History Of Physical Abuse Research Articles

Physical, sexual and social health factors associated with the trajectories of maternal depressive symptoms from pregnancy to 4years postpartum.

Few studies have examined the course of maternal depressive across pregnancy and early parenthood. The aim of this study was to identify the physical, sexual and social health factors associated with the trajectories of maternal depressive symptoms from pregnancy to 4years postpartum. Data were drawn from 1102 women participating in the Maternal Health Study, a prospective pregnancy cohort study in Melbourne, Australia. Self-administered questionnaires were completed at baseline (<24weeks gestation), and at 3-, 6-, 12-, and 18 months, and 4years postpartum. Latent class analysis modelling identified three distinct classes representing women who experienced minimal depressive symptoms (58.4%), subclinical symptoms (32.7%), and persistently high symptoms from pregnancy to 4years postpartum (9.0%). Risk factors for subclinical and persistently high depressive symptoms were having migrated from a non-English speaking country, not being in paid employment during pregnancy, history of childhood physical abuse, history of depressive symptoms, partner relationship problems during pregnancy, exhaustion at 3months postpartum, three or more sexual health problems at 3months postpartum, and fear of a partner since birth at 6months postpartum. This study highlights the complexity of the relationships between emotional, physical, sexual and social health, and underscores the need for health professionals to ask women about their physical and sexual health, and consider the impact on their mental health throughout pregnancy and the early postpartum.

The Influence of Violence Victimization on Sexual Health Behaviors and Outcomes.

This study examines the implications of a history of personal violence on health and health behaviors. A secondary analysis of cross-sectional data involving adults (n = 214) from a semirural area in southern Louisiana between October 2008 and December 2010 was conducted to ascertain the association between a personal history of violence victimization and indicators of sexual health behaviors and outcomes: communication with sexual partners about HIV status, consistent condom use, and sexually transmitted infection (STI). While violence victimization is widely accepted as a risk factor for high-risk sex behavior, the mechanisms underlying violence victimization's influence on sexual health outcomes remain unclear. Bivariate analyses demonstrated a significant positive association between experience of physical abuse and lifetime history of STI. Surprisingly, respondents reporting lifetime physical violence were more than two times more likely to ask sexual partners about HIV status [odds ratio (OR) for physical attack = 2.23, 95% confidence intervals (CI) = 1.00-4.97; OR for physical injury = 4.60, 95% CI = 1.79-11.85]. Consistent condom use was not significantly associated with violence exposure in adjusted models. There was no evidence that communication with sexual partners mediated the relationship between experiences of violence and condom use. The link between personal history of violence and condom use may be mediated through alternative pathways beyond communication.

The Use of Cognitive Behavioural Therapy on Two Case Reports of Paraphilic Infantilism, Substance Misuse and Childhood Abuse

Very limited research has looked at the use of cognitive behavioural therapy on paraphilic infantilism. Two case descriptions of paraphilic infantilism coexisting with substance use disorders and anxiety and/or a mood disorder are discussed. Both cases presented with a history of childhood physical and sexual abuse. One of the cases also reported engaging in transvestism during periods of stimulant abuse and paraphilic infantilism during substance misuse stabilisation or opiate intoxication. The application of cognitive behavioural techniques revealed that both cases’ paraphilic conduct was associated with their substance misuse and whilst they attended a drug maintenance programme, they did not wish to pursue any treatment intervention regarding their paraphilic behaviours. Both case descriptions of paraphilic behaviour are discussed in the context of substance misuse, mental health and the triggers associated with relapse.

