Psychological-Social Environment:  Research Article

Psychoneuroendocrine Menu

Sexual and Physical Abuse and Gastrointestinal Illness

CITATION:  Douglas A. Drossman, MD; Nicholas J. Talley, MD; Jane Leserman, PhD; Kevin W. Olden, MD; and Marcelo A. Barreiro, MD, MSc.  Sexual and Physical Abuse and Gastrointestinal Illness: Review and Recommendations. Duke University 15 November 1995 | Volume 123 Issue 10 | Pages 782-794. 


Objectives: To summarize the existing data on abuse history and gastrointestinal illness, suggest a conceptual scheme to explain these associations, suggest ways to identify patients at risk, and provide information about mental health referral. 

Data Sources: Review of the pertinent literature by clinicians and investigators at referral centers who are involved in the care of patients with complex gastrointestinal illness and who have experience in the diagnosis and care of patients with abuse history in these settings. 

Study Selection: All research articles and observational data that addressed abuse history in gastroenterologic settings. Articles were identified through a MEDLINE search. 
Data Extraction: Independent extraction by multiple observers. 

Data Synthesis: On the basis of literature review and consensus, it was determined that abuse history is associated with gastrointestinal illness and psychological disturbance; appears more often among women, patients with functional gastrointestinal disorders, and patients seen in referral settings; is not usually known by the physician; and is associated with poorer adjustment to illness and adverse health outcome. 


1. Stein JA, Golding JM, Diegel JM, Burnam MA, Sorensen SB. Long-term psychological sequelae of child abuse: the Los Angeles epidemiologic catchment area study. In: Wyatt GE, Powell GJ, eds. Lasting Effects of Child Sexual Abuse. Newbury Park: Sage; 1988:135-54. 

2. Bagley C, Ramsay R. Sexual abuse in childhood: psychosocial outcomes and implications for social work practice. Social Work Practice in Sexual Problems. 1985; 4:33-47. 

3. Felitti VJ. Long-term medical consequences of incest, rape, and molestation. South Med J. 1991; 84:328-31. 

4. Briere J. Medical symptoms, health risk, and history of childhood sexual abuse [Editorial]. Mayo Clin Proc. 1992; 67:603-4. 

5. Springs FE, Friedrich WN. Health risk behaviors and medical sequelae of childhood sexual abuse. Mayo Clin Proc. 1992; 67:527-32. 

6. Fry R. Adult physical illness and childhood sexual abuse. J Psychosom Res. 1993; 37:89-103. 

7. Laws A. Does a history of sexual abuse in childhood play a role in women's medical problems? A review. Journal of Women's Health. 1993; 2:165-72. 

8. Drossman DA. Physical and sexual abuse and gastrointestinal illness: what is the link? [Editorial] Am J Med. 1994; 97:105-7. 

9. Peters SD, Wyatt GE, Finkelhor D. Prevalence. In: Finkelhor D, ed. A Sourcebook on Child Sexual Abuse. Beverly Hills, California: Sage; 1986:15-59. 

10. Leventhal JM. Have there been changes in the epidemiology of sexual abuse of children during the 20th century? Pediatrics. 1988; 82:766-73. 

11. Leserman J, Drossman DA, Li Z, Toomey TC, Nachman G. The reliability and validity of a sexual and physical abuse history questionnaire in female patients with gastrointestinal disorders. Behavioral Medicine. 1995; [In press]. 

12. Wyatt GE, Peters SD. Methodological considerations in research on the prevalence of child sexual abuse. Child Abuse Negl. 1986; 10:241-51. 

13. Siegel JM, Sorenson SB, Golding JM, Burnam MA, Stein JA. The prevalence of childhood sexual assault: The Los Angeles Epidemiologic Catchment Area Project. Am J Epidemiol. 1987; 126:1141-53. 

14. Koss MP, Dinero TE. Discriminant analysis of risk factors for sexual victimization among a national sample of college women. J Consult Clin Psychol. 1989; 57:242-50. 

15. Joachim G, Milne B. Inflammatory bowel disease: effects on lifestyle. J Adv Nurs. 1987; 12:483-7. 

16. Briere J, Runtz M. Multivariate correlates of childhood psychological and physical maltreatment among university women. Child Abuse Negl. 1988; 12:331-41. 

17. Resnick HS, Kilpatrick DG, Dansky BS, Saunders BE, Best CL. Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women. J Consult Clin Psychol. 1993; 61:984-91. 

18. Badgley R, Allard H, McCormick N, Proudfood P, Fortin D, Ogilvie D, et al. Occurrence in the population. In: Anonymous Sexual Offences against Children (Volume 1). Ottawa: Canadian Government Publishing Centre; 1984:175-93. 

