History Of Sexual Abuse Research Articles

Internet-based treatment for provoked vulvodynia: factors associated with treatment outcomes

Abstract Introduction Previous research has indicated that internet-based Acceptance and Commitment Therapy (ACT) can reduce pain during intercourse and increase pain acceptance in individuals with provoked vulvodynia, but the factors associated with treatment outcomes remain unknown. Aim This study aimed to investigate factors associated with changes in pain acceptance following an internet treatment based on ACT. Methods This exploratory study used data from the EMBLA study, a multicenter randomized controlled trial that investigated the effects of internet-based ACT for provoked vulvodynia. The examined factors included sociodemographics, medical history, pain and sexual behavior, and psychosocial characteristics. Linear regression analysis was employed to assess the association of these factors with pain acceptance, including interaction effects. Results were adjusted for multiple testing using Bonferroni correction. Outcomes The outcome measure was pain acceptance assessed on the scale Chronic Pain Questionnaire–Revised, which comprises two sub-scales: activity engagement and pain willingness. Results Before adjustment, greater improvement in overall pain acceptance and the subscale activity engagement was seen participants in the intervention group who had a history of physical violence or sexual assault. Increased time spent on the treatment platform per week was also associated with greater improvement in pain acceptance. Participants who reported gastrointestinal problems before the internet-based treatment showed better treatment outcomes in activity engagement. Previous contact with a psychologist or counselor was associated with less improvement in activity engagement. The intervention was less effective on the subscale pain willingness with increased age and for those reporting urinary problems. No associations remained statistically significant after adjustment for multiple testing. Clinical implications Previous exposure to violence and sexual assault, concomitant gastrointestinal or urinary problems, and adherence to treatment should be further investigated in larger studies on factors associated with treatment outcomes after internet treatment based on ACT, especially regarding pain. Strengths and limitations This was a novel and exploratory study and provides information for researchers in future investigations of how individual characteristics may influence treatment outcomes. A range of variables were explored in the models, underscoring the importance of future studies to strengthen the findings. One limitation concerns the sample size, which was fairly small considering the nature of the study. Conclusion After correcting for multiple testing, no factors were found to be statistically associated with changes in pain acceptance after the treatment.

I Belong: Gender and Sexuality Minoritized Students' Positive Perceptions of Campus Climate Protect Against PTSD Following Sexual Assault.

Sexual assault is a widespread problem among institutions of higher education. Students whose gender and/or sexuality are minoritized (GSM; non-cisgender and/or non-heterosexual) are especially vulnerable to experiencing sexual assault and its negative consequences, including post-traumatic stress disorder (PTSD). A sense of belonging within the campus community can protect victims of sexual assault from negative psychological outcomes; however, no study to date has examined whether this aspect of a positive campus climate protects GSM victims, in particular, from developing more severe PTSD symptoms after sexual assault. We hypothesized that GSM victims would experience more severe PTSD symptoms than non-GSM victims after experiencing sexual assault and that their perceptions of campus climate would moderate this relationship. All undergraduate students from a public liberal arts college on the East Coast were asked to participate in an online survey about their history of sexual assault and emotional well-being. Of those who completed the survey, approximately 18% reported a history of sexual assault (N = 146). GSM victims of sexual assault reported more severe PTSD symptoms than non-GSM victims; however, a significant interaction showed that PTSD symptoms were similar for GSM and non-GSM victims with high ratings of campus climate. Thus, positive perceptions of campus climate protected GSM students from experiencing more severe PTSD symptoms. These findings inform administrative efforts by suggesting the need for more inclusive support resources (i.e., crisis centers and orientation materials), curricula, and community spaces for GSM students.

