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Chronic Pain Syndromes and Violence Against Women
Abstract
Chronic pain is a common form of disability, and is often reported among women with a history of victimization. In the present study, we combine six pain symptoms into a measure of self-reported pain, and compare women who have experienced child or domestic abuse with those who do not report such a history. A sample of 110 female patients (57 abused, 53 non-abused controls) was drawn from an adult primary-care practice of 905 patients in a small, affluent, predominantly Caucasian community in northern New England. The subjects ranged in age from 18 to 88 (M = 47). Subjects completed a self-administered questionnaire that was used clinically as part of the new-patient work-up. Women who reported either child or domestic abuse were significantly more likely to report pain symptoms than women in the control group. There was no significant difference between women who had experienced domestic abuse vs. child abuse alone. These findings held true even after controlling for depression.
... IPV is strongly associated with the emergence and/or worsening of chronic pain. For example, IPV is related to worse headaches, back pain, pelvic pain, painful intercourse, fibromyalgia, and abdominal pain, and is more generally associated with disabling pain and increased pain severity [7][8][9][10][11][12]. Daily pain complaints are common in the early aftermath of IPV and associated with increased risk for chronic pain development [13][14][15][16]. ...
... Chronic pain is a major global health problem [69]. Interpersonal violence (IPV) is associated with the emergence and/or worsening of pain [7][8][9][10][11][12]. However, there is a critical gap in our understanding of the factors that predict worsening pain in IPV survivors. ...
... Past research suggests a strong link between PTSD and pain [17]. IPV worsens headaches, back pain, pelvic pain, painful intercourse, fibromyalgia, and abdominal pain [7][8][9][10][11][12]. Among the strongest trauma-related predictors in our models were childhood emotional abuse and days since trauma. ...
Interpersonal violence (IPV) is highly prevalent in the United States and is a major public health problem. The emergence and/or worsening of chronic pain are known sequelae of IPV; however, not all those who experience IPV develop chronic pain. To mitigate its development, it is critical to identify the factors that are associated with increased risk of pain after IPV. This proof-of-concept study used machine-learning strategies to predict pain severity and interference in 47 young women, ages 18 to 30, who experienced an incident of IPV (i.e., physical and/or sexual assault) within three months of their baseline assessment. Young women are more likely than men to experience IPV and to subsequently develop posttraumatic stress disorder (PTSD) and chronic pain. Women completed a comprehensive assessment of theory-driven cognitive and neurobiological predictors of pain severity and pain-related interference (e.g., pain, coping, disability, psychiatric diagnosis/symptoms, PTSD/trauma, executive function, neuroendocrine, and physiological stress response). Gradient boosting machine models were used to predict symptoms of pain severity and pain-related interference across time (Baseline, 1-,3-,6- follow-up assessments). Models showed excellent predictive performance for pain severity and adequate predictive performance for pain-related interference. This proof-of-concept study suggests that machine-learning approaches are a useful tool for identifying predictors of pain development in survivors of recent IPV. Baseline measures of pain, family life impairment, neuropsychological function, and trauma history were of greatest importance in predicting pain and pain-related interference across a 6-month follow-up period. Present findings support the use of machine-learning techniques in larger studies of post-IPV pain development and highlight theory-driven predictors that could inform the development of targeted early intervention programs. However, these results should be replicated in a larger dataset with lower levels of missing data.
... Of the studies identified, 12 were included in the final review (see Figure 1). The majority of studies (n ¼ 10) were conducted in English-speaking countries including the United States, Australia, and Canada (As-Sanie et al., 2014;Bonomi et al., 2009;Campbell et al., 2002;Coker et al., 2000;Humphreys et al., 2011;Kendall-Tackett et al., 2003;Loxton et al., 2017;McCall-Hosenfeld et al., 2014;Symes et al., 2013;Wuest et al., 2008). All included studies used quantitative methods. ...
... Pain was largely measured using established measurement tools including the Brief Pain Inventory (BPI) short form (SF; As-Sanie et al., 2014;Humphreys et al., 2011;Symes et al., 2013), the Medical Outcomes Study 36-item Short-Form Health Survey Loxton et al., 2017), and the Von Korff 7-item Chronic Pain Grade (CPG) Scale (McCall-Hosenfeld et al., 2014;Tiwari et al., 2013;Wuest et al., 2008). The remaining studies used self-reported pain symptoms (Coker et al., 2000;Kendall-Tackett et al., 2003) and clinical records (Bonomi et al., 2009;Vives-Cases et al., 2011). Detailed characteristics for each study are shown in Table 2. ...
... Four of the 11 studies recruited a community sample (Humphreys et al., 2011;Loxton et al., 2017;Vives-Cases et al., 2011;Wuest et al., 2008). The remaining seven studies used clinical samples or a previous diagnosis by a doctor (As-Sanie et al., 2014;Bonomi et al., 2009;Campbell et al., 2002;Coker et al., 2000;Kendall-Tackett et al., 2003;McCall-Hosenfeld et al., 2014;Symes et al., 2013). Conclusions on causality could not be made as all study designs were observational. ...
Women experience persistent pain at higher rates than men; however, women are less likely to be provided with adequate or appropriate care and more likely to have their pain experiences dismissed. The purpose of this review is to consider the complex interaction of the biopsychosocial factors in the experience of persistent pain in order to inform improved models of care. Given persistent pain is among the most frequently reported health consequences of intimate partner violence (IPV), this review focused on studies exploring the association between persistent pain and IPV. Three reviewers independently and systematically searched seven databases. Qualitative and quantitative studies describing the association between IPV and persistent pain published between January 2000 and June 2018 were included. Twelve studies met the inclusion criteria. The included studies demonstrated that a history of IPV places an additional burden on women who experience persistent pain that cannot be explained by an underlying psychological condition. Health care practitioners should be aware of this phenomena to ensure diagnosis, assessment, and treatment plans are targeted accordingly. Future policy directives and research should account for and seek to elucidate this additional burden.
... In this context, intimate partner violence against females should also be considered as one of the possible persistent risk factors in the emergence of FMS. 8 Domestic violence against females is regarded as an important public health problem leading to physical and mental health problems. 9 In addition to psychiatric disorders, one of the major reasons for the violence victims to apply to health institutions is chronic pain. 9 Thus, it is important to consider domestic violence in the diagnosis of patients with unexplained chronic pain such as headache, myofascial pain and fibromyalgia. ...
... 9 In addition to psychiatric disorders, one of the major reasons for the violence victims to apply to health institutions is chronic pain. 9 Thus, it is important to consider domestic violence in the diagnosis of patients with unexplained chronic pain such as headache, myofascial pain and fibromyalgia. 11,12 There are several studies yielding higher prevalence of certain types of lifetime abuse in FMS 12 while there is only one study from Turkey exploring the relationship of domestic violence and FMS, to the best of our knowledge. ...
... In this context, intimate partner violence against females should also be considered as one of the possible persistent risk factors in the emergence of FMS. 8 Domestic violence against females is regarded as an important public health problem leading to physical and mental health problems. 9 In addition to psychiatric disorders, one of the major reasons for the violence victims to apply to health institutions is chronic pain. 9 Thus, it is important to consider domestic violence in the diagnosis of patients with unexplained chronic pain such as headache, myofascial pain and fibromyalgia. ...
... 9 In addition to psychiatric disorders, one of the major reasons for the violence victims to apply to health institutions is chronic pain. 9 Thus, it is important to consider domestic violence in the diagnosis of patients with unexplained chronic pain such as headache, myofascial pain and fibromyalgia. 11,12 There are several studies yielding higher prevalence of certain types of lifetime abuse in FMS 12 while there is only one study from Turkey exploring the relationship of domestic violence and FMS, to the best of our knowledge. ...
Objectives:
This study aims to compare the prevalence of intimate partner violence and comorbid psychiatric disorders among patients with fibromyalgia syndrome (FMS) and healthy controls and also to investigate the relationship of intimate partner violence with psychiatric disorders and severity of pain in FMS patients.
Patients and methods:
The study group consisted of 136 females including 68 patients with FMS (mean age 43±10.4 years; range, 25 to 70 years) and 68 FMS-free healthy females (mean age 38.5±11.3 years; range, 22 to 70 years). Following a Structured Clinical Interview for Diagnostic and Statistical Manual-IV Axis I Disorders by a psychiatrist experienced in psychological trauma, Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), Visual Analog Scale (VAS) for the severity of pain and Domestic Violence Against Women Scale (DVAWS) were applied.
Results:
In FMS group, 85% of the patients were diagnosed with mood or anxiety disorder. Almost half of these patients had major depressive disorder. The total scores of DVAWS and all subscales were significantly higher in the FMS group than in the control group (p<0.01). The severity of domestic violence were related to the presence of any psychiatric disorder only in FMS patients (p<0.01). Almost half of the FMS patients with high DVAWS score had comorbid mood and anxiety disorders. There was a significant positive correlation between the total scores of DVAWS, HDRS, HARS, and VAS (p<0.01).
Conclusion:
Although the etiology of FMS is still uncertain, psychosocial factors may play role as risk factors. Therefore, a multidisciplinary approach to the treatment should be considered.
... Although the etiology of FMS is still unknown, recent investigations reveal that psychosocial stress factors might well play a role (2). Domestic violence against women is considered to be an important public health problem leading physical and mental health problems (3). In addition to the psychiatric disorders, one of the major reasons for the violence victims to apply to health institutions is chronic pain (3). ...
... Domestic violence against women is considered to be an important public health problem leading physical and mental health problems (3). In addition to the psychiatric disorders, one of the major reasons for the violence victims to apply to health institutions is chronic pain (3). Thus, it is important to consider domestic violence in the diagnosis of patients with unexplained chronic pain such as headache, myofascial pain and fibromyalgia (4,5). ...
In addition to actual psychiatric diagnoses with SCID-I, average anxiety and depression levels were determined by HARS and HDRS in order to investigate the correlation with pain and domestic violence levels. Average HARS scores were reported as 22.28±13.32 in FMS group and 6.56±7.88 in healthy controls (p<0,01). Average HDRS scores were 24.59±14.75 in FMS group and 9.13±9.42 in healthy controls (p<0,01). In the FMS group, the average VAS score was 6.25 ± 2.03 and it was interpreted as moderate pain. Pain severity had positive correlations with both domestic violence levels and psychiatric measures. However, the strongest correlation of all was between DVAWS and VAS (r=0.707; p< 0.01) (Table 5). DISCUSSION Data observed in our study revealed that both psychiatric comorbidities and domestic violence were more common in FMS patients than in women without this syndrome. We also investigated the relation of domestic violence with regard to the presence of psychiatric comorbidity; and found a significant relationship only in FMS group. Furthermore, the severity of pain in FMS group showed positive correlation not only with the level of intimate partner violence but also with the level of depression and anxiety. There are several studies in the literature investigating the relationship between FMS and domestic violence; however, the number of studies in which a detailed and structured psychiatric interview was conducted is scarce. Psychiatric questionnaires used are mostly for screening purposes rather than being diagnostic. In particular, on sensitive issues such as domestic violence, the importance of the therapeutic relationship established during psychiatric interview is obvious, in order to reach accurate results (5). Thus, in our study both SCID-I and DVAWS have been performed by a psychiatrist trained in psychological trauma. The patients in need for treatment were referred to the psychiatry outpatient clinic for further follow-up and treatment. The results of our study emphasize that domestic violence is related to anxiety, depression and severity of pain in women with FMS. However, given the cross-sectional design of the study, we are unable to conclude whether FMS is a consequence of this pychological distress or viceversa.
... This type of violence has been associated with various forms of functional disorders, including gastrointestinal disorders, chronic pain syndromes, asthma, memory loss, disabilities, and dizziness. [12,[15][16][17][18] The mental health consequences of IPV are also enormous and include depressive symptoms, substance use, post-traumatic stress disorder, substance abuse, suicidal thoughts, and suicidal attempts. [11,[19][20][21] The reproductive health consequences of IPV include unwanted pregnancy, miscarriage, induced abortion, infertility, gynecological disorders, pregnancy-related complications, low birth weight, fetal injury, stillbirth and sexually transmitted diseases. ...
