Health Consequences of Child Maltreatment

Men and women who have experienced interpersonal violence often have poorer health than their nonabused counterparts-and these effects last long after the abuse has ended. Moreover, abuse survivors are significantly more likely to have a number of serious illnesses and to die prematurely compared to non-abused people. They often experience increased rates of cardiovascular disease, diabetes, and metabolic syndrome, the precursor to type 2 diabetes. Using an adult HMO sample, the Adverse Childhood Experiences (ACE) study found that men and women who had experienced four or more types of ACE were significantly more likely to have ischemic heart disease, cancer, stroke, skeletal fractures, chronic obstructive pulmonary disease, chronic bronchitis, and hepatitis. The types of adverse experiences included childhood maltreatment (physical abuse, sexual abuse, and neglect), parental mental illness, parental substance abuse, and parental criminal activity. The researchers counted each type (not incident) of ACE that a person experienced as “one.”

Given these rates of illness, it is not surprising that abuse survivors see doctors more often and have higher patterns of health care use. In an HMO sample, 22% of child sexual abuse survivors had visited a doctor 10 or more times a year, compared with 6% of the nonabused control group. High health care use was also noted in a study of women who had been battered or raped as adults.

In addition to office visits, health care use can include hospitalizations and surgery. Women who have experienced child or domestic abuse were also more likely to have had repeated surgeries. Severity of the abuse experience was the most powerful predictor of number of physician visits and outpatient costs.

One factor that might be driving the higher patterns of health care use among adult survivors is the increased likelihood of one or more chronic pain syndromes. Chronic pain is a major form of disability, accounting for an estimated $125 billion each year in health care costs, and it is common among victims of violence. In one study, pain was the most commonly occurring symptom in a community sample of child sexual abuse survivors.

Of the functional chronic pain syndromes, irritable bowel syndrome has been studied the most with regard to past abuse. In samples of patients in treatment for irritable bowel, abuse survivors comprise 50% to 70%. Abuse survivors can also suffer from chronic pain in other parts of the body. Abuse has been related to chronic or recurring headaches, pelvic pain, back pain, or more generalized pain syndromes. These findings apply to both survivors of childhood abuse and those abused as adults. Patients with these conditions often have marked physiological abnormalities in brain structure and function that are apparent using technology such as positron emission tomography (PET) scans, computed tomography (CT) scans, and magnetic resonance imaging (MRI) of the brain.