"Mark Thorson"

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net MCS Caused By Sexual Abuse

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net sexual abuse

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In this study, the severity of the abuse correlated with
the severity of the psychosomatic symptoms.

Arch Fam Med 1999 Jan-Feb;8(1):35-43
Health-related quality of life and symptom profiles of female
survivors of sexual abuse.
Dickinson LM, deGruy FV 3rd, Dickinson WP, Candib LM.
Department of Family Practice and Community Medicine,
College of Medicine, University of South Alabama, Mobile, USA.

OBJECTIVES: To determine the association
between severity of sexual abuse and psychiatric or
medical problems in a sample of female patients
from primary care medical settings and to assess
the relationship between sexual abuse severity
and health-related quality of life before and after
controlling for the effects of a current psychiatric
or medical diagnosis.

DESIGN: Structured interview and self-report
questionnaire.

SETTING: Three family practice outpatient clinics.

SUBJECTS: A total of 252 women selected
by somatization status using a screen for
unexplained physical symptoms.

MAIN OUTCOME MEASURES: Patient assessment
after administering the Medical Outcomes Study
36-item Short-Form Health Survey and self-report
medical problems questionnaire; the quality-of-life
scale developed by Andrews and Withey;
Diagnostic and Statistical Manual of Mental
Disorders, Third Edition, Revised, diagnoses and
symptom counts from the Diagnostic Interview
Schedule; the Dissociative Experiences Scale; and
the modified Dissociative Disorders Interview
Schedule.

RESULTS: A history of sexual abuse is
associated with substantial impairment in
health-related quality of life and a greater number of
somatized symptoms (P < .001), medical problems
(P < .01), and psychiatric symptoms and
diagnoses (P < .001). In regression analyses,
sexual abuse severity was a significant predictor of
high scores on 6 of the 8 subscales of the Medical
Outcomes Study Short-Form Health Survey
(P < .05) and all of the quality-of-life subscales
developed by Andrews and Withey (P < .01),
with average decrements of up to 0.41 SDs for
moderately abused women and 0.56 SDs for
severely abused women. Furthermore, sexual abuse
severity remained a significant predictor of
high scores on the subscales mental health (P < .05),
social functioning (P < .05), and quality of
life (P < .05), even after adjusting for the presence
of several common psychiatric diagnoses.

CONCLUSIONS: Female primary care patients
with a history of sexual abuse have more
physical and psychiatric symptoms and lower
health-related quality of life than those without
previous abuse. In addition, a linear relationship
exists between the severity of sexual abuse and
impairment in health-related quality of life, both
before and after controlling for the effects of a
current psychiatric diagnosis.

Med Hypotheses. 2003 Oct;61(4):419-30.
Are syndromes in environmental medicine variants
of somatoform disorders?
Wiesmuller GA, Ebel H, Hornberg C, Kwan O, Friel J.
Institute of Hygiene and Environmental Medicine,
University Hospital Aachen, Aachen, Germany.

To date, relatively little is known about the
etiology, pathophysiology, diagnosis, therapy,
prevention and prognosis of environment-related
syndromes like multiple chemical sensitivity
(MCS), idiopathic environmental intolerance (IEI),
sick building syndrome (SBS), chronic fatigue
syndrome (CFS), candida syndrome (CS) and
burnout syndrome (BS). Part of the reason is that
these syndromes have not been clearly defined
and classified in scientific categories distinct from
each other, and that they show clinical similarities
to classified somatoform disorders.
Furthermore, there are at least three possible
explanations for the existence of these syndromes:
(1) The syndromes may result from the interaction
of environmental factors, individual
susceptibility and psychological factors (i.e., how
they are perceived and seen by the patient); (2)
they may reflect socially and culturally accepted
methods of expressing distress; and/or (3) they
may be iatrogenic. Despite all the uncertainties
in evaluation of environmental syndromes,
physicians have the duty to take the affected
person's problems seriously. A comprehensive
systematic classification which better accounts
for these complex clinical manifestations is long
overdue. Until these syndromes are well defined,
the terms used for them should definitely not be
applied to connote a specific disease process.

Psychol Med 1999 Mar;29(2):399-406
The association of sexual and physical abuse with somatization:
characteristics of patients presenting with irritable bowel syndrome
and non-epileptic attack disorder.
Reilly J, Baker GA, Rhodes J, Salmon P.
Department of Clinical Psychology, University of Liverpool.

BACKGROUND: Physical symptoms are
commonly presented for treatment in the absence of
physical pathology. This study tests predictions
arising from the theory that childhood sexual
abuse leads to emotional distress, illness orientation
and social dysfunction as adults and that one
or more of these effects, in turn, leads to presentation
of functional (i.e. unexplained) symptoms.

METHODS: Two groups of patients with physical
symptoms in the absence of organic disease
(non-epileptic attack disorder or irritable bowel
syndrome) were contrasted with organically
diseased groups with comparable symptoms
(epilepsy and Crohn's disease, respectively).

RESULTS: Despite their contrasting clinical presentation,
irritable bowel and non-epileptic attack
groups were similar in recalling more sexual and
physical abuse, as both children and adults, than
their comparison groups. They were also similar
in being more emotionally and socially disturbed
and illness-orientated, but these putative mediating
variables could not account for the relationship
of abuse with presentation of functional symptoms.

CONCLUSIONS: Adults presenting
functional neurological and abdominal symptoms
are characterized by history of abuse. The
current focus on childhood sexual abuse should
be broadened to include sexual, and particularly
physical, abuse in adulthood as well as childhood.
The intervening processes that link abuse to
somatization remain to be identified but are
unlikely to include adult emotional and social
disturbance or general illness-orientation.