... The mechanisms that explain the impact of stressful events or sexual abuse on the development of a child's nervous system remain partially elucidated, however, they are of great theoretical interest. In the study by Kendall-Tackett et al. (2003), it was found that women who had experienced family violence as children or adults were more likely to report a variety of pain symptoms, along with evidence that previous abuse can be considered a cause of chronic pain. After stressful events (traumatic or chronic), the body develops the ability to hyper-respond to stimuli, which increases the experience of pain. ...
Fibromyalgia (FM) syndrome is a common illness characterized by chronic widespread pain, sleep problems, fatigue, and cognitive difficulties. Dysfunctional neurotransmitter systems that influence the body’s endogenous stress response systems are thought to underlie many of the major FM-related symptoms. A model of FM pathogenesis suggests biological and psychosocial variables interact to influence the genetic predisposition, but the precise mechanisms remain unclear. The Polyvagal Theory provides a theoretical framework from which to investigate potential biological mechanisms. The vagus nerve (VN) has anti-inflammatory properties via its afferent and efferent fibers. A low vagal tone (as assessed by low heart rate variability), has been observed in painful and inflammatory diseases, including FM, while the ventral branch of the VN is linked to emotional expression and social engagement. These anti-inflammatory and psychological (limbic system) properties of the VN may possess therapeutic potential in treating FM. This review paper summarizes the scientific literature regarding the potential role of the VN in transducing and/or therapeutically managing FM signs and symptoms.
... For instance, certain pain sensations can act as triggers of memories of trauma for IPV survivors, as the pain reminds them of when the initial pain occurred in the context of abuse (Cerulli et al., 2012). Working with IPV survivors to identify the source of their pain and associated mental health effects can be empowering and validating, affirming that the pain is real and not imagined (Kendall-Tackett et al., 2003). A biopsychosocial approach to pain management takes these mental health effects into account, ensuring that practitioners treat pain as a holistic and multifaceted condition (Walker et al., 2020). ...
This study explores pain among female survivors of intimate partner violence (IPV) with disabilities. Women with disabilities are subject to higher rates of IPV than nondisabled women, and experience health problems related to abuse, including chronic pain. Resident records (N = 114) from a disability-focused domestic violence shelter were reviewed to examine relationships between demographic characteristics, histories of abuse, and pain characteristics including pain severity rating, pain’s impact on daily functioning, and cause of pain. Results suggest that pain impacts the daily functioning of IPV survivors with disabilities. Close to 60% had a physical disability and almost half had a psychiatric diagnosis; residents were racially and ethnically diverse, with 41% identifying as Black and 40% Latinx. Residents, on average, rated their pain severity close to 5 (on a 0–10 scale; SD = 2.71), with half indicating that pain affecting their activities of daily living (50.0%). Residents reporting difficulty participating in life roles had significantly higher pain ratings than those who did not, as did those who reported that pain affected their daily functioning. The type of abuse experienced may also influence pain severity, and disability type is related to how pain impacts daily functioning. The study’s findings underscore the need for trauma-sensitive approaches to pain management for IPV survivors with disabilities. Given the complex interrelationships between pain severity, physical and mental health, and abuse, an interdisciplinary approach to working with IPV survivors with disabilities is warranted.
... This is consistent with the wider body of persistent pain research that commonly links post-traumatic stress disorder into the trauma-pain equation [52], particularly in association with a history of IPI trauma events [17,53]. Furthermore, often other studies have implicated factors such as attitudes and beliefs [54], catastrophizing, and coping style [55,56], none of which, including posttraumatic stress disorder, were accounted for in the present analysis, as such measures are not available in the ALSWH questionnaire. Also, although the analyses were conducted associating traumatic events experienced more than 12 months before 2012 with body pain levels at 2012, there was no way to conclusively discern whether the reported SF-36 BP scores were associated with events experienced more than 12 months ago. ...
Objective
To assess whether body pain was associated with different trauma histories (physical injury vs. interpersonal injury [IPI]) within Australian women, along with body pain and trauma history associations with biological and psychological (biopsycho) confounders.
Methods
A retrospective cross-sectional analysis was conducted on the Australian Longitudinal Study on Women’s Health (ALSWH) 1973–1978 birth cohort wave 6 data. Relevant life events were categorized into two types of traumatic experience and included as exposure variables in a multinomial regression model for body pain subgroups. Also, subgroup analyses considered trauma and pain effects and interactions on biopsycho burden.
Results
The unadjusted multinomial regression model revealed that a history of physical injury was found to be significantly associated with body pain severity, as was a history of IPI trauma. After the model was adjusted to include biopsycho confounders, the association between IPI and body pain was no longer significant, and post hoc analysis revealed the relationship was instead mediated by biopsycho confounders. Women with a history of IPI and body pain were also found to have the greatest biopsycho (physical functioning, stress, anxiety, and depression) burden.
Discussion
The relationship between IPI and body pain was found to be mediated by biopsycho burden, whereas the relationship between physical injury and body pain was not. Also, a history of IPI was associated with a greater biopsycho burden than was a history of physical injury. These results suggest there is clinical value in considering the comprehensive trauma history of patients with pain when developing their biopsychosocial model of care.
... There is increasing evidence of such effects on a variety of aspects. ETIs can affect physical health (Porcerelli et al., 2017;Rueness et al., 2020) by affecting a multitude of processes, such as increasing the likelihood of suffering from cardiovascular (Kendall-Tackett, 2007;Kumari & Mukhopadhyay, 2020), respi-ratory and gastrointestinal diseases (Bradford et al., 2012;Sowder et al., 2018), chronic pain (Kendall-Tackett et al., 2003), immune system deficiencies (Baumeister et al., 2016. Danese & Lewis, 2017, fibromyalgia (Haviland et al., 2010), sleep disorders (Clum et al., 2001), obesity (Danese & Tan, 2013), migraines (Tietjen et al., 2010), among others. ...
Objective:
Early traumatic experiences are related to profound and long-lasting negative effects on mental and physical health. Colombia has been involved in a war for the last six decades. Thus, the main objective was to adapt and validate the Early Trauma Inventory Self Report-Short Form in Colombia, as well as assess trauma prevalence in this country.
Method:
For this purpose, a total of 2,080 Colombians participated in this study (57.3% women and 42.4% men). Age ranged from 18 to 77 years old. They answered the 27-item version of the Early Trauma Inventory Self Report-Short Form and a sociodemographic evaluation tool. Web-based sampling was carried out between March 16 and March 30, 2020.
Results:
Original four factor structure was successfully explored and confirmed here. Reliability indexes were good with alphas ranging from .69 to .93. Items properties were also adequate. Most of the assessed sample suffered trauma in their early stages (99.8%). Gender differences were analyzed observing significant differences. As expected, sexual abuse is more prevalent in women.
Conclusions:
To the best of our knowledge, the Colombian population has suffered the highest prevalence of early trauma experiences so far when compared to other countries. Emotional and social implications are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
... There is strong evidence linking trauma in particular to adverse physical health symptoms-particularly among those victims who experience abuse across the lifespan (i.e., both in childhood and adulthood; Kendall-Tackett, 2009;Kendall-Tackett et al., 2003;Van Houdenhove et al., 2009). IPV victims are at an increased risk for a range of physical health issues, such as chronic pain (e.g., Dillon et al., 2013;Vives-Cases et al., 2011), cardiovascular symptoms (e.g., hypertension and chest pains; Breiding et al., 2008;Mason et al., 2012), gastrointestinal symptoms/disorders (e.g., Bonomi et al., 2009), seizures/epilepsy (Coker et al., 2000), back pain/issues (e.g., Coker et al., 2005), brain/head injuries (e.g., Gagnon and DePrince, 2017;Jackson et al., 2002), headaches/migraines (e.g., Coker et al., 2000), and type II diabetes (e.g., Mason et al., 2013). ...
Rationale
The negative physical and mental health consequences of intimate partner violence (IPV) have been well-documented, as those who are exposed to trauma experience more physical health issues. Further, an abuser’s direct access to a firearm drastically increases the risk for fatality, which can exacerbate ongoing stress and trauma in an abusive relationship. However, very little research has investigated the intersection of exposure to firearms and adverse health outcomes in the context of IPV. Objective. This study investigates the sensitivity of firearm exposure in IPV contexts by examining if abusive partner firearm ownership—regardless of actual use of a gun in the abuse—is associated with negative health outcomes. Methods. The research team administered questionnaires to IPV victims (N = 215) from six domestic violence shelters across rural and urban locations in a single state. Results. Having an abusive partner who owned a firearm was associated with significantly worse physical health—above and beyond IPV experienced in the relationship. Even so, IPV involving firearms was not significantly associated with physical health beyond partner firearm ownership. The relationship between partner firearm ownership and negative health outcomes was primarily attenuated by sleep disturbances among victims. Conclusions. The results provide initial information about the role that firearms play in adverse victim health beyond injuries (e.g., gunshot wounds) and fatalities.
... More damage may be expected if exposure to violence occurs during childhood because children's brains are still developing. However, due to higher resilience of children's brains, another possibility is that damage is minimized in a way to 're-wire' themselves (32) . Some studies reported that physical abuse in adulthood gave rise to the greatest symptoms in patients with FMS (18) , whereas others claimed a greater association between emotional (17) or sexual abuse during childhood (18,20,(33)(34)(35) . ...
... [8][9][10][11] Aile içi şiddet depresif belirtiler, madde kötüye kullanımı, travma sonrası stres bozukluğu gibi bir çok psikiyatrik bozukluk ile ilişkilendirilmektedir. 12,13 Literatürde aile içi şiddet ile somatik belirtilerin ve kronik ağrı sendromlarının ilişkili olduğunu ortaya koyan çalışmalar mevcuttur. 14 şiddetini ölçmekte kullanılan ölçek 17 soru içermekte ve sorulara 0-4 arasında puan verilmektedir. Türkçe geçerlik-güvenirlik çalışması Akdemir ve ark. ...
u çalışmada fizik tedavi ve rehabilitasyon polikliniğine başvuran ve fibromiyalji tanısı konulan kadınlara uygulanan aile içi fiziksel şiddetin depresyon, anksiyete düzeyleri ve ağrı şiddeti gibi klinik özelliklerle olan ilişkisinin araştırılması amaçlanmıştır.
Materyal ve Metot: Çalışmanın örneklemi Siirt ilinde bir ilçe devlet hastanesi fizik tedavi ve rehabilitasyon polikliniğine ağrı yakınması ile başvuran ve Amerikan Romatoloji Birliği 2010 ölçütlerine göre fibromiyalji tanısı konan 34 kadın olgudan oluşturulmuştur. Olgulara Hamilton Depresyon Derecelendirme (HAM-D) Ölçeği, Hamilton Anksiyete Derecelendirme (HAM-A) Ölçeği, ağrı şiddetini değerlendiren Vizüel Analog Skala ve Aile İçi Fiziksel Şiddet için Klinik Görüşme Formu uygulanmıştır.
Bulgular: Olguların %38,2'sinde evlilik, %29,4' sinde çocukluk döneminde aile içi fiziksel şiddet saptanmıştır. Ağrı şiddeti ile evlenme yaşı (r=-0,514, p=0,002) ve eğitim düzeyi (r=-0,143, p=0,002) arasında negatif yönde anlamlı bir ilişki saptanmıştır. Evlilikte
fiziksel şiddet ağrı şiddeti ile anlamlı derecede ilişkili bulunmuştur (p<0,001). HAM-D (r=-0,510, p=0,002) ve HAM-A (r=-0,407, p=0,017) ile evlenme yaşı arasında negatif yönde anlamlı bir ilişki bulunmuştur. HAM-D (p<0,001) ve HAM-A (p=0,002) ile evlilikte fiziksel şiddet arasında anlamlı bir ilişki saptanmıştır. Ağrı şiddeti ile HAM-D (r=0,561, p=0,001) ve HAM-A (r=0,420, p=0,013) arasında pozitif yönde anlamlı bir ilişki bulunmuştur. HAM-D ve HAM-A puanları arasında p<0,001 (r=0,793) düzeyinde pozitif yönde anlamlı bir ilişki olduğu görülmüştür.
