Sexual and physical abuse and gastrointestinal illness

The impact of sexual harassment on obesity in female adolescents: An update and perspective to control

BACKGROUND AND AIMS

Sexual victimization, happened during childhood and beyond, is known to be a substantial contributing factor for obesity development later in life. This work aims to bring about updated information on the relationship between sexual harassment and obesity.

METHODS

Based on an intensive scientific literature review in Google Scholar, Pubmed databases, the total of 106 studies (N = 141,199) were assessed including 52 studies on the connection between negative lifetime impacts and obesity, 11 studies on post-traumatic stress disorder (PTSD) symptoms with proposed biological mechanisms related to obesity, 15 studies on the relationship between major depressive disorder (MDD) symptoms and obesity, 11 studies on the body dismorphic disorder (BDD) and 17 studies on the binge eating disorder (BED) were also examined to evaluate the association of obesity and traumatic life experiences.

RESULTS

Although 40-70% of all cases related to obesity have been considered to be hereditary, many experts argue that deviations in the environment contribute to excessive food intake and depressed physical activity in numerous Western countries. Several studies have identified that childhood sexual abuse (CSA) may be nearly as common as obesity. However, just a few researchers have taken notice of the possible connection between these two.

CONCLUSIONS

By mentioning some possible obesity-related psychological disorders in response to CSA, we present updated information on the relationship between sexual harassment and obesity.

Effect of genetic background and postinfectious stress on visceral sensitivity in Citrobacter rodentium-infected mice

BACKGROUND

Infectious gastroenteritis is a major risk factor to develop postinfectious irritable bowel syndrome (PI-IBS). It remains unknown why only a subgroup of infected individuals develops PI-IBS. We hypothesize that immunogenetic predisposition is an important risk factor. Hence, we studied the effect of Citrobacter rodentium infection on visceral sensitivity in Th1-predominant C57BL/6 and Th2-predominant Balb/c mice.

METHODS

Eight-week-old mice were gavaged with C. rodentium, followed by 1 h of water avoidance stress (WAS) at 5 weeks PI. At 10, 14 days, and 5 weeks PI, samples were assessed for histology and inflammatory gene expression by RT-qPCR. Visceral sensitivity was evaluated by visceromotor response recordings (VMR) to colorectal distension.

KEY RESULTS

Citrobacter rodentium evoked a comparable colonic inflammatory response at 14 days PI characterized by increased crypt length and upregulation of Th1/Th17 cytokine mRNA levels (puncorrected  < 0.05) in both C57BL/6 and Balb/c mice. At 5 weeks PI, inflammatory gene mRNA levels returned to baseline in both strains. The VMR was maximal at 14 days PI in C57BL/6 (150 ± 47%; p = 0.02) and Balb/c mice (243 ± 52%; p = 0.03). At 3 weeks PI, the VMR remained increased in Balb/c (176 ± 23%; p = 0.02), but returned to baseline in C57BL/6 mice. At 5 weeks PI, WAS could not re-introduce visceral hypersensitivity (VHS).

CONCLUSIONS & INFERENCES

Citrobacter rodentium infection induces transient VHS in C57BL/6 and Balb/c mice, which persisted 1 week longer in Balb/c mice. Although other strain-related differences may contribute, a Th2 background may represent a risk factor for prolonged PI-VHS. As PI-VHS is transient, other factors are crucial for persistent VHS development as observed in PI-IBS.

Robust Association Between Inflammatory Bowel Disease and Generalized Anxiety Disorder: Findings from a Nationally Representative Canadian Study

BACKGROUND

Although the link between inflammatory bowel diseases (IBD) and depression is well accepted, less is known about the relationship between IBD and anxiety disorders and factors associated with anxiety among those with IBD.

