MedicallyUnexplained Symptoms in CSA Survivors

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Medically-Unexplained Symptoms in CSA Survivors

• Dr Sarah Nelson
• Dr Julie Taylor
• Prof Norma Baldwin
• University of Dundee

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MUS in Sexual Abuse Survivors

• A review of the research literature on MUS in
  people with sexual abuse histories and mental
  health symptoms
• National Programme for Improving Mental Health
  and Wellbeing Small Projects Initiative 2006

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MUS in Sexual Abuse SurvivorsWider health
issues in CSA

• Injuries and infections from the assaults
  themselves
• Effects of pregnancy, abortions etc at early age
• Escaping abuse many risks to health on streets
• Physical health effects of psychol. effects, e.g.
  eating disorders, depression, self-injury

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MUS in Sexual Abuse Survivors Wider health
issues in CSA 2

• Effects of misusing drink/drugs to cope with
  trauma
• Fear and avoidance of health dental checks
• Side-effects of prolonged psychiatric medication
• Survivors at higher risk for medically-explained
  conditions like diabetes, heart disease

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MUS in Sexual Abuse Survivors Main types of MUS

• Irritable bowel syndrome other GI complaints
• Chronic pelvic pain/severe premenstrual pain
• Fibromyalgia other chronic pain
• Respiratory conditions, wheezing, throat problems
• Non-epileptic seizures
• Chronic fatigue
• Symptoms across several organ systems

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MUS in Sexual Abuse Survivors Aims of the study

• To find out how CSA survivors with MUS and mental
  health issues have been identified and sampled
  the key findings of research literature
  theories used to explain inter-connections any
  interventions and treatments for the CSA group
  gaps in knowledge or understanding which require
  further research
• And to make recommendations!

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MUS in Sexual Abuse Survivors Methodology of the
review

• Electronic searches of medical, psychiatric and
  social work databases from 1990 quantitative or
  qualitative studies
• Studies had to refer to CSA, MUS and mental
  health issues
• Included review and discussion papers for theory
  section
• Hand searches plus SNs prior knowledge of issue
• Consultation with experts

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MUS in Sexual Abuse Survivors Key review
findings

• 96 studies retrieved 27 reviews or discussion
  papers overwhelmingly a medical literature
• Main recruitment was from tertiary care clinics
• CSA survivors were main focus in only 9 studies
  instead, people with certain symptoms were main
  focus
• Only three qualitative studies and three on
  males only one intervention identified for this
  specific group
• Most researchers were medical specialists not
  experts in CSA few collaborations with CSA
  services or support agencies

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MUS in Sexual Abuse Survivors Key review
findings 2

• Most papers confirm people with CSA are at higher
  risk for MUS, especially for GI and chronic pain
• The more serious the abuse, more serious the
  impact on MUS, disability, sick days and
  healthcare use
• Childhood physical abuse and adult physical
  assaults also significant influences on MUS
• Recomms. for general good practice include
  detailed history-taking, respectful listening,
  referral for psychol therapy.

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MUS in Sexual Abuse Survivors Theories of the
links

• Somatisation emotional stress translates into
  bodily symptoms
• Severe trauma causes changes in central nervous
  system increasing vulnerability to pain and
  infections (neurobiol. research)
• Dissociative re-enactments and body memories
  occur

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MUS in Sexual Abuse Survivors Theories of the
links 2

• Depression/anxiety lead people to amplify their
  physical symptoms
• Injury and infection through assaults directly
  influence symptoms, especially chronic pain

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MUS and Sexual Abuse Survivors Problems of
existing research

• An overriding concern with testing which risk
  factors contribute to which outcomes has produced
  a repetitive (and competitive) body of case
  control studies, which have failed to identify
  helpful interventions for sexually abused people
  with MUS

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MUS and Sexual Abuse Survivors Problems of
existing research 2

• Discrete variables used dont match survivors
  experience, whose forms of abuse neglect are
  often interlinked
• Key concept, somatisation problematic poorly
  defined
• Very little collaboration with specialists in CSA
• Voices of survivors themselves rarely heard
• Lack of ethical safeguards or support for abused
  people filling in intrusive questionnaires

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MUS and Sexual Abuse Survivors Problems about
somatisation

• Term is variously defined, or left undefined
• Prone to gender biases - most somatisers
  (heartsink patients? ) are women
• Ignores other possible explanations plus
  possibility that a medical condition may be
  inadequately diagnosed
• No convincing proof that the process even exists!

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MUS and Sexual Abuse Survivors Recomms for
research

• CSA survivors must be primary focus of research
• Needs to be geared to exploring causes and
  relieving suffering
• Needs open mind, free of value judgments re.
  somatisation
• Medical specialists need to collaborate with CSA
  specialists in design and interpretation of
  studies

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MUS and Sexual Abuse Survivors Recomms for
research 2

• Need qualitative research with adult survivors
  with MUS, to explore health history, abuse
  history, experiences of health system, and
  interconnections
• Studies of male survivors with MUS
• Case histories, exploring medical records and
  attitudes of clinicians

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MUS and Sexual Abuse Survivors Recomms for
research 3

• Research into direct physical effects of violence
  and injury, and into body memories, including
  collaboration with torture research experts
• Collaborative research with vol. sector support
  agencies
• Prospective studies with children young people
  whose abuse has been documented

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MUS and Sexual Abuse Survivors What can new
research achieve?

• Would help in design of good-practice interview
  schedules for MUS patients
• Would increase respect and dignity of CSA
  survivors
• Would inform design of therapeutic interventions
  which could be piloted and evaluated
• Would increase informed knowledge, understanding
  of causes, and long-term research collaboration

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MUS and Sexual Abuse Survivors

• Er - thats it!