Sonuç: Örneklemimizde aile içi fiziksel şiddetin ağrı şiddeti, depresyon ve anksiyete belirtileri ile ilişkili olduğu bulunmuştur. Anksiyete ve depresyon düzeylerinin de ağrı şiddetiyle ilişkili olduğu saptanmıştır. Bu nedenle fibromiyalji hastalarının tedavi ve izlem sürecinde aile içi şiddetin araştırılması ve eşlik eden anksiyete ve depresyon belirtilerinin değerlendirilmesi göz önünde bulundurulmalıdır.
Anahtar Kelimeler: Fibromiyalji, aile içi fiziksel şiddet, depresyon, anksiyete
... Moreover, evidence suggests that childhood trauma is related with pain severity in FMS [101,103]. Interestingly, high rates of child abuse and stressful life events have been reported in a variety of forms of chronic pain, including generalized pain [104][105][106], pelvic pain and vulvodynia [107][108], chronic musculoskeletal pain [109], headache [110], and irritable bowel syndrome and gastro-intestinal conditions [111][112][113]. Whether or not preceded by stressful life events or other pathogenic route, our present results support the existence of a link between pain and negatively biased cognitions of one's own body in FMS, including low body esteem. ...
Fibromyalgia syndrome (FMS) is a highly prevalent, chronic musculoskeletal condition characterized by widespread pain and evoked pain at tender points. This study evaluated various aspects of body awareness in a sample of 14 women with FMS and 13 healthy controls, such as plasticity of the body schema, body esteem, and interoceptive awareness. To this end, the Rubber Hand Illusion (RHI), the Body Esteem Scale (BES), and the Body Perception Questionnaire (BPQ) were used, respectively. Consistent with increased plasticity of the body schema, FMS patients scored higher, with large or very large effect sizes, across all three domains evaluated in the RHI paradigm, namely proprioceptive drift and perceived ownership and motor control over the rubber hand. Scores on all items addressed by the BES were consistently lower among FMS subjects (2.52, SEM .19 vs 3.89, SEM .16, respectively, p < .01, Cohen’s d = .38-.66). In the FMS sample, BES scores assigned to most painful regions also were lower than those assigned to the remaining body sites (1.58, SEM .19 vs 2.87, SEM .18, respectively, p < .01). Significantly higher scores (p < .01, Cohen’s d = .51-.87) were found in the FMS sample across awareness (3.57 SEM .15 vs 1.87 SEM .11), stress response (3.76 SEM .11 vs 1.78 SEM .11), autonomic nervous system reactivity (2.59 SEM .17 vs 1.35 SEM .07), and stress style 2 (2.73 SEM .27 vs 1.13 SEM .04) subscales of the BPQ. Intensity of ongoing clinical pain was found to be strongly correlated with interoceptive awareness (r = .75, p = .002). The results suggest a disturbed embodiment in FMS, characterized by instability of the body schema, negatively biased cognitions regarding one’s own body, and increased vigilance to internal bodily cues. These manifestations may be interpreted as related with the inability of incoming sensory inputs to adequately update negatively biased off-line somatorepresentations stored as long-term memory.
... Las diferencias en las medias de estos síntomas no eran explicadas por la edad o ninguna de las variables sociodemográficas evaluadas. Estos datos están en consonancia con estudios que concluyen que las mujeres víctimas de violencia de género presentan enfermedades respiratorias y alergias (Coker et al., 2000;Follingstad, 2009), diversas dolencias intestinales (Kendall-Tackett et al., 2003;McCauley et al., 1995), problemas de visión y oído (Heise et al., 1999), dolor de cabeza y migrañas (Jackson et al. 2002), dolor cervical crónico, de espalda, pélvico y artritis (Coker et al., 2000). Respecto a la relación entre las dimensiones del perdón y los síntomas psicosomáticos, cuando la dificultad se encuentra en perdonar la situación y a una misma, se hallaron más relaciones con enfermedades en comparación con las relaciones entre el perdón ejercido a otros y síntomas psicosomáticos. ...
Las consecuencias asociadas al tipo de perdón empleado por las mujeres que han sido víctimas de violencia de género pueden adquirir gran relevancia terapéutica. Desde una perspectiva tradicional, éste implica la reducción de los sentimientos negativos hacia el agresor y la aparición de compasión, lo que aumenta la probabilidad de retomar la relación. Por su parte, no perdonar supondría rabia, culpabilidad, evitación y otra serie de efectos negativos. Finalmente, el perdón disposicional implica la superación de los acontecimientos negativos vividos. El objetivo del estudio fue establecer la relación entre el perdón y las enfermedades psicosomáticas en mujeres que han sido víctimas de violencia de género. Participaron 17 mujeres de entre 26 y 60 años. Los resultados mostraron un efecto significativo del nivel de perdón y el tipo (perdón a la situación y autoperdón, perdón al otro) sobre las enfermedades psicosomáticas. De forma general, las dificultades para perdonar se asociaban a mayores frecuencias en la aparición de algunos síntomas psicosomáticos.
... Among various traumatic events, sexual victimization during childhood was found to significantly increase the odds of presenting with a clinical level of symptoms of distress as depression, dissociation and PTSD symptoms (Marshall and Ness 2014;Sonneveld et al. 2014). Several studies investigating the effect of sexual retraumatization on trauma-related memory in CSA survivors diagnosed with symptoms of distress, suggested that various trauma survivors experience dissociative responses that occur at the time of a trauma (Bryant 2005;Daphna-Tekoah and Harel-Shalev 2014;Gallo-Silver and Weiner 2006). ...
Previous studies indicate that childhood sexual abuse (CSA) has negative physical and psychological long-term effects and that childbirth may retraumatize women who were sexually abused in childhood due to the women’s association of the delivery with their earlier maltreatment. Childbirth might also include traumatic elements such as threat or perceived threat to life and/or physical danger to the woman giving birth and/or her baby. Pregnant women with a history of child sexual abuse tend to have high anxiety levels during pregnancy additionally to birth complications, which may cause labor to be painful physically, as well as emotionally.
For the previously sexually abused woman, the exposure to the medical treatment and medical staff who help handling intimate organs that are associated with sex might also be traumatizing. In addition, women with a history of child sexual abuse may develop, after delivery, symptoms of distress, such as Posttraumatic Stress Symptoms (PTSD), depression and dissociation.
The purpose of this chapter is to summarize some of the current studies and evidence in the literature about the influence of childhood sexual abuse on postpartum, posttraumatic stress reactions and symptoms of distress in pregnancy and childbirth. In addition, the extent to which childbirth may function as a retraumatization of childhood sexual abuse will be explored.
... They strongly recommended measuring physical functioning through different means. Focus group comments about the HADS suggested distrust of the instrument pointing to the mental health taboo that surrounds societal, often stigmatizing, stereotypes about chronic pain (Kendall-Tackett, Marshall, & Ness, 2003). The HADS, however, has been successfully used in other chronic pain trials. ...
Background:
To date, research on music for pain management has focused primarily on listening to prerecorded music for acute pain. Research is needed on the impact of active music therapy interventions on chronic pain management.
Objective:
The aim of this mixed methods research study was to determine feasibility and estimates of effect of vocal music therapy for chronic pain management.
Methods:
Fifty-five inner-city adults, predominantly African Americans, with chronic pain were randomized to an 8-week vocal music therapy treatment group or waitlist control group. Consent and attrition rates, treatment compliance, and instrument appropriateness/burden were tracked. Physical functioning (pain interference and general activities), self-efficacy, emotional functioning, pain intensity, pain coping, and participant perception of change were measured at baseline, 4, 8, and 12 weeks. Focus groups were conducted at the 12-week follow-up.
Results:
The consent rate was 77%. The attrition rate was 27% at follow-up. We established acceptability of the intervention. Large effect sizes were obtained for self-efficacy at weeks 8 and 12; a moderate effect size was found for pain interference at week 8; no improvements were found for general activities and emotional functioning. Moderate effect sizes were obtained for pain intensity and small effect sizes for coping, albeit not statistically significant. Qualitative findings suggested that the treatment resulted in enhanced self-management, motivation, empowerment, a sense of belonging, and reduced isolation.
Conclusions:
This study suggests that vocal music therapy may be effective in building essential stepping-stones for effective chronic pain management, namely enhanced self-efficacy, motivation, empowerment, and social engagement.
... In addition, women who had experienced lifetime abuse-related injury or childhood abuse were also more likely to experience chronic pain. Similarly, a study involving primarily Caucasian women in New England (US) found that women who reported domestic or child abuse were more likely to report chronic pain than women in the control group [32]. A study involving female veterans in the US ( = 213) found that the majority of women reported chronic pain (78%) and that a history of sexual trauma was associated with greater severity of pain [33]. ...
. National data from Canada and the United States identify women to be at greater risk than men for the misuse of prescription opioid medications. Various sex- and gender-based factors and patient and physician practices may affect women’s use and misuse of prescription opioid drugs.
Objectives
. To explore the particular risks, issues, and treatment considerations for prescription opioid misuse among women who experience chronic noncancer pain and trauma.
Methods
. A scoping review for articles published between January 1990 and May 2014 was conducted on sex- and gender-based risks and treatment considerations among women who experience chronic noncancer pain and trauma.
Results
. A total of 57 articles were identified. The present narrative review summarizes the specific risks for the misuse of prescription opioid medication among women who have experienced violence and trauma, Aboriginal women, adolescents and young women, older women, pregnant women, women of a sexual minority, and transwomen.
Discussion
. The majority of the literature is descriptive, with few studies that evaluate approaches and interventions to respond to the issue of chronic pain, trauma, and misuse of prescription opioids among women, particularly vulnerable subgroups of women.
Conclusions
. Trauma-informed and women-centred approaches that address women’s vulnerabilities and complex needs require further attention.
... As previously noted, much of the research on the effects of intimate partner violence refers to men abusing women. Women victimized by their spouses often suffer numerous negative consequences, such as short and long-term mental health issues (Golding, 2002;Gorde, Helfrich, & Finlayson, 2004;Tutty, 1998), physical health (Gazmararian, Lazorick, Spitz, Ballard, & Marks, 1996;Kendall-Tackett, Marshall, & Ness, 2003) and overall functioning (Bonomi, et al., 2006)). ...
Research has documented an association between substance use and intimate partner perpetration in both men and women (Leonard, 2001; Stuart, et al., 2008), though most treatments do not address these issues concurrently. In 2010, the Calgary Counselling Centre launched a pilot of the Strengthening Families program for couples who were dealing with both situational intimate partner violence and addictions. Modelled on Fals-Stewart and Clinton-Sherrod’s (2009) Behavioral Couples Counselling approach, the program was revised to fit the Canadian context and included additional domestic violence material. While 108 couples were referred over 2.5 years, a number were deemed inappropriate either because substance abuse or intimate partner violence was not of concern, or both partners were not available or willing to attend conjoint couples sessions. This report presents qualitative interviews with key stakeholders and program clients as well as a comparison of the demographics and outcome measures at pretest for program completers (N = 18) and non-completers (N = 30) and the pretest-posttest outcomes for the 16 individuals that completed, which showed a number of significant improvements despite the relatively small sample size. The improvements were in the scales addressing clinical symptoms, improvements in self-esteem, reductions in anxiety, less intimate partner abuse and improved relationships with spouse with respect to involvement, communication, role allocation and problem-solving. Finally, comparing the posttest OQ-45 scores for the entire sample, those who finished the program had statistically significantly improved scores compared to those who did not complete (based on their last session scores). Implications and recommendations are presented.
... Decades of research indicate that trauma increases the likelihood of experiencing one or more biopsychosocial sequelae such as higher rates of chronic pain syndromes (Kendall-Tackett, Marshall, & Ness, 2003), posttraumatic stress disorder (PTSD; e.g., Gillespie et al., 2009;Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995), and school dropout (Beauvais, Chavez, Oetting, Deffenbacher, & Cornell, 1996). These individual level consequences culminate in considerable societal financial burden such as increased health care and mental health care utilization (Cannon, Bonomi, Anderson, Rivara, & Thompson, 2010;Kartha et al., 2008). ...
