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An Epidemiological and Cotwin Control Analysis

Kenneth S. Kendler, MD; Cynthia M. Bulik, PhD; Judy Silberg, PhD; John M. Hettema, PhD, MD; John Myers, MS; Carol A. Prescott, PhD

Arch Gen Psychiatry. 2000;57:953-959.

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.

From the Departments of Psychiatry (Drs Kendler, Bulik, Hettema, and Prescott and Mr Myers) and Human Genetics (Drs Kendler and Silberg), Medical College of Virginia Commonwealth University, Richmond; and the Virginia Institute for Psychiatric and Behavioral Genetics, Richmond (Drs Kendler, Bulik, Silberg, Hettema, and Prescott, and Mr Myers).

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