Trauma and Physical Health

Understanding the effects of extreme stress and of psychological harm

Victoria L. Banyard, Valerie J. Edwards, Kathleen Kendall-Tackett, Victoria L. Banyard, Valerie J. Edwards, Kathleen Kendall-Tackett

• Publisher: Routledge
• Year: 2008
• ISBN:
  9781134018727
• Edition: 1
• Topic: Médecine
• Subtopic: Théorie, pratique et référence de la médecine

Trauma research and clinical practice have taught us much about the widespread problems of child maltreatment, partner violence, and sexual assault. Numerous investigations have documented links between such trauma exposure and long-term negative mental health consequences. As we learn more about traumatic stress, however, increasing attention has been drawn to the less studied physical health effects of maltreatment and trauma.

Trauma and Physical Health describes both the negative physical health effects of victimization in childhood as well as exploring theoretical models that explains these links. By bringing together new and current studies on the relationship between trauma and physical health, this edited collection assesses the clinical implications of these links. At a time when the mental health field is becoming increasingly cognizant of the value of collaboration with professionals in the physical health arena, this book suggests ways in which clinicians can work with primary care professionals to better meet the needs of trauma survivors across the lifespan. A key focus of the text is to clarify the relationship between the current knowledge base in trauma and physical health and directions for future research in primary care health settings.

With contributors from a wide range of clinical and psychological disciplines, it will be of interest to researchers, clinicians and professionals in the trauma field and to primary care professionals concerned with compassionate care for the traumatized.

1
The association between childhood abuse, health and pain-related problems, and the role of psychiatric disorders and current life stress

Natalie Sachs-Ericsson, Kiara Cromer, Annya
Hernandez, and Kathleen A. Kendall-Tackett

A GROWING BODY of literature has established an association between childhood abuse and adult health problems. In the current chapter we review the literature which has generally shown an association between childhood abuse (physical and/or sexual) and subsequent health problems, as well as increased pain reports in association with health problems. We will also discuss our research based on the National Comorbidity Survey (NCS), a representative sample of men and women aged 15 to 54 from the US population. Using these data, we have shown that health problems are distinctly increased in individuals who have experienced childhood sexual or physical abuse, that individuals who experienced childhood abuse report more pain in association with their health problems, and that current life stressors moderate the relationship between abuse and health such that the presence of stress doubles the effect of childhood abuse on health problems. We also discuss the influence of psychiatric disorders on the relationship between abuse and health problems.

We review theories underlying the association between childhood abuse and health functioning, including how early abuse may affect brain functioning to increase vulnerability to stress and decrease immune functioning. We discuss how childhood abuse is related to risky behaviors that are detrimental to health. Further, we discuss why there may be an association between childhood abuse and psychiatric disorders which in turn influences health and pain-related problems. Treatment recommendations are reviewed.

CHILDHOOD ABUSE AND MEDICAL PROBLEMS IN CLINICAL SAMPLES

Early studies, predominately of clinical samples of women, have found that medical problems are often overrepresented among individuals who have experienced childhood sexual abuse or childhood physical abuse (Sachs-Ericsson et al., 2005). For example, studies have found sexual and physical abuse to be associated with diabetes (Kendall-Tackett and Marshall, 1999), gastrointestinal problems (Drossman et al., 1995), obesity (Williamson et al., 2002), and irritable bowel disease (Talley et al., 1995).

Many of these earlier studies have been based on patients seeking medical treatment. Childhood abuse has been found to be associated with increased use of health services (Biggs et al., 2003; Finestone et al., 2000) and, thus, firm conclusions regarding the relationship between abuse and health cannot be based on clinical samples alone. However, studies of representative community population samples have generally confirmed the association between childhood abuse and health observed in clinical samples.

EPIDEMIOLOGICAL STUDIES OF ABUSE AND MEDICAL PROBLEMS

In a series of epidemiological investigations, Golding and colleagues consistently found a relationship between lifetime sexual abuse (occurring either in childhood or adulthood) and measures of overall health (Golding, 1994, 2003; Golding et al., 1997). Using data from a large, nationally representative sample of men and women, researchers (Thompson et al., 2004) found that physical abuse in childhood was related to health problems in adulthood for the sample as a whole.