19. Koss MP, Gidycz CA, Wisniewski N. The scope of rape: incidence and prevalence of sexual aggression and victimization in a national sample of higher education students. J Consult Clin Psychol. 1987; 55:162-70. 

20. Koss MP, Gidycz CA. Sexual experiences survey: reliability and validity. J Consult Clin Psychol. 1985; 53:422-3. 

21. Jacobson A, Richardson B. Assault experiences of 100 psychiatric inpatients: evidence of the need for routine inquiry. Am J Psychiatr. 1987; 144:908-13. 

22. Drossman DA, Leserman J. Nachman G, Li ZM, Gluck H, Toomey TC, et al. Sexual and physical abuse in women with functional or organic gastrointestinal disorders. Ann Intern Med. 1990; 113:828-33. 

23. Koss MP, Woodruff WJ, Koss PG. Relation of criminal victimization to health perceptions among women medical patients. J Consult Clin Psychol. 1990; 58:147-52. 

24. Hutchings PS, Dutton MA. Sexual assault history in a community mental health center clinical population. Community Ment Health J. 1993; 29:59-63. 

25. George LK, Winfield I, Blazer DG. Sociocultural factors in sexual assault: comparison of two representative samples of women. Journal of Social Issues. 1992; 48:105-25. 

26. Bachmann GA, Moeller TP, Benett J. Childhood sexual abuse and the consequence in adult women. Obstet Gynecol. 1988; 71:631-42. 

27. Rimsza ME, Berg RA, Locke C. Sexual abuse: somatic and emotional reactions. Child Abuse Negl. 1988; 12:201-8. 

28. Felice M, Grant J, Reynolds B, Gold S, Wyatt M, Heald FP. Follow-up observations of adolescent rape victims. Rape may be one of the more serious afflictions of adolescence with respect to long-term psychological effects. Clin Pediatr (Phila). 1978; 17:311-5. 

29. Lechner ME, Vogel ME, Garcia-Shelton LM, Leichter JL, Steibel KR. Self-reported medical problems of adult female survivors of childhood sexual abuse. J Fam Pract. 1993; 36:633-8. 

30. Talley NJ, Helgeson S, Zinsmeister AR. Are sexual and physical abuse linked to functional gastrointestinal disorders? [Abstract] Gastroenterology. 1992; 102:A52. 

31. Scarinci IC, McDonald-Haile M, Bradley LA, Richter JE. Altered pain perception and psychosocial features among women with gastrointestinal disorders and history of abuse: a preliminary model. Am J Med. 1994; 97:108-18. 

32. Leroi AM, Bernier C, Watier A, et al. Animus, sexual abuse and functional lower gastrointestinal tract disorders. Gastroenterology. 1993; 104:1047. 

33. Longstreth GF, Wolde-Tsadik G. Irritable bowel-type symptoms in HMO examinees: prevalence, demographics, and clinical correlates. Dig Dis Sci. 1993; 38:1581-9. 

34. Talley NJ, Fett SL, Zinsmeister AR, Melton LJ 3d. Gastrointestinal tract symptoms and self-reported abuse: a population-based study. Gastroenterology. 1994; 107:1040-9. 

35. Briere J, Runtz M. Symptomatology associated with childhood victimization in a nonclinical adult sample. Child Abuse Negl. 1988; 12:51-9. 

36. Walker EA, Katon WJ, Roy-Byrne PP, Jemelka RP, Russo J. Histories of sexual victimization in patients with irritable bowel syndrome or inflammatory bowel disease. Am J Psychiatry. 1993; 150:1502-6. 

37. Russell DH. The incidence and prevalence of intrafamilial and extrafamilial sexual abuse of female children. Child Abuse Negl. 1983; 7:133-46. 

38. Gelinas DJ. The persisting negative effects of incest. Psychiatry. 1983; 46:312-32. 

39. Walker EA, Katon WJ, Hansom J, Harrop-Griffiths J, Holm L, Jones ML, et al. Medical and psychiatric symptoms in women with childhood sexual abuse. Psychosom Med. 1992; 54:658-64. 

40. Bryer JB, Nelson BA, Miller JB, Krol PA. Childhood sexual and physical abuse as factors in adult psychiatric illness. Am J Psychiatry. 1987; 144:1426-30. 

41. Briere J, Runtz M. Symptomatology associated with childhood sexual victimization in a nonclinical adult sample. Child Abuse Negl. 1988; 12:51-9. 

42. Morrison J. Childhood sexual histories of women with somatization disorder. Am J Psychiatry. 1989; 146:239-41. 

43. Loewenstein RJ. Somatoform disorders in victims of incest and child abuse. In: Kluft RP, ed. Incest Related Syndromes of Adult Psychopathology. Washington, DC: American Psychiatric Pr; 1990:75-107. 

