The meaning of symptoms in 10 women with somatization disorder and a history of childhood abuse
D. S. Morse, A. L. Suchman and R. M. Frankel
Department of Medicine, Highland Hospital, University of Rochester School of Medicine and Dentistry, NY, USA.
OBJECTIVE: To understand the associated experiences and illness behavior in
patients with somatization disorder and a history of childhood abuse.
DESIGN: In-depth interviews were conducted with patients who had
somatization disorder and a history of childhood abuse; qualitative content
analysis was then performed. SETTING: Patients were recruited from 2
primary care teaching practices. PARTICIPANTS: Physicians were asked to
refer patients suspected of having both conditions, yielding 21 potential
participants. Eight declined, and 3 did not meet standardized screening
questionnaire criteria, yielding 10 women who participated in the study.
Participants and nonparticipants had a similar range of socioeconomic
variables. RESULTS: An analysis of the interviews yielded 22 themes. Seven
themes relevant to understanding the link between illness behavior and
abuse were the abuse experiences, emotional and behavioral reactions to the
abuse, relationship of abuse to somatoform symptoms, relationship of abuse
to health care use, attempts to tell about the abuse, relationships with
physicians, and physician behavior. Childhood attempts to tell adults about
the abuse resulted in threats of punishment, contributing to lifelong
patterns of secrecy, even with physicians. Six women reported having
childhood physicians who were family members, friends, or the abuser's
physician, reinforcing their subsequent secrecy. The women reported that
their current physicians denied their physical pain as adults, just as the
abusers denied their emotional and physical pain in childhood. Seven women
reported decreased health care use once they associated symptoms with abuse
experiences. Nine women reported spousal abuse. CONCLUSIONS: Somatization
and childhood abuse may involve a paradoxical pattern of hiding feelings
and reality, while seeking acknowledgment of suffering. Patient insight may
decrease health care use. Therefore, the exploration of patient experiences
may be useful for women with somatization disorder and a history of
childhood abuse. The risks of spousal abuse and denial and rejection in the
physician-patient relationship could also be important.
