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I wish to point out that one differential diagnostic perspective on abdominal pain is that of sexual abuse.

A (fictitious) example:

A middle aged woman reports that she suffered from abdominal pain for almost all of her childhood. In adulthood, she had undergone many investigations, and no organic correlate had been identified. Only now did she feel confident enough to speak out about the fact that she had been frequently sexually abused since her 5th year of life. Her symptoms are slowly disappearing while she is receiving psychotherapy.

Abdominal pain is certainly no definite indication of abuse, but can be a pointer.

There is neither detailed literature on this subject nor are there study materials (1). The materials that exist repeatedly point out that abdominal pain can be a symptom of sexual abuse (2).

Such symptoms are easy to understand even when merely thinking about the fact that stress, for example, can cause abdominal pain. Eating disorders and especially functional gastrointestinal disorders (3), which cause abdominal symptoms, also seem to indicate an association with experiences of abuse.

Current data show that further research is needed. This is of particular importance since research findings on the topic of symptoms of abuse, combined with differential diagnostic considerations, have direct effects on the diagnostic evaluation, prevention, and treatment of abdominal pain.

DOI: 10.3238/arztebl.2012.0110b

Dr. med. Barbara Bojack

Giessen

bbojack@web.de

Conflict of interest statement
The author declares that no conflict of interest exists.

1.
Wells R, McCann J, Adams J, Voris J, Dahl B: A validational study of the structured interview of symptoms associated with sexual abuse (SASA) using three samples of sexually abused, allegedly abused, and nonabused boys. Child Abuse & Neglect 1997; 21(12): 1159–67. CrossRef MEDLINE
2.
Werdin F, Hopp S, Koperska P, Döring M, Bolstorff M: Vernachlässigung, Kindesmisshandlung und sexueller Missbrauch – Auswirkungen, Erklärungsansätze, Grundlage der Diagnostik, Prävention und Intervention. www.slidefinder.net/1/12680_titel_vernachlässigung_kindesmisshandlung_sexueller/5797823.
3.
Leroi AM, Bernier C, Hemond M, et al.: Prevalence of sexual abuse among patients with functional disorders of the lower gastrointestinal tract. Int J Colorect Dis 1995; 10: 200–6. CrossRef MEDLINE
4.
Bufler Ph, Groß M, Uhlig HH: Recurrent abdominal pain in childhood. Dtsch Arztebl Int 2011; 108(17): 295–304. VOLLTEXT
1. Wells R, McCann J, Adams J, Voris J, Dahl B: A validational study of the structured interview of symptoms associated with sexual abuse (SASA) using three samples of sexually abused, allegedly abused, and nonabused boys. Child Abuse & Neglect 1997; 21(12): 1159–67. CrossRef MEDLINE
2. Werdin F, Hopp S, Koperska P, Döring M, Bolstorff M: Vernachlässigung, Kindesmisshandlung und sexueller Missbrauch – Auswirkungen, Erklärungsansätze, Grundlage der Diagnostik, Prävention und Intervention. www.slidefinder.net/1/12680_titel_vernachlässigung_kindesmisshandlung_sexueller/5797823.
3. Leroi AM, Bernier C, Hemond M, et al.: Prevalence of sexual abuse among patients with functional disorders of the lower gastrointestinal tract. Int J Colorect Dis 1995; 10: 200–6. CrossRef MEDLINE
4.Bufler Ph, Groß M, Uhlig HH: Recurrent abdominal pain in childhood. Dtsch Arztebl Int 2011; 108(17): 295–304. VOLLTEXT