Mental health problems and medically unexplained physical symptoms in adult survivors of childhood sexual abuse: an integrative literature review

Authors

  • S. NELSON PhD MA (Hons),

    Corresponding author
    1. Research Fellow, Centre for Research on Families and Relationships, University of Edinburgh, Edinburgh
      S. Nelson, CRFR, University of Edinburgh, 23 Buccleuch Place, Edinburgh EH8 9LN, Scotland, UK, E-mail: sarah.nelson@ed.ac.uk
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  • N. BALDWIN M Phil BA (Hons),

    1. Professor of Child Care and Protection (Emeritus), University of Dundee
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  • J. TAYLOR PhD RN MSc BSc (Hons) RNT

    1. Professor of Family Health, Research Dean, School of Nursing and Midwifery, University of Dundee: seconded to NSPCC (Head of Strategy and Development, Physical Abuse in High Risk Families), Dundee, UK
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S. Nelson, CRFR, University of Edinburgh, 23 Buccleuch Place, Edinburgh EH8 9LN, Scotland, UK, E-mail: sarah.nelson@ed.ac.uk

Abstract

Accessible summary

  • • People who were sexually abused as children are at higher risk than non-abused people of suffering symptoms that doctors can't explain (e.g. irritable bowel syndrome), and to have mental ill health (e.g. anxiety and depression).
  • • Relations between themselves and doctors or nurses can often become strained and frustrating, bringing high healthcare costs without relief of their ‘medically unexplained symptoms’. The aim in the literature review was to find an evidence base that might contribute to more helpful treatment or support, to improving relationships with medical staff and revealing gaps in knowledge.
  • • Some theories about why sexual abuse survivors with mental ill health have these unexplained symptoms were found to stigmatize them. Other theories conflicted with each other. This increases the difficulty of identifying helpful interventions. Research focussed on finding out ‘risk factors’ rather than on improving people's health. It rarely involved survivors themselves, or staff who worked closely with them.
  • • Recommendations include consulting survivors themselves about their experiences, and about how doctors and nurses could work more sensitively with them; learning from patients' case histories and medical records; studying sexually abused children's health problems as they grow into adulthood; and supporting neurobiological research.

Abstract

People sexually abused in childhood are at higher risk than non-abused people of medically unexplained symptoms such as irritable bowel syndrome or chronic pain, with mental ill health and high healthcare use. Friction and frustration, with high, unproductive healthcare costs, can often develop between these patients and health-care professionals such as general practitioners and nursing staff. The aim of this integrative literature review was to seek a sound evidence base from which to develop helpful interventions, improve relationships and identify gaps in knowledge. It found some theories about interconnections among childhood sexual abuse mental health and medically unexplained symptoms, such as ‘somatization’ or ‘secondary gain’, were used prejudicially, stigmatizing survivors. Conflicting theories make more difficult the search for effective interventions. Researchers rarely collaborated with sexual abuse specialists. Emphasis on identifying key risk factors, rather than providing support or alleviating distress, and lack of studies where survivors voiced their own experiences, meant very few targeted interventions for this group were proposed. Recommendations to enable effective interventions include making abuse survivors the prime study focus; qualitative research with survivors, to assist doctors and nursing staff with sensitive care; case histories using medical records; prospective studies with sexually abused children; support for the growing field of neurobiological research.

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