The type and severity of traumatic events differentially predict negative posttraumatic outcomes, with betrayal traumas (in which the victim is perpetrated by someone s/he trusts) touted as the most harmful. Although disclosure is considered an important component of the "healing process," nondisclosure and delayed disclosure persist. This study explored factors predicting and the context surrounding disclosure as well as the link between disclosure timing and a trauma survivor's experience with depression. Participants (N = 124) were attendees of a Mental Health Awareness event who had experienced a traumatic event. Participant report of traumatic experiences revealed that 28.2%, 36.3%, and 35.5% of participants had experienced a low betrayal (LB), medium betrayal (MB), and high betrayal (HB) trauma, respectively. Almost half (43.5%) disclosed immediately after the trauma, 32.3% disclosed within a month, and 24.2% disclosed after 1 month or more. Betrayal trauma level significantly predicted disclosure timing with individuals who had experienced HB traumas significantly more likely to delay disclosure (HB:LB, odds ratio [OR] = 21.79; MB:LB, OR = 4.57). Trauma survivors predominantly first disclosed to informal support sources (e.g., friends, family), typically citing that they thought it would allow them to feel better or they perceived the other person to be concerned about their well-being as their reason for disclosing. Experiencing a HB trauma predicted subsequent depression severity, but disclosure status was not predictive of subsequent depression. Results will be discussed with respect to implications for assessment and interventions for trauma survivors. (PsycINFO Database Record
(c) 2015 APA, all rights reserved).
... Because IPT still involves bodily violation, it may be linked to experiences of pain in specific parts of the body. 36 Over time, experiences of pain may be triggered more generally, based on the post-traumatic neurophysiological changes. 37 Another interesting finding was that a history of trauma exposure, particularly a history of IPT, appeared to increase self-reported social functioning. ...
The purpose of this cross-sectional study was to understand the prevalence and severity of health-related sequelae of traumatic exposure in a nonpsychiatric, outpatient sample.
Self-report surveys were completed by patients seeking outpatient medical (n = 123) and dental care (n = 125) at a large, urban academic medical center.
Results suggested that trauma exposure was associated with a decrease in perceptions of overall health and an increase in pain interference at work. Contrary to prediction, a history of interpersonal trauma was associated with less physical and emotional interference with social activities. A history of trauma exposure was associated with an increase in time elapsed since last medical visit. Depression and anxiety did not mediate the relationship between trauma history and medical care.
Based on these results, clinical and research implications in relation to the health effects of trauma are discussed. The results suggest that routine screening for traumatic events may be important, particularly when providers have long-term relationships with patients.
... In addition to possibly experiencing immediate physical injuries, IPV victims may also experience several long-term physical health effects as a result of their victimization. Aside from poor physical health overall (Campbell & Alford, 1989;Campbell & Soeken, 1999;Eby & Campbell, 1995), victims may also experience hypertension, chest pain, chronic pain syndrome, suppression of the immune system, fainting, and seizures (Campbell, 2002;Kendall-Tackett, Marshall, & Ness, 2003;McCauley et al., 1995). Victims also are more likely to suffer from loss of appetite or eating disorders, along with chronic irritable bowel syndrome, and pregnant victims may suffer from fetal fractures, ruptured organs, and premature labor (Coker et al., 2000;Leserman, Li, Drossman, & Hu, 1998;McFarlane, Campbell, Sharps, & Watson, 2002). ...
Studies have demonstrated a relationship between intimate partner violence (IPV) and depression and other mental health issues such as suicidal behavior and posttraumatic stress disorder. Despite the breadth of the literature, there is a dearth of information specifically regarding the effects of IPV in same-sex relationships. Information regarding the prevalence of substance abuse and health issues in non-heterosexual IPV victims when compared to heterosexual IPV victims will be extremely helpful in developing tailored victim services to sexual minorities. This study uses the National Violence Against Women Survey to examine hypothesized relationships between IPV, its effects, and sexual orientation. Given the higher prevalence rates of IPV in same-sex relationships (Messinger, 201150.
Messinger , A. ( 2011 ). Invisible victims: Same-sex IPV in the National Violence Against Women Survey . Journal of Interpersonal Violence , 26 , 2228 – 2243 . [CrossRef], [PubMed], [Web of Science ®]View all references), logistic regression models are used to test the hypotheses that non-heterosexual victims of IPV will have higher rates of depression, substance use, and health issues.
... Although the present narrative study could not show causality or give the prevalence of violence and abuse among FM patients, it could elucidate how such women interpret the causes and consequences of violence in their own context and highlight the extreme individual suffering that lies behind these experiences. Thus, the present study accords with and expands the knowledge of the impact of violence and abuse reported in several quantitative studies on FM. (Anderberg et al., 2000;Campbell, 2002;Haviland et al., 2010;Kendall-Tackett et al., 2003). ...
According to earlier research, the prevalence of violence and abuse in the life history of patients with chronic widespread pain and fibromyalgia seems to be high in comparison with other pain patients and healthy controls. The purpose of the present study was to explore how experiences of violence and abuse are expressed and reflected on and how the causes and consequences of violence are interpreted by female patients with a long history of fibromyalgia. The data were drawn from narrative interviews of 11 women who had earlier participated in a fibromyalgia-specific rehabilitation course. The findings are presented through three main themes: loss of self-esteem, physical and mental bruises, and loss of womanhood. The onset of fibromyalgia was perceived as an inevitable result of physical or mental trauma. In conclusion, the narrated life stories indicated that violence is still hidden behind a wall of silence and noninterference in our society. The devastating mental and physical consequences of violence in different forms may be carried by the individual for years, even decades. Understanding any exposure to violence that a patient has endured may help healthcare professionals to understand the individual’s health behaviour and any possible reluctance to undergo treatment and rehabilitation
... Although the present narrative study could not show causality or give the prevalence of violence and abuse among FM patients, it could elucidate how such women interpret the causes and consequences of violence in their own context and highlight the extreme individual suffering that lies behind these experiences. Thus, the present study accords with and expands the knowledge of the impact of violence and abuse reported in several quantitative studies on FM. (Anderberg et al., 2000; Campbell, 2002; Haviland et al., 2010; Kendall-Tackett et al., 2003). As Campbell (2002) emphasized, we are only beginning to understand the health risks associated with abuse and violence. ...
... The AN people's experiences appear to be constant with other ACE research. The impact of sexual abuse is known to increase the risk of multiple negative health events (23–26), which can all lead to further victimisation. Like the ACE study, research addressing sexual abuse documents that the severity of abuse correlates with the severity of symptoms and is rarely a stand-alone traumatic event (27, 28). ...
The Alaska Native (AN) population has endured multiple historical traumatic events. This population has poorer health outcomes on nearly all factors compared with Alaska non-Natives with more than 75% reportedly being physically assaulted in their lifetime, and child sexual abuse nearly 6 times the national average.
This article describes the Pathway to Hope (PTH) program, which is an indigenous approach to ending silence and denial related to child sexual abuse and encourages multigenerational healing.
PTH was developed by ANs who believe that each community is unique, thus strategies for ending denial and support for healing must be woven from the historical context, cultural strengths of individual communities. Strengths-based solutions built on truth, honesty, compassion and shared responsibility for healing and protecting today's children have been profound and successful. The PTH curriculum addresses child sexual abuse from a historical perspective; that the higher rates of sexual abuse among certain Tribes, regions and communities is linked in part to years of victimisation, but may also be perpetuated by internalised oppression and lateral violence among Tribal members.
Data suggest that community-based dialogue and wisdom of Native elders and spiritual leaders paired with readiness of community service providers are necessary for sustained change. At all levels, this Indigenous model for learning, sharing, helping and healing brings hope for an end to denial and silence about child sexual abuse for Native people.
The PTH program utilises the wisdom and values that have sustained Native people for generations. Ending silence and denial about child sexual abuse and building upon strengths have assisted many Indigenous communities begin the journey toward wellness. Through the PTH, communities have taken steps to accept the challenges associated with establishing safety for children, supporting child victims in healing and to holding offenders accountable.
... Pain is associated with more health care utilization (Plichta, 2004;Wong, Wester, Mol, Romkens, & Lagro-Janssen, 2007). Chronic pain is often reported in abused women (Humphreys et al., 2011;Kendall-Tackett, Marshall, & Ness, 2003;Wuest et al., 2010). This can be chronic low back pain, chronic headache (Humphreys et al., 2011), chronic pelvic pain (Thomas, Moss-Morris, & Faquhar, 2006), or fibromyalgia (Rubin, 2005). ...
Past studies mainly focused on the physical and structural brain injuries in women survivors with a history of intimate partner violence (IPV), but little attention has been given to the biological impact and cognitive dysfunction resulting from such psychological stress. In this article, we aim to establish the connection between IPV and the brain by reviewing current literature examining (1) the biological mechanisms linking IPV, stress, and the brain; (2) the functional and anatomical considerations of the brain in abused women; and (3) the abused women's behavioral responses to IPV, including fear, pain, and emotion regulation, by utilizing functional neuroimaging. The major significance of this study is in highlighting the need to advance beyond self-reports and to obtain scientific evidence of the neurological impact and cognitive dysfunction in abused women with a history of IPV, an area in which current literature remains at a descriptive level.
... Survivors of IPV experience multiple psychological health sequelae in addition to PTSD, MDD, and anxiety, including suicidal ideation, panic disorder, eating disorders, and substance abuse (Campbell & Lewandowski, 1997, Carbone-Lopez, Kruttschnitt, & Macmillan, 2006El-Bassel, et al., 2003;Gorde, Helfrich, Finlayson, 2004;Kelly, 2010;McNutt, Carlson, Persaud, & Postmas, 2002). Physical health problems can include physical injuries, many somatic and medically unexplained symptoms, chronic pain, (Campbell, 2002;Coker, et al., 2002;Kendall-Tackett, Marshall, & Ness, 2003;McFarlane, Groff, O'Brien, & Watson, 2006) and health risk behaviors (Kelly, 2010;Tomasulo & McNamara, 2007). As Campbell et al. (2011) noted, the cycle of violence can be perpetuated in Latino and African American communities, related to the cultural context, lack of resources, and structural oppression. ...
The mental health field lacks an array of effective interventions designed to assist women victims of intimate partner violence (IPV). Moreover, treatment modalities responsive to the needs of racially and ethnically diverse populations are under researched. This presents a significant challenge to serving ethnic minority women who are known to experience more crime, violence victimization, and psychological trauma than their dominant-ethnic group counterparts. This study integrated research and theory of trauma with current IPV literature and tested the utility of a brief trauma-based approach in reducing trauma related symptomatology in a predominantly Latina and African American clinical sample. Traumatic Incident Reduction (TIR) is a time limited intervention that seeks to resolve trauma and psychological symptoms through various memory-based methods, guided exposure techniques, and the use repetitious story-telling of traumatic event(s). By taking this approach, this research sought to add to the emerging literature on the effects of TIR in alleviating symptoms associated with trauma exposure. Treatment effects in 106 survivors of IPV were examined (age = 36, SD=9, 80.2% Latina, 19.8% African American, mean hours spent in TIR treatment M = 6.4, SD = 5.28). Paired t-tests supported the hypotheses that TIR significantly (p < .001) reduced symptoms of PTSD, anxiety, and depression and increased self-concept. Multiple regression analyses found that as the hours in TIR increased so did the participants self-concept (R2 = .179, F(4, 75) = 4.08, p = .005). Multiple regression analysis also supported the hypothesis that as the total number of crimes as a victim increased Depression increased significantly (R2 = .125, F(4, 76) = 2.72, p = .036). Chi squares and t-tests found no differences between those who remained in treatment versus those who terminated prematurely.
