Childhood Sexual Abuse and Adult Psychiatric and Substance Use Disorders in Women: An Epidemiological and Cotwin Control Analysis
Abstract
BACKGROUND: Women who report childhood sexual abuse (CSA) are at increased risk for developing psychiatric disorders in adulthood. What is the diagnostic 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 background and diagnoses of psychiatric and substance dependence disorders. Odds ratios (ORs) were calculated by logistic regression. RESULTS: By self-report, 30.4% reported any CSA and 8.4% reported intercourse. Self-reported CSA was positively associated with all disorders, the highest 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 and 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 developing a wide range of psychopathology. Most of this association is due to more severe forms of CSA and cannot be explained by background familial factors. Although other biases cannot be ruled out, these results are consistent with the hypothesis that CSA is causally related to an increased risk for psychiatric and substance abuse disorders.
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In a study of 1,411 adult twin females, CSA was equally predictive of a wide array of psychiatric disorders.
“In a study of 1,411 adult twin females, Kendler and colleagues (2000) found that CSA was equally predictive of a wide array of psychiatric disorders;”
From Child Sexual Abuse as a Unique Risk Factor for the Development of Psychopathology: The Compounded Convergence of Mechanisms (2021) · cites this paper as Kendler et al. 2000
Kendler et al. (2000) twin study found adjusted odds ratios for major depression, generalized anxiety disorder, panic disorder, bulimia nervosa, and alcohol and drug use disorders ranging from 2.5 to 6.5, and increased CSA severity corresponded with linear increases in adjusted odds ratios.
“AORs for major depression, generalized anxiety disorders, panic disorder, bulimia nervosa, and alcohol and drug use disorders ranged from 2.5 to 6.5.”
From Child Sexual Abuse as a Unique Risk Factor for the Development of Psychopathology: The Compounded Convergence of Mechanisms (2021) · cites this paper as Kendler et al. 2000
Kendler and colleagues posited that CSA may not have any diagnostic specificity per se but instead may act to lower the threshold for expression of psychopathology when there is already a genetic predisposition.
“on the basis of these findings, the authors posited that CSA may not have any diagnostic specificity per se but instead may act to lower the threshold for expression of psychopathology when there is already a genetic predisposition.”
From Child Sexual Abuse as a Unique Risk Factor for the Development of Psychopathology: The Compounded Convergence of Mechanisms (2021) · cites this paper as Kendler et al. 2000
The risk of psychiatric disorders is higher for childhood sexual abuse that involves intercourse compared with nongenital sexual abuse.
“For instance, it has been found that the risk of psychiatric disorders is higher for childhood sexual abuse that involves intercourse compared with nongenital sexual abuse (Kendler et al., 2000).”
From Stressful life events increase the risk of major depressive episodes: A population-based twin study (2023) · cites this paper as Kendler et al., 2000
Recent behavioral genetics research suggests that the negative outcomes associated with child abuse cannot be accounted for by genetic factors.
“Second, recent behavioral genetics research (19) suggests that the negative outcomes associated with child abuse cannot be accounted for by genetic factors.”
From Early experience is associated with the development of categorical representations for facial expressions of emotion (2002) · cites this paper as [19]
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Self-citation
- Authors
- Kendler, K. S., Bulik, C. M., Silberg, J., Hettema, J. M., Myers, J., & Prescott, C. A.
- Affiliations
- Virginia Commonwealth University (US)
- Venue
- Archives of General Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2000-10-01
- Volume
- 57
- Issue
- 10
- Pages
- 953
- ISSN
- 0003-990X (ISSN-L)
- OpenAlex
- W2145856053
- Cited by
- 1,259
- References
- 41
- Citations by year
- 2026: 16 · 2025: 12 · 2024: 21 · 2023: 31 · 2022: 31 · 2021: 31 · 2020: 57 · 2019: 38 · 2018: 44 · 2017: 57 · 2016: 53 · 2015: 68 · 2014: 78 · 2013: 78 · 2012: 79
- FWCI
- 35.71
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of General Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Robert Wood Johnson Foundation
- W. M. Keck Foundation
- John Templeton Foundation
- Virginia Commonwealth University
- National Institutes of Health (5k05mh001277-05)
- National Institute on Alcohol Abuse and Alcoholism (R01AA009095, AA-09095)
- National Institute of Mental Health (MH-01277, R01MH040828, MH 40828)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
- Social Sciences › Gender Studies › Sexual Assault and Victimization Studies
- Keywords
- child sexual abuse, women, mental illness, substance use disorders, alcoholism, drug addiction, bulimia nervosa, incest, causal relationship, family background, parental psychopathology, twin discordance
- MeSH terms
- Adult, Mental Disorders, Child, Child Abuse, Sexual, Diseases in Twins, Family Relations, Female, Humans, Parents, Psychiatric Status Rating Scales, Surveys and Questionnaires, Regression Analysis, Sex Factors, Odds Ratio, Diagnosis, Dual (Psychiatry), Substance-Related Disorders
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