(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

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.