Unhealed wounds: Physical and psychological problems of primary care female patients abused as children

Introduction: Internists underestimate the prevalence of childhood abuse in adult, female patients and little is known about the relationship of childhood physical or sexual abuse to adult illness. The aims of this study were to determine the prevalence of past childhood physical and sexual abuse in adult female patients and to identify physical or psychologic problems associated with that abuse. Methods: Cross-sectional, self-administered, anonymous survey given to women of diverse sodoeconomic backgrounds presenting to four community-based, primary care, internal medicine practices from February through July 1993. Résulta: 2392 women were given the survey and 1,941 (81%) completed it. Of the 1,941 respondents, 429 (22.0%) had experienced physical or sexual abuse before age 18. Compared to women who had never experienced violence, patients experiencing childhood abuse were more likely to be less than 25 years old (Prevalence Ratio [PR] = 2.4; 95% confidence ratio (CI) 1.7-3.6); were more likely to be single, separated, or divorced than married (PR = 1.7; CI 1.2 to 2.4); had more physical symptoms (mean 62 vs. 4.0; p<-001); had higher scores for depression, anxiety, somatization, and interpersonal sensitivity (low self-esteem) (p<.001); were more likely themselves to be abusing drugs (PR = 4.7; CI 2.7-7.6) or have a history of past alcohol abuse (PR = 2.2; CI 1.5-3.2); were more likely to have attempted suicide (PR - 3.7; CI 2.6-5.1); and were more likely to have had a psychiatric admission (PR - 33; O 23-4.8). Conclusions: Our data suggest that 1 out of every 5 women in a large, diverse, community-based population of primary care patients had experienced abuse as a child or adolescent. Childhood physical or sexual abuse is associated with a variety of adult health problems including physical symptoms, psychological problems, suicide attempts, and substance abuse. Because of the prevalence in women of past childhood physical and sexual abuse and the association of such abuse with physical and psychological problems in adult life, internists should screen their female patients for childhood abuse.