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ARTICLE |

Clinical Characteristics of Women With a History of Childhood Abuse:  Unhealed Wounds

Jeanne McCauley, MD, MPH; David E. Kern, MD, MPH; Ken Kolodner, ScD; Laurie Dill, MD; Arthur F. Schroeder, MD; Hallie K. DeChant, MD; Janice Ryden, MD; Leonard R. Derogatis, PhD; Eric B. Bass, MD, MPH
JAMA. 1997;277(17):1362-1368. doi:10.1001/jama.1997.03540410040028.
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Objectives.  —To determine the prevalence of childhood physical or sexual abuse in women seen in primary care practices; to identify physical and psychologic problems associated with that abuse; and to compare the effects of childhood physical vs sexual abuse and childhood vs adult abuse.

Design.  —Cross-sectional, self-administered, anonymous survey.

Setting.  —Four community-based, primary care internal medicine practices.

Patients.  —A total of 1931 women of varied age and marital, educational, and economic status examined from February through July 1993.

Main Outcome Measures.  —Prevalence of physical and sexual abuse, physical symptoms, psychological symptoms (Symptom Checklist-22), alcohol abuse (CAGE questions), and street drug use.

Results.  —Of the 1931 respondents, 424 (22.0%) reported childhood or adolescent physical or sexual abuse. Compared with women who reported never having experienced abuse (n=1257), women who reported abuse as children but not adults (n=204) had more physical symptoms (mean±SE, 6.2±0.2 vs 4.0±0.9; P<.001) and had higher scores for depression, anxiety, somatization, and interpersonal sensitivity (low self-esteem) (P<.001); were more likely to be abusing drugs (prevalence ratio [PR], 4.7; 95% confidence interval [CI], 2.9-7.6) or to have a history of alcohol abuse (PR, 2.2; 95% CI, 1.5-3.2); were more likely to have attempted suicide (PR, 3.7; 95% CI, 2.6-5.1); and were more likely to have had a psychiatric admission (PR, 3.2; 95% CI, 2.2-4.7). Women abused only as children did not differ from women who reported current, but not childhood, abuse in number of physical symptoms, emotional distress, substance abuse, or suicide attempts. Patients who reported both childhood and adult abuse had higher levels of psychological problems and physical symptoms than those who reported childhood or adult abuse alone.

Conclusions.  —Childhood physical or sexual abuse is associated with adult health problems including physical symptoms, psychological problems, and substance abuse; for many variables, this association is as strong as for patients experiencing current abuse.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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