METHODS

Data were derived from the nationally representative 2012 Canadian Community Health Survey-Mental Health. The survey response rate was 68.9%. Two sets of analyses were undertaken. First, a series of logistic regression analyses were used to estimate the odd ratios of generalized anxiety disorder among those with IBD compared with those without (n = 22,522). The fully adjusted model controlled for sociodemographics, depression, substance abuse/dependence, pain, and adverse childhood experiences. Second, among those with IBD (n = 269), significant correlates of generalized anxiety disorder were identified using logistic regression. The presence of generalized anxiety disorder was determined using the WHO-CIDI lifetime criteria, and IBD was assessed by a self-reported health professional diagnosis.

RESULTS

Individuals with IBD had over twice the odds of anxiety compared with those without IBD, even when controlling for a range of potential explanatory factors (odds ratio = 2.18; 95% confidence interval, 1.50-3.16). Controlling for chronic pain and childhood adversities attenuate the relationship the most. Among those with IBD, a history of childhood sexual abuse, female gender, and chronic pain are the strongest correlates of anxiety. Those with Crohn's and ulcerative colitis were equally vulnerable to generalized anxiety disorder.

CONCLUSIONS

Our findings show that IBD is robustly related to generalized anxiety disorder. Health care professionals should be aware of the increased prevalence of generalized anxiety disorder among their patients with IBD, particularly women, those in chronic pain, and those with a history of childhood sexual abuse.

Upregulation of cystathionine β-synthetase expression contributes to visceral hyperalgesia induced by heterotypic intermittent stress in rats

Background

Hydrogen sulfide (H₂S) functions as a neuromodulator, but whether it modulates visceral pain is not well known. This study was designed to determine the role for the endogenous H₂S producing enzyme cystathionine β-synthetase (CBS) and cystathionine γ-lyase (CSE) in a validated rat model of visceral hyperalgesia (VH).

Methods

VH was induced by nine-day heterotypic intermittent stress (HIS). Abdominal withdrawal reflex (AWR) scores were determined by measuring the visceromoter responses to colorectal distension (CRD). Dorsal root ganglia (DRG) neurons innervating the colon were labeled by injection of DiI (1,1'-dioleyl-3,3,3',3-tetramethylindocarbocyanine methanesulfonate) into the colon wall. Patch clamp recording techniques were employed to examine excitability and sodium channel currents of colon specific DRG neurons. Tissues from colon related thoracolumbar DRGs were analyzed for CBS, CSE and sodium channel expression.

Results

HIS significantly increased the visceromotor responses to CRD in association with an upregulated expression of CBS not CSE proteins in colon related DRGs. Administration of O-(Carboxymethyl)hydroxylamine hemihydrochloride (AOAA), an inhibitor of CBS, attenuated the AWR scores in HIS-treated rats, in a dose dependent fashion. In contrast, AOAA did not produce any effect on AWR scores in healthy control rats. AOAA reversed the potentiation of sodium channel current densities of colon specific DRG neurons of HIS rats. To further confirm the role for CBS-H₂S signaling, NaHS was used to mimic the production of H₂S by CBS. Application of NaHS significantly enhanced neuronal excitability and potentiated sodium channel current densities of colon DRG neurons from healthy control rats. Furthermore, AOAA reversed the upregulation of Na_V1.7 and Na_V1.8 in colon related DRGs of HIS rats.

Conclusion

Our results suggest that upregulation of CBS expression might play an important role in developing VH via sensitization of sodium channels in peripheral nociceptors, thus identifying a specific neurobiological target for the treatment of VH in functional bowel syndromes.

Newer treatments for fibromyalgia syndrome

Fibromyalgia syndrome is a common chronic pain disorder of unknown etiology. The lack of understanding of the pathophysiology of fibromyalgia has made this condition frustrating for patients and clinicians alike. The most common symptoms of this disorder are chronic widespread pain, fatigue, sleep disturbances, difficulty with memory, and morning stiffness. Emerging evidence points towards augmented pain processing within the central nervous system (CNS) as having a primary role in the pathophysiology of this disorder. Currently the two drugs that are approved by the United States Food and Drug Administration (FDA) for the management of fibromyalgia are pregabalin and duloxetine. Newer data suggests that milnacipran, a dual norepinephrine and serotonin reuptake inhibitor, may be promising for the treatment of fibromyalgia. A double-blind, placebo-controlled trial of milnacipran in 125 fibromyalgia patients showed significant improvements relative to placebo. Milnacipran given either once or twice daily at doses up to 200 mg/day was generally well tolerated and yielded significant improvements relative to placebo on measures of pain, patient's global impression of change in their disease state, physical function, and fatigue. Future studies are needed to validate the efficacy of milnacipran in fibromyalgia.

