Sexual abuse and lifetime diagnosis of somatic disorders: A systematic review and meta-analysis

Molly L. Paras, Mohammad Hassan Murad, Laura P. Chen, Erin N. Goranson, Amelia L. Sattler, Kristina M. Colbenson, Mohamed B. Elamin, Richard J. Seime, Larry J. Prokop, Ali Zirakzadeh

Research output: Contribution to journalReview article

284 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)550-561
Number of pages12
JournalJAMA - Journal of the American Medical Association
Volume302
Issue number5
DOIs
StatePublished - Aug 5 2009

ASJC Scopus subject areas

  • Medicine(all)

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    Paras, M. L., Murad, M. H., Chen, L. P., Goranson, E. N., Sattler, A. L., Colbenson, K. M., Elamin, M. B., Seime, R. J., Prokop, L. J., & Zirakzadeh, A. (2009). Sexual abuse and lifetime diagnosis of somatic disorders: A systematic review and meta-analysis. JAMA - Journal of the American Medical Association, 302(5), 550-561. https://doi.org/10.1001/jama.2009.1091