EFFECTS OF PHYSICAL AND SEXUAL ABUSE IN FACIAL-PAIN - DIRECT OR MEDIATED

Research has identified a relationship between a history of physical a nd/or sexual abuse and a range of psychological, functional, and physi cal factors; however, the nature of this relationship has not been tes ted, We hypothesize two different mechanisms through which an abuse hi story could influence later life distress and dysfunction, A history o f abuse could increase an individual's vulnerability to emotional dist ress or could increase an individual's tendency to attend, amplify, an d over-interpret somatic symptoms, The purpose of this study was to te st the influence of emotional distress and somatic focus on the relati onship between a history of physical and/or sexual abuse and later chr onic pain-related disability in patients with temporomandibular disord ers. The subjects were 139 female patients evaluated at a facial pain clinic, Of the 139 subjects, 49% (n = 69) reported a history of physic al and/or sexual abuse, Abused subjects reported significantly higher levels of anxiety, depression, and somatic symptoms than nonabused sub jects. Path analysis with latent variables, using the LISREL-8 (Scient ific Software International, Inc., Chicago, Illinois) statistical prog ram was used to test the hypothesized relationships. When emotional di stress and somatic focus were tested as mediators, the path coefficien t from somatic focus to physical functioning was significant (beta = - 0.38) while the path coefficient from negative emotion to physical fun ctioning was not significant. These results favor somatization as the hypothesized mechanism over the emotional distress vulnerability hypot heses.