Perspectives on fatigue from the study of chronic fatigue syndrome and related conditions

Fatigue is a symptom whose causes are protean and whose phenotype includes physical, mood, and behavioral components. Chronic fatigue syndrome (CFS) is an illness that has strong biological underpinnings and no definite etiology. Diagnostic criteria established by the Centers for Disease Control and Prevention have helped classify CFS as an overlap of mood, behavioral, and biological components. These include the presence of fatigue for more than 6 months associated with a diminution of functional activity and somatic symptoms, and pain not attributable to a specific diagnosis or disease. Four of the following criteria need to be present: sore throat, impaired memory or cognition, unrefreshing sleep, postexertional fatigue, tender glands, aching stiff muscles, joint pain, and headaches. Many researchers have observed that CFS shares features in common with other somatic syndromes, including irritable bowel syndrome, fibromyalgia, and temporomandibular joint dysfunction. Correlations between inflammation and infection, augmented sensory processing, abnormalities of neurotransmitters, nerve growth factors, low levels of serotonin and norepinephrine, abnormalities of homeostasis of the stress system, and autonomic dysfunction may be hallmarks of CFS. The relative contributions of each of these abnormalities to the profound fatigue associated with CFS need to be explored further to better evaluate and treat the syndrome.

Unexplained gastrointestinal symptoms after abuse in a prospective study of children at risk for abuse and neglect

PURPOSE

Unexplained gastrointestinal symptoms are more common in adults who recall abuse as a child; however, data available on children are limited. The aim of this study was to investigate the association of childhood maltreatment and early development of gastrointestinal symptoms and whether this relation was mediated by psychological distress.

METHODS

Data were obtained from the Longitudinal Studies of Child Abuse and Neglect, a consortium of 5 prospective studies of child maltreatment. The 845 children who were observed from the age of 4 through 12 years were the subjects of this study. Every 2 years information on gastrointestinal symptoms was obtained from parents, and maltreatment allegations were obtained from Child Protective Services (CPS). At the age of 12 years children reported gastrointestinal symptoms, life-time maltreatment, and psychological distress. Data were analyzed by logistic regression.

RESULTS

Lifetime CPS allegations of sexual abuse were associated with abdominal pain at age 12 years (odds ratio [OR] = 1.75; 95% confidence interval [CI] = 1.1-2.47). Sexual abuse preceded or coincided with abdominal pain in 91% of cases. Youth recall of ever having been psychologically, physically, or sexually abused was significantly associated with both abdominal pain and nausea/vomiting (range, OR = 1.5 [95% CI, 1.1-2.0] to 2.1 [95% CI, 1.5-2.9]). When adjusting for psychological distress, most effects became insignificant except for the relation between physical abuse and nausea/vomiting (OR = 1.5; 95% CI, 1.1-2.2).

CONCLUSION

Youth who have been maltreated are at increased risk for unexplained gastrointestinal symptoms, and this relation is partially mediated by psychological distress. These findings are relevant to the clinical care for children who complain of unexplained gastrointestinal symptoms.

Long-term physical health consequences of childhood sexual abuse: a meta-analytic review

OBJECTIVE

The purpose of the present article was to systematically review the literature investigating the long-term physical health consequences of childhood sexual abuse (CSA).

METHODS

Literature searches yielded 31 studies comparing individuals with and without a history of CSA on six health outcomes: general health, gastrointestinal (GI) health, gynecologic or reproductive health, pain, cardiopulmonary symptoms, and obesity. Exploratory subgroup analyses were conducted to identify potential methodological moderators.

