Abstract: (see Poster Gallery) Different Trauma Exposure Types and Symptom Profiles Affect Health-Related Quality of Life in a Sample of Women Diagnosed with Chronic Pelvic Pain (Society for Social Work and Research 27th Annual Conference - Social Work Science and Complex Problems: Battling Inequities + Building Solutions)

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SSWR 2023 Poster Gallery: as a registered in-person and virtual attendee, you have access to the virtual Poster Gallery which includes only the posters that elected to present virtually. The rest of the posters are presented in-person in the Poster/Exhibit Hall located in Phoenix A/B, 3rd floor. The access to the Poster Gallery will be available via the virtual conference platform the week of January 9. You will receive an email with instructions how to access the virtual conference platform.

260P (see Poster Gallery) Different Trauma Exposure Types and Symptom Profiles Affect Health-Related Quality of Life in a Sample of Women Diagnosed with Chronic Pelvic Pain

Friday, January 13, 2023
Phoenix C, 3rd Level (Sheraton Phoenix Downtown)
* noted as presenting author
Lisa S. Panisch, PhD, MSW, Assistant Professor, Wayne State University, Detroit, MI
Rebecca G. Rogers, MD, Chair, Department of Obstetrics and Gynecology, Albany Medical Center
Michael T. Breen, MD, FACOG, Associate Professor, Associate Chair of Clinical Integration & Operations, Associate Program Director, University of Texas at Austin
Stephanie Nutt, MA, MPA, Assistant Director of Strategic Initiatives and Research, University of Texas at Austin
Soraya Dahud, Lead Medical Assistant, University of Texas at Austin
Christina A. Salazar, MD, FACOG, Assistant Professor, Minimally Invasive Gynecologic Surgeon, University of Texas at Austin
Background and Purpose: Child interpersonal trauma is common among women with chronic pelvic pain (CPP) and can negatively impact health-related quality of life (HRQOL). High betrayal trauma (HBT), or interpersonal trauma perpetrated by someone close, is linked to dissociation and shame, while trauma perpetrated by someone less close, low betrayal trauma (LBT), is associated with post-traumatic stress disorder (PTSD). Distinguishing between these different profiles of trauma exposures and symptoms among women with CPP is important. Trauma-focused psychosocial interventions that assist with processing traumatic memories can improve mental and physical HRQOL. However, symptoms associated with childhood HBT can hinder traumatic memory processing. Furthermore, women exposed to HBT are likely to experience somatoform dissociative symptoms (e.g., unexplained pelvic pain) and thereby more frequently seek medical services for conditions like CPP as opposed to behavioral health. Despite known connections between CPP, childhood interpersonal trauma, and subsequent symptom profiles, many studies looking at psychosocial correlates of HRQOL among CPP patients do not examine trauma-related variables. Our study addresses this gap by exploring indirect relationships between HRQOL and childhood HBT versus LBT, as mediated by symptoms of dissociation, shame, and PTSD.

Methods: Cross-sectional survey data were analyzed from a convenience sample of 96 female patients with CPP recruited from a women’s health clinic (mean age=33, 59% White non-Hispanic, 62% married or cohabitating, 61.5% completed post-high school degree). Prevalence of HBT and LBT were 65.2% and 45.6%, respectively. Parallel mediation analyses were conducted using bootstrapped bias-corrected 95% confidence intervals calculated from 5,000 samples. These examined indirect relationships between mental and physical HRQOL and retrospective exposure to childhood HBT and LBT, as mediated by dissociation, shame, and PTSD.

Results: Dissociation mediated relationships between childhood HBT and current mental (b=-.39, Bootstrapped SE=.20, 95% Bootstrapped CI: [-.87, -.89]) and physical (b=-.61, Bootstrapped SE=.25, 95% Bootstrapped CI: [-1.67, -.19]) HRQOL. Similar results were found in relation to the mediating effect of shame on the indirect relationships between childhood HBT and mental (b=-1.65, Bootstrapped SE=.43, 95% Bootstrapped CI: [-.26, -.86]) and physical (b=-.62, Bootstrapped SE=.26, 95% Bootstrapped CI: [-1.14, -.11]) HRQOL. Shame, but not PTSD, mediated relationships between childhood LBT and current mental (b=-1.66, Bootstrapped SE=.49, 95% Bootstrapped CI: [-2.61, -.69]) and physical (b=-.85, Bootstrapped SE=.37, 95% Bootstrapped CI: [-1.60, -.14]) HRQOL.

Conclusions and Implications: Our study provides preliminary evidence that dissociation and shame negatively impact physical and mental HRQOL among women with CPP in the context of different exposures to childhood betrayal trauma. There have been increasing calls for a more holistic, trauma-informed framework for CPP diagnosis and intervention. Our findings support the incorporation of trauma screening tools that differentiate between different types of interpersonal trauma exposures (e.g., HBT vs. LBT) and symptom profiles (dissociation, shame, and PTSD) into routine care for women with CPP. This approach can help streamline services in busy gynecological clinical settings which may serve as the first opportunity for HBT-exposed women with CPP to be connected to integrated behavioral care resources. Replication studies to validate our results with larger samples and longitudinal designs are encouraged.