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by Dr. Daniel J. Heller
One of the hardest things to discuss about women’s health and women’s medicine is the heartbreaking prevalence of abuse and trauma, including sexual abuse. This isn’t limited to abusive relationships, which were recently brought into the headlines by the sad story of Kasandra Perkins and her boyfriend Jovan Belcher of the Kansas City Chiefs. Abuse, trauma, and sexual abuse leave a mark on their victims no matter when they occur.
This is an important factor in PMDD & PMS. These occur more often in women who have PTSD, whether that post-traumatic stress is a result of serving in the armed forces in Iraq or Afghanistan; a rape that occurred as an adult or sexual abuse that occurred as a child; or even losing your home in a storm or tornado or flood. Although these might seem like very different circumstances, the body and mind’s reaction to them is quite similar. The victim lives in a near-constant state of alarm, feeling like at any moment everything in their life could be turned topsy-turvy or taken away, and as a result feeling unbearable and constant stress and tension.
When an event like last week’s murder-suicide of a professional athlete hits the headlines, the discussion often turns to well-worn subjects: guns, professional athletes, and the like. Perhaps because of what we mentioned at the beginning – just how difficult a subject this is – all too often the more painful discussion of the abuse of women, and the sexual abuse of women and girls is left untouched. Domestic violence is estimated to affect 25% of women during their lifetime (the number is as high as 70% in other countries). The numbers are similar for child sexual abuse: 15-25% of girls are sexually abused, while 5-15% of boys are.
The point here is to realize that a) this is more common than is usually discussed in polite company; and b) this has real consequences for health. Obviously, the headlines are full of the difficulties that veterans experience after returning from battle. For many of them, it is difficult or impossible to enter normal life again. But PTSD, abuse, and trauma are much more widespread than that, and affect the health of a broad swath of our society.
In fact, an amazing research study that began in Southern California has shown that violence and neglect in childhood leads to poor health in adulthood. While PMDD and PMS aren’t specifically part of this study, it’s clear enough that the consequences of childhood abuse and trauma affect all of a person’s health: physical, mental, emotional, and even spiritual. What these doctors and researchers have found is that childhood trauma, in the form of neglect and violence, have an impact many years down the road. Interestingly, a doctor at Kaiser Health Plan in San Diego who was directing a weight loss program discovered this. He found that these “adverse childhood events” were present in many of the people who, despite initial success in the weight loss program, dropped out. These individuals tended to have many other elevated health risks. So far, these studies indicate quite clearly that there is a definite connection between how well people take care of themselves, and how well taken care of they felt as children.
This study is so compelling and important that it has now been taken up by the Centers for Disease Control (CDC) in partnership with Kaiser of San Diego. Whether it’s a woman with PMDD or PMS, or simply anyone who has experienced childhood trauma (take their test to see if you have), this is an important and too often overlooked area of health, especially women’s health. The fact that it is a difficult and painful subject does not mean that we should ignore it, or remain ignorant of it.