Special Needs in Substance Use Treatment for Women Who Use Drugs: Social and Mental Health Factors

Women who receive substance use treatment have a particular classification of sensitivity to European drugs and drug use (according to the EMCDDA). The average level of women’s treatment is lower than men’s across Europe, while women’s abandonment is higher than men’s. The purpose of this study was to examine the factors associated with problems for women who use drugs, analyzing several psychological and social factors (gender, substance use, mental health, source of economic support, legal status, and abuse). Methodology: This was a quantitative study. Data on 2179 people receiving rehabilitation treatment were obtained from the EuropASI survey. The dependent variables in this study were (1) a patient’s known history of addiction and mental illness; (2) primary drug use; (3) drug use in their lifetime and the past month; (4) mood in their lifetime and the past month, physical condition, and sexual abuse history; (5) mental illness in their lifetime and the past month (including suicide attempts); (6) legal status in their lifetime and the past month; (7) and source of income in the past month and (8) and the number of patients. The factor of gender was taken as a dichotomous variable (male–female). The confidence interval used was 95%. Results: In summary, we found that women had consumed more alcohol, used more drugs, and suffered more from depression, anxiety, and suicidal ideation than men, both during their lifetimes and in the past month. In addition, women were more likely than men to be stigmatized for prostitution because their financial support came mainly from colleagues, friends, and family, as well as from prostitution. Finally, women had experienced more violence (emotional, physical, and sexual) during their lifetimes and in the last month than men. Conclusion: There appears to be a need to develop a comprehensive treatment network for addictive behaviors from a multifactorial perspective, including harm reduction, psychosocial support, and recovery programs; furthermore, targeting specific groups with special needs, such as women, especially those with mental health problems, women with alcoholism, and abused women, it also seems important to develop adaptive recovery programs within addictive behavior treatment networks.

The impact of childhood abuse on future military sexual assault and PTSD symptomology in Australian veterans.

The trauma most commonly associated with the military is combat-related trauma. It is increasingly recognised that childhood sexual and physical abuse and military sexual assault may influence or exacerbate posttraumatic stress disorder (PTSD) when military members are exposed to combat. The study aimed to determine whether a history of childhood sexual and physical abuse would increase the likelihood of military sexual assault (MSA) and determine whether a history of sexual abuse (childhood or military) impacted the incidence and severity of post-trauma sequelae compared to veterans without this history. A retrospective correlational analysis was performed on baseline data collected from clinical case records of a cohort of 134 Australian veterans with PTSD who had attended an outpatient Military Service Trauma Recovery Day Programme between October 2020 and May 2022. Almost half (48.5%) of veterans reported a history of abuse. Prevalence rates of military sexual abuse, child sexual abuse and child physical abuse were 14.9%, 13.4% and 23.1% respectively. The relationship between those who experienced childhood abuse and those who experienced military sexual abuse was not significant. No significant differences were observed between those who experienced any sexual abuse and those who did not on intake scores of psychological symptoms. This is the first Australian study to investigate the prevalence of childhood abuse and military sexual abuse and its impact on PTSD and associated psychopathology in a sample of veterans seeking mental health treatment. No additional risks of experiencing military sexual assault were found for those who had survived childhood sexual abuse.

Breaking the silence: Do I tell my child about their sexual abuse history? Longitudinal analysis of parental decision-making regarding disclosure of preverbal sexual abuse by parents to their child: A qualitative study

BackgroundThe Amsterdam Sexual Abuse Case (ASAC) presented parents with a dilemma about disclosing preverbal sexual abuse to their child. Advising parents was challenging due to limited knowledge about the consequences of preverbal child sexual abuse (CSA) and the rarity of children having no conscious awareness of their experience. To enhance recommendations and knowledge, we explored parents' experiences over the years. ObjectiveThis unique qualitative study introduced “parental disclosure”, where non-offending parents disclose CSA to their child, and investigated the decision-making process spanning a decade after the ASAC discovery. MethodsLongitudinal qualitative data were collected through yearly interviews. Participants and settingIn total, 41 parents participated for 47 children. An additional in-depth interview was conducted with 20 parents in 2015. ResultsQuantitative data highlighted that over 10 years, parents of more than half of the children disclosed the preverbal CSA. Our analyses revealed that parental disclosure decisions entail dilemmas and unfold as a gradual process. Factors influencing decision-making included fear of stigma, child's emotional readiness, perceived benefits and risks, parental beliefs, values, and CSA circumstances. ConclusionThis study underscores the complex nature of parental disclosure and shows that it is an ongoing process rather than a singular event. Parents' choices evolved based on changing circumstances and new information. Outcomes enrich the understanding of parental disclosure decision-making, highlighting the need for tailored support services to aid parents navigating the aftermath of preverbal CSA. Parental disclosure is highly individualized and calls for evidence-based interventions and policies.