44. Walker E, Katon W, Harrop-Griffiths J, Holm L, Russo J, Hickok LR. Relationship of chronic pelvic pain to psychiatric diagnoses and childhood sexual abuse. Am J Psychiatry. 1988; 145:75-9. 

45. Reiter RC, Shakerin LR, Gambone JC, Milburn AK. Correlation between sexual abuse and somatization in women with somatic and nonsomatic chronic pelvic pain. Am J Obstet Gynecol. 1991; 165:104-9. 

46. Harrop-Griffiths J, Katon W, Walker E, Holm L, Russo J, Hickok L. The association between chronic pelvic pain, psychiatric diagnoses, and childhood sexual abuse. Obstet Gynecol. 1988; 71:589-94. 

47. Domino JV, Haber JD. Prior physical and sexual abuse in women with chronic headache: clinical correlates. Headache. 1987; 27:310-4. 

48. Wurtele SK, Kaplan GM, Keairnes M. Childhood sexual abuse among chronic pain patients. Clin J Pain. 1990; 6:110-3. 

49. Hall RC, Tice L, Beresford TP, Wooley B, Hall AK. Sexual abuse in patients with anorexia nervosa and bulimia. Psychosomatics. 1989; 30:73-9. 

50. Miller BA, Downs WR, Gondoli DM. The role of childhood sexual abuse in the development of alcoholism in women. Violence Vict. 1987; 2:157-72. 

51. Rosenhow DJ, Corbett R, Devine D. Molested as children: a hidden contribution to substance abuse? J Subst Abuse Treat. 1988; 5:13-8. 

52. Sheldon H. Childhood sexual abuse in adult female psychotherapy referrals. Incidence and implications for treatment. Br J Psychiatry. 1988; 152:107-11. 

53. Drossman DA. Irritable bowel syndrome. The Gastroenterologist. 1994; 2:315-26. 

54. Bharucha AE, Camilleri M, Low PA, Zinsmeister AR. Autonomic dysfunction in gastrointestinal motility disorders. Gut. 1993; 34:397-401. 

55. Almy TP, Kern FJ, Tulin M. Alteration in colonic function in man under stress: II. Experimental production of sigmoid spasm in healthy persons. Gastroenterology. 1949; 12:425-36. 

56. Drossman DA, Sandler RS, McKee DC, Lovitz AJ. Bowel patterns among subjects not seeking health care. Use of a questionnaire to identify a population with bowel dysfunction. Gastroenterology. 1982; 83:529-34. 

57. Almy TP. Experimental studies on the irritable colon. Am J Med. 1951; 10:60-7. 

58. Welgan P, Meshkinpour H, Beeler M. Effect of anger on colon motor and myoelectric activity in irritable bowel syndrome. Gastroenterology. 1988; 94:1150-6. 

59. Whitehead WE, Crowell MD, Robinson JC, Heller BR, Schuster MM. Effects of stressful life events on bowel symptoms: subjects with irritable bowel syndrome compared to subjects without bowel dysfunction. Gut. 1992; 33:825-30. 

60. Cervero F, Jaenig W. Visceral nociceptors: a new world order? Trends Neurosci. 1992; 15:374-8. 

61. Mayer EA, Gebhart GF. Basic and clinical aspects of visceral hyperalgesia. Gastroenterology. 1994; 107:271-93. 

62. Ness TJ, Metcalf AM, Gebhart GF. A psychophysiological study in humans using phasic colonic distension as a noxious visceral stimulus. Pain. 1990; 43:377-86. 

63. Willis WJ Jr Mechanical allodynia. A role for sensitized nociceptive tract cells with convergent input from mechanoreceptors and nociceptors? APS Journal. 1993; 2:23-33. 

64. Engel GL. "Psychogenic" pain and pain-prone patient. Am J Med. 1959; 26:899-918. 

65. Drossman DA. The problem patient: evaluation and care of medical patients with psychosocial disturbances. Ann Intern Med. 1978; 88:366-72. 

66. Walker EA, Katon WJ, Jemelka RP, Roy Bryne PP. Comorbidity of gastrointestinal complaints, depression, and anxiety in the Epidemiologic Catchment Area (ECA) Study. Am J Med. 1992; 92:26S-30S. 

67. Lydiard RB, Fossey MD, Marsh W, Ballenger JC. Prevalence of psychiatric disorders in patients with irritable bowel syndrome. Psychosomatics. 1993; 34:229-34. 

68. Drossman DA, McKee DC, Sandler RS, Mitchell CM, Cramer EM, Lowman BC, et al. Psychosocial factors in the irritable bowel syndrome. A multivariate study of patients and nonpatients with irritable bowel syndrome. Gastroenterology. 1988; 95:701-8. 