... For example, previous research has revealed that child abuse survivors have an increased tendency to report digestive disorders (69,70). Survivors of trauma are also more likely to report chronic pain conditions (71,72) and symptoms of genitourinary dysfunction, such as stress and urge incontinence (73). Moreover, stress is associated with the onset or exacerbation of both gastrointestinal conditions (74) and chronic pain conditions (75). ...
Background:
Daily stressors, such as an argument with a spouse or an impending deadline, are associated with short-term changes in physical health symptoms. Whether these minor hassles have long-term physical health ramifications, however, is largely unknown.
Purpose:
The current study examined whether exposure and reactivity to daily stressors is associated with long-term risk of reporting a chronic physical health condition.
Methods:
Participants (N = 435) from the National Study of Daily Experiences completed a series of daily diary interviews between 1995 and 1996 and again 10 years later.
Results:
Greater affective (i.e., emotional) reactivity to daily stressors at time 1 was associated with an increased risk of reporting a chronic physical health condition at time 2.
Conclusion:
Results indicate that how people respond to the daily stressors in their lives is predictive of future chronic health conditions.
... Thus, the present study accords with and expands the knowledge of the impact of traumatic life events reported in several quantitative studies on fibromyalgia. (Haviland et al., 2010;Kendall-Tackett, Marshall & Ness, 2003;Campbell, 2002;Anderberg et al., 2000.) In conclusion, the present study gives insights into invisible symptoms and unheard experiences, which may help us to understand the individual suffering that is associated with fibromyalgia. ...
In this article we explored narrated life stories of 20 women with a long history of fibromyalgia to reach a deeper understanding of how people interpret the causes and consequences of different life events and illness experiences. Based on narrative analysis, we identified three model narratives that illustrate the different life courses of women with fibromyalgia. In addition, we described a counternarrative that questions fibromyalgia as a chronic disease. In this narrative study, we give insights to the invisible symptoms and unheard experiences that are associated with fibromyalgia and to the ongoing discussion on the etiology and maintenance of fibromyalgia.
... Research was conducted to understand the prevalence of partner violence, the consequences of partner violence, and the cost of partner violence. This work has shown that partner violence is highly prevalent, with 22% of women experiencing abuse by a partner in their lifetime (Tjaden & Thoennes, 1998) has serious physical and psychological consequences such as chronic pain (Kendall-Tacket, Marshall, & Ness, 2003), irritable bowel syndrome (Drossman, Lesserman, Toomey, & Hu, 1996), and various gynecological and reproductive health consequences (Campbell et al., 2002) costs approximately 5.8 billion per year in healthcare costs and lost productivity (National Center for Injury Prevention and Control, 2003). ...
There is growing consensus that preventing partner violence requires interventions that begin before partner violence begins. In recent years, a number of evaluations of primary prevention programs targeting partner violence have been published. This article presents a systematic review of recent interventions for primary prevention of partner violence. A total of 11 programs met inclusion criteria for the review. All 11 studies used some combination of feminist theory and social learning theory as a basis for the intervention. All targeted middle- or high-school aged students, and all but one were set in a school setting and were universal interventions (i.e., were not targeted to an at risk group). Interventions tended to be brief, with only two using interventions totaling more than 5 h in duration. Although a majority of studies were randomized trials, study quality was generally poor due to relatively short follow-up periods, high attrition rates, and poor measurement. Of the four studies that measured behavior, two found a positive intervention impact. Those two studies had the most comprehensive interventions, using both individual-level curricula and other community-based interventions. Both also employed rigorous designs. Conclusions about the overall efficacy of dating violence interventions are premature, but such programs are promising. We discuss recommendations regarding the content and evaluation of dating violence prevention programs.
... Victims of IPV experience multiple psychological health sequelae in addition to PTSD, MDD, and anxiety, including suicidal ideation, panic disorder, eating disorders, and substance abuse (Campbell & Lewandowski, 1997;Carbone-Lopez et al., 2006;El-Bassel et al., 2003;Gorde et al., 2004;McNutt et al., 2002). Physical health problems include physical injuries, many somatic and medically unexplained symptoms, chronic pain (Campbell, 2002;Coker et al., 2002;Kendall-Tackett, Marshall, & Ness, 2003;McFarlane et al., 2006), and health risk behaviors (Tomasulo & McNamara, 2007). Shetterly et al. (1996) found that Hispanics are 3.4 times more likely to report poor or fair health status than whites. ...
The purpose of this study was to describe symptoms of PTSD and major depression in abused Latinas and to explore the relationships among intimate partner violence (IPV) experiences, these symptoms, and health related quality of life (HRQOL). The rate of PTSD was 69.7% and of major depressive disorder (MDD) was 57.6%. The comorbidity of PTSD and MDD was 54.5%. PTSD and MDD were not consistently correlated with IPV, although some significant relationships were found. PTSD and MDD symptoms were highly correlated with HRQOL. The impact of PTSD and MDD on psychological well-being and functioning in Latinas needs further investigation.
... Flowe-Valencia, Rosenblum, & Tait, 2001;Kendall-Tackett, 2001;Kendall-Tackett, Marshall, & Ness, 2003), pelvic pain and vulvodynia (Harlow & Stewart, 2005;Lampe et al., 2003;Latthe, Mignini, Gray, Hills, & Khan, 2006), fibromyalgia (Boisset-Pioro, Esdaile, & Fitzcharles, 1995), chronic musculoskeletal pain (Kopec & Sayre, 2004), headache (Golding, 1999), and irritable bowel syndrome and gastrointestinal illnesses (Drossman et al., 2000;Leserman, 2005;Leserman et al., 1996;Talley, Fett, & Zinsmeister, 1995). Similarly, epidemiological studies have documented that several painful medical conditions (e.g., painful gynecological problems, headaches, arthritis, musculature pain, tender-point pain, back pain, and generally distressing physical symptoms) are more common among abuse survivors (Golding, 1994(Golding, , 1999Goodwin et al., 2003;Linton, 2002;McBeth, Macfarlane, Benjamin, Morris, & Silman, 1999;Romans et al., 2002). ...
The current article reviews recent research demonstrating the relationship between childhood physical and sexual abuse and adult health problems. Adult survivors of childhood abuse have more health problems and more painful symptoms. We have found that psychiatric disorders account for some, but not all, of these symptoms, and that current life stress doubles the effect of childhood abuse on health problems. Possible etiologic factors in survivors' health problems include abuse-related alterations in brain functioning that can increase vulnerability to stress and decrease immune function. Adult survivors are also more likely to participate in risky behaviors that undermine health or to have cognitions and beliefs that amplify health problems. Psychiatric disorders, although not the primary cause of difficulties, do have a role in exacerbating health and pain-related problems. We conclude by outlining treatment recommendations for abuse survivors in health care settings.
... Abuse survivors can also suffer from chronic pain in other parts of the body. Abuse has been related to chronic or recurring headaches, pelvic pain, back pain, or more generalized pain syndromes (Kendall-Tackett, Marshall & Ness, 2003). These findings have been true for both survivors of childhood abuse and for those abused as adults. ...
In the 20 years since the founding of the Journal of Interpersonal Violence, there have been exciting new discoveries on the long-term physical health effects of family violence. As exciting as these discoveries have been, we still know little about why the experience of family violence makes people sick. Some of the most promising areas of study on this topic will be in neuroscience, sleep studies, and cognitive variables such as hostility. Once we understand mechanisms, we can design interventions that can ameliorate these effects.
... Head injury is an often unrecognized form of injury to women who are exposed to IPV (Jackson, Philp, Nuttall, & Diller, 2002). Chronic pain syndromes are found more commonly in women who have experienced domestic violence and child abuse than controls (Kendall-Tackett, Marshall, & Ness, 2003). Violence and abuse during pregnancy may also result in detrimental health outcomes to a mother and child including low birth weight; fetal death by placenta abruption; antepartum hemorrhage; fetal fractures; rupture of the uterus, liver, or spleen; and premature labor (Bullock, 1989;Huth-Bocks, Levendosky, & Bogat, 2002;McFarlane, Campbell, Sharps, & Watson, 2002;McFarlane, Parker, & Soeken, 1995;Saltzman, 1990;Torres et al., 2000). ...
The high prevalence of adverse health outcomes related to intimate partner violence (IPV) is well documented. Yet we know little about the pathways that lead to adverse health outcomes. Research concerning the psychological, biological, neurological, behavioral, and physiological alterations following exposure to IPV--many of which are associated with posttraumatic stress disorder (PTSD)--represents a promising area of empirical discovery. New technologies and interdisciplinary collaborative efforts are required to integrate diverse methodologies and to apply new findings to improving the health and well being of those affected by IPV. This article focuses on victimization by IPV and addresses the most important research findings in the last 20 years (health and mental health burden of IPV), the most important research issue for the next decade (pathways between IPV and adverse health outcomes), and the most promising methodological innovation for the study of IPV (integrated, interdisciplinary, biobehavioral methodology).
Background: Chronic pain, one of the leading causes of suffering and disability worldwide, is becoming an important field in medical as well as behavioural sciences. A variety of chronic pain syndromes lie on the spectrum of medically unexplained syndromes, causing dysfunction and reduced quality of care. Because of its multi-faceted nature, involving physiological, psychological and social factors, chronic pain warrants extensive research to understand and guide comprehensive interventions. Materials and Methods: A cross sectional, exploratory, comparison group research design was employed. Sixty participants were recruited through invitation on social media platforms as well as from the pain clinic in a tertiary care hospital of North India, which were allocated to the primary chronic pain (n=30) and secondary chronic pain (n=30) groups as per the inclusion/ exclusion criteria. Telephonic interview was conducted with the consenting participants and Trauma antecedent's questionnaire, Toronto alexithymia scale (Hindi) and Short Form-36 were administered with eligible participants in both the groups. Results: Significant differences were found in the two groups on age, marital status, and number of pain locations, reporting of fatigue, lack of freshness after sleep and depressed mood/irritability. Results revealed significant differences on measures of trauma antecedents, alexithymia and quality of life between primary chronic pain group and secondary chronic pain group (p< 0.05). Conclusions: Primary chronic group showed higher levels of trauma exposure, emotional regulation as well as lower quality of life as compared to secondary chronic pain group.
The World Mental Health Surveys were established by the World Health Organization in 2000 to provide valuable information for physicians and health policy planners. These surveys have shed light on the prevalence, correlates, burden, and treatment of mental disorders in countries throughout the world. This volume focuses on the epidemiology of coexisting physical and mental illness around the world. This book includes surveys from 17 discrete countries on six continents, covering epidemiology, risk factors, consequences, and implications for research, clinical work, and policy. Many physical and mental illnesses share a relationship with one another and often occur simultaneously. Clinicians from the disciplines of both psychiatry and medicine are increasingly faced with both challenges on a daily basis, making this an ideal book for a wide range of health professionals. This is the first book devoted to this topic on such a wide-ranging scale.
Objectives
Native Hawaiians (NH) report higher rates of interpersonal trauma in childhood or adolescence (ITCA) as well as higher rates of chronic physical illness and psychopathology. Given that physical activity (PA) has positive impacts on physical and mental health, it may also serve as a protective factor in the development of poor health outcomes in adulthood following ITCA. The present study investigated what factors contribute to wellbeing and transdiagnostic posttraumatic sequelae for individuals with exposure to ITCA using a dataset from a longitudinal study cohort (n = 989) of ethnically diverse older individuals (mean age = 60) in Hawaiʻi.
Methods
Five univariate general linear models were used to explore the unique effects of: PA; ITCA level; NH status; interactions with ITCA level; and interactions with NH status on the dependent variables: posttraumatic sequelae (i.e., dissociation, avoidance, interpersonal difficulty) and aspects of wellbeing (i.e., satisfaction with life [SWL], self-rated health).
Results
PA was a significant predictor of SWL, self-rated health, and dissociation, while exposure to ITCA predicted SWL. NH group status interacted with PA to uniquely predict dissociation. Exposure to ITCA differentially predicted SWL.
Conclusions
Findings support prior evidence that processes in posttraumatic experience are significantly associated with poor health-promoting behaviors (e.g., PA). Additionally, for NHs, PA may reduce dissociation, or levels of dissociation already present in the NH group may play a role in disengagement from PA. Future research should consider whether PA holds benefits across trauma types (e.g., historical trauma), or if culturally based PA is differentially more protective.
