Differentiated health problems according to gender among adolescents reporting sexual or physical assault

Background and objectives: Gender studies previously enlightened our research. Gender differences among traumatized adolescents remain understudied. We hypothesized that comparing health problems between adolescents reporting physical assault and adolescents reporting sexual assault could show a gender difference and could help to identify risks.MethodsIn our 1993 cross-sectional epidemiological representative survey of adolescents in France – 14 278 enrolled in the school system, and 3005 who had left school – we selected the 5893 adolescents in the 16–20 age span, and extracted the sub-sample of 1324 who reported sexual or physical assaults (23%). The symptoms noted were not necessarily a consequence of the assault, but they clearly captured health states in these groups.ResultsThe rate of sexual assault reports by adolescents who left the school system (9.4%) was higher than in the other group (4.2%, p < 0.001). The symptoms selected for the comparisons sexual / physical were chosen because they were significantly more frequent (p < 0.001) among adolescents reporting assault compared to non-assaulted adolescents. For each gender and each type of assault, these symptoms were explored using logistic regressions, adjusting age and schooling status (being inside or outside the school system): among boys, health problems seem more salient when the assault report was sexual rather than physical (e.g. suicide attempts: OR = 3.9, 95%CI = [1.9–8.0]); in contrast, among girls, the two groups seem equally affected.ConclusionThis gender study highlights the risk of suicide among assaulted adolescents. Sexually assaulted boys require care, including suicide prevention, even though they seem to cope effectively with physical assault. (AU)

[Personality and somatic disorders]. / Personnalité et troubles somatiques.

In the title of this text, by somatic disorders we mean those physical illnesses clearly related to a non-psychiatric medical field, frequently termed psychosomatic illnesses and somatoform disorders. For forty years, a trend of thought has focused with pertinence on the psychological peculiarities in patients with severe somatic diseases. Moreover, causality was often supposed in the regularly mentioned association between personality features and somatoform disorders. However, the revival of the study of the earlier field of relationships between mind and body by Briquet, Charcot, Janet and Freud in his first period has led to the reassessment of the meaning of these observations. This reexamination is marked out by several assertions. Two of them work as preliminaries to argumentation: 1. existential wounds may produce long-lasting personality alterations; 2. existential wounds may produce somatoform disorders. These phenomena have been rediscovered over the last few years among assaulted subjects as well as war veterans in whom a frequent occurrence of somatizations has been, in addition, closely linked to the incidence of behavior or personality disorders. Two theses then emerge: 1. somatic diseases may produce long-lasting personality alterations; 2. until now no premorbid personality univocally predisposing to somatic diseases could be found. Indeed, during the 1980s a growing body of negative results coming from retrospective and prospective studies as well as anatomical comparisons have accumulated upon the potential role of certain personality factors in the incidence of somatic illnesses. This dialectic leads to the connection of two corollary assertions: 1. "pensée opératoire" and "alexithymia" in patients with somatic diseases may represent only an effect of the announcement or chronicity of the organic disease; 2. the old "dissociative hysteria" with somatic manifestations finds its substratum in existential wounds and not in pre-trauma personality. Indeed, on the one hand, recent publications do not allow the assertion to be confirmed that alexithymia and "pensée opératoire" predispose to somatizations. On the other hand, personality disorders in subjects with "dissociative hysteria" as well as their somatoform symptoms appear mainly as an effect of an existential wound and express in fact the Janetian concept of "a drop in Psychological Tension". Then, in spite of their differences, conversion and psychosomatic symptoms share the property of being a primitive response to existential wounds in which the subject cannot produce any appropriate psychic or behavioral response to his distress. Light is shed on these phenomena when put alongside the field of "fixed ideas" thought of by Pierre Janet as the recourse to archaic automatisms. Indeed, the experience which contradicts the vision of existence provokes an "unspeakable terror". It is mentally unrepresented or represented in too slight a way. In such cases, no previous personality prevails, but the resulting personality often appears modified, including when the breakdown of vision of the existence results from the diagnosis of an illness or its protracted course.

