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Review | Clinician's Corner

Sexual Abuse and Lifetime Diagnosis of Somatic Disorders A Systematic Review and Meta-analysis

Molly L. Paras, BS; Mohammad Hassan Murad, MD; Laura P. Chen, BS; Erin N. Goranson, BS; Amelia L. Sattler, BS; Kristina M. Colbenson, BS; Mohamed B. Elamin, MBBS; Richard J. Seime, PhD; Larry J. Prokop, MLS; Ali Zirakzadeh, MD
JAMA. 2009;302(5):550-561. doi:10.1001/jama.2009.1091.
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Published online

Context Many patients presenting for general medical care have a history of sexual abuse. The literature suggests an association between a history of sexual abuse and somatic sequelae.

Objective To systematically assess the association between sexual abuse and a lifetime diagnosis of somatic disorders.

Data Sources and Extraction A systematic literature search of electronic databases from January 1980 to December 2008. Pairs of reviewers extracted descriptive, quality, and outcome data from included studies. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled across studies by using the random-effects model. The I2 statistic was used to assess heterogeneity.

Study Selection Eligible studies were longitudinal (case-control and cohort) and reported somatic outcomes in persons with and without history of sexual abuse.

Results The search identified 23 eligible studies describing 4640 subjects. There was a significant association between a history of sexual abuse and lifetime diagnosis of functional gastrointestinal disorders (OR, 2.43; 95% CI, 1.36-4.31; I2 = 82%; 5 studies), nonspecific chronic pain (OR, 2.20; 95% CI, 1.54-3.15; 1 study), psychogenic seizures (OR, 2.96; 95% CI, 1.12-4.69, I2 = 0%; 3 studies), and chronic pelvic pain (OR, 2.73; 95% CI, 1.73-4.30, I2 = 40%; 10 studies). There was no statistically significant association between sexual abuse and a lifetime diagnosis of fibromyalgia (OR, 1.61; 95% CI, 0.85-3.07, I2 = 0%; 4 studies), obesity (OR, 1.47; 95% CI, 0.88-2.46; I2 = 71%; 2 studies), or headache (OR, 1.49; 95% CI, 0.96-2.31; 1 study). We found no studies that assessed syncope. When analysis was restricted to studies in which sexual abuse was defined as rape, significant associations were observed between rape and a lifetime diagnosis of fibromyalgia (OR, 3.35; 95% CI, 1.51-7.46), chronic pelvic pain (OR, 3.27; 95% CI, 1.02-10.53), and functional gastrointestinal disorders (OR, 4.01; 95% CI, 1.88-8.57).

Conclusion Evidence suggests a history of sexual abuse is associated with lifetime diagnosis of multiple somatic disorders.

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Figure 1. Study Selection Process
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The literature review included search for articles with psychiatric outcomes reported elsewhere.

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Figure 2. Odds Ratio for the Association of Sexual Abuse and Somatic Disorders
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CI indicates confidence interval; GI, gastrointestinal.
aNo event total available.

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Figure 3. Odds Ratio for the Association of Rape With Somatic Disorders
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CI indicates confidence interval; GI, gastrointestinal.

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