CİNSEL İSTİSMAR MAĞDURU KIZ ÇOCUKLARIN
UMUTSUZLUK DÜZEYİ İLE SALDIRGAN TUTUMLARI
ARASINDAKİ İLİŞKİ
(Güneydoğu Anadolu Bölgesi Örneği)
Objective: In this study, it was aimed to investigate the effect of domestic physical violence with clinical features of depression, anxiety levels and pain severity in female cases who applied to the physical therapy and rehabilitation outpatient clinic and diagnosed with fibromyalgia. Material and Method: The sample is constituted by 34 female patients who applied with pain to the physical therapy and rehabilitation outpatient clinic of a state hospital in Siirt, and diagnosed with fibromyalgia according to American College of Rheumatology 2010 criteria. Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Visual Analog Scale which evaluate pain severity and a clinical interview form for domestic physical violence were applied to cases. Results: Domestic physical violence was found to be 29.4% during childhood and 38.2% during adulthood. Significantly negative relationship was detected between pain severity and age at marriage (r=-0.514, p=0.002) as well as education level (r=-0,143, p=0.002). Domestic physical violence in marriage was found to be significantly related with pain severity (p<0.001). Significantly negative relationship was detected between HAM-D (r=-0.510, p=0.002), HAM-A (r=-0.407, p=0.017) and age at marriage. A significant relationship was found between HAM-D (p<0.001), HAM-A (p=0.002) and physical violence in marriage. A positive correlation between pain severity and HAM-D (r=0.561, p=0.001) and HAM-A (r=0.420, p=0.013) was found. A significant positive correlation was found between HAM-D and HAM-A scores (p<0.001 r=0.793). Conclusion: Domestic physical violence was found to be related with pain severity and symptoms of depression and anxiety in our sample. Anxiety and depression levels were related with pain severity. Therefore during the treatment and follow up of fibromyalgia patients, investigation of domestic violence and evaluation of comorbid symptoms of anxiety and depression might be useful.
Chronic pain affects every facet of a patient's life, and nowhere is this more evident than in the complex arena of family life. Chronic Pain and Family: a Clinical Perspective examines typical family issues associated with prolonged illness, offering realistic ways to approach them in therapy. Informed by current practice and his own experience, noted author/clinician Ranjan Roy brings fresh insights to common pain scenarios and therapeutic impasses, and provides a framework for assessing marital and family relationships when chronic pain is a defining factor. Clinicians will get not only a clearer understanding of sensitive issues, but also effective strategies for engaging clients without turning them off. Coverage includes: Meanings of pain in relationships "Who Does What?": exploring changes in family roles Resistance to treatment: why it occurs and how to work through it Health concerns and other burdens on well spouses and children Sexuality, domestic abuse, and other "silent" issues Case examples demonstrating therapy step-by-step with a range of couples and families For therapists and social workers who deal with this growing population of patients, Chronic Pain and Family: A Clinical Perspective stands at a unique intersection of pain/disability and family resources. Roy's recognition of the family's changing demographics together with his synthesis of clinical knowledge make the book suitable for graduate-level courses as well. © 2006 Springer Science+Business Media, Inc. All rights reserved.
People who have experienced traumatic events have higher rates than the general population of a wide range of serious and life-threatening illnesses including cardiovascular disease, diabetes, gastrointestinal disorders, and cancer. An important question, for both researchers and clinicians, is why this occurs. Researchers have discovered that traumatic events dysregulate the hypothalamic-pituitary-adrenal axis and sympathetic nervous system. More recently, research from the field of psychoneuroimmunology (PNI) suggests that traumatic life events can lead to health problems through dysregulation of another key system: the inflammatory response. Prior trauma “primes” the inflammatory response system so that it reacts more rapidly to subsequent life stressors. Elevated inflammation has an etiologic role in many chronic illnesses. Recent PNI studies also suggest some interventions that can serve as adjuncts to traditional trauma treatment. These treatments include long-chain omega-3 fatty acids, exercise, and sleep interventions. Each of these interventions downregulates inflammation, which will likely halt the progression to chronic disease for some trauma survivors. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
IntroductionChronic Pain Syndromes in AdultHigher Patterns of Health-Care UseWhy Child Sexual Abuse Makes People SickConclusions
For women, any one type of abuse rarely occurs in isolation of other types, and a single abusive experience is often the exception rather than the norm. The importance of this concept of the cumulative nature of abuse and its negative impact on health has been well recognized within the empirical literature, however there has been little consensus on what to call this phenomenon or how to study it. For the most part researchers have operated on the premise that it is the sheer number of different types of cumulating abuse experiences that is primarily responsible for worse health outcomes among women. And although this simplistic 'more is worse' approach to conceptualizing and operationalizing cumulative abuse has proven to be a powerful predictor of poorer health, it contradicts growing empirical evidence that suggests not all victimizations are created equal and that some victimizations may have a more deleterious effect on health than others. Embedded in abuse histories are individual and abuse characteristics as well as other life adversities that need to be considered in order to fully understand the spectrum and magnitude of cumulative abuse and its impact on women's health. Furthermore, given the long-term and persistent effects of abuse on health it becomes imperative to not only evaluate recent abusive experiences, but rather all abuse experiences occurring across the lifespan. This review highlights and evaluates the conceptual, operational, and methodological challenges posed by our current methods of studying and understanding the phenomenon of cumulative abuse and suggests that this phenomenon and its relationship to health is much more complex than research is currently portraying. This paper calls for the urgent need for interdisciplinary collaboration in order to more effectively and innovatively study the phenomenon of cumulative abuse.
Although associations between intimate partner violence, chronic pain, depression, posttraumatic stress disorder (PTSD), and lifetime trauma exposure are well known, previous studies are limited by their recruitment of women from shelters. These relationships were explored with a community-based sample of formerly abused women ( N = 84). Seventy-seven percent of women reported pain of >3 months duration, and 75% had moderate to severe pain. Based on logistic regression analysis, women with moderate to severe chronic pain were significantly less likely to be employed, had more depressive symptoms, and were in the abusive relationship longer than women in mild chronic pain. Both pain severity groups had equally high levels of depressive and PTSD symptoms and multiple trauma exposures. Findings document the persistence of significant symptomatology in formerly abused women.
This study examined linkages between physical and psychological violence in childhood from parents and three dimensions of adult health (self-rated health, functional limitations, chronic conditions).
Regression models were estimated using data from the 1995 and 2005 waves of the National Survey of Midlife in the U.S. Responses to an adapted version of the Conflict Tactics Scales in 1995 were used to code respondents into one of nine profiles of violence distinguished by types and frequency of violence.
Reports of both frequent physical and frequent psychological violence were associated with poorer health at baseline across the three dimensions of health, as well as with more severe declines in health across all three dimensions over the 10-year study period.
Results suggest that having experienced frequent physical and psychological violence in childhood is a risk factor for poorer adult health status and declining trajectories of health throughout adulthood.
Do traumatic events increase the risk of health problems? Over the past decade, researchers in a number of fields—health psychology, medicine, nursing, epidemiology, and public health—have found that they do. In the early stages of this work, researchers worked independently and did not communicate with one another, which limited the application of their findings. For example, researchers in nursing and several fields of medicine— gynecology, gastroenterology, rheumatology—began to notice, quite inde- pendently, that patients with pain often had a history of child or domestic abuse (Kendall-Tackett, Marshall & Ness, 2003; Sachs-Ericsson, Cromer, Hernandez, & Kendall-Tackett, this issue). Unfortunately, for many years these findings were discounted because the pain syndromes were usually so-called functional conditions (such as irritable bowel syndrome or fibro- myalgia), meaning that lab or radiologic findings rarely matched a patient's level of pain or impairment from that pain. Because these findings were not placed in a broader context, symptoms were viewed as idiosyncratic, written off as primarily psychological in origin, and were generally not of interest to health care providers.
To improve understanding of the complex dynamics in intimate partner violence (IPV) in heterosexual relationships, we explored violence and substance use among the female partners of men entering treatment for both IPV and substance-related problems. All male participants (n = 75) were alcohol dependent and had at least one domestic-violence arrest. Results showed that female partners were as likely as men to engage in substance use the week before treatment; however, according to reports by the men, the female partners were more likely than men to use substances during the last week of treatment, due to a reported increase in use during the men's treatment. Regarding violence, 59 percent of female IPV victims reported engaging in some form of mild violence against their male partners, and 55 percent reported engaging in some form of severe violence. By contrast, only 23 percent of male batterers reported that their female partners had engaged in mild violence, and only 19 percent reported that their partners had engaged in severe violence. Regardless of whether the violence was defensive in nature, the data suggest that women in relationships involving substance abuse and IPV are in need of treatment. Implications of these findings are discussed.
This article presents a case study of a 39-year-old European American married woman with a history of child and adolescent incest,marital rape, and physical abuse from her husband for more than 10 years. She was referred to a pain clinic for treatment of headaches and Tourette's syndrome. The client was evaluated with the Ackerman-Banks Neuropsychological Rehabilitation Battery to identify neuropsychological strengths and weaknesses. The Vulnerability to Stress Audit was used to identify life events that were positively and negatively influencing her life. The client was treated for mild traumatic brain injury, post-traumatic stress disorder,cognitive difficulties, impulsivity, confabulation, low frustration tolerance, and inability to evaluate and make decisions about socially appropriate behaviors. Treatment involved traditional psychotherapy, hypnosis, cognitive rehabilitation, biofeedback training, electromyography, finger temperature, and blood pressure.
In the current study we sought, first, to distinguish associations with health arising from types of trauma as indicated by betrayal trauma theory (Freyd, 1996, 2001), and, second, to investigate the impact of disclosing a trauma history in survey form and/or writing essays about betrayal traumas. We recruited 99 community adults reporting at least 12 months of chronic medical illness or pain, 80 of whom completed all four sessions of this six-month longitudinal intervention study. Participants were randomly assigned to write about betrayal traumas or neutral events, and they were randomly assigned to complete an extensive trauma survey or a long personality inventory, producing four groups of participants. All 99 participants were assessed at their initial visit for trauma history using the Brief Betrayal Trauma Survey (BBTS) and physical and mental symptoms. The BBTS assesses exposure to both traumas high in betrayal (such as abuse by a close other) and traumas low in betrayal but high in life-threat (such as an automobile accident). Exposure to traumas with high betrayal was significantly correlated with number of physical illness, anxiety, dissociation, and depression symptoms. Amount of exposure to other types of traumas (low betrayal traumas) did not predict symptoms over and above exposure to betrayal trauma. While neither the survey manipulation nor the writing intervention led to main effects on change in symptoms over time, there were interactions between betrayal trauma history and condition such that participants with many betrayal traumas fared better in the control conditions while participants with fewer betrayal traumas had better outcomes if they were placed in the trauma writing and/or survey conditions. We discuss ongoing and future research aimed at evaluating the role of increased structure in writing assignments as beneficial for those with severe histories of betrayal trauma.
This research evaluated the relationship between pain and sleep problems, and the role of pain and sleep problems in depression, in a sample of 242 patients who had been diagnosed with definite or classical rheumatoid arthritis (RA). Patients completed the Pain scale of the Arthritis Impact Measurement Scales, the Center for Epidemiological Studies Depression Scale, and self-reports of sleep disturbance at two data waves over a 2-year interval. Cross-sectional multiple regression analysis revealed that the sleep problems variable was independently associated with depression at Time 1. Longitudinal multiple regression analyses demonstrated that prior pain predicted subsequent adverse changes in sleep problems, whereas sleep problems did not affect pain over time, and prior pain and the interaction of high pain and high sleep problems were independently associated with depression from Time 1 to Time 2. These data suggest that pain may exacerbate sleeping difficulty in RA patients, and that both factors may contribute to depression over time.
To determine the prevalence of a history of sexual and physical abuse in women seen in a referral-based gastroenterology practice, to determine whether patients with functional gastrointestinal disorders report greater frequencies of abuse than do patients with organic gastrointestinal diseases, and to determine whether a history of abuse is associated with more symptom reporting and health care utilization.
