Beyond Survivor - The Wounded Warrior Blog

Common Symptoms in Adult Survivors of Childhood Sexual Abuse:

Physical Presentations
Chronic pelvic pain
Gastrointestinal symptoms/distress
Musculoskeletal complaints
Obesity, eating disorders
Insomnia, sleep disorders
Pseudocyesis
Sexual dysfunction
Asthma, respiratory ailments
Addiction
Chronic headache
Chronic back pain
Psychologic and Behavioral Presentations
Depression and anxiety
Posttraumatic stress disorder symptoms
Dissociative states
Repeated self-injury
Suicide attempts
Lying, stealing, truancy, running away
Poor contraceptive practices
Compulsive sexual behaviors
Sexual dysfunction
Somatizing disorders
Eating disorders
Poor adherence to medical recommendations
Intolerance of or constant search for intimacy
Expectation of early death

Although there is no single syndrome that is universally present in adult survivors of childhood sexual abuse, there is an extensive body of research that documents adverse short- and long-term effects of such abuse. To appropriately treat and manage survivors of CSA, it is useful to understand that survivors' symptoms or behavioral sequelae often represent coping strategies employed in response to abnormal, traumatic events. These coping mechanisms are used for protection during the abuse or later to guard against feelings of overwhelming helplessness and terror. Although some of these coping strategies may eventually lead to health problems, if symptoms are evaluated outside their original context, survivors may be misdiagnosed or mislabeled (5).

In addition to the psychologic distress that may potentiate survivors' symptoms, there is evidence that abuse may result in biophysical changes. For example, one study found that, after controlling for history of psychiatric disturbance, adult survivors had lowered thresholds for pain (13). It also has been suggested that chronic or traumatic stimulation (especially in the pelvic or abdominal region) heightens sensitivity, resulting in persistent pain such as abdominal and pelvic pain or other bowel symptoms (14, 15).

Although responses to sexual abuse vary, there is remarkable consistency in mental health symptoms, especially depression and anxiety. These mental health symptoms may be found alone or more often in tandem with physical and behavioral symptoms. More extreme symptoms are associated with abuse onset at an early age, extended or frequent abuse, incest by a parent, or use of force (4). Responses may be mitigated by such factors as inherent resiliency or supportive responses from individuals who are important to the victim (4). Even without therapeutic intervention, some survivors maintain the outward appearance of being unaffected by their abuse. Most, however, experience pervasive and deleterious consequences (4).

The primary aftereffects of childhood sexual abuse have been divided into seven distinct, but overlapping categories (16):

Emotional reactions
Symptoms of posttraumatic stress disorder (PTSD)
Self-perceptions
Physical and biomedical effects
Sexual effects
Interpersonal effects
Social functioning

Responses can be greatly variable and idiosyncratic within the seven categories. Also, survivors may fluctuate between being highly symptomatic and relatively symptom free. Health care providers should be aware that such variability is normal.

References

McCauley J, Kern DE, Kolodner K, Schroeder AF, DeChant HK, Ryden J, et al. Clinical characteristics of women with a history of childhood abuse: unhealed wounds. JAMA 1997;277:1362-1368

Koss MP, Koss PG, Woodruff WJ. Deleterious effects of criminal victimization on women's health and medical utilization. Arch Intern Med 1991;151:342-347

Drossman DA, Leserman J, Nachman G, Li ZM, Gluck H, Toomey TC, et al. Sexual and physical abuse in women with functional or organic gastrointestinal disorders. Ann Intern Med 1990;113:828-833

American Medical Association. Diagnostic and treatment guidelines on mental health effects of family violence. Chicago: AMA, 1995

Hendricks-Matthews M. Long-term consequences of childhood sexual abuse. In: Rosenfeld J, Alley N, Acheson LS, Admire JB, eds. Women's health in primary care. Baltimore: Williams & Wilkins, 1997:267-276

Britton H, Hansen K. Sexual abuse. Clin Obstet Gynecol 1997;40:226-240

Maltz W. Adult survivors of incest: how to help them overcome the trauma. Med Aspects Hum Sex 1990;24:42-47

Hendricks-Matthews MK. Caring for victims of childhood sexual abuse. J Fam Pract 1992;35:501-502

Tjaden P, Thoennes N. Prevalence, incidence, and consequences of violence against women: findings from the National Violence Against Women Survey. Research in Brief. Washington, DC: U.S. Dept of Justice, Office of Justice Programs, November 1998, NCJ 172837

Moore KA, Driscoll A. Partners, predators, peers, protectors: males and teen pregnancy. New data analysis of the 1995 National Survey of Family Growth. In: Not just for girls: the roles of boys and men in teen pregnancy. Washington, DC: The National Campaign to Prevent Teen Pregnancy, 1997: 7-12

Schoen C, Davis K, Collins KS, Greenberg L, Des Roches C, Abrams M. The Commonwealth Fund survey of the health of adolescent girls. New York: The Commonwealth Fund, 1997

Walker EA, Torkelson N, Katon WJ, Koss MP. The prevalence rate of sexual trauma in a primary care clinic. J Am Board Fam Pract 1993;6:465-471

Scarinci IC, McDonald-Haile J, Bradley LA, Richter JE. Altered pain perception and psychosocial features among women with gastrointestinal disorders and history of abuse: a preliminary model. Am J Med 1994:97:108-118

Cervero F, Janig W. Visceral nociceptors: a new world order? Trends Neurosci 1992;15:374-378

Drossman DA. Physical and sexual abuse and gastrointestinal illness: what is the link? Am J Med 1994;97:105-107

Courtois CA. Adult survivors of sexual abuse. Prim Care 1993;20:433-446

Beyond Survivor - The Wounded Warrior Blog

Saturday, 25 October 2014

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Common Symptoms in Adult Survivors of Childhood Sexual Abuse