Childhood Sexual Abuse and Adult Psychiatric and Substance Use Disorders in Women

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Abstract
ALTHOUGH women who report a history of childhood sexual abuse (CSA) are clearly at increased risk for psychiatric disorders in adulthood,1-6 4 critical issues about this association remain unclear. First, what is the magnitude of the association given that the impact of CSA on current adjustment may be modest?7-10 Second, CSA often occurs along with multiple other risk factors that reflect disturbed family and parent-child relationships.4,5,9,10 Is the CSA-psychopathology association causal or is it due to these confounded risk factors?11 Third, CSA is a sensitive subject. Could the CSA-psychopathology association arise through reporting bias wherein persons with psychiatric illness are more likely to recall and report abuse experiences?12,13 Fourth, how specific are the effects of CSA? Does CSA increase risk for only 1 or 2 psychiatric disorders or for a wide range of psychopathologic disorders, including psychoactive substance use disorders? We examine these questions in 1411 female twins ascertained from a population-based registry.