Chronic Pain -- long term sequel to childhood abuse?
Nov 12, 2012
As visitors to my site will know, I post articles / entries when I have received news of interesting recent research studies in the childhood abuse ==> adult mental suffering area. I'm reliant on the services of a number of journals automated services for this, and the service available from PubMed -- but things have been relatively quiet recently in "my" special area. However, I've just received a copy of a pre-press proof from a German author Winfried Hauser, Associate Professor, and Director of Psychomatic Medicine unit at Technische Universität München, Germany [LINK]
As Professor Hauser explains: Systematic reviews of case-control studies have demonstrated an association between self-reported sexual and physical abuse in childhood and (FMS) Fibromyalgia Syndrome in adulthood. However, the case-control studies reviewed have not analysed whether the association of self-reported childhood maltreatments and FMS was attributable to depression. In this study, randomly selected age- and sex-matched controls from a representative survey of the general German population were used as controls. Childhood maltreatments were assessed by the German version of the Childhood Trauma Questionnaire CTQ and depression by the two-item depres-sion scale of the German version of the Patient Health Questionnaire PHQ-4. The scores of the five CTQ-subscales were compared between FMS-patients and controls using analysis of covariance adjusting for depressed mood. The researchers sample consisted of 153 FMS-patients (87.6% women; mean age 50.3 years) and 153 age- and sex matched participants of the general population. The comparison between FMS-patients and population controls, adjusted for depressed mood, demonstrated a significant group difference for emotional (p<0.001), and sexual abuse (p=0.01). Depressed mood fully accounted for group difference in physical abuse (p=0.01) and in emotional neglect (p<0.001). Depressed mood partially accounted for group difference in emo-tional abuse (p<0.001), but did not account for group difference in sexual abuse (p=0.10). The authors conclude that reports of FMS-patients some on childhood maltreatments were biased by depressed mood. However, the difference in self-reported childhood sexual abuse between adult FMS-patients and population controls was not attributable to depression.
Biological, psychological and social factors are presumed to interact in the predisposing to, triggering and perpetuating FMS-symptoms. This study gives further evidence that childhood sexual abuse may constitute one (not obligatory) predisposition to FMS. Prospective designs, although cumber-some, are needed to clarify the causal mechanisms that can account for observed associations between reports of past sexual abuse and the presence of FMS. The Hauser et al study demonstrates that patients diagnosed with FMS can differ in various dimensions: Many, but not all FMS-patients report childhood adversities and many, but not all FMS-patients are depressed. A recent study (Loevinger et al 2012 [LINK]) defined by cluster analysis a subgroup of FMS-patients distinguished by a history of childhood maltreatment, hypocortisolism and reports of the most pain and disability . The definition of distinct FMS-subgroups is necessary to evaluate most appropriate treatment strategies. The same may be said concerning the role of effects of childhood maltreatment in other disorders.