Profile of depression in women attending antenatal clinics in Blantyre District, Malawi

IntroductionDepression is one of major health problems affecting pregnant women in low resource settings. It can lead to poor uptake of antenatal services. Data about prevalence of antenatal depression and associated risk factors remain scanty in Malawi. The study settings were eight selected antenatal clinics in Blantyre district, Malawi. The aim of this study was to assess prevalence of antenatal depression and associated risk factors among pregnant women attending antenatal clinics in Blantyre district, Malawi.MethodsThis was a quantitative study which used a random sample of 97 pregnant women. Ethical approval was granted by relevant bodies. Descriptive and inferential statistics were used to analyse data.ResultsPrevalence of antenatal depression in Blantyre district was 25.8% (n = 25). Risk factors associated with antenatal depression included: “being distressed by anxiety or depression for more than two weeks during this pregnancy”; “feeling that pregnancy has been a positive experience”; “having a history of feeling miserable or depressed for two weeks or more before this pregnancy”; “relationship with partner is an emotionally supportive one”; “experiencing major stresses, changes or losses in the course of this pregnancy”; “having history of physical abuse when growing up”, and “having concerns about being or becoming a mother”.ConclusionThis study has shown that antenatal depression is prevalent in Malawi. It suggests that psychosocial interventions targeting pregnant women may be necessary to reduce antenatal depression and associated risk factors. However, further research regarding ways for assisting pregnant women to build and strengthen their psychosocial support structures is needed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Risk factors of self-injury behavior among psychiatric inpatients

BackgroundSelf-injury behavior among mental patients has been recognized for several years, yet our understanding of its mechanisms and its risk factors remains limited.ObjectivesThis study aimed to assess the prevalence of deliberate self-harm (DSH) among psychiatric inpatients and to identify its association with personal and clinical factors.MethodsIt was a descriptive and analytic study. It included 87 psychiatric inpatients followed in the psychiatry department “C” at the Hedi Chaker University Hospital of Sfax in Tunisia. Barratt Impulsivity Scale (Bis11) and the 28-items Childhood Trauma Questionnaire (CTQ) were used to assess respectively impulsivity and child maltreatment.ResultsThe average age of patients was 29.32 ± 8 years. Most of them were male (75%) and single. Fifty-nine percent of patients had previously attempted suicide. A history of DSH was found in 60.9% of cases. The most frequent trauma types were emotional abuse and physical neglect with respectively 58.7% and 69.8%. Factors positively correlated with DSH were: male gender (P = 0.026), father alcoholism (P = 0.024), history of suicide attempts (P = 0.017), borderline personality (P = 0.00) and history of emotional abuse (P = 0.008) or physical abuse (P = 0.04) or neglect (P = 0.004). Score “Bis11” was significantly correlated with suicide attempts (P = 0.00) and presence of childhood abuse (P = 0.00) or neglect (P = 0.01).ConclusionDSH seems to be a prevalent problem among psychiatric inpatients. It concerns mainly patients with a history of child abuse and impulsive behavior such as suicidal attempts underlying borderline personality disorder. Patients with these risk factors warrant specific attention in mental health services.Disclosure of InterestThe authors have not supplied their declaration of competing interest.

Major psychotrauma and social stress–risk factors for the unfavorable course of paranoid schizophrenia

IntroductionRecent studies in the neurobiology of schizophrenia highlighted the role of neuropsychoendocrine activations as a consequence of psychostress followed by the activation of the HPA axis with an excess of endogenous cortisol. The relation endogenous cortisol–glutamatergic hyperactivation enhances the excito-toxic mechanisms and the cortical-subcortical alterations in schizophrenia.MethodWe conducted a retrospective study on 40 patients, with ages between 25 and 55 years, admitted in the university clinic of Craiova between January 1, 2015 and December 31, 2015 for paranoid schizophrenia according to ICD-10 criteria and with positive history of psychotrauma and physical abuse in childhood and adolescence.ResultsThe frequency of psychotraumas, social stress and physical abuse in our group was significantly higher in women (63.33%), in patients with urban residence (80.00%) and age group 36–45 years (46.67). There was a pattern of residual defectuality reflected by positive symptoms (83.33%), alcohol abuse (80.00%), aggressive behavior (66.67%) and suicide attempts (30.00%). The poor course with minimal social functioning (GAFS &lt; 40; 36.67%) was correlated with a high number of relapses and hospitalizations (&gt; 9 hospitalizations; 43.33%), cognitive deficit (MMSE &lt; 23; 76.67%). The psychosocial factors involved in the pathogenesis and course of schizophrenia were social stress (60.00%), physical abuse in childhood and adolescence (20.00%) and psychotraumas (20.00%).Conclusions.Psychotrauma and physical abuse in childhood and adolescence and during the course of paranoid schizophrenia constitute a risk factor for a poor outcome with cognitive deterioration, aggressive and suicidal behavior that call for prophylactic measures and qualified psycho-social interventions associated to the pharmacological treatments.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Childhood trauma and lifetime syncope burden among older adults