69. Toner BB, Koyama E, Garfinkel PE, Jeejeebhoy KN, Gasbarro I. Social desirability and irritable bowel syndrome. Int J Psychiatry Med. 1992; 22:99-103. 

70. Lowman BC, Drossman DA, Cramer EM, McKee DC. Recollection of childhood events in adults with irritable bowel syndrome. J Clin Gastroenterol. 1987; 9:324-30. 

71. Drossman DA. Illness behaviour in the irritable bowel syndrome. Gastroenterology International. 1991; 4:77-81. 

72. Whitehead WE, Winget C, Fedoravicius AS, Wooley S, Blackwell B. Learned illness behavior in patients with irritable bowel syndrome and peptic ulcer. Dig Dis Sci. 1982; 27:202-8. 

73. Creed H. Life events and physical illness. J Psychosom Res. 1985; 29:113-23. 

74. Berkman LF. The relationship of social networks and social support to morbidity and mortality. In: Cohen S. Syme SL, eds. Social Support and Health. New York: Academic Pr; 1985:241-77. 

75. Lazarus RS, Folkman S. Stress. Appraisal, and coping. New York: Springer; 1984:1-445. 

76. Talley NJ, Fett SL, Zinsmeister AR, Melton LJ 3I. Gastrointestinal tract symptoms and self-reported abuse: a population-based study. Gastroenterology. 1994; 107:1040-9. 

77. Drossman DA. Sexual and physical abuse and gastrointestinal illness. Scand J Gastroenterol Suppl. 1995; 208:90-6. 

78. Drossman DA. Struggling with the "controlling" patient. Am J Gastroenterol. 1994; 89:1441-6. 

79. Darke LL, Kames LD, Stampler FM. Sexual and physical abuse in chronic pain patients [Abstract]. American Pain Society Meetings. 1988; 149. 

80. Devroede G. Constipation and sexuality. Medical Aspects of Human Sexuality. 1990; 24:40-6. 

81. Laws A. Sexual abuse history and women's medical problems. J Gen Intern Med. 1993; 8:441-3. 

82. Braun BG. Multiple personality disorder: an overview. Am J Occup Ther. 1990; 44:971-6. 

83. Lindberg FH, Distad LJ. Post-traumatic stress disorders in women who experienced childhood incest. Child Abuse Negl. 1985; 9:329-34. 

84. Drossman DA. Psychosocial factors in the care of patients with gastrointestinal disorders. In: Yamada T, ed. Textbook of Gastroenterology. 2d ed. Philadelphia: Lippincott: 1995. 

85. Pilowsky I. A general classification of abnormal illness behaviors. Br J Med Psychol. 1978; 51:131-7. 

86. Arnold RP, Rogers D, Cook DG. Medical problems of adults who were sexually abused in childhood. BMJ. 1990; 300:705-8. 

87. Drossman DA. The link between early abuse and GI disorders in women. Emerg Med. 1992; 2:171-5. 

88. Levinson W, Stiles WB, Inui TS, Engle R. Physician frustration in communicating with patients. Med Care. 1993; 31:285-95. 

89. Groves JE. Taking care of the hateful patient. N Engl J Med. 1978; 298:883-7. 

90. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders DSM-IV. 4th ed. Washington, D.C.: American Psychiatric Association; 1994:1-886. 

91. Spielberger CD. Manual for the State-Trait Anxiety Inventory (Form Y). Palo Alto, California: Consulting Psychologists Pr; 1983. 

92. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961; 4:561-71. 

93. Sheehan DV. Sheehan patient-related anxiety scale. In: McGlynn TJ, Mecalf L, eds. Diagnosis and Treatment of Anxiety Disorders: A Physician's Handbook. Washington, D.C.: American Psychiatric Pr; 1989; 98-9. 

94. Garner DM, Garfinkel PE. The eating attitudes test: an index of the symptoms of anorexia nervosa. Psychol Med. 1979; 9:273-9. 

95. Dahlstrom WG, Dahlstrom LE, Welsh GS. An MMPI Handbook Revised Ed. Minneapolis: University of Minnesota Pr; 1972. 

96. Derogatis LR. SCL-90-R: Administration, Scoring, and Procedures Manual II For the R(evised) Version. Towson, Maryland: Clinical Psychometric Research; 1983. 

97. Pilowsky I, Barrow CG. A controlled study of psychotherapy and amitriptline used individually and in combination in the treatment of chronic intractable, ‘psychogenic’ pain. Pain. 1990; 40:3-19. 

98. Brown HN, Zimberg NE. Difficulties in the integration of psychological and medical practices. Am J Psychiatry. 1982; 139:1576-80. 

99. Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977; 196:129-36.