Women report more intense, more numerous, and more frequent bodily symptoms than men. This difference appears in samples of medical patients and in community samples, whether or not gynecologic and reproductive symptoms are excluded, and whether all bodily symptoms or only those which are medically unexplained are examined. More limited, but suggestive, literature on experimental pain, symptom reporting in childhood, and pain thresholds in animals are compatible with these findings in adults. A number of contributory factors have been implicated, supported by varying degrees of evidence. These include innate differences in somatic and visceral perception; differences in symptom labeling, description, and reporting; the socialization process, which leads to differences in the readiness to acknowledge and disclose discomfort; a sex differential in the incidence of abuse and violence; sex differences in the prevalence of anxiety and depressive disorders; and gender bias in research and in clinical practice. General internists need to keep these factors in mind in obtaining the clinical history, understanding the meaning and significance that symptoms hold for each patient, and providing symptom relief.

/pdf/somatic-symptom-reporting-in-women-and-men-2lmqy43m8w.pdf

Somatic Symptom Reporting in Women and Men

Objective: To summarize the relationship between abuse during childhood and physical health outcomes in adulthood and to examine the role of potential moderators, such as the type of health outcome assessed, gender, age, and the type of abuse. Studies using self-report assessment methods were compared with studies using objective or independently verifiable methods. Method: The current study is a quantitative meta-analysis comparing results from 78 effect sizes across 24 studies including 48,801 individuals. Results: Experiencing child abuse was associated with an increased risk of negative physical health outcomes in adulthood (effect size d = 0.42, 95% Confidence Interval = 0.39-0.45). Neurological and musculoskeletal problems yielded the largest effect sizes, followed by respiratory problems, cardiovascular disease, gastrointestinal and metabolic disorders. Effect sizes were larger when the sample was exclusively female and when the abuse was assessed via self-report rather than objective, independently verifiable methods. Conclusions: Child abuse is associated with an increased risk of poor physical health in adulthood. The magnitude of the risk is comparable to the association between child abuse and poor psychological outcomes. However, studies often fail to include a diverse group of participants, resulting in a limited ability to draw conclusions about the population of child abuse survivors as a whole. Important methodological improvements are also needed to better understand potential moderators. Language: en

A meta-analytic review of the effects of childhood abuse on medical outcomes in adulthood.

Research conducted over the past decade indicates that a wide range of psychological and interpersonal problems are more prevalent among those who have been sexually abused than among individuals with no such experiences. Although a definitive causal relationship between such difficulties and sexual abuse cannot be established using current retrospective research methodologies, the aggregate of consistent findings in this literature has led many to conclude that childhood sexual abuse is a major risk factor for a variety of problems. This article summarizes what is currently known about these potential impacts of child sexual abuse. The various problems and symptoms described in the literature on child sexual abuse are reviewed in a series of broad categories including posttraumatic stress, cognitive distortions, emotional pain, avoidance, an impaired sense of self, and interpersonal difficulties. Research has demonstrated that the extent to which a given individual manifests abuse-related distress is a function of an undetermined number of abuse-specific variables, as well as individual and environmental factors that existed prior to, or occurred subsequent to, the incidents of sexual abuse.

https://www.jstor.org/stable/pdfplus/1602523.pdf

Immediate and long-term impacts of child sexual abuse.

The following study tested the hypothesis that women with post-traumatic stress disorder (PTSD) related to childhood sexual abuse would display elevated norepinephrine-to-cortisol ratios similar to that found in male combat veterans diagnosed with PTSD. Twenty-four-hour urine samples were collected from 28 women: 11 women with PTSD who experienced childhood sexual abuse (PTSD+), 8 women who experienced childhood sexual abuse without PTSD (PTSD-), and 9 nonabused controls. All urine samples were tested for creatinine, total catecholamines, free-cortisol, and 17-ketosteroid levels. Psychological testing validated that the PTSD+ group was significantly elevated on all three subscales of the Impact of Events Scale. Both abused groups (PTSD+ and PTSD-) showed a tendency for polyuria, and the PTSD+ group showed a tendency towards obesity. Thus, neuroendocrine values (micrograms/day) were adjusted by creatinine clearance rates (creatinine mg/day/kg body weight). The corrected values indicated that the PTSD+ group had significantly elevated daily levels of norepinephrine, epinephrine, dopamine, and cortisol. However, because of the parallel elevation in cortisol, the norepinephrine-to-cortisol ratio was not significantly elevated in the PTSD+ diagnosed women in contrast to the findings reported for male PTSD patients. This discrepancy may reflect an important gender difference, an interaction between gender and age at onset of the traumatic experience (childhood abuse in females vs. combat experience in young adult males), or physiological variation related to phase of the disorder. Language: en

Abuse-related posttraumatic stress disorder: evidence for chronic neuroendocrine activation in women.

BACKGROUND: Recent empirical evidence suggests that childhood abuse may be related to the experience of chronic pain in adulthood. To date, a systematic quantitative review of the literature has not been presented. OBJECTIVES: The purpose of this study was to use meta-analytic procedures to evaluate the strength of existing evidence of the association between self-reports of childhood abuse and the experience of chronic pain in adulthood. METHODS: Analyses were designed to test the relationship across several relevant criteria with 4 separate meta-analyses. RESULTS: Results of the analyses are as follows: 1) individuals who reported being abused or neglected in childhood also reported more pain symptoms and related conditions than those not abused or neglected in childhood; 2) patients with chronic pain were more likely to report having been abused or neglected in childhood than healthy controls; 3) patients with chronic pain were more likely to report having been abused or neglected in childhood than nonpatients with chronic pain identified from the community; and 4) individuals from the community reporting pain were more likely to report having been abused or neglected than individuals from the community not reporting pain. CONCLUSION: Results provide evidence that individuals who report abusive or neglectful childhood experiences are at increased risk of experiencing chronic pain in adulthood relative to individuals not reporting abuse or neglect in childhood. Language: en

Are reports of childhood abuse related to the experience of chronic pain in adulthood? A meta-analytic review of the literature.

The previously noted association between a history of childhood sexual abuse and an unusual number of medical complaints in adult women was examined in this study. In total, 60 women, 27 of whom had and 33 of whom had not been sexually abused as children, completed questionnaire measures of their medical complaints. Results revealed that the women with a history of sexual abuse had significantly more frequent complaints of a variety of medical problems, some of which, such as pelvic pain, have been noted in previous literature, and some of which, such as asthma, represent new findings.

Thomas Pearce

Papers

Childhood Sexual Abuse and Medical Complaints in Adult Women