Prevalence and associated factors of suicide-related behaviors in Iranian students: a large sample cross-sectional study

BackgroundAdmission to the university changes life conditions and thereby increases mental pressure. If the students cannot bear the psychological pressure of being a student, that may lead to suicide among the vulnerable persons. Therefore, in this research, we would like to investigate the prevalence and associated factors of suicide-related behaviors in Iranian students.MethodsThis online, cross-sectional survey was performed from March 18 to April 15, 2023, in Iran. The questionnaires were completed by 2181 students. In this study, Perceived Stress Scale (PSS-4), Meaning in Life Questionnaire (MLQ), Generalized Anxiety Disorder Scale (GAD-7), and Suicidal Behaviors Questionnaire-Revised (SBQ-R), and Oslo Social Support Scale (OSSS-3) were used. Finally, we identified the factors associated with suicide-related behaviors using univariate and multiple regression.ResultsThe prevalence of suicidal behaviors in students was 57.95%. According to the results, male gender, marriage, having meaning in life, occasional smoking, sleeping after 1 a.m., and having social support were associated with a reduced risk of suicide. In addition, a history of sexual abuse, more anxiety, and higher perceived stress were associated with an increased risk of suicide.ConclusionsThe prevalence of suicide-related behaviors in Iranian students was higher than expected. Urgent interventions should be considered to prevent students from committing suicide. Helping students find meaning in life, as well as eliminating the causes of students’ anxiety and stress, may be effective in this respect. Additionally, teaching students how to control anxiety and stress may be helpful.

Discontinuation of long-acting reversible contraception: a retrospective Dutch study in general practice

Background In the Netherlands, the use of long-acting reversible contraception (LARC) methods increases. Studies show high premature discontinuation rates of LARCs, but comprehensive insights into the Dutch situation remain limited. Aim The aim of this study is to determine (1) the rate and reasons of discontinuation of different types of LARC in the first 2.5 years of use and (2) what patient characteristics are associated with premature discontinuation. Design and setting Retrospective cohort study utilising data from a Dutch primary care research network. Methods We included all women who received a LARC between 2017 and 2019 with a 2.5-year follow-up period. We performed a descriptive analysis, Kaplan Meier and logistic regression analysis to answer the research questions. Results We included 642 women. In total, 166 women (25.9%) discontinued their LARC within 2.5 years. Discontinuation rates were 22% for levonorgestrel intra-uterine systems (LNG-IUS) 52 mg, 25% for LNG-IUS 19.5 mg, 39% for copper IUDs and 47% for subdermal implants. Common reasons for discontinuation were: alterations in bleeding pattern (68%), abdominal pain (32%), headache or mood fluctuation (24%) and a preference for natural contraceptive methods (23%). Factors associated with discontinuation for reasons other than pregnancy wish were: age between 30 and 34 years old (OR 5.1, 95% CI [1.26–20.48]) and a history of sexual, physical and/or psychological abuse (OR 3.16, 95% CI [1.60–6.23]). A high educational level (OR 0.33, 95% CI [0.12–0.89]) was associated with a lower risk of discontinuation. Conclusion The discontinuation rates of LARCs are high. Better counselling might prevent premature discontinuation.

