Runtz / MALTREATMENT
CHILD HEALTH CONCERNS
/ AUGUST
AND CHILD
2002 MALTREATMENT
Health Concerns of University
Women With a History of Child
Physical and Sexual Maltreatment
Marsha G. Runtz
University of Victoria
Three health symptom checklists were used to measure physi-
cal health concerns among university women in relation to
prior child physical maltreatment (CPM) (20%, n = 153)
and child sexual abuse (CSA) (19%, n = 143). A history of
CPM was related to all three general areas of health concerns
as well as to many of the specific subscales comprising the
measures (e.g., muscular-skeletal symptoms and gyne-
cological problems), whereas an interaction between CSA and
CPM was linked to greater premenstrual distress subscale
scores (particularly emotional and behavioral symptoms).
Overall, although CSA was not related to health symptoms,
within the CSA subgroup, greater duration and severity of
CSA was predictive of higher premenstrual distress even after
controlling for CPM. This study emphasizes the need for
greater awareness of the physical health-related correlates of
both physical and sexual maltreatment in childhood and
their associated implications for womens health care needs.
R ecent research and clinical observations have sug-
gested that women with a history of child abuse may
suffer disproportionately from a variety of physical
health problems. Just as maltreatment during child-
hood has been demonstrated to be associated with an
increased risk of psychological and emotional prob-
lems later in life (Neumann, Houskamp, Pollock, &
Briere, 1996), a variety of physical health problems
have also been linked to a history of early victimiza-
tion (Bendixen, Muus, & Schei, 1994; Leserman et al.,
1996). For example, a link has been found between
victimization in childhood and later health problems
such as fibromyalgia, premenstrual dysphoric disor-
CHILD MALTREATMENT, Vol. 7, No. 3, August 2002 241-253
2002 Sage Publications
der, chronic pelvic pain, and even such serious condi-
tions as cancer and heart disease (e.g., Felitti et al.,
1998; Girdler et al., 1998; Walker et al., 1988, 1997).
Women with a history of childhood abuse or neglect
also incur significantly higher health costs than
nonabused women (Walker et al., 1999).
Studies of women who have been sexually assaulted
(which often include sexual assaults occurring in
childhood) have also shown that sexual victimization
is linked with significant physical health concerns
long after the initial victimizing event. For example,
sexually assaulted women report more somatic com-
plaints, poorer perceptions of their physical health,
and increased use of medical services (Kimerling &
Calhoun, 1994; Koss, Koss, & Woodruff, 1991). Simi-
larly, gynecological symptoms and sexual dysfunction
are the most frequently reported type of long-term
health problems appearing among sexually assaulted
women (Koss et al., 1991). Because a sizable propor-
tion of sexual assaults experienced by women occur
during adolescence and earlier, it is likely that many
of the health concerns evidenced among these
women will be similar to those shown in women who
were sexually abused as children.
Just as the sexual assault of adult women can have
long-term health implications, recent literature has
Authors Note: This research was supported in part by a grant from
the Social Sciences and Humanities Research Council of Canada.
Appreciation is due to Jayne Embree, M.A., who worked as a re-
search assistant on the original project. Correspondence concern-
ing this article and requests for reprints should be addressed to
Marsha G. Runtz, Ph.D., Department of Psychology, P.O. Box 3050,
University of Victoria, Victoria, British Columbia, Canada, V8W
3P5; e-mail: runtz@uvic.ca.
241
242 Runtz / HEALTH CONCERNS AND CHILD MALTREATMENT
suggested that adult women with a history of child sex-
ual abuse (CSA) also suffer from a variety of health
concerns and physical symptoms. These include
chronic headache (Domino & Haber, 1987),
somatization (Briere & Runtz, 1988), premenstrual
symptoms (Friedman, Hurt, Clarkin, Corn, &
Aronoff, 1982; Miccio-Fonseca, Jones, & Futterman,
1990), gynecological problems (Cunningham,
Pearce, & Pearce, 1988), abdominal pain (Haber &
Roos, 1985), abnormal Pap tests and a history of sexu-
ally transmitted diseases (Coker, Patel, Krishnaswami,
Schmidt, & Richter, 1998; Young & Katz, 1998),
premenstrual dysphoric disorder (Girdler et al.,
1998), fibromyalgia (Walker et al., 1997), chronic pel-
vic pain (Rapkin, Kames, Darke, Stampler, & Naliboff,
1990; Walker, Katon, Neraas, Jemelka, & Massoth,
1992), pregnancy complications (Jacobs, 1992), and a
variety of serious adult diseases such as cancer and
heart disease (e.g., Felitti et al., 1998). Women with a
history of CSA also seek medical help more frequently
(Cunningham et al., 1988), have more frequent
emergency department visits (Walker et al., 1999),
and have more somatic complaints than women in
general (Walker et al., 1988, 1992). Women with a his-
tory of sexual abuse have also been found to engage in
behaviors related to greater health risk, such as multi-
ple sexual partners, exchanging sex for drugs or
money, using alcohol and drugs, and smoking (Coker
et al., 1998; Young & Katz, 1998); these behaviors
would be expected to increase the likelihood of physi-
cal health problems within this group of women.
