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Somatic Symptoms Among US Adolescent Females: Associations with Sexual and Physical Violence Exposure

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The objective of this study is to examine the association between physical and sexual violence exposure and somatic symptoms among female adolescents. We studied a nationally representative sample of 8,531 females, aged 11–21 years, who participated in the 1994–1995 Wave I of the National Longitudinal Study of Adolescent Health (Add Health). Female adolescents were asked how often they had experienced 16 specific somatic symptoms during the past 12 months. Two summary categorical measures were constructed based on tertiles of the distributions for the entire female sample: (a) total number of different types of symptoms experienced, and (b) number of frequent (once a week or more often) different symptoms experienced. Groups were mutually exclusive. We examined associations between adolescents’ violence exposure and somatic symptoms using multinomial logistic regression analyses. About 5 % of adolescent females reported both sexual and non-sexual violence, 3 % reported sexual violence only, 36 % reported non-sexual violence only, and 57 % reported no violence. Adolescents who experienced both sexual and non-sexual violence were the most likely to report many different symptoms and to experience very frequent or chronic symptoms. Likelihood of high symptomatology was next highest among adolescents who experienced sexual violence only, followed by females who experienced non-sexual violence only. Findings support an exposure–response association between violence exposure and somatic symptoms, suggesting that symptoms can be markers of victimization. Treating symptoms alone, without addressing the potential violence experienced, may not adequately improve adolescents’ somatic complaints and well-being.

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  1. 1.

    We examined symptom variables as counts and also applied other cutpoints; findings were consistent across variable formats.


  1. 1.

    Centers for Disease Control and Prevention. (2010). Youth risk behavior surveillance—United States, 2009. MMWR Surveillance Summaries, 59, SS-5.

  2. 2.

    Bailey, B. N., Delaney-Black, V., Hannigan, J. H., et al. (2005). Somatic complaints in children and community violence exposure. Journal of Developmental and Behavioral Pediatrics, 26(5), 341–348.

  3. 3.

    Ciccone, D. S., Elliott, D. K., Chandler, H. K., et al. (2005). Sexual and physical abuse in women with fibromyalgia syndrome: A test of the trauma hypothesis. Clinical Journal of Pain, 21(5), 378–386.

  4. 4.

    Walling, M. K., Reiter, R. C., O’Hara, M. W., et al. (1994). Abuse history and chronic pain in women: I. Prevalences of sexual abuse and physical abuse. Obstetrics and Gynecology, 84(2), 193–199.

  5. 5.

    Chandler, H. K., Ciccone, D. S., & Raphael, K. G. (2006). Localization of pain and self-reported rape in a female community sample. Pain Medicine, 7(4), 344–352.

  6. 6.

    Margolin, G., Vickerman, K. A., Oliver, P. H., et al. (2010). Violence exposure in multiple interpersonal domains: Cumulative and differential effects. Journal of Adolescent Health, 47(2), 198–205.

  7. 7.

    Golding, J. M. (1996). Sexual assault history and limitations in physical functioning in two general population samples. Research in Nursing & Health, 19, 33–44.

  8. 8.

    Koss, M. P., Koss, P. G., & Woodruff, W. J. (1991). Deleterious effects of criminal victimization on women’s health and medical utilization. Archives of Internal Medicine, 151, 342–347.

  9. 9.

    Stein, M. B., Lang, A. J., Laffaye, C., et al. (2004). Relationship of sexual assault history to somatic symptoms and health anxiety in women. General Hospital Psychiatry, 26, 178–183.

  10. 10.

    Eberhard-Gran, M., Schei, B., & Eskild, A. (2007). Somatic symptoms and diseases are more common in women exposed to violence. Journal of General Internal Medicine, 22(12), 1668–1673.

  11. 11.

    Beck, J. (2008). A developmental perspective on functional somatic symptoms. Journal of Pediatric Psychology, 33(5), 547–562.

  12. 12.

    McLean, S. A., Clauw, D. J., Abelson, J. L., & Liberzon, I. (2005). The development of persistent pain and psychological morbidity after motor vehicle collision: Integrating the potential role of stress response systems into a biopsychosocial model. Psychosomatic Medicine, 67(5), 783–790.

  13. 13.

    Green, P. G., Alvarez, P., Gear, R. W., Mendoza, D., & Levine, J. D. (2011). Further validation of a model of fibromyalgia syndrome in the rat. The Journal of Pain, 12(7), 811–818.

  14. 14.

    Satoh, M., Kuraishi, Y., & Kawamura, M. (1992). Effects of intrathecal antibodies to substance P, calcitonin gene-related peptide and galanin on repeated cold stress-induced hyperalgesia: Comparison with carrageenan-induced hyperalgesia. Pain, 49(2), 273–278.

  15. 15.

    Vidal, C., & Jacob, J. (1982). Hyperalgesia induced by non-noxious stress in the rat. Neuroscience Letters, 32(1), 75–80.

  16. 16.

    Gamaro, G. D., Xavier, M. H., Denardin, J. D., et al. (1998). The effects of acute and repeated restraint stress on the nociceptive response in rats. Physiology & Behavior, 63(4), 693–697.

  17. 17.

    McLean, S. A., Diatchenko, L., Lee, Y. M., et al. (2011). Catechol O-methyltransferase haplotype predicts immediate musculoskeletal neck pain and psychological symptoms after motor vehicle collision. The Journal of Pain, 12(1), 101–107.

  18. 18.

    Orrey, D. C., Bortsov, A. V., Hoskins, J. M., et al. (2012). Catechol-O-methyltransferase genotype predicts pain severity in hospitalized burn patients. Journal of Burn Care & Research, 33(4), 518–523.