Seven Identities Co-existing, A Noteworthy Manifestation of Complex Childhood Trauma: A Case Report

Background Childhood trauma increases the risk for psychiatric disorders such as Dissociative Identity Disorder (DID), Other Specified Dissociative Disorder (OSDD), Depersonalisation/Derealisation disorder (DDD), Post-Traumatic Stress Disorder Dissociative Type (D-PTSD), and Borderline Personality Disorder (BPD). Children who experience prolonged stress, trauma, or abuse during developmental years of growth and change have a wide range of outcomes. Case Presentation We report a case of a 22-year-old female with a significant history of physical abuse and sexual assault who initially presented to the hospital for suicidal ideation with a stated plan. During the patient’s stay at the hospital, we encountered two of the six alternate identities of the patient. The patient revealed she experiences all 7 identities (her true self plus 6 alters) in parallel, recalls the events of each alter, and can intermittently switch between identities; all rare features of dissociative disorders. Conclusion Given our patient’s extensive history of trauma, previous psychiatric diagnoses, and current dissociative presentation, we conclude that a diagnosis of OSDD and defence mechanisms of dissociation and regression may be appropriate. The patient was discharged with clomipramine for Obsessive-Compulsive Disorder and mood, lurasidone for mood, mirtazapine for mood, insomnia, and appetite stimulation, clonidine for nightmares and Postural Orthostatic Tachycardia Syndrome (POTS), fludrocortisone for POTS, gabapentin for Generalized Anxiety and fibromyalgia, and levothyroxine for hypothyroidism, and counselled to follow up with an outpatient therapist specialising in trauma. This case highlights the impact that childhood physical, sexual, and emotional trauma can have on one’s psychiatric presentation and the complexity of diagnosing dissociative presentations in an inpatient psychiatry setting.

Sexual Abuse, Post-Traumatic Stress Disorder and Psychopathological Characteristics in Women with Functional/Dissociative Seizures.

Functional/dissociative seizures (FDS), also known as psychogenic non-epileptic seizures (PNES), are sudden, transient, and involuntary events that include motor, sensory, cognitive or autonomic function alterations. In this work we analyzed the psychopathological characteristics of a subgroup of women who suffer from FDS with the aim to analyze the role of psychological trauma, with special emphasis on trauma due to sexual abuse (SA). Forty-five women diagnosed with FDS were included in the study (age range 18 to 64 years, mean = 34.7, standard deviation (SD) = 13.1). Clinical and psychopathological characteristics were reviewed. All patients have completed the clinical interviews, the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID II) and the Global Assessment of Functioning (GAF) according to a special protocol for mental health assessment. Also, the history of sexual abuse trauma, the history of other non-sexual traumas and absence of history of trauma were reviewed. Eighty percent of the cases reported a history of trauma, and 40% reported a history of SA. Patients with a history of SA presented a significantly lower average age of seizure onset than patients with a history of other non-sexual traumas (p = 0.021). Significant associations were found between SA and post-traumatic stress disorder (PTSD) (p = 0.031), and SA and history of suicide attempts (p = 0.037). SA carries serious implications for the mental health of women suffering from FDS. Mental health professionals must consider the history of this type of trauma to provide the necessary care for this patient population.

A - 62 Sexual Trauma in the Autistic LGBTQ+ Community

Abstract Objective Individuals with neurodevelopmental disabilities are more than twice as likely to be sexually abused than individuals without neurodevelopmental disabilities. Similarly, LGBTQ+ individuals experience greater instances of sexual assault than their heterosexual, cisgender counterparts. Using a qualitative approach, this study explored reports of sexual trauma in a sample of LGBTQ+ individuals diagnosed with autism spectrum disorder (ASD). Method Participants were recruited electronically, by word of mouth, and using handouts disseminated throughout the Chicagoland community. In addition to reporting a diagnosis of ASD and identifying as part of the LGBTQ+ community, participants had to be at least 18 years of age, independent of a legal guardian, and English-speaking. Sixty-four participants completed electronically-administered surveys with forced-choice and open-ended questions about their experiences of sexuality and gender identity formation. A secondary analysis was completed to identify participants who reported histories of sexual trauma. Results Five participants (7%) reported histories of sexual abuse. Two participants referenced learning about sex as a result of their abuse. One participant referenced their sexual abuse as a contribution to their identity formation as a queer, non-binary individual. Participants noted current personal struggles as a result of their trauma (e.g., sexual and relationship difficulties, loneliness, isolation). Conclusions Participant responses demonstrate the lasting, pervasive impact sexual assault has on social and emotional wellbeing. Findings from this analysis indicate a need for early educational opportunities for children regarding consent, boundaries, and sexual safety. Future research to address abuse and trauma prevention in sex education curriculum is warranted.

