Adults who were abused or neglected as children tend to visit doctors more often

Oct 21 2004

Adults who were abused or neglected as children tend to visit doctors more often than those who did not suffer abuse or neglect, a study in Great Britain has found.

"Many patients visit doctors with symptoms that cannot be explained by underlying physical disease," says researcher Francis Creed, M.D., of the University of Manchester. "Common examples are headache, abdominal and chest pains and constant tiredness."

Creed and colleagues have been studying "medically unexplained symptoms" for some time, and their new findings suggest that among people with medically unexplained symptoms, those who report childhood adversity go to doctors more often than those who have not experienced adversity during childhood or those whose symptoms can be explained by a recognized medical illness. These patients might benefit from a combination of antidepressant medications and talk therapy, the researchers say.

The research findings appear in the journal General Hospital Psychiatry.

Creed and co-investigators interviewed 129 adults who were newly referred to the neurology, cardiology and gastroenterology outpatient clinics at two large teaching hospitals in an inner-city area. Seventy-one of the patients visited doctors because of symptoms that could be explained by recognized physical diseases and 58 had medically unexplained symptoms.

Each patient filled out several questionnaires assessing anxiety and depression, health-related quality of life and concerns about illness. The researchers also interviewed subjects about their childhood experiences, including abuse and neglect. In addition, the researchers reviewed patients' medical records to determine the number of times each patient went to the doctor during an 18-month time period.

Of the 129 patients, 41 percent reported at least one type of childhood adversity, which may have been physical, sexual or psychological abuse or severe parental neglect or indifference. During the 18-month period, people who reported childhood adversity visited the doctor an average of 16 times and people who did not report adversity visited the doctor an average of 10 times.

Those who had adverse childhood experiences also had higher levels of depression and greater concerns about illness and reported more symptoms.

Among patients whose symptoms could be explained by recognized physical disease, the average number of visits during 18 months was about the same for patients who had and had not experienced childhood adversity (11.5 and 13 visits, respectively).

Childhood sexual abuse and parental neglect appeared to have the strongest effect on how often patients with unexplained symptoms visited doctors.

The researchers suggest that antidepressants, psychotherapy or cognitive-behavioral therapy could help patients with a history of childhood adversity, particularly if they have many medically unexplained symptoms and visit doctors frequently. Creed said these treatments were effective in a previous study of their effect on irritable bowel syndrome.

"The practical implication of this study is that people who attribute numerous symptoms to their presenting illness are at high risk of frequent consultation," Creed and colleagues write in the new study. "Our findings would suggest that both antidepressant treatment and cognitive behavior therapy, aimed at changing the person's attitude to normal bodily sensations, would help these patients."