[May Medically Assisted Procreation (MAP) be relevant for homosexual women? Study among 147 gynaeco-logists involved in MAP techniques]. / La procréation des homosexuelles pourrait-elle relever d'une aide médicale?

The second part of the twentieth century has seen societal modifications as well as evolution of medical techniques allowing now thinking human procreation in terms of choices or even rights. Certain voices require sometimes Medically Assisted Procreation (MAP) for lesbians. Even though society did not allow such a possibility in France, it seemed interesting to question about it professionals actively involved in the use of MAP techniques. Through systematic internet queries, we obtained a list of one hundred private or public french medical institutions with a unit for the treatment of sterility. A telephone call to their secretary allowed us to individualize those doctors who did practice MAP. A sample of 147 medical doctors practicing MAP was then drawn. They were questioned with a clinical instrument including 20 ended-questions in order to assess their opinions on: homosexual women with a desire of a child; possibility for these clinicians to intervene with a donor insemination in such situations; developmental risk for such children. One hundred twenty five (85%) accepted to answer. Nine percent of these gynaecologists still consider homosexuality as pathological, and 10% as deviant - contrary to international classifications of mental disorders - and 5% deny good maternal abilities to homosexual women. Before the so-called french laws of bioethics in 1994, none of them had practiced a donor insemination for a lesbian couple, though 4% had realized some for single homosexual women. Two third of them do not agree opening donor insemination to homosexual women though for half of them, the anonymity of a donor is not perceived as prejudicial to the child. Eighty-seven percent of these gynaecologists think that a child brought up by homosexual parents is at risk for developmental disorder, the configuration supposed the most pathogenic being when the birth results from a donor insemination. The supposedly most important risk factors are thought to be the marginality of an homosexual family and the lack of a paternal figure at home. However, for 68% of the clinicians, this role can be taken by another male figure. These reasons make the gynaecologists reluctant to participate actively in the constitution of such a kind of family by the practice of a donor insemination. Even though demands of lesbian couples were not listed as an indication of donor insemination in the laws of bioethics, this does not seem to lessen the number of these demands in this population, and moreover if the law would allow this indication, half of these doctors would agree to practice it. The expression of the desire of a child by homosexual women and their request for its realization through medical techniques places the clinicians at the center of an ethical reflexion fed more by personal affects rather than scientific studies - however available - on the development of children brought up by an homosexual couple. Indeed, these studies indicate that these children suffer more from a societal view than parental sexual orientation, and it seems therefore appropriate to shed light on it in order to alleviate the weight of a stigmatization without any clinical argument founding it until now.

Validation of a French version of the Dissociative Experiences Scale in a rape-victim population.

OBJECTIVE: To appreciate the extent and the features of dissociation in a hypothesized highly dissociated population, rape trauma victims, while assessing construct validity and internal consistency of a French version of the Dissociative Experiences Scale (DES), a simple screening instrument for dissociative symptoms. METHODS: One hundred and forty rape victims (mean age 23.6 years, 9% male) consecutively attending a Consultation for Victims of Psychological Trauma at the university hospital in Tours, France, were assessed through a French version of the 28-item self-rated DES. RESULTS: The mean score (24.1) was high, and 33% of the scores exceeded a threshold set at 30. The Principal Components Analysis of the DES ratings yielded a 3-factor solution: depersonalization-derealization, amnestic fragmentation of identity, and absorption-imaginative involvement. DES reliability was studied through computation of Cronbach's alpha coefficient (0.94). CONCLUSION: During validation of a French version of the DES, the study showed that dissociation is considerably linked to rape-trauma victim populations.

Similarities and differences between incestuous and nonincestuous rape in a French follow-up study.

Clinicians are familiar with the life and psychological difficulties of incest victims, but their observations often are refuted as being retrospective and unsystematic. We aimed to ascertain similarities and differences between incestuous rape and nonincestuous rape. One hundred and two victims consulting a French forensic center were interviewed in a systematic follow-up study over 6 months using structured interview schedules. Stepwise logistic regression analysis adjusted for age, gender, and characteristics of the trauma showed that posttraumatic stress disorder, dissociative disorders, agoraphobia, and low self-esteem were overrepresented in the incest-rape group compared to the nonincest-rape group.