Multi-level correlates of oral pre-exposure prophylaxis discontinuation among English and Spanish-speaking transgender women of color in New York City: the TURNNT cohort study

Background Transgender women of color in the US are disproportionately vulnerable to HIV risks. Pre-Exposure Prophylaxis (PrEP) has demonstrated effectiveness in preventing HIV transmission among transgender women of color. However, factors across multiple levels can hinder oral PrEP adherence. Methods We analyzed the baseline data from The Trying to Understand Neighborhoods and Networks Among Transgender Women of Color (TURNNT) Cohort Study of women not living with HIV. We analyzed questionnaire responses to identify why participants stopped using PrEP and if they would consider taking it again. To identify multi-level determinants that were associated with PrEP discontinuation, we conducted bivariate analysis and created multivariable modified Poisson models comparing factors between former users and current users. Results Among 140 transgender women of color included in this analysis, 44.3% were currently on PrEP, 25.0% were on formerly on the regimen, and 30.7% had never used it. Participants reported many reasons for discontinuing PrEP, notably, 22.9% reported being concerned about interactions with hormones. 60.0% reported that they were likely to take PrEP again in the future. Discontinuation was positively associated with history of sexual assault (Prevalence Ratio: 1.78; 95% CI: 1.01, 3.14) and negatively with having a primary care provider (PR: 0.43; 95% CI: 0.25, 0.73). Conclusion Many factors can influence PrEP discontinuation among transgender women of color. A majority of those who discontinued PrEP were interested in restarting it again, indicating a potential for reengagement. We recommend a holistic approach to HIV prevention to reduce PrEP discontinuation.

Association Analysis of Demographic Factors and the Likelihood of Self-reporting Mental Illness at Student Run Clinics

Background: Patients in the student-run clinics operated by the Tulane University School of Medicine report higher rates of previous diagnoses of mental illness (45.3%) when compared to the national average (22.8%). The diverse group of patients who utilize these resources have various demographic factors that may influence the likelihood of reporting a mental illness. Our objective is to analyze data from Tulane University School of Medicine’s student-run clinics to identify associations of self-reported psychological diagnoses with demographic and psychosocial factors. Methods: Data collected from surveys filled out by students interviewing patients in student-run clinics (n=1494), chi-square analysis, and multivariate regression analysis were conducted to evaluate associations between self-reported psychiatric illness with demographic and psychosocial factors. Results: In the chi square analysis, patients who were age 18-39, reported using psychiatric medications, identified as White, were female, did not report being homeless, had a previous suicide attempt, had a history of trading drugs for sex or money, were a victim or witness of a violent or traumatic event, and had a history of physical, emotional, and sexual abuse were more likely to report a mental health condition. Patients aged 60-99, who were African American, male, reported homelessness were less likely to report a history of a mental health conditions. Persons who identified as male were the only category statistically associated with decreased odds of reporting a mental health diagnosis. In the regression analysis, patients aged 18-39, aged 40-59, who were female, white, who had a suicide attempt, and had a history of incarceration were likely to report a mental health diagnosis. Conclusions: Patients with specific demographic and psychosocial characteristics were more likely to report a mental health diagnosis.

