The prevalence of sexual abuse in women with fibromyalgia

Abstract

Objective. To determine the prevalence of sexual abuse in women diagnosed as having fibromyalgia (FM) compared with controls.Methods. A self-administered questionnaire designed to obtain information regarding demographics, health care utilization, and history of sexual and physical abuse was completed by 40 women with FM and by 42 women who had no evidence of connective tissue disease or other major medical condition.Results. Women with FM reported more physical symptoms and were significantly different on multiple indices of health compared with controls. Twenty-six FM subjects (65%) reported sexual abuse, in comparison with 22 controls (52%). The prevalence and type of abuse were not significantly different between groups. Sexually abused FM subjects reported significantly more symptoms than did non-sexually abused FM women, but did not differ in the number of symptoms for which they sought medical treatment.Conclusion. Sexual abuse does not appear to be a specific factor in the etiology of FM, but is correlated with the number and severity of associated symptoms.Fibromyalgia (FM) is commonly encountered in outpatient rheumatology practice. In addition to characteristic tender points, FM patients have multiple somatic complaints, including fatigue, stiffness, myalgias, arthralgias, headaches, and irritable bowel syndrome (IBS), as well as feelings of hopelessness (1,2). The frequent association of FM and IBS has been previously described (3,4). Using strict criteria, Veale (6) published data suggesting that there is an increased prevalence of physical and sexual abuse in women diagnosed as having functional IBS compared with those who had organic gastroenterologic disorders.Over the last several decades, reports of violence against children, adolescents, and women have been steadily climbing (7,8). A history of physical and/or sexual abuse is often associated with physical and psychological symptoms: increased rates of depression, suicide, alcoholism, anxiety, and somatic disorders (i.e., abdominal pain, headaches) (9,lO). Because many of the somatic complaints reported by sexually abused women overlap with those seen in patients with FM, and in light of findings by Drossman relating sexual abuse to functional gastrointestinal disorders, we undertook the present study to evaluate the prevalence of sexual and physical abuse in an FM population. It was hypothesized that subjects with FM would more frequently report sexual or physical abuse than would healthy community controls, and that those FM patients with a history of sexual/physical abuse would report greater levels of somatic complaints and more frequent use of the health care system. PATIENTS AND METHODSStudy subjects. Forty women who met the American College of Rheumatology 1990 criteria for FM (2) and had no evidence of other rheumatologic disorders were identified through the Medical College of Wisconsin Rheumatology Division. Subjects were contacted personally and all patients who qualified for the study agreed to participate.Forty-two women were rec...

Cerebrospinal Fluid Corticotropin-Releasing Factor Concentration is Associated with Pain but not Fatigue Symptoms in Patients with Fibromyalgia

“…Error in classification would underestimate true differences between those with or without self-reported abuse, and could increase the inaccuracy of regression model estimates. However, the self-reported abuse prevalence among FM patients in our sample is similar to that reported in other FM tertiary care populations (Taylor et al, 1995;Goldberg et al, 1999;Carpenter et al, 2004), and the validity of the brief selfreport measure used in the study is supported by the lower CSF CRF levels found among those reporting abuse, which is consistent with the known biological affects of early life stress (Carpenter et al, 2004;Heim et al, 2004).…”

“…This finding is consistent with that of Carpenter et al (2004), who found that perceived life stress during the preteen years was associated with decreased CSF CRF. The influence of selfreported childhood abuse has only recently been assessed in studies of stress axis function in FM (McLean et al, 2005b;Weissbecker et al, 2005), despite the fact that FM patients are often recruited for research studies from tertiary care clinic populations, where the prevalence of self-reported abuse is often 50% or more (Taylor et al, 1995;Goldberg et al, 1999;Carpenter et al, 2004). These recent studies describe relatively low cortisol levels in FM patients reporting a history of childhood abuse, and relatively high levels in those not reporting a history (McLean et al, 2005b;Weissbecker et al, 2005).…”

Perceived physical and emotional trauma as precipitating events in fibromyalgia. Associations with health care seeking and disability status but not pain severity

“…Sexual and physical abuse was assessed with an interview previously used in the National Population Survey of Canada and in recent studies of FMS patient groups (13,14,18). Patients and nonpatients were classified as either abused or nonabused based on their responses to 7 questions regarding abuse during childhood or adulthood.…”

“…This relationship was evaluated after controlling for demographic factors and a history of sexual or physical abuse, both of which are associated with increased health care usage and frequently occur among patients with FMS (11)(12)(13)(14). Three central issues were then examined regarding relationships between perceived physical and emotional trauma and several outcomes in patients with FMS.…”

Primary attributions in women suffering fibromyalgia emphasize the perception of a disruptive onset for a long-lasting pain problem

“…Other authors found a high prevalence (> 30%) of sexual and physical abuse in women with FM and reported higher rates of abuse in these patients as compared with a group of women without FM [45][46][47]. However, still other authors questioned the association between sexual abuse and FM onset [48][49][50].…”