ObjectiveVasovagal syncope is governed by the autonomic nervous system and often precipitated by highly salient emotional situations. We hypothesized that a lifetime tendency towards vasovagal syncope may be precipitated by exposure to childhood trauma. MethodsWe examined data from the first wave of The Irish Longitudinal Study on Ageing (TILDA) of adults aged 50+ (n=6497) who were asked to report lifetime syncope frequency and any history of childhood sexual or physical abuse. Mediation analysis was used to assess the relative importance of pathways via which childhood trauma could plausibly increase risk of later life recurrent syncope including via depression, mid-life cardiovascular disease and frequent syncope in youth. Results18.2% reported a lifetime syncopal event: 4.0% frequent syncope in youth and 1.5% recurrent syncope in the last year. 10.9% reported childhood sexual or physical abuse, rising to 14.2% among those reporting any lifetime syncopal event, 21.0% with frequent syncope in youth and 20.2% with recurrent syncope in later life. In fully adjusted logistic regression models the report of childhood sexual or physical abuse was independently associated with frequent syncope in youth (OR 1.85 (CI 95% 1.27–2.71); p=0.001; OR 2.14 (1.48–3.10); p<0.001 respectively). A history of frequent syncope in youth and depression partially mediated the relationship between childhood sexual and physical abuse and recurrent syncope in later life, while mid-life cardiovascular disease was less important. ConclusionChildhood trauma may contribute to a lifelong vasovagal tendency. Early attention should be given to the potential precipitating and perpetuating psychosocial factors affecting recurrent syncope.

Gender Differences in Victimization and the Relation to Personality Disorders in Forensic Psychiatry

ABSTRACTGender differences in victimization were retrospectively examined in 218 male and 218 female patients who have been admitted to one of four Dutch forensic psychiatric hospitals between 1984 and 2014. Case files were studied and variables relating to victimization and psychopathology were coded. It was found that the prevalence rates of victimization were higher among female patients than among male patients, both during childhood and adulthood. Childhood sexual abuse was found to be more prevalent among women than men, however, no differences were found for emotional and physical abuse or neglect during childhood. Women with a history of emotional or sexual abuse were significantly more often diagnosed with borderline personality disorder than women without childhood victimization. Men with a history of physical abuse were significantly more often diagnosed with antisocial personality disorder than men without childhood victimization. Clinical and policy implications of this study for forensic practice are discussed.

Screening for bipolar disorder among migraineurs: the impact of migraine-bipolar disorder comorbidity on disease characteristics.