Association between childhood maltreatment and obsessive-compulsive disorder comorbid with eating disorders: a cross-sectional study

BackgroundObsessive-compulsive disorder (OCD) and eating disorders (ED) share common features, including the presence of obsessions and compulsions, and they often co-occur. Additionally, there is a significant comorbidity between ED and childhood traumatic experiences (CTE), as well as between CTE and OCD. Various biological and environmental factors have been proposed to explain the connection between ED, OCD, and CTE. This study explores the link between CTE and the comorbidity of ED and OCD, with the hypothesis that specific types of CTE may increase the risk of developing OCD in individuals with ED.MethodsParticipants (N = 562) were enrolled at an eating disorder unit in Montpellier, France, between March 2013 and January 2020. The Childhood Trauma Questionnaire (CTQ), Eating Disorder Examination Questionnaire (EDE-Q), and Mini International Neuropsychiatric Interview (MINI) were used to evaluate childhood maltreatment, assess clinical characteristics associated with ED, and categorize participants into two groups: patients with and without OCD.ResultsBivariate analysis revealed that patients with comorbid ED and OCD had higher EDE-Q scores (p < 0.001), more anxiety disorders (p < 0.001), depressive disorders (p = 0.02), post-traumatic stress disorder (PTSD) (p < 0.001), and a higher incidence of sexual abuse (p < 0.001) and physical neglect (p = 0.04) compared to those without OCD. Multivariate analysis showed that the association between CTE and OCD was influenced by the presence of an anxiety disorder (p = 0.01) and a higher EDE-Q total score (p = 0.03), with a significant association with a history of sexual abuse (p = 0.04).ConclusionsThis demonstrates that CTE increases the risk of comorbid OCD in ED patients, correlating with more clinically severe ED and a higher likelihood of anxiety disorders.

Childhood maltreatment as predictor and moderator for treatment outcome in patients with major depressive disorders treated with metacognitive therapy or behavioral activation

BackgroundChildhood maltreatment (CM) is a risk factor for developing and maintaining depression. It is unclear whether CM influences the effect of treatments for depression. This study examined CM's predictor and moderator effect in Behavioral Activation (BA) and Metacognitive Therapy (MCT). MethodCM was analyzed in a trial comparing a six months treatment program of either BA or MCT for 122 outpatients with major depressive disorder (MDD). Depression was assessed by the Hamilton Rating Scale for Depression (HRSD-24). CM was assessed using the Childhood Trauma Questionnaire (CTQ). ResultsLinear mixed models showed no predictor or moderator effects for the CTQ total score (all p > .58) but revealed a moderator effect for ‘sexual abuse’ on the reduction of depressive symptoms (β = 10.98, SE = 4.48, p = .015) indicating that patients with experiences of childhood sexual abuse benefited more from BA. There also was a predictor effect for ‘physical neglect’ (β = −3.35, SE = 1.70, p = .049): patients without the experience of physical neglect benefited more from treatment regardless of condition. Exploratory analyses indicated no predictor or moderator effects for the onset or persistence of depression, comorbid anxiety disorders or Cluster-C PDs (all p > .28). LimitationsLimitations include small sample sizes for some of the subsamples. ConclusionChildhood sexual abuse seems to moderate treatment effectiveness in a sample of severely affected outpatients with MDD treated with MCT or BA. If confirmed in further trials, a history of sexual abuse might guide the choice between MCT and BA. Trial registrationGerman Clinical Trials Register DRKS-ID: DRKS00011536 (retrospectively registered on February 13, 2017, without changes to the study protocol).

From Early Trauma to Cardiovascular Risk Among a Nationally Representative Sample of Young Adults.

This study aimed to investigate the connection between childhood abuse history and cardiovascular health indicators among a nationally representative sample of young adults aged 24-32. Using data from waves three and four of the National Longitudinal Study of Adolescent to Adult Health (n = 4, 164) multivariate logistic regression was employed to investigate childhood trauma (i.e., childhood physical abuse, sexual abuse, and neglect) as predictors for cardiovascular disease, hypertension, high cholesterol, diabetes, and obesity. Results showed that adults who reported history of sexual abuse were 4.3 times more likely to report diagnosis of cardiovascular disease and those who reported childhood physical abuse at wave three had 1.4 times the odds of reporting high cholesterol diagnosis. Although trauma history is often calculated as a composite, some forms of childhood abuse may have greater impacts on cardiovascular risk than others.