  19. 19.

    Eminson, M., Benjamin, S., Shortall, A., et al. (1996). Physical symptoms and illness attitudes in adolescents: An epidemiological study. Journal of Child Psychology and Psychiatry, 37(5), 519–528.

  20. 20.

    Ghandour, R. M., Overpeck, M. D., Huang, Z. J., et al. (2004). Headache, stomachache, backache, and morning fatigue among adolescent girls in the United States: Associations with behavioral, sociodemographic, and environmental factors. Archives of Pediatrics and Adolescent Medicine, 158(8), 797–803.

  21. 21.

    Perquin, C. W., Hazebroek-Kampschreur, A., Hunfeld, J., et al. (2000). Pain in children and adolescents: A common experience. Pain, 87(1), 51–58.

  22. 22.

    Taylor, D. C., Szatmari, P., Boyle, M. H., et al. (1996). Somatization and the vocabulary of everyday bodily experiences and concerns: A community study of adolescents. Journal of Child Psychology and Psychiatry, 35(4), 491–499.

  23. 23.

    Rhee, H., Miles, M. S., Halpern, C. T., et al. (2005). Prevalence of recurrent physical symptoms in US adolescents. Pediatric Nursing, 31(4), 314–319, 350.

  24. 24.

    Gini, G., & Pozzoli, T. (2009). Association between bullying and psychosomatic problems: A meta-analysis. Pediatrics, 123, 1059–1065.

  25. 25.

    Nixon, C. L., Linkie, C. A., Coleman, P. K., & Fitch, C. (2011). Peer relational victimization and somatic complaints during adolescence. Journal of Adolescent Health, 49, 294–299.

  26. 26.

    Brendgen, M., & Vitaro, F. (2008). Peer rejection and physical health problems in early adolescence. Journal of Developmental and Behavioral Pediatrics, 29, 183–190.

  27. 27.

    Nishina, A., Juvonen, J., & Witkow, M. R. (2005). Sticks and stones may break my bones, but names will make me feel sick: The psychosocial, somatic, and scholastic consequences of peer harassment. Journal of Clinical Child and Adolescent Psychology, 34(1), 37–48.

  28. 28.

    Singer, M. I., Anglin, T. M., Song, L. Y., et al. (1995). Adolescents exposure to violence and associated symptoms of psychological trauma. Journal of American Medical Association, 273(6), 477–482.

  29. 29.

    McGruder-Johnson, A. K., Davidson, E. S., Gleaves, D. H., et al. (2000). Interpersonal violence and posttraumatic symptomatology—The effects of ethnicity, gender, and exposure to violent events. Journal of Interpersonal Violence, 15(2), 205–221.

  30. 30.

    Creed, F. H., Davies, I., Jackson, J., Littlewood, A., Chew-Graham, C., Tomenson, B., et al. (2012). The epidemiology of multiple somatic symptoms. Journal of Psychosomatic Research, 72, 311–317.

  31. 31.

    Wright, M. R., & von Wright, J. (1992). Habitual somatic discomfort in a representative sample of adolescents. Journal of Psychosomatic Research, 36(4), 383–390.

  32. 32.

    Puzanovova, M., Arbogast, P. G., Smith, C. A., et al. (2009). Autonomic activity and somatic symptoms in response to success vs. failure on a cognitive task: A comparison of chronic abdominal pain patients and well children. Journal of Psychosomatic Research, 67(3), 235–243.

  33. 33.

    Harris, K. M. (2011). Design Features of Add Health [WWW document]. Carolina Population Center Website. http://www.cpc.unc.edu/projects/addhealth/data/guides/design%20paper%20WI-IV.pdf. Accessed 21 Feb 2011.

  34. 34.

    Nicolaidis, C., Curry, M. A., McFarland, B., & Gerrity, M. (2004). Violence, mental health, and physical symptoms in an academic internal medicine practice. Journal of General Internal Medicine, 19, 819–827.

  35. 35.

    McCauley, J., Kern, D. E., Kolodner, K., Derogatis, L. R., & Bass, E. B. (1998). Relation of low severity violence to women’s health. Journal of General Internal Medicine, 13, 687–691.

  36. 36.

    Alfvena, G., Östbergb, V., & Hjernc, A. (2008). Stressor, perceived stress and recurrent pain in Swedish schoolchildren. Journal of Psychosomatic Research, 65, 381–387.

  37. 37.

    Halpern, C. T., Spriggs, A. L., Martin, S. L., et al. (2009). Patterns of intimate partner violence victimization from adolescence to young adulthood in a nationally representative sample. Journal of Adolescent Health, 45(5), 508–516.

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This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development [Grants R01HD57046 and T32 HD07168] and a training grant from the Department of Health and Human Services, Health Resources and Services Administration (T76MC00004). This research uses data from Add Health, a program Project directed by Kathleen Mullan Harris and designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris at the University of North Carolina at Chapel Hill, and funded by Grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations. Special acknowledgment is due Ronald R. Rindfuss and Barbara Entwisle for assistance in the original design. Information on how to obtain the Add Health data files is available on the Add Health website (http://www.cpc.unc.edu/addhealth). No direct support was received from Grant P01-HD31921 for this analysis. Use of this acknowledgment requires no further permission from the persons named.

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Correspondence to Carolyn Tucker Halpern.

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Halpern, C.T., Tucker, C.M., Bengtson, A. et al. Somatic Symptoms Among US Adolescent Females: Associations with Sexual and Physical Violence Exposure. Matern Child Health J 17, 1951–1960 (2013). https://doi.org/10.1007/s10995-013-1221-1

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  • Somatic symptoms
  • Violence
  • Sexual violence
  • National sample
  • Adolescence