Physical, emotional, and sexual abuse among pain patients and health care providers: Implications for psychologists in multidisciplinary pain treatment centers.

Abstract

This study surveyed 200 back pain patients and 64 health care providers/staff on their physical, emotional, and sexual abuse histories as victims or perpetrators. Depending on the type of abuse, 27%-36% of female patients, 6%-23% of male patients, and 33%-55% of female providers/staff were abuse victims. From 1%-12% of female patients, 3%-10% of male patients, and 3%-15% of providers/staff were abuse perpetrators, depending on the type of abuse. A startling 94% of abuse perpetrators were also abuse victims. Among those who were both victim and perpetrator, 81% of physical-abuse perpetrators, 60% of sexual-abuse perpetrators, and 41 % of emotional-abuse perpetrators were previously or concurrently some type of abuse victim. The study discusses the implications for health care diagnoses and treatment decisions, caregiving by providers/staff, and the psychologist's role on multidisciplinary treatment teams.Physical, emotional, and sexual abuse are powerful life events. Yet health care providers rarely inquire about abuse in their standard history and physical examinations. The lack of attention to this subject by health care providers is particularly ROBERT L. KAROL received his PhD from the University of Missouri-Columbia in 1981. He is the director of Psychological Services at the Institute for Low Back Care and program director for the Backs at Work Reactivation Program. He also sees brain-injury survivors through Karol Neuropsychological Services & Consulting. His clinical and research interests focus on the application of medical psychology to back pain and neuropsychological assessment and intervention after brain injury. REBECCA GORMAN MICKA received her physician assistant B.A. from the University of Nebraska in 1985. She works clinically with neurological patients, and her research interests concern the interaction of psychological variables and medical treatment. She is also studying at the Gestalt Institute of the Twin Cities. MICHAEL KUSKOWSKI received his PhD from the Institute of Child Development at the University of Minnesota in 1983. He is currently employed at the Geriatric Research, Education and Clinical Center (GRECC) at the Minneapolis Veterans Administration Medical Center. His research interests include the psychophysiology of the aging nervous system, particularly as it relates to Alzheimer's disease.

Pet Attachment and Dissociation

“…A total of 72% of the 211 participants reported having experienced some type of psychological, physical, or sexual abuse in childhood. This is consistent with another study (Karol et al, 1992) that found a high rate of histories of abuse in health care providers in a pain treatment center (55% reported a history of emotional abuse, 36%, a history of physical abuse, and 33%, sexual abuse). Ferguson and Dacey (1997) …”

“…Some evidence supports a relationship between individuals in the helping professions and histories of childhood abuse (Ferguson & Dacey, 1997;Karol et al, 1992). Ferguson and Dacey (1997) surveyed abuse histories in health care providers, (primarily nurses), employed in a hospital.…”

Health Concerns of University Women with a History of Child Physical and Sexual Maltreatment

“…In addition, much of this research has not specifically examined the unique relation of child physical maltreatment (CPM) with health outcomes but instead has examined CPM in combination with a number of types of victimization experiences. This body of research has shown the following: a high incidence of CPM (as well as CSA) among chronic pelvic pain patients (Karol, Micka, & Kuskowski, 1992;Rapkin et al, 1990), greater health problems in relation to exposure to multiple forms of childhood abuse (Felitti et al, 1998;Moeller, Backmann, & Moeller, 1993;Walker et al, 1997), and poorer health outcomes for women with a history of physical maltreatment (including abuse in childhood as well as adulthood; Leserman et al, 1996). Similarly, women with a history of both child physical and sexual maltreatment are more likely than others to engage in heavy drinking and health-risk behaviors (Bensley, Van Eenwyk, & Simmons, 2000), both of which have potential health consequences.…”

Memory of Childhood Sexual Abuse Among Clinicians: Characteristics, Outcomes, and Current Therapy Attitudes

“…Other surveys of therapists have used similar items to identify those with sexual abuse histories (e.g., Karol et al, 1992;Nuttall & Jackson, 1994;Pearlman & Maclan, 1995). Respondents were able to reply that they suspected they were sexually abused but had no memories in addition to identifying themselves as definite victims or nonvictims.…”

“…Clinical practitioners are treating greater numbers of victims of abuse and violence than ever before. As a result, there has been a growing interest in the role that clinicians' own personal trauma plays in the treatment of their clients and the long-term impact their abuse history has on their personal and professional lives (Elliott & Guy, 1993;Karol, Mika, & Kuskowski, 1992;Little & Hamby, 1996;Pearlman & Maclan, 1995;Wilson & Lindy, 1994). Concerns by the public and professionals over therapists' sexual misconduct, vicarious traumatization, boundary errors, and other countertransference difficulties have multiplied over the last 5 years, but no research has examined the role memories for CSA have on the subsequent impact on this population.…”