The impact of childhood abuse on patients with obsessive–compulsive disorder: an Egyptian study

BackgroundThe presence of childhood abuse is expected to have a great impact on several psychological domains on obsessive–compulsive disorder (OCD) patients. This study was designed to assess the psychological impact of history childhood abuse (emotional abuse, physical abuse, sexual abuse, and emotional and physical neglect) on five psychological domains among OCD patients (self-esteem, depression, suicidal risk, cognitive functions, and anxiety).MethodsThis cross-sectional study included 101 OCD patients who were seen in the psychiatric department’s outpatient clinic at Zagazig University Hospital. They were diagnosed according to DSM-IV (SCID-I interview). All the patients were assessed using Childhood Trauma Questionnaire (CTQ-28), the Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HAM-A), Beck’s Suicide Scale, Rosenberg Self-Esteem Scale, and the MoCA scale (Montreal Cognitive Assessment Test).ResultsThe prevalence of childhood abuse in the studied group was 74.3%. 24.8% with emotional abuse, 20.8% with physical abuse, 16.8% with sexual abuse, and 11.9% of patients with emotional and physical neglect. The different types of childhood abuse (emotional, physical, and sexual abuse) were significantly associated with decreased self-esteem and increased depressive symptoms, while emotional and physical neglect were associated with decreased self-esteem only among OCD patients. The most powerful and significant predictor of lower self-esteem and depression was sexual abuse, and it was also the only significant predictor of increased suicidal risk among OCD patients.ConclusionsHistory of childhood abuse was significantly associated with decreased self-esteem and increased depressive symptoms among OCD patients. Only history of sexual abuse was significantly associated with increased suicidal risk. So, evaluation of the childhood abuse history is highly important among OCD patients to be incorporated in the management plan to reduce the suffering of OCD patients and for better improvement.

Patient and Provider Opinions Regarding Chaperones for Sensitive Exams.

Recommendations for chaperone use during sensitive exams have been left mostly to individual institutions, despite a paucity of data providing guidance. The purpose of this study was to survey patients and medical providers on their attitudes toward chaperone use and explore factors that may influence these attitudes. A survey was administered at a single tertiary military medical center to providers and patients across multiple specialties, and further sub-analysis of the data were completed. For patients, sub-analysis was done for gender, age, history of sexual abuse, and clinic seen. For providers, sub-analysis was done for provider gender and training status. Before data collection, this study was deemed exempt from institutional review board approval by the Eisenhower Army Medical Center Human Research and Protections Office. A total of 319 patient surveys and 61 provider surveys were collected. Fifty seven percent of patients have no preference regarding chaperone use, 19% prefer having a chaperone, and 24% prefer to not have a chaperone. Female patients and patients with a history of sexual abuse are more likely to prefer a chaperone. Forty two percent of providers always use a chaperone, 79% are more likely to use a chaperone if a patient is of the opposite gender, and 43% select a chaperone based on the gender of the patient. Male providers and providers still in training are more likely to use a chaperone. The majority of patients do not have a preference regarding chaperone presence during sensitive exams; however, female gender and history of sexual abuse increase the likelihood of a patient preferring to have a chaperone present. These factors should be considered when creating an institutional policy regarding chaperone use. Future research should focus on homosexual and transgender patient preferences as this has yet to be explored.

Sexual function, health functionality, and quality of life in females with pulmonary arterial hypertension: a cross-sectional study.