RESULTS

Results suggested that a history of CSA was associated with small to moderate group differences on almost all health outcomes assessed, such that individuals with a history of CSA reported more complaints for each health outcome. Suggestive trends in moderating variables of study design and methodology are presented.

CONCLUSIONS

Results highlight the long-term physical health consequences of CSA and identify potential moderators to aid in the design of future research.

Sexual violence and its association with health self-perception among pregnant women

OBJECTIVE

To estimate the prevalence of sexual violence history among pregnant women and its association with the self-perception of health status.

METHODS

Cross-sectional study including a total of 179 pregnant women older than 14 years old at gestation week 14 to 28 attending public health services in the city of São Paulo, Southeastern Brazil, between 2006 and 2007. Data collection instruments included: questionnaire on sexual violence; questionnaire on sociodemographic data; and an assessment of health-related quality of life using the Medical Outcomes Study 12-Item Short-Form Health Survey (SF-12(R)). Age, skin color, education, occupational and marital status, and self-perception of physical and mental health were compared between women with and without a lifetime history of sexual violence. Sexual violence was categorized as penetrative and non-penetrative sex.

RESULTS

Among all women interviewed, the prevalence of sexual violence was 39.1%, of which 20% were of penetrative type by known perpetrators. In 57% of cases, the first episode of violence was before the age of 14. There were no sociodemographic differences between women with and without history of sexual violence. Mean scores of self-perception of physical health among women with history of sexual violence were lower (42.2; SD= 8.3) compared to those without history of sexual violence (51.0; SD= 7.5) (p<0.001). Mean scores of self-perception of mental health were 37.4 (SD= 11.2) and 48.1 (SD= 10.2) (p<0.001), respectively.

CONCLUSIONS

There was found high prevalence of sexual violence among pregnant women studied. Women with history of sexual violence showed poorer self-perception of health status compared to those without history of sexual violence.

Fibromyalgia: an overview

Fibromyalgia is the diagnosis given to individuals with chronic widespread musculoskeletal pain for which no alternative cause, such as tissue inflammation or damage, can be identified. Fibromyalgia is now believed to be, at least in part, a disorder of central pain processing that produces heightened responses to painful stimuli (hyperalgesia) and painful responses to nonpainful stimuli (allodynia). Aberrations in central pain processing may also be partly responsible for symptoms experienced in several chronic pain disorders that coaggregate with fibromyalgia, which is itself a product of genetic and environmental factors. Thus, aberrational central pain processing is implicated in irritable bowel syndrome, temporomandibular disorder, chronic low back pain, and certain other chronic pain disorders. Fibromyalgia and related disorders appear to reflect deficiencies in serotonergic and noradrenergic, but not opioidergic, transmission in the central nervous system. The heightened state of pain transmission may also be owing to increases in pronociceptive neurotransmitters such as glutamate and substance P. In some cases, psychological and behavioral factors are also in play. Although the overlapping symptomatology between fibromyalgia and related disorders may present diagnostic challenges, proper examination and observation can help clinicians make an accurate diagnosis. In recent years, the vastly improved understanding of the mechanism underlying fibromyalgia and the related spectrum of diseases has fostered rapid advances in the therapy of these chronic pain disorders by both pharmacologic and nonpharmacologic interventions.

Prevalence, types, and pattern of intimate partner violence among pregnant women in Lima, Peru

This study assesses the prevalence, types, and pattern of intimate partner violence (IPV) during lifetime and current pregnancy for 2,392 women in Lima, Peru. The reported lifetime prevalence of any IPV (physical, sexual, or emotional) is 45.1%. For women who experienced abuse, the prevalence of lifetime physical, emotional, and sexual IPV is 34.2%, 28.4%, and 8.7%, respectively. Older (>/= 30 years), unmarried, employed, and economically disadvantaged women and those with little education are more likely to experience lifetime and pregnancy IPV. Efforts at universal antepartum IPV screening and appropriate interventions are needed to reduce the burden of violence experienced by pregnant women.