PurposeThe aim of this study was to evaluate the prevalence of comorbid bipolar disorder (BD) among migraineurs and the impact of migraine–BD comorbidity on disease characteristics.Patients and methodsA total of 120 adult patients diagnosed with migraine at a single tertiary care center were included in this cross-sectional study. Data on sociodemographic and migraine-related characteristics, family history of psychiatric diseases, comorbid psychiatric diseases, and first-episode characteristics were recorded. Mood Disorders Diagnosis and Patient Registration Form (SCIP-TURK), Mood Disorder Questionnaire (MDQ), and Hypomania Checklist-32-Revised (HCL-32-R) were applied to all patients by experienced clinicians, and clinical diagnoses were confirmed using Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Migraine Disability Assessment Scale (MIDAS) was used to evaluate the headache-related disability. Study parameters were compared between migraineurs with and without comorbid BD.ResultsThe diagnosis of comorbid BD was confirmed in 19.2% of migraineurs. A significantly higher percentage of patients with comorbid BD than those without comorbid BD had family history of BD (39.1% vs 6.2%, P<0.001), suicide attempt (30.4% vs 5.2%, P<0.001), and physical abuse (52.2% vs 26.8%, P=0.019). MIDAS scores were significantly higher (50.6 [43.2] vs 33.8 [42.7], P=0.0422) in migraineurs with comorbid BD than in those without comorbid BD. Multivariate logistic regression model revealed that a positive family history of type I BD (odds ratio [OR], 14.42; 95% confidence interval [CI], 2.94–70.73; P=0.001) and MIDAS scores >30 (OR, 3.69; 95% CI, 1.12–12.19; P=0.032) were associated with 14.42 times and 3.69 times increased likelihood of BD, respectively.ConclusionOur findings revealed comorbid BD in a remarkable percentage of migraineurs and a higher likelihood of having BD in case of a positive family history of type I BD and MIDAS scores >30. Comorbid BD was associated with a higher rate for a family history of BD, suicide attempt, and childhood physical abuse as well as aggravated migraine-related disability among migraineurs. Migraineurs with and without comorbid BD showed similar sociodemographic and migraine disease characteristics as well as similar high rates for comorbid anxiety and first-episode depression.

Prevalence and Predictors of Intimate Partner Violence in a Military Urogynecology Clinic

Intimate partner violence (IPV) is common, with prevalence in women of 15 to 71% over the lifespan, 4 to 54% currently. Violence is associated with poor health, and may be more common in military populations. A history of abuse is also common in patients with pain, urinary/bowel symptoms, and dyspareunia. Our purpose was to determine the prevalence and predictors of abuse in a military urogynecology clinic. Patients presenting to a military urogynecology clinic were screened for IPV with the 4-item Hurt-Insult-Threaten-Scream (HITS) screen. Patients' abuse history, reason for visit, and risk factors for IPV were assessed. χ2 and Fisher's exact tests were used for categorical variables. Out of 142 surveys, only 4 (2.8%) indicated a positive HITS screen (score of 10 or greater on a scale of 4-20), and 39 (27.5%) responded positively to at least one item. These individuals were significantly more likely to have a history of physical abuse or abuse in their families, with at least one positive response in 45.4% of patients with a history of family abuse compared to 20.8% of patients without this history (p = 0.007). The lifetime prevalence of physical abuse by an intimate partner was reported by 10 women (7%). A total of 29 women (20%) reported a history of forced sex and 33 (23%) reported a history of abuse in their family. Participants with a family history of abuse were more likely to have a positive HITS score, relative risk (RR) 2.19 (95% confidence interval [CI] 1.29-3.71), p = 0.004, as were those with history of physical abuse RR 2.44 (95% CI 1.35-4.39), p = 0.003 and a history of forced sexual contact, RR 1.73 (95% CI 1.00-3.00), p = 0.049. Race, education, marital status, and employment showed no association with a positive HITS response. The self-reported rate of IPV in a sample of women presenting to a urogynecology clinic in a military setting was 2.8%, below the rate reported in the civilian literature of 4 to 54%. We found that lifetime prevalence of IPV (7%) was also lower than the civilian rate of 15 to 71%. Routine screening for IPV is recommended by the American College of Obstetricians and Gynecologists, U.S. Preventative Services Task Force, and the Joint Commission. Even though IPV rates in the military are below civilian rates, IPV affects 3 to 7% of our population and remains a significant and preventable problem affecting women. IPV in military urogynecology patients was lower than the civilian setting; however, women with a history of abuse may be at increased risk of experiencing current IPV, and continued screening is important.

