Relation Between Physical or Sexual Abuse and Functional Gastrointestinal Disorders

In many parts of the world, people are becoming increasingly aware of the major problem of sexual and physical abuse. Population estimates of selfreported sexual abuse range from 7% to 22% for childhood abuse and from 13% to 25% for lifetime abuse. An additional 10% of women report serious physical abuse, and an association between sexual and physical abuse has been reported. Women are abused much more commonly than men. Extensive information exists on the long lasting and serious psychologic effects of child abuse. Recent research has focused on the important medical sequelae of abuse. For example, obesity, headache, drug abuse, chronic pelvic pain, somatization, and number of surgical procedures (especially hysterectomies) correlate with an abuse history. Evidence links abuse to functional gastrointestinal disorders, such as irritable bowel syndrome (IBS) and functional dyspepsia, which present common reasons for seeking health care. IBS, the prototypical functional gastrointestinal disorder, is best understood by using the biopsychosocial model popularized by Engel, ie, by viewing IBS as a disorder in which biologically determined symptoms may be influenced by cultural, social, interpersonal, and psychologic factors. Defining IBS as a purely enteric or psychologic disorder is not supported by current knowledge; instead, the concept of abnormal central nervous systementeric regulation is emerging. Current information supports a “link” from abuse to functional gastrointestinal symptoms and to care-seeking behavior.