A consecutive sample of women seen in a university-based gastroenterology practice over a 2-month period was asked to complete a brief questionnaire.
The self-administered questionnaire requested information about demographics, symptoms, health care utilization, and history of abuse. Physicians indicated the primary diagnosis for each patient and whether she had ever discussed having been sexually or physically abused.
Of 206 patients, 89 (44%) reported a history of sexual or physical abuse in childhood or later in life; all but 1 of the physically abused patients had been sexually abused. Almost one third of the abused patients had never discussed their experiences with anyone; only 17% had informed their doctors. Patients with functional disorders were more likely than those with organic disease diagnoses to report a history of forced intercourse (odds ratio, 2.08; 95% CI, 1.03 to 4.21) and frequent physical abuse (odds ratio, 11.39; CI, 2.22 to 58.48), chronic or recurrent abdominal pain (odds ratio, 2.06; CI, 1.03 to 4.12), and more lifetime surgeries (2.7 compared with 2.0 surgeries; P less than 0.03). Abused patients were more likely than nonabused patients to report pelvic pain (odds ratio, 4.05; CI, 1.41 to 11.69), multiple somatic symptoms (7.1 compared with 5.8 symptoms; P less than 0.001), and more lifetime surgeries (2.8 compared with 2.0 surgeries; P less than 0.01).
We found that a history of sexual and physical abuse is a frequent, yet hidden, experience in women seen in referral-based gastroenterology practice and is particularly common in those with functional gastrointestinal disorders. A history of abuse, regardless of diagnosis, is associated with greater risk for symptom reporting and lifetime surgeries.
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.
The sample included 239 female patients from a referral gastroenterology clinic who were interviewed to assess sexual and physical abuse history.
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.
The authors conclude that asking about abuse should be integrated into history taking within referral-based gastroenterology practices.
We describe those sensations that are unpleasant, intense, or distressing as painful. Pain is not homogeneous, however, and comprises three categories: physiological, inflammatory, and neuropathic pain. Multiple mechanisms contribute, each of which is subject to or an expression of neural plasticity-the capacity of neurons to change their function, chemical profile, or structure. Here, we develop a conceptual framework for the contribution of plasticity in primary sensory and dorsal horn neurons to the pathogenesis of pain, identifying distinct forms of plasticity, which we term activation, modulation, and modification, that by increasing gain, elicit pain hypersensitivity.
During the past 10 years, researchers have documented how trauma--especially severe trauma--can alter the functioning of the brain. In some cases, these alterations create a state of chronic hyperarousal. The present review serves as an introduction to this research.
Persons who have experienced traumatic events are often "primed" to over-react to subsequent stressors, making them more vulnerable to these events.
Chronic hyperarousal underlies three common and often co-occurring sequelae of childhood abuse: post-traumatic stress disorder (PTSD), depression, and irritable bowel syndrome. Knowledge of these physiological correlates can affect treatment decisions as well as our theories about the mechanisms underlying the development of symptoms.
The long-term consequences of criminal victimization on physical health were examined among 390 adult women (74 nonvictims and 316 victims of crime). Data included health status self-ratings and objective service utilization. Findings indicated that severely victimized women, compared with nonvictims, reported more distress and less well-being, made physician visits twice as frequently in the index year, and had outpatient costs that were 2.5 times greater. Criminal victimization severity was the most powerful predictor of physician visits and outpatient costs. Utilization data across 5 years preceding and following crime were obtained from 15 rape victims, 26 physical assault victims, and 27 noncontact crime victims and were compared with five continuous years of utilization among 26 nonvictims. Victims' physician visits increased 15% to 24% during the year of the crime compared with less than 2% change among nonvictims. We conclude that these long-term deleterious effects suggest that criminally victimized women's needs for medical treatment transcend the traditional focus on emergency care and forensic evaluation.(Arch Intern Med. 1991;151:342-347)
Purpose: To examine possible relations between childhood sexual abuse and women's medical problems. Data sources: Potential articles were retrieved by searching Medline and Psychlit databases using keywords which included incest, sexual abuse and assault, pain, alcohol and substance abuse, eating disorders, anorexia, bulimia, and obesity. Additional references were identified from bibliographies of these articles, from textbooks
on child sexual abuse, and by experts in these fields. Study selection: Only those case series, case-control studies, and population-based surveys that were published in peer-reviewed journals were included. Results: Although available literature is sparse and many studies lack methodological rigor, data suggest that a history of sexual abuse in childhood is common in women with a history of chronic pain (especially pelvic pain), functional bowel disorders, eating disorders, obesity, and alcohol abuse. Conclusions: Given the high prevalence of sexual abuse of girls and its possible relation to common medical problems often refractory to treatment, further research is needed both to substantiate associations and to guide therapies.
PURPOSE: Patients with fibromyalgia have been reported to display high rates of several concomitant medical and psychiatric disorders, including migraine, irritable bowel syndrome, chronic fatigue syndrome, major depression, and panic disorder. To test further these and other possible associations, we assessed the personal and family histories of a broad range of medical and psychiatric disorders in patients with fibromyalgia. PATIENTS AND METHODS: Subjects were 33 women (mean age 42.1 years) who each met American College of Rheumatology criteria for fibromyalgia and presented to a rheumatologist at a tertiary referral center. They received the Structured Clinical Interview for DSM-III-R (SCID); a supplemental interview, in SCID format, for other medical and psychiatric disorders, including migraine, irritable bowel syndrome, and chronic fatigue syndrome; and an interview for family history of medical and psychiatric disorders. RESULTS: Patients with fibromyalgia displayed high lifetime rates of migraine, irritable bowel syndrome, chronic fatigue syndrome, major depression, and panic disorder. They also exhibited high rates of familial major mood disorder. CONCLUSIONS: The finding that migraine, irritable bowel syndrome, chronic fatigue syndrome, major depression, and panic disorder are frequently comorbid with fibromyalgia is consistent with the hypothesis that these various disorders may share a common physiologic abnormality.
Twenty-five women with chronic pelvic pain who had undergone diagnostic laparoscopy and 30 women who had laparoscopic examinations for tubal sterilization or infertility investigation were compared psychologically using structured psychiatric and sexual abuse interviews. Results of the fiberoptic pelvic examination were rated independently using the American Fertility Society classification of endometriosis. Compared with controls, the patients with chronic pelvic pain showed significantly greater prevalence of lifetime major depression, current major depression, lifetime substance abuse, adult sexual dysfunction, and somatization. They were also significantly more likely than controls to have been a victim of childhood and adult sexual abuse. There were no significant differences in either the degree or type of pelvic disease between patients with pelvic pain and controls.
(C) 1988 The American College of Obstetricians and Gynecologists
Objective:
To determine the prevalence of sexual and physical abuse in female patients with fibromyalgia syndrome (FMS), as compared with rheumatic disease control patients.
Methods:
Eighty-three female FMS patients and 161 consecutive female rheumatology (non-FMS) control patients answered a standardized confidential questionnaire recording previous sexual and physical abuse, drug and alcohol abuse, and eating disorders. Demographic information was collected on age, education, economic status, and cultural group.
Results:
Overall abuse was greater in FMS patients than in control patients (53% versus 42%; P not significant). Significant differences were observed for lifetime sexual abuse (17% versus 6%), physical abuse (18% versus 4%), combined physical and sexual abuse (17% versus 5%), and drug abuse (16% versus 3%). There was a trend toward a higher incidence of childhood sexual abuse (37% versus 22%) and of eating disorders (10% versus 3%) in the FMS patient group.
Conclusion:
A high frequency of sexual abuse was identified both in control patients and in FMS patients. A statistical association was demonstrated between FMS and the frequency and severity of sexual abuse, and the frequency of physical abuse and drug abuse. These results raise the possibility that abuse may have an effect upon the expression and perpetuation of FMS in adult life.
In a retrospective study of 86 patients who underwent lumbar spine surgery, patients who had three or more of a possible five serious childhood psychological traumas (risk factors) had an 85% likelihood of an unsuccessful surgical outcome. Conversely, in patients with a poor surgical outcome, the incidence of these traumas was 75%. In the group of 19 patients with no risk factors, there was only a 5% incidence of failure. This study shows that a highly significant correlation exists between unsuccessful lumbar spine surgery and a history of childhood traumas. Although recognition of predictors for unsuccessful outcome can be useful in avoiding surgery in patients whose indications for surgery are borderline, the greater challenge is to help the patient who, despite being at high psychological risk for negative outcome, has severe spinal pathology that will likely require surgery. In such cases, psychiatric treatment is critical. In the group of 19 patients with no risk factors, single-level laminectomies and discectomies were performed on 6 patients. The other 13 cases were complex, involving a combination of repeat surgeries (n = 4) fusions (n = 3), and/or multilevel laminectomies and discectomies (n = 11).
Patients with fibromyalgia have been reported to display high rates of several concomitant medical and psychiatric disorders, including migraine, irritable bowel syndrome, chronic fatigue syndrome, major depression, and panic disorder. To test further these and other possible associations, we assessed the personal and family histories of a broad range of medical and psychiatric disorders in patients with fibromyalgia.
Subjects were 33 women (mean age 42.1 years) who each met American College of Rheumatology criteria for fibromyalgia and presented to a rheumatologist at a tertiary referral center. They received the Structured Clinical Interview for DSM-III-R (SCID); a supplemental interview, in SCID format, for other medical and psychiatric disorders, including migraine, irritable bowel syndrome, and chronic fatigue syndrome; and an interview for family history of medical and psychiatric disorders.
Patients with fibromyalgia displayed high lifetime rates of migraine, irritable bowel syndrome, chronic fatigue syndrome, major depression, and panic disorder. They also exhibited high rates of familial major mood disorder.
The finding that migraine, irritable bowel syndrome, chronic fatigue syndrome, major depression, and panic disorder are frequently comorbid with fibromyalgia is consistent with the hypothesis that these various disorders may share a common physiologic abnormality.
The long-term consequences of criminal victimization on physical health were examined among 390 adult women (74 nonvictims and 316 victims of crime). Data included health status self-ratings and objective service utilization. Findings indicated that severely victimized women, compared with nonvictims, reported more distress and less well-being, made physician visits twice as frequently in the index year, and had outpatient costs that were 2.5 times greater. Criminal victimization severity was the most powerful predictor of physician visits and outpatient costs. Utilization data across 5 years preceding and following crime were obtained from 15 rape victims, 26 physical assault victims, and 27 noncontact crime victims and were compared with five continuous years of utilization among 26 nonvictims. Victims' physician visits increased 15% to 24% during the year of the crime compared with less than 2% change among nonvictims. We conclude that these long-term deleterious effects suggest that criminally victimized women's needs for medical treatment transcend the traditional focus on emergency care and forensic evaluation.
One hundred thirty-one patients who gave a history of childhood sexual abuse were seen in a general medical practice decades after the event and were compared with a control group. The subject patients were found to be distinct for chronic depression, morbid obesity, marital instability, high utilization of medical care, and certain psychosomatic symptoms, particularly chronic gastrointestinal distress and recurrent headaches. It is clear that these remote events can underlie difficult chronic medical problems. Questions about childhood sexual abuse must become part of the practitioner's review of systems in these difficult cases, if not routinely.
The aim of the study was to see whether adults who had been sexually abused in childhood were vulnerable to physical symptoms and therefore investigation and intervention. The case histories of seven patients who were aged 22-39, were under the care of three consultant psychiatrists, had experienced childhood sexual abuse, and had a history of medical or surgical intervention were surveyed. The patients had had a mean of 18 contacts with non-psychiatric consultant teams and a mean of eight operations, with a high rate (66-70%) of normal findings. They had experienced many somatic symptoms, which led to investigations and interventions in the specialties of gynaecology, obstetrics, gastroenterology, urology, rheumatology, haematology, orthopaedics, neurology, and neuropsychiatry. The history of childhood sexual abuse was recognised only in the later stages of this medical and surgical intervention. The possibility of childhood sexual abuse should be considered earlier in such cases to prevent further unnecessary intervention.