Association of Suicide Attempts and Non-Suicidal Self-Injury Behaviors With Substance Use and Family Characteristics Among Children and Adolescents Seeking Treatment for Substance Use Disorder

ABSTRACTBackground: Numerous studies in youth and adults suggest strong association between substance use disorders and non-suicidal self-injury (NSSI) and suicidal behaviors. There is paucity of studies exploring the association of substance use with history of suicide attempts (HSA) and NSSI in children and adolescents in Turkey. Objective: We aimed to examine the prevalence of NSSI and HSA and their relationship with substance use and family characteristics among youth seeking treatment for substance use in Turkey. Method: Participants were children and adolescents who were admitted to the Bakirkoy Trainee and Research Hospital for Psychiatric and Neurologic Disorders in Istanbul between January 2011 and December 2013. Two thousand five hundred eighteen participants were included. Questionnaires were applied to all patients. The association of NSSI and HSA with substance use, family characteristics, and subject characteristics were analyzed. Results: The prevalence of NSSI and HSA behaviors among substance using youth in our sample were 52% and 21% respectively. Cannabis and cocaine use was found to be a significant risk factor for HSA, and polysubstance use was associated with both NSSI and HSA. Parental separation/divorce, parental mental disorders, alcohol and drug use, and crime were the risk factors for HSA. A positive history of physical and sexual abuse increased the risk of HAS, and a history of neglect increased the risk of NSSI. Conclusions/importance: We suggest that results showing relationship between substance use and associated social features with NSSI and HSA may contribute to elaborating effective and targeted preventive and intervention programs for these high-risk youth groups in Turkey.

Boys are not exempt: Sexual exploitation of adolescents in sub-Saharan Africa

Research on youth sexual exploitation in Africa has largely neglected the experiences of exploited boys. To date, much of the research in sub-Saharan Africa continues to consider boys mainly as exploiters but not as exploited. Using the only publicly available population-based surveys from the National Survey of Adolescents, conducted in four sub-Saharan African countries — Burkina Faso, Ghana, Malawi, and Uganda—we assessed factors associated with transactional sexual behaviour among never-married adolescent boys and girls. We also examined whether boys’ reported sexual exploitation was linked to similar risky sexual behaviours as has been noted among girls in sub-Saharan Africa. Results from our analyses indicated that even though adolescent girls have a somewhat higher likelihood of reporting sexual abuse and exploitation, the odds of trading sex were significantly elevated for previously traumatized boys (that is those with a history of sexual and physical abuse) but not for their female counterparts. Just like adolescent girls, transactional sexual behaviour was associated with the risk of having concurrent multiple sexual partners for boys. These findings support the reality of boys’ sexual exploitation within the African context, and further highlight the importance of including males in general and boys in particular in population-based studies on sexual health, risk, and protective factors in the sub-Saharan African region. Understanding the factors linked to sexual exploitation for both boys and girls will help in developing policies and programs that could improve the overall sexual and reproductive health outcomes among adolescents and youth in sub-Saharan Africa.

Parents' perceptions about child abuse and their impact on physical and emotional child abuse: A study from primary health care centers in Riyadh, Saudi Arabia.

OBJECTIVE:To determine perceptions of parents about child abuse, and their impact on physical and emotional child abuse.MATERIALS AND METHODS:Two hundred parents attending three primary health care centers (PHCCs) in Riyadh serving National Guard employes and their families, were requested to participate in this survey. Data was collected by self administered questionnaire. Five main risk factors areas/domains were explored; three were parent related (personal factors, history of parents' childhood abuse, and parental attitude toward punishment), and two were family/community effects and factors specific to the child. SPSS was used for data entry and analysis. Descriptive analysis included computation of mean, median, mode, frequencies, and percentages; Chi-square test and t-test were used to test for statistical significance, and regression analysis performed to explore relationships between child abuse and various risk factors.RESULTS:Thirty-four percent of the parents reported a childhood history of physical abuse. Almost 18% of the parents used physical punishment. The risk factors associated significantly with child abuse were parents' history of physical abuse, young parent, witness to domestic violence, and poor self-control. Child-related factors included a child who is difficult to control or has attention deficit hyperactivity disorder (ADHD). Parents who did not own a house were more likely to use physical punishment. Abusive beliefs of parent as risk factors were: physical punishment as an effective educational tool for a noisy child; parents' assent to physical punishment for children; it is difficult to differentiate between physical punishment and child abuse; parents have the right to discipline their child as they deem necessary; and there is no need for a system for the prevention of child abuse.CONCLUSION:The causes of child abuse and neglect are complex. Though detecting child abuse may be difficult in primary care practice, many risk factors can be identified early. Parents' attitudes can be measured, and prevention initiatives, such as screening and counseling for parents of children at risk, can be developed and incorporated into primary care practice.