Pulmonary arterial hypertension (PAH) can have several consequences on sexual function, which can lead to worsened quality of life. The study sought to assess sexual function and its association with health functionality and quality of life in females with PAH. A descriptive cross-sectional study was carried out in pulmonary circulation outpatient clinics from January 2022 to March 2023 in females diagnosed with pulmonary hypertension. Assessment was carried out through the application of the Female Sexual Function Index, the 36-item World Health Organization Disability Assessment Schedule, and the Medical Outcome Study 36-Item Short Form Survey. Data were analyzed using SPSS version 22.0 and JASP, and Spearman's correlation tests were applied between the instruments, with a P value <.05 considered significant. A total of 91 females were assessed. It was identified that 90.1% of females had sexual dysfunction, with worse scores in females with sexual dysfunction in the domains of satisfaction, arousal, and desire, with average health functionality and quality of life. There were significant correlations between the domains of mobility, getting along, life activities, and the overall functionality score with some domains of sexual function, especially arousal and satisfaction. We found significant correlations between some domains of quality-of-life assessment with the domains of desire, arousal, and satisfaction, and with the overall score of sexual function assessment, as well as strong correlations between health functionality and quality of life. The data reinforce the need for rehabilitation programs and social support for this population. This is one of the few studies to evaluate sexual function, quality of life, and health functionality in women with PAH. Due to limitations in data collection, we were unable to assess certain factors such as hormone levels and a history of sexual abuse. We identified a high prevalence of sexual dysfunction in females with PAH with mild functional impairment and a moderate quality-of-life score with correlations between sexual function, health functionality, and quality of life.

Increased Human Chorionic Gonadotropin Level in a Nonsexually Active Young Female

BackgroundQuantitative and qualitative human chorionic gonadotropin (hCG) tests are obtained in the emergency department (ED) to determine if a female of child-bearing age is pregnant. A positive hCG result is commonly assumed to indicate an intrauterine or other form of pregnancy. However, elevated hCG levels can also result from various other conditions, such as ovarian tumors, pituitary tumors, and thyroid disorders. Intracranial germ cell tumors, rare central nervous system tumors capable of secreting hCG, primarily affect adolescent and young adult females. Case ReportA 16-year-old female student without significant past medical history presented to our ED with a complaint of intermittent bilateral frontal headache for two days. Last menstrual period started two days prior to presentation. The headache was associated with phonophobia, photophobia, nausea, and vomiting. Serum quantitative hCG was elevated. She denied history of sexual activity or sexual assault. Transabdominal ultrasound was negative for intrauterine pregnancy. Obstetrics and gynecology as well as pediatric oncology were consulted. Subsequent investigations, including brain imaging, revealed a 3.5 cm mass in the right caudate nucleus and corpus callosum. The patient was diagnosed with an intracranial nongerminomatous germ cell tumor, necessitating hospitalization and prompt initiation of chemotherapy. Why Should an Emergency Physician Be Aware of This?An elevated quantitative hCG is not always indicative of pregnancy, especially in a young patient without sexual history. In the case of a nonrevealing transabdominal ultrasound, obstetrics and gynecology should be consulted for discussion of further testing and imaging. Emergency physicians should include malignancy high on their differential since prompt initiation of chemotherapy, evaluation by surgical services, and family planning will be required.

A history of abuse is associated with more severe migraine- and pain-related disability: Results from the American Registry for Migraine Research.

Prior studies have established an association between a history of abuse and more severe migraine presentation. This cross-sectional, observational study of a clinic-based migraine population used validated measures to elucidate migraine-specific and migraine-related burdens among patients with a history of abuse. Patients with migraine (n = 866) from the American Registry for Migraine Research self-reported if they had a history of emotional, physical, and/or sexual abuse and completed questionnaires assessing migraine-related burden: Migraine Disability Assessment, Subjective Cognitive Impairment Scale for Migraine Attacks, Work Productivity and Activity Impairment, Patient-Reported Outcomes Measurement Information System Pain Interference, Patient Health Questionnaire-2, and Generalized Anxiety Disorder-7. Migraine-related burden in patients with versus without a history of abuse was compared. Subsequently, a mediation analysis evaluated the impact of depression and anxiety symptoms in the relationship between abuse history and migraine burden. A history of abuse was reported by 36.5% (n = 316/866) of participants. After controlling for patient age, sex, years lived with headache, and headache frequency, a history of abuse was significantly associated with more severe migraine-related disability. The combined burden of depression and anxiety symptoms mediated the relationship. A history of abuse is associated with greater migraine-related disability. Future studies should determine if identification and management of the psychological and physical sequelae of abuse reduce migraine burden.