Although researchers have examined the relation-
ship between the physical abuse of adult women and
physical health effects (e.g., Goodman, Koss, & Russo,
1993), relatively few studies have been done to exam-
ine the health of adult women who have been physi-
cally maltreated as children. In addition, much of this
research has not specifically examined the unique
relation of child physical maltreatment (CPM) with
health outcomes but instead has examined CPM in
combination with a number of types of victimization
experiences. This body of research has shown the fol-
lowing: a high incidence of CPM (as well as CSA)
among chronic pelvic pain patients (Karol, Micka, &
Kuskowski, 1992; Rapkin et al., 1990), greater health
problems in relation to exposure to multiple forms of
childhood abuse (Felitti et al., 1998; Moeller,
Backmann, & Moeller, 1993; Walker et al., 1997), and
poorer health outcomes for women with a history of
physical maltreatment (including abuse in childhood
as well as adulthood; Leserman et al., 1996). Similarly,
women with a history of both child physical and sexual
maltreatment are more likely than others to engage in
heavy drinking and health-risk behaviors (Bensley,
Van Eenwyk, & Simmons, 2000), both of which have
potential health consequences. As many women who
experience sexual abuse in childhood also have expe-
rienced physical maltreatment, it is essential that
researchers assess both types of experiences when
examining the sequelae of child maltreatment. The
present study aims to make a comparison between
these two common forms of child maltreatment with
regard to their relationships with womens health
concerns.
Although there has been no conclusive evidence
regarding the mechanism by which maltreatment
during childhood may influence the health of those
individuals during their adult lives, researchers have
begun to explore the link between life stress and phys-
ical health and to apply this model to their under-
standing of child maltreatment sequelae. It has long
been apparent that life stress can have a negative
impact on both the physical and mental health of
adults (Lazarus & Folkman, 1984; Walker & Greene,
1987). It has been suggested that stressful life events
and life changes may create a disequilibrium that
leaves a person vulnerable to stress and may ultimately
lead to health impairment (Kessler, Price, &
Wortman, 1985; Sarason & Sarason, 1984). Although
the exact mechanism through which this may occur is
not yet known, it has been speculated that chronic
stress may compromise immune system functioning
leaving the individual more vulnerable to illness
(Kiecolt-Glaser & Glaser, 1992). Girdler et al. (1998)
found evidence to suggest that deregulation of the
generalized stress response may occur among women
who have histories of exposure to prolonged stress
such as sexual abuse and that this may result in greater
vulnerability to subsequent stressors, hence contrib-
uting to physical illness. The trauma of either physical
or sexual maltreatment during childhood can con-
tribute to significant life stress that may be prolonged
or particularly severe in relation to the invasive extent
of the abuse and its potential for physical or emo-
tional injury.
Given that many previously victimized women con-
tinue to experience both psychological and physical
distress long after the initial victimizing event, it is
apparent that the health care delivery system has an
important role to play in assisting women to overcome
these experiences and to achieve healthy functioning.
This is particularly crucial as women often continue to
seek medical attention rather than psychological
treatment, long after the time when the directly
assault-related health complaints have subsided
(Kimerling & Calhoun, 1994). It may be that some vic-
timized women interpret psychological distress as ill-
ness, which may lead them to seek medical services
CHILD MALTREATMENT / AUGUST 2002

rather than psychological services or that medical ser-
vices are perceived as being more accessible (and
potentially less stigmatizing) than are psychological
services.
