Q. I am interested in the link between sexual abuse and schizophrenia. I know that most cases are thought to be genetic and/or use of drugs may cause the disorder, but many women that I have encountered who have the disorder have been sexually abused as children. Can you tell me more on the topic?

A. There appears to be some association between sexual abuse and schizophrenia, but the precise relationship is not yet known. This stems, in part, from difficulties in ascertaining actual versus "alleged" sexual abuse--a huge controversy in itself.

In one study by Coverdale and Turbott (J Nerv Ment Dis 2000 Jul;188(7):440-5), the prevalence of sexual and physical abuse reported by psychiatric outpatients was compared with matched controls. The sample consisted of 158 outpatients with major mental disorders including schizophrenia and bipolar disorder who responded to a semi-structured interview. These were individually matched for gender, age, and ethnicity with 158 outpatients who had never been treated for psychiatric illness. Forty-five psychiatric patients (28.5%) were sexually abused and 43 (27.3%) were physically abused.

Compared with the controls, patients were significantly more likely to report a history of sexual or physical abuse during adulthood. However, patients were not significantly more likely to report a history of sexual or physical abuse during childhood compared with the controls. This might suggest that once schizophrenia develops, abuse is more likely to occur, rather than abuse playing a causal role in schizophrenia.

On the other hand, there is evidence that childhood sexual abuse is associated with more severe working memory deficits in adults with schizophrenia spectrum disorders (Lysaker et al, Ann Clin Psychiatry 2001 Jun;13(2):89-92). I think the jury is still out on the link, if any, between childhood sexual abuse and schizophrenia.

Personally, I doubt that there is a causal relationship, but it would not surprise me at all if such abuse greatly worsens the psychopathology of a child already in the early stages of the illness. This may amount to a superimposed post-traumatic stress disorder in those already suffering with schizophrenia (see Mueser et al, J Consult Clin Psychol 1998 Jun;66(3):493-9).

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• More Questions about Schizophrenia

September 2002

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