Screening for psychologically traumatized rape victims.

OBJECTIVE: This study aimed to determine whether the General Health Questionnaire, a simple psychological screening instrument, could be useful to non-specialists in screening for psychologically traumatized rape victims. STUDY DESIGN: 285 rape victims (mean age 22.5, men 8%) attending consecutively a Consultation for Victims of Psychological Trauma at the University Hospital in Tours, France, were assessed through the Structured Interview for Post-Traumatic Stress Disorder (SI-PTSD), and the French 28-item version of the self-rated General Health Questionnaire (GHQ-28). RESULTS: 70% had Post-Traumatic Stress Disorder (PTSD) and 72% a GHQ-28 overthreshold score. The principal component analysis of the GHQ-28 ratings yielded a 4-factor solution: social dysfunction, feeling of foreshortened future type of depression, somatoform complaints and hyperalertness anxiety. GHQ-28 reliability and validity in screening for PTSD were studied through computation of Cronbach's alpha coefficient (0.95), sensitivity (88%) and positive predictive value (86%). CONCCLUSION: Using the GHQ-28 is valid and appropriate for practical use.

Gender differences in symptoms of adolescents reporting sexual assault.

Sexual assault on children and adolescents has become a common topic of study, but there has been little research into the specific characteristics of the population of male victims. A national survey representative of school-age adolescents in France enabled us to study 465 adolescents reporting sexual assault (121 boys, 344 girls; mean age 15.4, SD 2.5 years). Girls were shown to be more frequently affected by certain medicopsychological symptoms: nightmares, multiple somatic complaints and some items concerning mood disorders. On the other hand, behavioural symptoms were much more frequently expressed in boys, in particular: repeated suicide attempts, running away, fits of violence and substance use. Boys presenting these symptoms should be questioned as a matter of routine concerning a history of sexual assault.

Predictive factors of chronic Post-Traumatic Stress Disorder in rape victims.

This study aimed to investigate the psychological disorders following rape as well as the course of Post-Traumatic Stress Disorder (PTSD), and to determine clinical factors predictive of chronic PTSD. Seventy-three rape victims were observed in a systematic follow-up study over 1 year following rape using structured interview schedules. The frequency of PTSD was massive. The early disorders predicting PTSD 1 year after rape included somatoform and dissociative disorders, agoraphobia and specific phobias as well as depressive and gender identity disorders and alcohol abuse. Through stepwise logistic regressions, the following were found to be good models of prediction of chronic PTSD 1 year after rape: for the characteristics of the traumas, intrafamily rape, being physically assaulted outside rape, and added physical violence during rape; for the early psychological and behavioural attitudes, low self-esteem, permanent feelings of emptiness and running away; and for early mental disorders, agoraphobia and depressive disorders. Finally, among all these predictive factors, added physical violence during rape, low self-esteem, permanent feelings of emptiness and agoraphobia were shown to constitute a strong model of predictors. People presenting features such as the predictive factors of chronic PTSD found in the study should be asked about a history of rape and symptoms of PTSD.

Self-reported health and behavioral problems among adolescent victims of rape in France: results of a cross-sectional survey.

OBJECTIVES: To measure the prevalence rate of rape among French adolescents; to analyze the associated health and behavioral problems; to analyze the use of the health care system by rape victims. METHOD: A national representative sample of 8,140 students attending public secondary schools in France (grades 8 to 12) filled in a self-administered questionnaire (274 questions) on health and behavior problems (acceptance rate = 87%). Each rape victim in the sample (n = 61) was matched to two nonvictims (n = 122). RESULTS: The reported prevalence rate of rape was .8% (.9% among girls, .6% among boys). For both boys and girls, there was a relationship between rape and current sleep difficulties, depressive symptoms, somatic complaints, tobacco consumption, and behavior problems (running away, violent behavior, stealing, and school absenteeism). Additional problems were associated for boy rape victims: attempted suicide, regular use of alcohol and of illicit drugs. Rape victims did consult health professionals, but the majority saw neither a mental health specialist nor a social worker. CONCLUSION: The findings indicate that rape victims, especially boys, have more behavior problems and health problems than nonrape victims. Authors suggest that adolescents who have ran away from home, attempted suicide, or manifested violent behavior should be systematically asked about rape.

