Background. Physical symptoms are commonly presented for
treatment in the absence of physical
pathology. This study tests predictions arising from the theory that childhood
sexual abuse leads
to emotional distress, illness orientation and social dysfunction as adults
and that one or more of
these effects, in turn, leads to presentation of functional (i.e. unexplained)
symptoms.Methods. Two groups of patients with physical symptoms in the
absence of organic disease
(non-epileptic attack disorder or irritable bowel syndrome) were contrasted
with organically diseased
groups with comparable symptoms (epilepsy and Crohn's disease, respectively).Results. Despite their contrasting clinical presentation, irritable
bowel and non-epileptic attack
groups were similar in recalling more sexual and physical abuse, as both
children and adults, than
their comparison groups. They were also similar in being more emotionally
and socially disturbed
and illness-orientated, but these putative mediating variables could not
account for the relationship
of abuse with presentation of functional symptoms.Conclusions. Adults presenting functional neurological and
abdominal symptoms are characterized
by history of abuse. The current focus on childhood sexual abuse should
be broadened to include
sexual, and particularly physical, abuse in adulthood as well as childhood.
The intervening
processes that link abuse to somatization remain to be identified but are
unlikely to include adult
emotional and social disturbance or general illness-orientation.
Prevalence of associated psychosomatic symptoms in patients of irritable bowel syndrome