Partial mediator role of physical abuse on the relationship between attention-deficit/hyperactivity disorder symptoms and severity of dissociative experiences in a sample of inpatients with alcohol use disorder.

Aim:This study aimed to evaluate the relationship of attention-deficit/hyperactivity disorder (ADHD) symptoms with dissociative experiences, and the mediator role of childhood traumas on this relationship, while controlling the effect of depression in alcohol use disorder (AUD).Settings and Design:It was a hospital-based, cross-sectional study.Materials and Methods:One hundred and ninety inpatients with AUD were evaluated with the Beck Depression Inventory, the Adult ADHD Self-Report Scale (ASRS), Childhood Trauma Qestionnaire, and Dissociative Experiences Scale (DES).Statistical Analysis:One-way ANOVA, Chi-squared test, and hierarchical linear regression model were performed.Results:The ratio of those who receive 10 points or less from DES was 26.8%, those who receive points between 11 and 30 was 45.3%, and those who receive more than 30 points was 27.9%. The latter group that was considered as a group with high risk of dissociative disorder had higher scores from depression, childhood trauma, and ADHD scores than the other groups. Rate of those with high probability of ADHD was higher among this group. ASRS total score and inattentive subscale scores were moderately (r = 0.552 and r = 0.547, respectively) and hyperactive/impulsive subscale was mildly (r = 0.430) correlated with DES score. Severity of ADHD was related with the severity of dissociative symptoms, and physical abuse had partial mediator effect on this relationship, even after controlling the depressive symptoms.Conclusions:These findings demonstrate that the presence of severe IN symptoms is an important factor related with dissociative tendency in AUD population with a history of physical abuse.

General and emotion-specific alterations to cognitive control in women with a history of childhood abuse

BackgroundAlthough limited, the literature suggests alterations in activation of cognitive control regions in adults and adolescents with a history of childhood abuse. The current study examined whether such alterations are increased in the face of emotionally-distracting as compared to emotionally neutral information, and whether such alterations occur in brain regions that exert cognitive control in a more top-down sustained manner or a more bottom-up transient manner.MethodsParticipants were young adult women (ages 23–30): one group with a history of childhood physical or sexual abuse (N = 15) and one with no trauma exposure (N = 17), as assessed through the Trauma History Questionnaire and a two-stage interview adapted from the National Crime Victims Survey. Participants underwent fMRI scanning while completing hybrid block/event-related versions of a classic color-word and an emotional Stroop paradigm (threat and positive words). This paradigm allowed us to examine both sustained (activation persisting across blocks) and transient (event-specific activation) aspects of cognitive control.ResultsWomen with a history of childhood abuse demonstrated decreased recruitment of frontal-parietal regions involved in cognitive control and enhanced recruitment of a ventral attention surveillance network during blocks of both versions of the Stroop task. Additionally, they had less suppression of brain regions involved in self-referential processes for threat blocks, but greater suppression of these regions for positive blocks. Severity of avoidance symptoms was associated with sustained activation in lateral prefrontal regions, whereas hyperarousal/re-experiencing symptoms were associated with sustained activity in temporal regions. No differential effects were observed for transient control.ConclusionsResults suggest exposure to childhood abuse is associated with blunted recruitment of brain regions supporting task-set maintenance but hypervigilance for task-irrelevant information, regardless of whether distractors are emotionally neutral or emotional. Exposure to childhood abuse is also associated with less suppression of default mode brain regions associated with self-referential processing in the face of irrelevant threat information, but heightened ability to suppress similar processing for irrelevant positive information.