Rape-related psychotraumatic syndromes.

OBJECTIVE: This study took place in a forensic center for rape victims. Our aims were: first, to explore the longitudinal course of post-traumatic stress disorder (PTSD) and prevalence of disorders over the 6-month period following rape, then second, to group these disorders into syndromes related to chronic PTSD whilst remaining distinct from it, and third, to establish some predictive factors for chronic PTSD. STUDY DESIGN: 92 rape victims consecutively admitted to the center were regularly interviewed over a 6-month period by a psychiatrist. RESULTS: The paper confirms that rape leads to a high proportion of PTSD. Generally speaking, the psychopathology following rape is severe. PTSD at 6 months is associated with phobic and dissociative disorders. It is further associated with a cluster of symptoms arising after rape that we term borderline-like. Incestuous rape is a predictive factor for PTSD at 6 months. CONCLUSION: In the aftermath of rape several semiologically distinct psychotraumatic syndromes exist.

[Syndrome secondary to post-traumatic stress disorder and addictive behaviors]. / Syndrome secondaire à un stress traumatique (PTSD) et conduites addictives.

Ninety psychiatric female inpatients had an interview using structural clinical instruments. The patients were often exposed during their lifetime to psychic trauma and especially to sexual abuse in childhood (27%) and rape (21%). Rape is a risk factor for chronicity and severity of mental disorders. Post-traumatic disorders such as PTSD, dissociative disorders, somatoform disorders and borderline-like disorder are linked to rape. Addictive behavior such as alcohol abuse, drugs use, repeated suicide attempts or eating disorders, is also associated with raped patients and especially with those who developed PTSD after rape.

[Psychotic women and their children]. / Les femmes psychotiques et leurs enfants.

With desinstitutionalization, the social life of psychiatric patients and particularly that of psychotics has arisen in new terms over the past twenty years. In particular, relationships and sexuality of these patients are manifest realities to which few studies are devoted. 61 schizophrenic and 21 bipolar women (18-45 years of age, mean 34 in-or outpatients) were interviewed with a battery of instruments (PANSS, Carpenter's criteria of schizophrenia with deficit syndrome, axis V of DSM-III-R) and with a semi-structured questionnaire related to clinical data, sexuality, relationships, children and motherhood. Half of the schizophrenic women have an active sexual life, and children. The study provides information about the reproduction rate of schizophrenic women, the precocity of their pregnancies and the outcome of their children. The study also treats these women's ability to rear their children, their desire to have children and any hospitalizations during the perinatal period. These results, as well as those related to abortion and contraception, are discussed in the light of those of the bipolar control group.

Sexual victimization in women with schizophrenia and bipolar disorder.

Exposure of populations with psychosis to traumatic events (among them sexual trauma) has seldom been studied. In addition, the clinical features developed by victims with psychosis after a traumatic event are rarely taken into account. Sixty-four women with schizophrenia and 26 women with bipolar disorder (DSM-III-R diagnosed, 18-45 years, inpatients and outpatients) were interviewed using a clinician-rated battery of instruments, including a semi-structured questionnaire concerning sexual victimization and its impact. In childhood or adolescence, 36% of women with schizophrenia (vs 28% of those with bipolar disorder) had been victims of sexual abuse involving body contact. In the women with schizophrenia, this sexual abuse was associated with addictions, suicide attempts and becoming psychiatric patients earlier. Over their lifetime, the prevalence of rape was 23% in the two clinical groups. In women with schizophrenia, rape was associated with a greater severity of their disorder and addictions. Moreover, a frequent repetition of sexual trauma was observed in women with schizophrenia, whereas such repeated traumas were less frequent in those with bipolar disorder. The results suggest that these two clinical groups are at risk of rape and the study highlight clinical features in victims with schizophrenia that have been described for other groups of victims of sexual abuse.