Among primary care patients, it has been esti-
mated that as many as 60% request assistance with
somatic symptoms that have their origin in psycholog-
ical distress (Cummings & VandenBos, 1981; Katon,
Ries, & Kleinman, 1984). If, as the research suggests,
many of these patients are women with a history of vic-
timization, then medical treatment alone may not be
sufficient to help these women overcome their health-
related problems. In general, when medical patients
are provided with psychotherapy, there is a 20%
decrease in the use of medical services (Jones &
Vischi, 1980). It has been estimated that only 5% of
sexually abused women ever disclose information
about their sexual abuse experiences to a physician
(Lechner, Vogel, Garcia-Shelton, Leichter, & Steibel,
1993); therefore, the average medical practitioner
may be unaware of the potential need for psychologi-
cal services within this group. Without having a com-
plete history of a womans important life stressors
(such as victimization history), inadequate or insensi-
tive medical treatment may be provided. At worst, a
previously victimized womans health complaints
(particularly if persistent, recurrent, or not readily
explained or responsive to treatment) may be dis-
counted as being all in her head. However, when
appropriate and sensitive inquiry into a womans vic-
timization history does occur, there is a significant
increase in the likelihood of disclosure of previously
undisclosed experiences of sexual trauma (Briere &
Zaidi, 1989; Ende, Rockwell, & Glasgow, 1984). Such
disclosure (to a well-informed and sensitive practitio-
ner) not only enables the medical practitioner to take
a more complete patient history and provide better
health care, but it may also provide an avenue for the
woman to be directed to appropriate psychological
resources if needed or requested. Overall, womens
health needs would be better served if health practi-
tioners were more fully aware of the potential for
womens physical health concerns to be related to
prior victimization experiences.
The current study is an exploratory examination of
the relationships between early experiences of sexual
and physical maltreatment and physical health con-
cerns among young adult women from a university
setting. A previous examination of this sample of
women indicated that significant relationships
existed between both CPM and CSA in relation to a
range of psychological symptoms as measured by the
Trauma Symptom Inventory (TSI) (Runtz & Roche,
1999). Therefore, it was anticipated that women with
CHILD MALTREATMENT / AUGUST 2002
Runtz / HEALTH CONCERNS AND CHILD MALTREATMENT 243
a history of either form of child maltreatment would
be more likely than nonvictimized women to report
concerns related to their general health and that
women with a history of sexual abuse would be most
likely to experience problems related to their repro-
ductive-system functioning and gynecological or sex-
ual health. In addition, specific characteristics of the
victimization experiences (such as abuse severity and
duration, age at first episode of abuse, and relation-
ship to the offender) are examined for their potential
association with physical health concerns.
METHOD
Participants and Procedures
Research participants were 775 women enrolled in
psychology at a medium-size western Canadian uni-
versity who volunteered for a study of womens health
concerns. All female students enrolled in the first-year
introduction to psychology course at the University of
Victoria were eligible to participate and to receive
course bonus points for their participation. Data were
gathered over a period of three consecutive academic
terms, and approximately 55% to 60% of eligible
female students participated in the study.
The study involved the completion of a 20-page
paper-and-pencil survey in groups of about 20 to 30
women and took about 75 minutes to complete. Par-
ticipants were informed that the study would include
questions that may be viewed as sensitive in nature,
and that they were free to discontinue the study (or to
leave questions blank) without risk of losing their
bonus points. No one chose to leave the study early.
Of the 785 questionnaires that were initially returned,
10 (1.3%) were not included in the study due to
incomplete or inaccurate responses. This resulted in
a final sample of 775 subjects.
The women ranged in age from 17 to 56, with a
median age of 18 years (SD = 4.7; 94% were 25 years of
age or younger). Most women were single (93%), in
their first or second year of university (89%), identi-
fied their field of study as social sciences or education
(51%), were of European descent (85%), and were
raised by both biological parents in intact families
(77%). The average participant came from a middle-
class background (i.e., median family of origin
income = $34,500 to $46,000 [approximate US$]).
Participants within the three groups of interest (i.e.,
CSA, CPM, and no abuse) did not differ from each
other on any of the demographic variables assessed
(i.e., age, family size, family of origin income, birth
order, marital status, ethnic background, or family
composition). Only age was related to some of the
244 Runtz / HEALTH CONCERNS AND CHILD MALTREATMENT
health variables; hence, age was used as a covariate in
the appropriate analyses.
