the case. Rape and incest provide pertinent examples. Sexual activity has been implicated in both physical and psychiatric morbidity but there are a number of methodological difficulties in interpreting these associations, as illustrated by the ‘coital coronary’. Stress does not invariably exert negative effects on sexual response and anxiety arousal can sometimes facilitate sexual arousal in both men and women.     

Degree of Somatoform and Psychological Dissociation in Dissociative Disorder Is Correlated with Reported Trauma

In this study, the prevalence and severity of traumatic experiences as reported by patients with dissociative disorders and with other DSM-IV psychiatric diagnoses were compared. Furthermore, the predictive value of emotional, physical, and sexual trauma with respect to somatoform and psychological dissociation was analyzed. In contrast with comparison patients, dissociative disorder patients reported severe and multifaceted traumatization. Physical and sexual trauma predicted somatoform dissociation, sexual trauma predicted psychological dissociation as well. According to the memories of the dissociative disorder patients, this abuse occurred in an emotionally neglectful and abusive social context. Pathological dissociation was best predicted by early onset of reported intense, chronic and multiple traumatization. Methodological limitations restricting causal inferences between reported trauma and dissociation are discussed.     

Educational,occupational, and relationship histories of men who were sexually and/or physically abused as children

Ninety men (mean age 26) at an urban Northeastern university were administered a self-report assessment of their early sexual and physical abuse experiences, and their educational, occupational, relationship, and substance abuse histories. Subjects were classified as sexually abused according to criteria used by Wyatt (1985) and Finkelhor (1979). Sixteen men (17.8%) experienced sexual abuse alone, 22 men (24.4%) physical abuse alone, 15 men (16.7%) both sexual and physical abuse, and 37 men (41.1%) were classified as nonabused. Of the 31 men who reported sexual abuse, 24 (77.4%) were contact, the rest noncontact. Sexually abused men reported significantly greater difficulties than nonabused men at all levels of education: grade school, high school and college. They also reported more negative job experiences and more negative experiences in relationships. Physically abused men showed a similar but less pervasive pattern of difficulties. Substance abuse was significantly more prevalent among both sexually and physically abused men than among nonabused subjects.     

Childhood Maltreatment and Psychiatric Morbidity in Bariatric Surgery Candidates

Background This study used standardized assessments to evaluate the association between childhood maltreatment (i.e., emotional, physical, and sexual abuse and emotional and physical neglect) and Axis I and II psychiatric disorders in patients presenting for bariatric surgery. Methods Participants (N = 230) provided demographic information and completed the Childhood Trauma Questionnaire, short form. The Structured Clinical Interview for the DSM-IV was used to assess Axis I clinical disorders and Axis II personality disorders. Results Approximately 66% of participants had a history of childhood maltreatment. Individuals reporting childhood maltreatment had a greater number of lifetime Axis I diagnoses than did those without, although the effect for physical neglect was no longer significant after controlling for multiple comparisons. With respect to specific Axis I diagnoses, a history of emotional or sexual abuse was associated with increased rates of lifetime mood and anxiety disorder diagnoses. Emotional neglect also was associated with increased rates of mood disorder diagnoses, and physical abuse was associated with increased rates of substance use disorders. There was no significant association between childhood maltreatment and personality psychopathology. Conclusion This study confirms high rates of childhood maltreatment in patients presenting for bariatric surgery that are associated with increased prevalence of lifetime mood, anxiety, and substance use disorders. Future prospective studies should include evaluation of a broad range of mental health and childhood experiences to tease apart the nature of the relationships between these factors and their potential impact on post-surgical outcomes.     

The reported prevalence of physical and sexual abuse among a sample of children and adolescents at a public psychiatric hospital

In this retrospective analysis of inpatient charts, a total of 298 children and adolescents admitted to a public psychiatric hospital over a 1-year period were examined for the prevalence of reported histories of physical or sexual abuse. Physical abuse was reported in 15% of the cases, while sexual abuse occurred in 13%. A variety of comparisons were made examining possible differences in gender, age, race, diagnosis, and personality trait disturbance among the abused and nonabused patients. Relative to known prevalence rates as reported to child protective agencies, physical or sexual abuse occurred much more frequently among our sample of patients, suggesting the need for careful assessment of such histories upon admission and during treatment.     

Intimacy Dysfunction and Trauma Symptomatology: Long-Term Correlates of Different Types of Child Abuse

The relationships among interpersonal functioning, symptomatology, and childhood abuse were examined in 315 university women. Women reporting childhood abuse had lower quality of past interpersonal relationships, greater fear of intimacy, and greater trauma symptomatology than nonabused women had. Regression analyses indicated that experiencing both sexual and physical abuse, more extensive psychological abuse, and current sexual concerns, defensive avoidance, dissociation, and intrusive experiences were significant predictors of fear of intimacy. Dysfunctional sexual behaviors, impaired self-reference, and depression were significant predictors of the quality of current interpersonal relationships, whereas sexual abuse or multiple abuse experiences in childhood and anger/irritability were predictors of the quality of prior interpersonal relationships. Implications for future research and treatment are discussed.