A situational analysis of tendency of deliberate self harm among students

Deliberate Self Harm (DSH) is a globally serious mental health problem among young people andis associated with multiple maladaptive psychological and social outcomes. The current study ismotivated by the relative lack of research on self-harm among adolescents. Therefore this crosssectional study is planned to find the prevalence of tendency of Deliberate Self Harm (DSH) andassociated psycho-social and demographic factors among university students. In the study 340students were participated. The semi-structured interview schedule was used to assess thepsycho-social-demographic factors in the adolescents who had a tendency of deliberately selfharm. The tendency of DSH was significantly (P =0.003) high among students of more than 24years age group (30.3% ) as compared to age group of below 20 years (14.9%) and 20-24 yearsage group (18.1%). Age, history of substance abuse and physical abuse, poor relationship withfamily member and with friends, negative optimism, anger, impulsivity and history of psychiatricillness showed significant relationship with tendency of DSH. Gender, course, family type, socioeconomic status and history of physical illness were not associated with tendency of DSH instudents.

Management of Bladder Pain Syndrome: Green-top Guideline No. 70.

Management of Bladder Pain Syndrome: Green-top Guideline No. 70.

The Mayo Clinic Experience with Diagnosis and Treatment of Gardner-Diamond Syndrome

Introduction: Gardner-Diamond Syndrome (GDS), also known as psychogenic purpura, is a rare disorder characterized by unexplained recurrent painful bruising typically arising after physical and/or psycho-emotional stress. Classically ecchymoses (ecch) spontaneously appear and are associated with a prodrome of warmth and pain at the ecch sites. Prior GDS reports are limited to single cases or small series.Aims:To characterize presentation, natural history, management and long term outcomes (LTO) of GDS.Methods: In this retrospective study, after IRB approval, patients (pt) with GDS, encountered between 1976 and 2016, were identified from within Mayo Clinic Rochester clinical databases. Medical records of consenting pts were reviewed.Results: 75 females (ages 16-69 years (yr)) and 2 males (46-65 yr) met our study criteria. Pt presented 3.2 yrs (range 0-27) after onset of initial symptoms (sym). 52 pt (67.5%) had an antecedent history of physical abuse (n=2), trauma (n=12), an emotional event (n=13), surgery (n=11), or infection (n=3). Prodromal sensations prior to appearance of ecch in 55 pts (71.4%) were described as itching (n=15), burning (n=19), stinging (n=11), and/or pain (n=44). Other localized sym after appearance of ecch included swelling (n=46) and pain (n=67). Maximum size of ecch ranged from >0 and ≤5 cm (n=26), ≥6 and ≤ 10 cm (n=14), and >10 cm (n=13) and not described in 24 pts Systemic sym at time of ecch, reported in 49 pts, included malaise (n=26), myalgia (n=21), headaches (n=19), fevers (n=15), and abdominal pain (n=10). 50 (65%) of pts’ lesions were isolated to arms and legs, while 27 (35%) had trunk and head involvement in addition to extremity involvement. Ecch duration varied: 0-7 days (n=14), 1 week-1 month (n=31), or >1 month (n=5) and not described in 27 pts.Complete blood count was normal (nl) in 84% (64/76) of pts tested; anemia was the most common abnormality. PT, APTT, VWF, and Factor XIII screen were nl in 100% (67/67), 98.4% (63/64), 97.9% (46/47), and 100 % (30/30) of pts respectively. Platelet aggregation studies were nl in 83% (25/30) with abnormalities attributed to drug effect. Bleeding (bld) scores (ISTH BAT), calculated with exclusion of cutaneous (cut) manifestations in scoring, were: 0 (n=48), 1 (n=12), 2 (n=9), 4 (n=2), 5-6 (n=2), 7 (n=2), and 9 (n=2). 21 pts had testing with subcut injections of autologous red cells (SCIAR) with 9 positive and 2 equivocal. 28 pts had skin biopsies with the most common finding being subcut hemorrhages.45 pts (58.4%) underwent psychiatric (psych) evaluations and 7 (15%) pts were found not to have a psych dx. 42 pts had a psych dx including depression (n=23), hysterical personality (n=8), anxiety (n=2), personality disorder (n=2), psych other (n=7). Of these pts, 4 did not undergo further psych eval given prior dx. 42 pts had a history of a neurological dx including headaches (n=34), paresthesias (n=10), and seizures (n=7). Additional pharmacological treatments (pharmt) were recommended for 30 pts: antidepressants (n=4), antihistamines (n=13), anti-inflammatory/immunosuppressants (n=11), or hormonal (n=2) medications. 47 pts were treated with observation and/or counseling alone to address psychological stressors. 28 pts had follow-up (fu) at least 1 yr (1 to 34 yrs) after the initial visit. 13 of these pts had no mention of recurrence during fu while 15 pts had continued recurrence. Of those with recurrence, 7 pts continued to seek fu for GDS.Conclusion: In this large clinical cohort of GDS pts we confirm and expand on known clinical findings of GDS. Majority of pts had fairly benign disease (dz) manifestations; however, in a subset, a negative impact on pt quality of life was noted due mainly to persistent/recurrent pain. Refractory dz was mostly associated with ongoing/ recurrent stressors. The relatively low bld scores, together with laboratory assessments, support that GDS is primarily a dermal rather than a systemic bld diathesis. SCIAR did not provide additional value in dx. CBC, PT, APTT & VWF testing should be performed, and platelet testing considered, to rule out other hemostatic dz. Addressing stressors was the most effective treatment for pts, however pharmt was given for refractory dz. Though our study provides new insights regarding dx, therapy and LTO, future work investigating the pathophysiology leading to the hemostatic abnormalities in GDS would be valuable. DisclosuresNo relevant conflicts of interest to declare.