Irritable bowel syndrome and dyspepsia among women veterans: prevalence and association with psychological distress

BACKGROUND

The burden of functional GI disorders and their associations with psychological distress in women veterans is unclear.

AIM

To examine 1-year prevalence of irritable bowel syndrome (IBS) and dyspepsia symptoms and their associations with anxiety, depression and post-traumatic stress disorder (PTSD) among women veterans receiving primary care at a Veteran Affairs Medical Center Women's Clinic.

METHODS

Irritable bowel syndrome, dyspepsia and psychological distress were assessed using the validated self-administered Bowel Disorder Questionnaire, the Beck Depression and Anxiety Inventories, as well as the Mississippi Scale for Combat-Related Post-Traumatic Stress Disorder Questionnaire.

RESULTS

We enrolled 248 women (84% participation rate). Ninety-three (38%) reported IBS and 51 (21%) dyspepsia symptoms. Women with IBS and dyspepsia reported higher mean scores of anxiety (IBS: 24 vs. 12, P < 0.0005 and dyspepsia: 26 vs. 12, P < 0.0005), depression (IBS: 22 vs. 11, P = 0.0005 and dyspepsia: 23 vs. 11, P < 0.0005) and PTSD (IBS: 87 vs. 69, P < 0.001 and dyspepsia: 86 vs. 69, P < 0.0005). Age- and ethnicity-adjusted logistic regression analyses showed a 3- to 46-fold increase in odds of IBS and dyspepsia among women with anxiety, depression or PTSD.

CONCLUSION

Women veterans have high prevalence of IBS and dyspepsia symptoms, both of which are highly associated with presence of depression, anxiety and PTSD.

Unexplained and underpowered: the relationship between psychosomatic disorders and interpersonal abuse -- a critical review

Although it is commonly accepted that interpersonal violence (IntPV) leads to adverse health consequences, the available data are far from decisive. To test the hypothesized link, the authors devised an evidence-based strategy to determine the data quality in studies purporting to link IntPV and some medically unexplained disorders in women (irritable bowel syndrome, chronic pelvic pain, fibromyalgia/chronic fatigue, and other chronic pain syndromes). English language studies with control groups of unaffected women were assessed for the quality of their methodologies. The number of studies, together with the consistency of their findings in each domain, was collated to determine the overall weight of evidence regarding the link for each condition. The quantity and quality of research in each clinical area proved to be sparse. In general, most research was limited to small, convenience samples, with insufficient attention to the design of control groups and to sample size. The evidence currently available regarding irritable bowel syndrome, fibromyalgia/chronic fatigue, chronic pelvic pain, and other chronic pain syndromes does not allow for any firm conclusion regarding their link to IntPV. More research - paying particular regard to the methodological concerns identified here - is required in order to generate any definitive conclusions.

Effect of abuse history on pain reports and brain responses to aversive visceral stimulation: an FMRI study

BACKGROUND & AIMS

Abuse history is common in irritable bowel syndrome (IBS) and is associated with greater pain reporting, psychologic distress, and poorer health outcome. These effects may be mediated by enhanced responses to aversive visceral stimuli. We investigated the effects of IBS and abuse history on pain reporting and brain activation in response to rectal distentions.

METHODS

Ten female patients with IBS and 10 controls were included. Half of patients in each group reported a history of abuse. Brain functional magnetic resonance imaging (fMRI) images and pain ratings were obtained during rectal distentions. Statistical parametric mapping identified activation in subregions of the dorsal cingulate cortex and covariation with rated pain.

RESULTS

(1) Distention-elicited pain correlated with anxiety and activation of the posterior (PCC) and middle (MCC) dorsal cingulate subregions. (2) Subjects with a history of abuse showed greater activation in the left MCC (P = .022; t = 5.61) and PCC (P = .033; t = 5.00) than subjects without abuse. (3) Those with IBS and abuse reported greater pain than all others (P = .004), had more activity in the left MCC (P = .021; t = 5.29) and PCC (P = .049; t = 4.81), and had less activity in the left supragenual anterior cingulate (sACC) (P = .01; t = 4.86).