Other studies have found increased rates of specific health problems among individuals with abuse histories. Specific health problems, such as gynecological problems, headaches, diabetes, arthritis, breast cancer for women (Golding, 1994, 1999; Golding et al., 1998; Stein and Barrett-Connor, 2000) and thyroid disease for men (Stein and Barrett-Connor, 2000) are higher for those who experienced sexual abuse in their lifetime. Further, childhood sexual abuse has been found to be associated with chronic fatigue, bladder problems, asthma, and heart problems (Dong et al., 2004; Romans et al., 2002). In her review of the literature, Leserman (2005) concluded that childhood sexual abuse appears to be related to a greater likelihood of headache, gastrointestinal, and gynecological problems. Childhood physical abuse has also been found to be associated with increased risk of specific health problems in adulthood. For example, both childhood sexual and physical abuse was found to be associated with ischemic heart disease (Dong et al., 2004). Further, in a national representative epidemiological survey of adults, an association between childhood physical abuse and increased odds of gastrointestinal problems and migraine headaches were found (Goodwin et al., 2003).

In our studies using a population sample from the National Comorbidity Survey (NCS; Sachs-Ericsson et al., 2005), we found childhood sexual and physical abuse to be associated with the one-year prevalence of serious health problems for both men and women, even after controlling for an array of family-of-origin problems (e.g., family-of-origin income, early parental loss, and parental psychiatric problems), as well as controlling for participants’ psychiatric problems. Specifically, we found that individuals who had been physically abused as children (controlling for the effects of sexual abuse and other covariates) were more than twice as likely as those who had not been physically abused to have a serious health problem. In addition, those who had been sexually abused (controlling for the effects of physical abuse) were almost one-and-a-half times as likely to have a current serious health problem compared to those who had not been sexually abused.

In further analyses of the data, we found that childhood physical and sexual abuse was associated with increased prevalence of a number of specific medical problems. After controlling for the influence of family-of-origin variables and participants’ current psychiatric diagnoses, the relationship between childhood abuse and several health problems remained significant including blindness or deafness; heart problems; and lupus, thyroid, or autoimmune problems (Cromer and Sachs-Ericsson, 2006).

CHILDHOOD ABUSE AND PAIN

Researchers from a wide range of medical specialties have noted that a relatively high percentage of patients with painful medical conditions and chronic pain have a history of childhood physical or sexual abuse (Kendall-Tackett, 2001). Specifically, clinical studies have found a higher proportion of child abuse survivors among patients with generalized pain (Finestone et al., 2000; Green et al., 2001; Kendall-Tackett, 2001; Kendall-Tackett et al., 2003), pelvic pain and vulvodynia (Harlow and Stewart, 2005; Lampe et al., 2003; Latthe et al., 2006), fibromyalgia (Boisset-Pioro et al., 1995), chronic musculoskeletal pain (Kopec and Sayre, 2004), headache (Golding, 1999), and irritable bowel syndrome and gastrointestinal illnesses (Drossman et al., 2000; Leserman et al., 1996; Talley et al., 1995).

Epidemiological and case-controlled studies have generally supported findings from medically based samples. 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 overrepresented in individuals with abuse histories (Golding, 1994, 1999; Goodwin et al., 2003; Linton, 2002; McBeth et al., 1999; Romans et al., 2002).

However, Raphael and colleagues have argued that the data are not altogether consistent. In their review of the literature of case-controlled and epidemiological studies, Raphael and colleagues (Raphael et al., 2004) point out that only cross-sectional studies with relatively large samples have consistently found a relationship between childhood abuse and painful medical conditions (i.e., pain associated with chronic pelvic pain, headache, back or neck pain, and general widespread pain). Specifically, five out of six cross-sectional studies (including those involving community and primary care samples) reported higher rates of pain associated with childhood sexual abuse (Bendixen et al., 1994; Jamieson and Steege, 1997; Linton, 1997; Newman et al., 2000; Romans et al., 2002). For two cross-sectional studies on childhood physical abuse and pain (Goodwin et al., 2003; Romans et al., 2002), only one found an association.