Pre-foster Care Maltreatment Class as a Predictor of Maltreatment in Foster Care

The majority of youth in the foster care system have been removed from their homes as means of protection against parental maltreatment. Studies have shown, however, that foster youth may continue to experience maltreatment after they have entered the child welfare system (Poertner et al. in Child Youth Serv Rev 21(7):549–563, 1999; Tittle et al. in Urbana 51:61801, 2008). In this study, we explore how maltreatment prior to foster care entry may predict maltreatment while in care for youth who are preparing to emancipate. Using latent class analysis and multinomial logistic regression, we find that current or former foster youth with histories of multiple maltreatment (particularly, combined pre-foster care histories of neglect and physical abuse) are more likely to report neglect, physical abuse and sexual abuse in care than those with histories of low maltreatment. These youth should be the target of prevention efforts in child welfare agencies.

The moderating role of resiliency on the negative effects of childhood abuse for adolescent girls involved in child welfare

Child abuse is associated with a number of negative psychosocial outcomes, including mental health problems, substance abuse, and interpersonal violence. Yet some children thrive or “adapt well” despite experiencing abuse; researchers are increasingly interested in the protective factors and mechanisms that may prevent negative outcomes. The purpose of this study was to explore the role of resiliency characteristics in the relationship between childhood abuse and the negative outcomes of depression, posttraumatic stress disorder (PTSD), substance abuse, and revictimization in adolescent girls involved in child welfare. Participants were 237 adolescent girls ages 12–19years (M=14.9, SD=1.6), and who were youths of color (75%) and white (25%). Data were collected through surveys assessing histories of physical, sexual, and emotional child abuse; symptoms of posttraumatic stress and depression; lifetime substance use; and experiences of physical, verbal, and relational revictimization in the last three months. All forms of childhood abuse were significantly associated with symptoms of depression and PTSD as well as revictimization and substance use. Higher levels of resiliency were associated with fewer depression and PTSD symptoms and experiencing less revictimization. Resiliency significantly moderated the relationship between sexual abuse and depression, PTSD, and revictimization. Resiliency also moderated the relationship between emotional abuse and depression. No significant interactions emerged in the relationship between physical abuse and any of the mental health and behavioral problems. This study suggests that resiliency may serve as a protective factor in the relationship between abuse (sexual and emotional) and depression, PTSD, and revictimization during adolescence.