CONCLUSIONS

Pain ratings during rectal distention are associated with activation of dorsal cingulate regions implicated in homeostatic afferent processing, and prior abuse enhances this activation. Patients with IBS and abuse report more pain, greater MCC/PCC activation, and reduced activity of a region implicated in pain inhibition and arousal (sACC). These findings suggest a possible explanation for the clinical observation of greater pain reporting and poorer outcome in IBS patients with a history of abuse.

Peripheral and central mechanisms of visceral sensitization in man

Visceral hypersensitivity (perception of gastrointestinal sensory events at a lower-than-normal threshold) is considered to be an important pathophysiological mechanism in the development of functional gastrointestinal disorders (FGIDs), such as irritable bowel syndrome, non-cardiac chest pain and functional dyspepsia. These disorders are associated with significant health care and socioeconomic costs due to factors such as repeated visits to consultants, hospitalizations and work absenteeism. Despite the presence of extensive evidence linking visceral hypersensitivity and FGIDs, the mechanism(s) underlying visceral hypersensitivity has not been fully elucidated. Suggested hypotheses include sensitization of afferent neurones, both at the level of the enteric and the (afferent) autonomic nervous system (peripheral sensitization), sensitization of spinal cord dorsal horn neurones (central sensitization) and psychosocial factors/psychiatric comorbidity influencing the processing of afferent signals at the level of the brain. Importantly, these hypotheses may be complementary rather than mutually exclusive. However, the degree to which each of these mechanisms contributes to the overall perception of visceral pain, and therefore the generation of symptoms, still remains unclear. This article discusses the mechanisms that may underlie visceral hypersensitivity, with reference to FGIDs. Understanding these mechanisms is essential in order to improve the diagnosis and treatment of patients with these disorders.

Depression in patients with irritable bowel syndrome in Jos, Nigeria

AIM: To study the brain-gut interaction and the effect of behavioral or psychiatric conditions on irritable bowel syndrome (IBS) in an African population.

METHODS: IBS was diagnosed using the Rome II diagnostic criteria. The entry of each patient was confirmed following detailed explanations of the questions. Four hundred and eighteen patients were studied. Subjects satisfying the Rome II criteria for IBS were physically examined and stool microscopy was done to identify the presence of “alarm factors”. Depression was diagnosed using the symptom-check list adapted from the Research Diagnostic Criteria (DSM-IV) of the American Psychiatric Association.

RESULTS: Seventy-five (56.8%) of the 132 IBS patients were depressed whereas only 54 (20.1%) of the 268 non-IBS patients were depressed. There was a significant relationship between IBS and depression (χ² = 54.29, Odds ratio = 5.21, 56.8 ± 8.4 vs 20.1 ± 5.2, P = 0.001). Even though constipation predominant IBS patients were more likely to be depressed, no significant relationship was found between the subtype of IBS and depression (χ² = 0.02, OR = 0.95, P = 0.68).

CONCLUSION: IBS is significantly associated with major depression but not gender and bowel subtypes of the patients. Patients with IBS need to be evaluated for depression due to the highly significant relationship between the two conditions.

Childhood sexual abuse and psychosomatic symptoms in irritable bowel syndrome

Irritable bowel syndrome is characterized by chronic gastrointestinal symptoms without a demonstrable physical cause. In a subgroup of patients, irritable bowel syndrome may be part of a cluster of psychosomatic symptoms related to childhood sexual abuse. To investigate this possibility, the Dissociative Disorders Interview Schedule (DDIS), the Dissociative Experiences Scale (DES) and the Symptom Checklist-90 (SCL-90) were administered to 105 subjects with either irritable bowel syndrome, inflammatory bowel disease (Crohn's disease or ulcerative colitis), or other gastrointestinal disorders. The subjects in the three groups did not differ on the DES, the SCL-90 or most sections of the DDIS. However, subjects with irritable bowel syndrome reported much higher rates of childhood sexual abuse and psychosomatic symptoms.

