Pain, Fatigue and Headaches: Long-Term Patterns of Somatic Symptoms Among Men with and without Histories of Child Sexual Abuse

Background/purpose: Somatic symptoms disorders are common in the general population (5-7%), exacting tremendous suffering and impairment on individuals, their families, and society (e.g., healthcare over-utilization). Consisting of unexplained physical problems (e.g., pain, fatigue, headaches) and excessive worry about health concerns, these disorders are more frequently diagnosed in women and often misdiagnosed or minimized among older adults, especially men. Theories suggest that somatic symptoms may represent unresolved, masked traumatic histories, such as child sexual abuse (CSA). However, few empirical studies have explored these associations among adult male survivors of CSA. Guided by somatization theory and gender role socialization, study objectives were: 1) to investigate trajectories of somatic problems across middle and late adulthood for men, and 2) to examine the moderating effect of CSA on the longitudinal change in somatic problems.

Methods: Our analysis was based on data collected within the Wisconsin Longitudinal Study (WLS), a multi-wave, population-based survey of 1957 high school graduates (n = 10,317) and siblings. We analyzed data from three waves (i.e., 1993-1994, 2004-2005, 2010-2011), in which men were in middle and late adulthood (i.e., 50s, 60s, and 70s). The final sample (N = 2,451) consisted of one group of men with histories of CSA (n = 129) and another matched comparison group without histories of CSA (n = 2322). The dependent variable, somatic symptom severity, was assessed using 16 items from the Patient Health Questionnaire. Items asked respondents about frequency of physical symptoms in the past six months. Total score was an item average (range=0-4); higher scores indicated higher somatic severity. Models controlled for demographic background, family of origin, childhood adversities (other than CSA), current health, and marital status. Linear growth curve modeling was used to examine the trajectories of somatic symptoms severity.

Results: Over three waves of data collection, average level of somatic symptom severity for the entire sample was 1.87 (SD = .64). The abused group averages for each wave were, respectively, 2.33, 1.64 and 2.17; the comparison group averages were 2.16, 1.51, and 2.08. Multivariate results confirmed that men with a history of CSA had higher somatic symptoms than men with no history of CSA (b = 0.10, p < .05). For both CSA and non-CSA groups, somatic symptoms decreased over time; there was no significant difference between groups in terms of the rate of change (i.e., linear slopes, b = .00, p = ns). Other childhood adversities were also positively related to somatic symptom severity over time (b = 0.03, p < .01).

Conclusion/Implications: This investigation was one of the first population-based, longitudinal studies to establish the far-reaching somatic effects of CSA among men. Due to high levels of stigma and marginalization, male survivors of CSA may experience somatic symptoms as a culturally acceptable expression of psychological distress that masks underlying trauma histories. Based on these findings, mental and physical healthcare providers should include CSA and childhood adversities in clinical assessments for middle-aged and older men. Future research should explore gender-specific interventions and effective treatment modalities for this population.