REVIEW - Sexual abuse and lifetime diagnosis of somatic disorders

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JAMA. 2009;302(5):550-561.

Sexual Abuse and Lifetime Diagnosis of Somatic Disorders

A Systematic Review and Meta-analysis

Molly L. Paras, BS; Mohammad Hassan Murad, MD; P. Chen, BS;

N. Goranson, BS; Amelia L. Sattler, BS; a M. Colbenson, BS;

Mohamed B. Elamin, MBBS; J. Seime, PhD; Larry J. Prokop, MLS;

Ali Zirakzadeh, MD

ABSTRACT

Context Many patients presenting for general medical care have a

history of sexual abuse. The literature suggests an association

between a history of sexual abuse and somatic sequelae.

Objective To systematically assess the association between sexual

abuse and a lifetime diagnosis of somatic disorders.

Data Sources and Extraction A systematic literature search of

electronic databases from January 1980 to December 2008. Pairs of

reviewers extracted descriptive, quality, and outcome data from

included studies. Odds ratios (ORs) and 95% confidence intervals (CIs)

were pooled across studies by using the random-effects model. The I2

statistic was used to assess heterogeneity.

Study Selection Eligible studies were longitudinal (case-control and

cohort) and reported somatic outcomes in persons with and without

history of sexual abuse.

Results The search identified 23 eligible studies describing 4640

subjects. There was a significant association between a history of

sexual abuse and lifetime diagnosis of functional gastrointestinal

disorders (OR, 2.43; 95% CI, 1.36-4.31; I2 = 82%; 5 studies),

nonspecific chronic pain (OR, 2.20; 95% CI, 1.54-3.15; 1 study),

psychogenic seizures (OR, 2.96; 95% CI, 1.12-4.69, I2 = 0%; 3

studies), and chronic pelvic pain (OR, 2.73; 95% CI, 1.73-4.30, I2 =

40%; 10 studies). There was no statistically significant association

between sexual abuse and a lifetime diagnosis of fibromyalgia (OR,

1.61; 95% CI, 0.85-3.07, I2 = 0%; 4 studies), obesity (OR, 1.47; 95%

CI, 0.88-2.46; I2 = 71%; 2 studies), or headache (OR, 1.49; 95% CI,

0.96-2.31; 1 study). We found no studies that assessed syncope. When

analysis was restricted to studies in which sexual abuse was defined

as rape, significant associations were observed between rape and a

lifetime diagnosis of fibromyalgia (OR, 3.35; 95% CI, 1.51-7.46),

chronic pelvic pain (OR, 3.27; 95% CI, 1.02-10.53), and functional

gastrointestinal disorders (OR, 4.01; 95% CI, 1.88-8.57).

Conclusion Evidence suggests a history of sexual abuse is associated

with lifetime diagnosis of multiple somatic disorders.

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Read the full article here:

http://jama.ama-assn.org/cgi/content/full/302/5/550

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