Childhood adversities in patients with fibromyalgia and somatoform pain disorder

Primary fibromyalgia is regarded as disorder with a complex symptomatology, and no morphological alterations. Findings increasingly point to a dysfunction of the central nervous pain processing. The study aims to discuss vulnerability for fibromyalgia from a developmental psychopathological perspective. We investigated the presence of psychosocial adversities affecting the childhood of adult fibromyalgia patients (FM) and compared them to those of patients with somatoform pain disorders (SOM) and a control group (CG) with medically explained chronic pain. Using the structured biographical interview for pain patients (SBI-P), 38 FM patients, 71 SOM patients, and 44 CG patients were compared on the basis of 14 childhood adversities verified as relevant regarding longterm effects for adult health by prospective studies. The FM patients show the highest score of childhood adversities. In addition to sexual and physical maltreatment, the FM patients more frequently reported a poor emotional relationship with both parents, a lack of physical affection, experiences of the parents' physical quarrels, as well as alcohol or other problems of addiction in the mother, separation, and a poor financial situation before the age of 7. These experiences were found to a similar extent in the SOM patients, but distinctly less frequently in the CG. The results point to early psychosocial adversities as holding a similar etiological meaning in fibromyalgia as well as in somatoform pain disorders. The potential role of these factors as increasing the vulnerability for fibromyalgia is discussed.

Chronic fatigue, abuse-related traumatization, and psychiatric disorders in a community-based sample

The relationship between sexual and physical abuse history and negative health effects has been well-documented in medical facility samples. Few studies have examined the role of abuse history and its relationship with chronic fatigue and psychiatric disorders in a diverse, randomly selected community-based sample. The present study compared rates of different types of abuse events in individuals with chronic fatigue and non-symptomatic controls. Relationships between specific types of abuse and psychiatric disorders commonly associated with chronic fatigue were also explored. A stratified random sample of 18,675 adults residing in ethnically and socioeconomically diverse neighborhoods in Chicago first completed a telephone screening questionnaire. A control group and a group of individuals with chronic fatigue symptomatology were identified and administered a semi-structured psychiatric interview assessing DSM-IV Axis I psychiatric disorders and a sexual and physical abuse history questionnaire. Controlling for sociodemographic differences, fatigue outcome was significantly predicted by childhood sexual abuse and the total number of different childhood abuse events. Within the chronic fatigue group, diagnosis of posttraumatic stress disorder (PTSD) was significantly predicted by childhood sexual abuse, childhood death threat, the total number of childhood abuse events, and lifetime abuse events. Sexual abuse during adolescence or adulthood significantly predicted other anxiety disorders among individuals with chronic fatigue. These findings suggest that a history of abuse, particularly during childhood, may play a role in the development and perpetuation of a wide range of disorders involving chronic fatigue. Among individuals with chronic fatigue, PTSD and other anxiety disorders appear to demonstrate the strongest association with abuse history. The implications of these findings are discussed.

Homeopathy in survivors of childhood sexual abuse

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

Sexual abuse, physical abuse, chronic fatigue, and chronic fatigue syndrome: a community-based study

Using a randomly selected community-based sample, this investigation examined whether histories of childhood sexual, physical, and death threat abuse predicted adulthood outcomes of specific medical and psychiatric conditions involving chronic fatigue. This study also tested prior suggestions that most individuals with chronic fatigue syndrome report a past history of interpersonal abuse. Multinomial logistic regression was used to examine the relationship between abuse history and chronic fatigue group outcomes while controlling for the effects of sociodemographics. Compared with healthy controls, childhood sexual abuse was significantly more likely to be associated with outcomes of idiopathic chronic fatigue, chronic fatigue explained by a psychiatric condition, and chronic fatigue explained by a medical condition. None of the abuse history types were significant predictors of chronic fatigue syndrome. A closer examination of individuals in the chronic fatigue syndrome group revealed that significantly fewer individuals with CFS reported abuse as compared with those who did not. The implications of these findings are discussed.

