July 5, 2011 (Brighton, United Kingdom) — Sexual abuse in childhood is a strong predictor of schizophrenia in later life, according to new research presented here at the International Congress of the Royal College of Psychiatrists 2011 and published in the July issue of the British Journal of Psychiatry.
Sexual abuse is a contributing cause of 17% of cases of psychotic illness, including schizophrenia, said lead study author Paul Bebbington, MD, emeritus professor of social and community psychiatry at University College London, United Kingdom.
"Sexual abuse appears likely to have considerable and lasting negative effects on individuals' views of themselves, particularly in relation to other people, and this in turn seems likely to parallel cognitions in schizophrenia," Dr. Bebbington told Medscape Medical News.
|Dr. Paul Bebbington|
"Thus, at the psychological level, the association is plausibly causal, and at the moment we lack good evidence about what causes schizophrenia," he added.
Dr. Bebbington said he has been interested in social factors affecting schizophrenia and psychosis for a long time. He also worked in a women's prison for 6 years.
"This provided everyday clinical experience of the effects of sexual abuse, which was very common, and commonly associated with persistent auditory hallucinosis," he said.
This long-standing interest prompted the current study. Dr. Bebbington and colleague used data from the Adult Psychiatric Morbidity Survey 2007, a representative cross-sectional sample that included 7353 adults in England.
Respondents answered questions about various forms of sexual abuse along with the date of first abuse.
The study showed that sexual abuse before the age of 16 years was strongly associated with psychosis, particularly if it involved nonconsensual sexual intercourse (odds ratio, 10.14; 95% confidence interval, 4.8 – 21.3).
The study also showed higher rates of depression and anxiety among those who had experienced nonconsensual sexual intercourse before the age of 16 years.
"The increased risk of psychosis may be linked to the intrusive nature of childhood sexual abuse and having no control over what is happening to you. It has disastrous effects on self-esteem and psychological well-being and is linked to paranoia and suspiciousness, even in people who don’t go on to develop psychosis," Dr. Bebbington said.
He added that he hopes the study will encourage clinicians to focus on the evaluation of histories of sexual abuse and to consider direct treatment.
"Dealing with the consequences of abuse may be quite a feasible way of improving the treatment of psychosis. Cognitive behavior therapy for psychosis also needs to take account of the frequent possibility of sexual abuse," he said.
He would also like the study to shape the responses of the criminal justice system to the predicament of women prisoners.
"Treatment of sexual trauma might well assist their effective rehabilitation," he noted.
Finally, this research could also lead to a reevaluation of the possibility of social causes of psychosis on the part of the research community, he said.
"There is already a movement in this direction...There are resource implications in this, and I would hope that increased treatment resources might be gradually developed."
Dr. Bebbington has disclosed no relevant financial relationships.
International Congress of the Royal College of Psychiatrists (RCP) 2011. Presented July 1, 2011.
Br J Psychiatry. 2011;199:29-37. Abstract
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