To determine the prevalence of sexual abuse in women diagnosed as having fibromyalgia (FM) compared with controls.
A self-administered questionnaire designed to obtain information regarding demographics, health care utilization, and history of sexual and physical abuse was completed by 40 women with FM and by 42 women who had no evidence of connective tissue disease or other major medical condition.
Women with FM reported more physical symptoms and were significantly different on multiple indices of health compared with controls. Twenty-six FM subjects (65%) reported sexual abuse, in comparison with 22 controls (52%). The prevalence and type of abuse were not significantly different between groups. Sexually abused FM subjects reported significantly more symptoms than did non-sexually abused FM women, but did not differ in the number of symptoms for which they sought medical treatment.
Sexual abuse does not appear to be a specific factor in the etiology of FM, but is correlated with the number and severity of associated symptoms.
A link between functional bowel disease and sexual, physical, emotional, or verbal abuse remains controversial. We aimed to determine whether abuse is associated with functional bowel disease in outpatients.
A consecutive sample of outpatients completed a validated questionnaire; 997 responded. Using standard criteria, we obtained data on symptoms, psychosocial factors, and abuse (sexual, physical, and emotional or verbal). Logistic regression analysis was used to determine whether abuse was associated with functional bowel disease (versus organic disease) and with irritable bowel syndrome (IBS)-type symptoms defined by the Manning criteria. Adjustments were made for age, gender, marital status, education level, psychological distress, and social support.
Of those with a physician-based diagnosis of functional bowel disease (n = 440), 22% reported some form of abuse (13% sexual and/or physical abuse), compared with those with organic disease (n = 557), 16% of whom reported some form of abuse; this difference was not significant. However, abused patients were significantly more likely to report IBS-type symptoms than those who did not report a history of abuse (odds ratio = 1.7, 95% confidence interval = 1.2, 2.5).
Outpatients who report abuse are more likely to have IBS-type symptoms.
A link between abuse and irritable bowel syndrome (IBS) has been reported in outpatients but remains controversial. No population-based studies have investigated this issue. The aim of this study was to determine the prevalence of abuse and its association with symptoms in a representative community sample.
An age- and sex-stratified random sample of residents of Olmsted County, Minnesota ranging in age from 30 to 49 years was mailed a valid self-report symptom questionnaire. Abuse was assessed by standard published criteria.
Of the 919 responders (74%), the age-adjusted prevalence of any abuse was 41% in women and 11% in men, resulting in an age- and sex-adjusted prevalence of 26%. Symptoms of IBS, dyspepsia, and frequent heartburn were reported by 14%, 23%, and 12%, respectively. There was a significant association between IBS and sexual abuse, emotional or verbal abuse, and abuse in childhood and adulthood. Similarly, dyspepsia and heartburn were both significantly associated with abuse. In the population, 31% had visited a physician for gastrointestinal symptoms; the odds of visiting a physician were highest in those reporting abuse in adulthood and childhood.
Self-reported abuse is common in middle-aged subjects; those who report abuse are more likely to have symptoms consistent with IBS, dyspepsia, or heartburn and to visit a physician for bowel symptoms.
To assess the potential role of childhood and adulthood physical and sexual abuse and complaints of chronic pain in accounting for psychiatric symptomatology in adult women.
We assessed sexual abuse, physical abuse, depression, anxiety, and somatization in 64 women with chronic pelvic pain, 42 women with chronic headache, and 46 women without chronic pain complaints. Using multiple regression analyses, we tested a model comprising sociodemographic, chronic pain, childhood sexual abuse and physical abuse, and adulthood sexual abuse and physical abuse variables in the prediction of depression, anxiety and somatization.
This model significantly predicted all three outcomes. However, childhood sexual abuse was not significant in the prediction of any of the outcome variables, whereas childhood physical abuse was significant in the prediction of all three. Further, the adulthood abuse variable set contributed significantly to the prediction of somatization, and the individual variable of adulthood sexual abuse was predictive of anxiety.
The relation observed between childhood sexual abuse and the outcomes of depression, anxiety, and somatization in women may be a function of its association with other forms of abuse, particularly childhood physical abuse. Further investigation is clearly needed of the nature of the relations between the various categories of abuse and psychological morbidity.
To compare the prevalences of childhood and adult physical and sexual abuse in women with chronic pelvic pain to those in women with chronic nonpelvic pain (headache) and pain-free women.
Using a structured interview, we assessed the prevalence rates of both sexual abuse and physical abuse in 64 women with chronic pelvic pain, 42 women with chronic headache, and 46 pain-free women. Abuse histories were stratified by age at occurrence and severity. Demographic characteristics of the three groups were also assessed.
Women with chronic pelvic pain were found to have a higher lifetime prevalence of sexual abuse, involving penetration or other contact with the unclothed genitals or anus (ie, major sexual abuse), than either comparison group. Further, more women in the chronic pelvic pain group had experienced major sexual abuse in both childhood and adulthood than women in the headache group, but there was no difference with the pain-free group. With respect to physical abuse, women in the chronic pelvic pain group had a higher lifetime prevalence than pain-free women, but not compared to those with chronic headache. In addition, more women with chronic pelvic pain reported physical abuse in both childhood and adulthood and both major sexual abuse and physical abuse at some time in their lives than did either comparison group.
These results support a specific association between major sexual abuse and chronic pelvic pain and a more general association between physical abuse and chronic pain. Moreover, the global nature of the abuse histories of the women in the chronic pelvic pain group suggests that more rigorous studies of the relation between abuse history and chronic pelvic pain are needed.
To evaluate the relationships between sexual/physical abuse, pain perception, environmental events, coping strategies, and psychiatric morbidity in a sample of female patients with painful gastrointestinal disorders.
Fifty paid volunteers from a tertiary care center including 13 patients with gastroesophageal reflux disease (GERD), 26 with noncardiac chest pain (NCCP), and 11 with irritable bowel syndrome (IBS).
(1) Sexual and physical abuse interview questions; (2) Structured psychiatric interview; (3) Self-report questionnaires: demographics, clinical pain measurement, Millon Behavioral Health Inventory, Hassles and Uplifts Scales, Sickness Impact Profile, Life Experiences Survey, Pain Beliefs and Perceptions Inventory, and Coping Strategies Questionnaire; (4) Pain Perception and Sensory Decision Theory tasks.
Fifty-six percent of the sample reported a history of sexual/physical abuse. Abuse was significantly more prevalent among patients with GERD (92%) and IBS (82%) compared with those with NCCP (27%). Abused patients, relative to nonabused patients, had significantly lower pain threshold levels in response to finger pressure stimuli and significantly lower cognitive standards for judging stimuli as noxious. Abused patients reported significantly higher levels of functional disability and a significantly greater number of psychiatric disorders, minor daily hassles, and pain syndromes unrelated to gastrointestinal disorders. In addition, abused patients more frequently blamed themselves for their pain and reported significantly greater use of maladaptive pain coping strategies than nonabused patients.
These data suggest that the relationships between abuse, disability, multiple pain syndromes, and health care seeking behavior are mediated by abnormal pain perception, psychiatric disorders, disruption of physical function, and environmental stressors.
Two reports have suggested a possible association between a history of sexual trauma and irritable bowel syndrome, but several factors in their study designs limited their generalizability. The authors used a more rigorous methodology to confirm this association.
They administered structured psychiatric and sexual trauma interviews to 28 patients with irritable bowel syndrome and 19 patients with inflammatory bowel disease and compared prevalence rates of sexual victimization in the two groups.
Compared with patients diagnosed as having inflammatory bowel disease, patients with irritable bowel syndrome had a significantly higher rate of severe lifetime sexual trauma (32% versus 0%), severe childhood sexual abuse (11% versus 0%), and any lifetime sexual victimization (54% versus 5%). The nine patients who had experienced severe lifetime victimization had significantly higher odds ratios for lifetime depression, panic disorder, phobia, somatization disorder, alcohol abuse, functional dyspareunia, and inhibited sexual desire than the 38 patients who had experienced less severe sexual trauma or no trauma. A logistic regression analysis showed that gender, the number of medically unexplained physical symptoms, and self-reported anxiety and hostility accounted for all of the variance in the victimized group.
These preliminary results suggest that sexual victimization may be an important factor in the development of irritable bowel syndrome in some patients. Future studies attempting to categorize subgroups of patients with irritable bowel syndrome should inquire into past histories of sexual victimization.
This article uses data from 7 population surveys to evaluate the association of sexual assault history with health perceptions. It estimates the extent of generalizability across gender, ethnic groups, and studies; the extent to which depression accounts for or mediates the association; and whether some circumstances of assault are more strongly related to poor subjective health. Data from each of 18 subsamples of the surveys were analyzed (pooled N = 10,001; 7,550 women and 2,451 men), and results were combined by using meta-analysis. Assault was associated with poor subjective health (odds ratio [OR] = 1.63, 95% confidence interval [CI] = 1.36, 1.95) and this result was consistent regardless of gender, ethnicity, or sample. Controlling depression did not markedly change this result (OR = 1.46, 95% CI = 1.21, 1.77), indicating that depression did not account for or mediate the assault-health perceptions association. Multiple assaults and assaults by strangers or spouse were most strongly associated with poor subjective health.
To determine whether a previous episode of major depression leaves a "scar" that places previously depressed patients with rheumatoid arthritis (RA) at risk for experiencing high levels of pain, fatigue, and disability.
A cohort of 203 patients with RA was randomly selected from a national panel and interviewed by phone about pain, fatigue, depressive symptoms, disability, and history of major depression.
Excluding patients who met the criteria for current major depression, patients with both a history of depression and many depressive symptoms at the time of the interview (dysphoria) reported more pain than those without current dysphoria, irrespective of whether they had a history of depression. Dysphoria alone was not reliably related to pain reports.
An episode of major depression, even if it occurs prior to the onset of RA, leaves patients at risk for higher levels of pain when depressive symptoms persist, even years after the depressive episode.
Unequal treatment: What you don't know about how women are mistreated by the medical community
- Kendall-Tackett
- Ness Marshall
- E Nechas
- D Foley
Kendall-Tackett, Marshall, and Ness Nechas, E., & Foley, D. (1994). Unequal treatment: What you don't know about how women are mistreated by the medical community. New York: Simon & Schuster.
Clinical outcome and economic evaluation of multidisciplinary pain centers Handbook of Pain Syndromes Altered pain perception and psychosocial features among women with gastrointestinal dis-orders and history of abuse: A preliminary model
- A Okifuji
- D C Turk
- D Kalauokalani
Okifuji, A., Turk, D. C. & Kalauokalani, D. (1999). Clinical outcome and economic evaluation of multidisciplinary pain centers. In A. R. Block, E. F. Kremer, & E. Fernandez (Eds.) Handbook of Pain Syndromes (pp. 77-97). Mahwah, NJ: Law-rence Erlbaum Associates. Scarinci, I. C., McDonald-Haile, J., Bradley, L. A., & Richter, J. E. (1994). Altered pain perception and psychosocial features among women with gastrointestinal dis-orders and history of abuse: A preliminary model. The American Journal of Medi-cine, 97, 108-118.
Childhood sexual abuse and long-term sequelae Posttraumatic stress disorder: A lifespan de-velopmental perspective
- F Teegen
Teegen, F. (1999). Childhood sexual abuse and long-term sequelae. In A. Maercker, M. Schutzwohl, & Z. Solomon (Eds.) Posttraumatic stress disorder: A lifespan de-velopmental perspective (pp. 97-112). Seattle: Hogrefe & Huber.
Clinical outcome and economic evaluation of multidisciplinary pain centers
- A Okifuji
- D C Turk
- D Kalauokalani
Okifuji, A., Turk, D. C. & Kalauokalani, D. (1999). Clinical outcome and economic
evaluation of multidisciplinary pain centers. In A.R. Block, E. F. Kremer & E.
Fernandez (Eds.) Handbook of Pain Syndromes (pp. 77-97). Mahwah, NJ:
Lawrence Erlbaum Associates.