Treating traumatized patients and victims of violence

This chapter presents a thorough exposition of treating traumatized patients and victims of violence, addressing many aspects of trauma and victimization critical to a vast proportion of the work that mental health professionals find themselves doing.

Sex differences in long-term stress-induced colonic, behavioural and hormonal disturbances

Functional bowel disorders are more prevalent in women than in men, but the reason for this is unclear. Stressful experiences can increase the risk for or precipitate intestinal dysfunction. Using a model for long-term stress-induced sensitisation in rats, it was investigated whether male and female rats differ in susceptibility for long-term colonic, behavioural and hormonal disturbances following brief but intense stress. Male and female Wistar rats were fitted with chronic electrodes on proximal colon and given either a 15-minute session of foot shocks or no shocks. Two weeks later, rats were exposed to two different novel stressful challenges in the home cage: an electrified prod (day 14) and an 85 dB noise stressor (day 15). Digitalised colonic myoelectric spike burst activity was quantified automatically. Behaviour during prod and noise exposure was scored blindly from videotape. Resting plasma hormone concentrations at the end of the study were determined by radio-immuno assay. Following prod stress on day 14, both male and female preshocked rats showed a greater increase in colonic spike burst frequency than controls, but similar behaviour, and the dynamics of colonic motility differed between sexes. Following noise stress on day 15, only a small change in burst frequency was seen in all rats, but preshocked rats showed less self-grooming behaviour and there was a tendency for preshocked females to show increased noise-induced immobility. Preshocked rats also had lower levels of plasma free thyroxine. While both male and female rats show long-term stress-induced colonic sensitisation and hormonal changes, females show a different activation pattern of colonic motility, and may be more vulnerable for altered behavioural reactivity, following stress.

Irritable bowel syndrome and recurrent abdominal pain. A comparative review

Clinical findings on irritable bowel syndrome in adults and recurrent abdominal pain in children are reviewed to determine if what is known about each disorder can illuminate our understanding of the other. The evidence reveals striking similarities between the disorders in prevalence, course, medical and psychiatric comorbidity, family medical and psychiatric history, and association with life events. Continuity between the two disorders is also suggested by the results of follow-up and follow-back studies. The review shows the importance of a developmental perspective for understanding functional bowel disorders in adults and points to areas where further research would be useful.

A psychological perspective of irritable bowel syndrome

Irritable bowel syndrome (IBS) is a common and often intractable disorder. Although the causes of this syndrome are not clear, psychological factors do play a major role in determining whether a patient seeks medical care. Patients who have IBS tend to suffer from a psychiatric disorder, most notably anxiety and depression. Traditional medical care with its emphasis on pharmacological interventions and dietary changes has not been effective. Psychotherapy has been shown to be an important, yet underutilized, approach in the treatment of IBS. A clinical example of a young man suffering from IBS illustrates how traditional medical care and psychotherapy enhance the treatment of this disorder.

Sexually abused children 5 years after presentation: a case-control study

OBJECTIVE

A total of 68 sexually abused children and their nonoffending parents were reassessed 5 years after presentation and were compared with a cohort of children of similar age and sex who were not known to have been abused.

METHOD

Outcome measures were behavior, depression, self-esteem, anxiety, eating problems, drug use, suicide attempts, self-injury, running away, criminal activity, and attributional style. Recent life events, demographics, family functioning, and mothers' mental health were taken into account when examining outcome.

RESULTS

Although the abused children had experienced more negative life events, were from lower socioeconomic groups, had more changes in parent figures, and had mothers who were more psychologically distressed, multiple regression analysis showed that after allowing for these and other demographic factors, there were still significant differences between the groups after the 5 years. The abused children displayed more disturbed behavior, had lower self-esteem, were more depressed or unhappy, and were more anxious than controls. Sexually abused children had significantly higher levels of bingeing, self-injury, and suicide attempts.

CONCLUSIONS

It is clear that many children who are sexually abused have ongoing problems. Their ongoing problems may be indicative of false beliefs about themselves and the sexual abuse experience.