Effects of physical and sexual abuse in facial pain: direct or mediated?

Research has identified a relationship between a history of physical and/or sexual abuse and a range of psychological, functional, and physical factors; however, the nature of this relationship has not been tested. We hypothesize two different mechanisms through which an abuse history could influence later life distress and dysfunction. A history of abuse could increase an individual's vulnerability to emotional distress or could increase an individual's tendency to attend, amplify, and over-interpret somatic symptoms. The purpose of this study was to test the influence of emotional distress and somatic focus on the relationship between a history of physical and/or sexual abuse and later chronic painrelated disability in patients with temporomandibular disorders. The subjects were 139 female patients evaluated at a facial pain clinic. Of the 139 subjects, 49% (n = 69) reported a history of physical and/or sexual abuse. Abused subjects reported significantly higher levels of anxiety, depression, and somatic symptoms than nonabused subjects. Path analysis with latent variables, using the LISREL-8 (Scientific Software International, Inc., Chicago, Illinois) statistical program was used to test the hypothesized relationships. When emotional distress and somatic focus were tested as mediators, the path coefficient from somatic focus to physical functioning was significant (beta = -0.38) while the path coefficient from negative emotion to physical functioning was not significant. These results favor somatization as the hypothesized mechanism over the emotional distress vulnerability hypotheses.