Recognizing Sexual Abuse

Sexually abused adolescent girls are more likely than nonabused teens to report more somatic complaints, including headaches, asthma, spastic colitis, and heart palpitations as well as gynecological symptoms. Somatic complaints have been linked to powerlessness surrounding the abuse experience and resulting fear and anxiety.

A small study of females, ages 12-17, of which 11 were identified victims of sexual abuse and 11 were not known to have been abused compared them with respect to emotional disorders and somatic complaints. The study included: 1) interview questions used in a large-scale prior study of sexually abused women , 2) a self-report clinical rating scale of psychological symptoms including somatization, and 3) Symptoms of Stress (SOS) Inventory. The SOS has been used with adolescents and elicits specific categories of stress symptoms, e.g., muscle tension, cardiopulmonary symptoms.

The abused group scored higher on somatic complaints than the nonabused group on every aspect, e.g., headaches, muscle tension, upper respiratory symptoms, anxiety and difficulty concentrating or inability to keep fearful thoughts out of mind. They also showed more anxiety (described as feeling fearful, suddenly scared for no reason, or having a sense of terror).

The interview about sexual abuse history avoided "value-laden" words such as "incest," "rape," or "sexually abused" in favor of descriptive phrases and questions, e.g., "attempted or completed sexual intercourse" or "did anyone try or succeed in touching your breasts or genitals against your wishes?

The authors advised that anxiety reported by abused teens can make school success difficult. Difficulty concentrating or frightening thoughts interfere with attention to academic tasks. Suggestions for nurses included making more thorough inquiry about possible sexual abuse, and when that is the case, validating the experience, confirming that abuse was not their fault, and helping them realize they are not alone.

(Cornman, B. Female adolescent response to childhood sexual abuse. JCAPN 1997;10(2):17-25)

COMMENT: While this was a very small study and one cannot apply the findings to other groups, the attention to careful questioning is noteworthy. This is consistent with the concern for related terms such as "sexually active" which can mean one thing to a teenager and another to adults. - J.O.