In a longitudinal study (based on participants’ retrospective reports of abuse), Linton and colleagues (Linton, 2002) found that among participants with no pain at baseline, childhood abuse was associated with an increased occurrence of new episodes of back pain one year later. However, for those already reporting back pain at baseline, no association between childhood sexual or physical abuse and pain at follow-up was shown (Linton, 2002).

In another study, prospective findings (based on documented abuse cases in childhood) differed from retrospective findings (based on self-report in adulthood) for the same sample (Raphael et al., 2001). In this study, documented cases of sexually and physically abused and neglected children were matched with non-abused children. Participants were followed prospectively and in adulthood were asked to report retrospectively about childhood abuse experiences. Interestingly, almost half (49 percent) of the “non-abused” matched control group retrospectively reported childhood abuse experiences. Since the control group also had high numbers of abuse survivors, it is not surprising that there would be no difference between groups on rates of chronic pain syndromes. However, the retrospective data from these participants were consistent with previous studies finding an association between childhood abuse and pain.

DIFFERENCES DUE TO MEDICAL CONDITIONS

Differences in studies’ findings may reflect, in part, which medical conditions are being identified. Examining differences in the population between abused and non-abused participants for painful conditions that have relatively low base rates are less likely to show significant results than disorders that are more prevalent. In this regard, most of the studies have been limited to a specific type of painful medical condition (e.g., headache, back pain, musculoskeletal pain (Raphael et al., 2004)). Studies have commonly not identified the potential range of medical problems that may have been experienced by the participant, and the level of pain experienced in relation to current health problems. This may have attenuated the true relationship between childhood abuse and painful medical conditions.

In our research with the NCS sample, we examined a wide range of medical problems and the degree of reported pain associated with each of these conditions, and compared individuals with a history of childhood abuse (sexual and physical) to those with no abuse history. We found that individuals who experienced abuse reported more pain in relation to their current health problems than those without abuse experiences (Sachs-Ericsson et al., 2007).

ADDITIVE EFFECTS OF ABUSE ON HEALTH

Several studies have found an additive effect of different types of childhood abuse experiences in predicting the severity of poor health outcomes (e.g., Arnow et al., 2000; Diaz et al., 2000; Felitti et al., 1998; Golding et al., 1997; Kessler 2000; Kessler et al., 1997). For example, researchers found an additive effect of childhood sexual, physical, and emotional abuse on the number of distressing physical symptoms experienced (Walker et al., 1999). In a large representative sample of women, those who experienced both childhood physical and sexual abuse were at increased risk of health problems in adulthood compared with women who experienced only one type of abuse (Thompson et al., 2002). Felitti et al. (1998) found a relationship between the number of childhood abuse experiences (e.g., psychological, physical, emotional, and household dysfunction) and the occurrence of several specific medical problems (e.g., heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease). However, in our research using the NCS data (Sachs-Ericsson et al., 2005) contrary to expectations, individuals who experienced a combination of sexual and physical abuse did not have a higher frequency of health problems than those who experienced either type of abuse alone.

Nonetheless, understanding the independent implications of childhood sexual abuse and childhood physical abuse for health problems is important and can be complex because they often occur together, as well as with other negative childhood events (Felitti et al., 1998; Kessler et al., 1997; Mullen et al., 1993; Romans et al., 2002; Zuravin and Fontanella, 1999). For example, Felitti and colleagues (1998) found that when respondents experienced one childhood adversity, the probability of having experienced another was approximately 80 percent. Kessler (2000) argued that researchers often look at one childhood adversity, such as physical abuse, and assume subsequent problems are related to that, ignoring the possibility that physical abuse often occurs within a cluster of other childhoo...