[Psychological trauma and mental disorders]. / Les traumatismes psychiques et les troubles mentaux.

Fifty-eight female impatients consecutively hospitalized in the University Hospital Department of Psychiatry in Tours were interviewed with a clinician battery of instruments (among them, the SI-PTSD by Davidson). The diagnoses leading to hospitalization were: severe disorders of psychotic type (schizophrenic, schizophreniform, schizo-affective, schizoid and paranoid delusional disorders as well as bipolar disorder), borderline and narcissistic personalities for 7%, and other disorders for 53%. Among the results, we observed that 59% of these patients had experienced at least one major stressful event (rape 26%, other sexual assault 29%, physical assault 31%, seeing somebody dying in a violent way 8%, war scene 2%, injured in an accident 2%). As a consequence, 61% of the victims have suffered from PTSD and the diagnosis of PTSD was still present in 21%. In addition, in the victims, somatoform and dissociative disorders were significantly more frequent.

[Treating psychic traumas: a psychiatric emergency]. / Traiter les traumatismes psychiques: une urgence psychiatrique.

Interest for the psychopathological field of trauma has experienced a revival over the last fifteen years. Early and active treatment of victims is necessary to attenuate the psychopathological consequences of trauma. However, emergency psychiatry still rarely places a high value on it. This paper presents a case which contains in itself many aspects of psychological responses to psychologically traumatizing events. Trauma induced in this case, in particular, Dissociative Disorders (including a Dissociative Fugue), a Post-Traumatic Stress Disorder, Somatoform Disorders and Phobic Disorders. This case gives us the opportunity to situate the psychiatric emergency--"psychological trauma"--and to illustrate our talk with regard to the principles of mid-term and emergency treatment of victims.

[Nosography of autism. Critical discussion of current classifications]. / Nosographie de l'autisme. Discussion critique des classifications actuelles.

Child autism is a serious and early-forming developmental disorder and its nosography is evolving quickly. Classifications of autism have been produced since the works of Kanner in 1943 and especially in the last fifteen years, or so in order to respond to the needs of clinical practice and of research. Because of the presence of borderline or various uncommon clinical forms and, more generally, considering the heterogeneousness of clinical conditions concerning autism, it appears necessary to break up autism into better defined sub-groups. Moreover, the existing systems do not apply very well before the age of two or three, when the diagnosis and investigations nevertheless begin. Progress is achieved today by using simultaneously multidimensional and quantitative evaluations, an example of which is presented. In the future, a knowledge of etiological factors and/or the identification of biological markers will guide the classification of developmental disorders.

[Treatment of post-traumatic stress syndrome]. / Traitement des états de stress post-traumatiques.

This paper reviews different psychotherapeutic and drug treatments for Post Traumatic Stress Disorder (PTSD). Psychotherapeutic treatments have changed from the abreaction technique to more classical psychodynamic approaches and recently to cognitive and behavioral techniques. Many drugs have been used in the treatment of PTSD but most of the studies were not controlled and included very few patients. More recently, double blind controlled studies have been performed comparing imipramine, desipramine, amitriptyline, phenelzine and placebo. A global efficacy has been found but the improvement was more closely related to associated symptoms, namely anxiety and depression, than to the core symptoms of PTSD.

[Values and limitations of the notion of chronic hallucinatory psychosis. Study of 17 cases]. / Intérêt et limites de la notion de psychose hallucinatoire chronique. Etude de 17 cas.

From a study of 17 cases of Chronic Hallucinatory Psychosis (PHC) hospitalized between 1982 and 1990 at Tours in the public university department of psychiatry, and from recent results about the female specificities of schizophrenia, the article puts forward the hypothesis that PHC primarily describes a late and singular modality of schizophrenia in women.