Childhood sexual abuse and adult psychiatric and substance use disorders in women - An epidemiological and Cotwin control analysis

Background: Women who report childhood sexual abuse (CSA) are at increased risk for developing psychiatric disorders in adulthood. What is the diagnos tic specificity and cause of this association! Methods: In a population-based sample of 1411 female adult twins, 3 levels of CSA were assessed by self-report and cotwin report: nongenital, genital, and intercourse. Interviews with twins and parents assessed family backgro und and diagnoses of psychiatric and substance dependence disorders. Odds r atios (ORs) were calculated by logistic regression. Results: By self-report, 30.4% reported any CSA and 8.4% reported intercour se. Self-reported CSA was positively associated with all disorders, the hig hest ORs being seen with bulimia and alcohol and other drug dependence. The ORs were modest and often nonsignificant with nongenital CSA and increased with genital CSA and especially intercourse, where most ORs exceeded 3.0. A similar pattern of findings was seen with CSA as reported by the cotwin, although many ORs were smaller. Controlling for family background factors a nd parental psychopathology produced a small to modest reduction in ORs. In twin pairs discordant for CSA, the exposed twin was at consistently higher risk of illness. Conclusions: Women with CSA have a substantially increased risk for develop ing a wide range of psychopathology. Most of this association is due to mor e severe forms of CSA and cannot be explained by background familial factor s. Although other biases cannot be ruled out, these results are consistent with the hypothesis that CSA is causally related to an increased risk for p sychiatric and substance abuse disorders.