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.