Measures
Child Maltreatment History
CSA. CSA was defined as pressured or forced sexual
contact occurring prior to age 18 that was also viewed
by the woman as being sexually abusive.1 When a
woman indicated that she had been pressured into
forced sexual contact as a child but did not view the
experience as sexual abuse, the event was classified as
CSA if (a) she had been 13 years or younger and the
other person had been either 18 years or older or in a
position of trust, or (b) she had been 13 years of age or
younger and the other person was a family member
and the sexual contact was of long duration and/or
involved intercourse or attempted intercourse. Evi-
dence of the utility of the definition of CSA used in
this study is apparent in that higher levels of psycho-
logical symptoms on the TSI (e.g., depression, PTSD
symptoms, sexual problems) were found to be associ-
ated with overall occurrence of CSA as well as with cer-
tain CSA characteristics (such as severity, intrafamilial
CSA, and multiple CSA experiences) within this same
sample of women (Runtz & Roche, 1999).
Participants responded to six items (with a 6-point
Likert-type scale of not applicable to more than 20 times)
about sexual behaviors occurring during childhood
(e.g., intercourse, someone touching or fondling
the sexual parts of your body). Detailed questions fol-
lowed that explored the nature of the CSA experience
(i.e., age of onset, relationship to offender, disclo-
sure). Internal consistency reliability (Cronbachs
alpha) for the CSA scale was .69 in the present sample.
CPM. CPM involved physical punishment (beyond
relatively mild physical punishment such as occa-
sional spanking or being slapped once or twice) or
other physical violence that was experienced prior to
age 18.2 CPM was assessed through the use of a modi-
fied version of the Physical Maltreatment Scale devel-
oped by Briere and Runtz (1988). In their original
study, internal consistency reliabilities were accept-
able ( = .78 for mothers and .75 for fathers). The cur-
rent version of the scale included seven items (e.g.,
being slapped, being hit with an object, being symptoms, thus indicating that either frequency or
kicked) and used a 6-point Likert-type scale ranging
from not applicable to more than 20 times. Detailed ques-
tions followed that explored the nature of the CPM
experience (e.g., identity of perpetrator, age of onset,
duration). Internal consistency reliability (Cronbachs
alpha) for the scale in the present sample was .77. The
predictive validity of the CPM variable has been previ-
ously demonstrated in that CPM was found to be asso-
ciated with psychological symptoms on the TSI
(Briere, 1995) within this same sample of women
(Runtz & Roche, 1999).
Physical Health Concerns
Menstrual Distress Questionnaire (MDQ). The MDQ
(Moos, 1968) is a widely used questionnaire designed
to retrospectively assess physical and psychological
symptoms associated with various phases of the men-
strual cycle. Forty-six items assess the level of distress
experienced during the premenstrual, menstrual,
and intermenstrual phases with regard to weight gain,
headaches, cramps, irritability, fatigue, and other re-
lated symptoms. Moos (1968) derived the following
eight intercorrelated subscales through factor analy-
sis: Pain, Concentration, Behavior Change, Auto-
nomic Reactions, Water Retention, Negative Affect,
Arousal, and Control. Boyle (1992) substantiated the
eight-factor structure of the MDQ using confirmatory
factor analysis.
The construct validity of the MDQ has been dem-
onstrated through studies that have shown expected
correlations between particular symptoms and vari-
ous phases of the menstrual cycle (Boyle & Grant,
1992; Moos, 1968), and changes in scores on the
MDQ have been found to be independent of psycho-
logical factors such as neuroticism and depression
(Herrera, Gomez-Amor, Martinez-Selva, & Ato,
1990). The MDQ has also been shown to be useful in
discriminating between women who complained of
premenstrual syndrome from those who did not (Rus-
sell, Coleman, & Hart, 1988), and MDQ responses
have been found to be independent of the phase of
the menstrual cycle that the woman was in when com-
pleting the questionnaire (Moos, 1968). The MDQ
has demonstrated high internal consistency reliability
and correlates strongly with menstrual symptom
reports generated by use of daily symptoms diaries
(Thys-Jacob, Alvir, & Fratarcangelo, 1995).
Although Moos (1968) used a severity scale of mea-
surement (ranging from no experience of the symptom to
acute or partially disabling experience of the symptom), he
indicated that other researchers (Paulson, cited in
Moos, 1968) had found high correlations between
measures of frequency and severity of menstrual
severity measurements would provide similar infor-
mation. In the present study, a Likert-type scale (rang-
ing from never to always) was used to assess the occur-
rence of symptoms in the premenstrual and
menstrual phases during the past 6 months. This pro-
vides for greater consistency among the health mea-
sures used in this study (which were all set to assess
symptoms within the previous 6 months).
CHILD MALTREATMENT / AUGUST 2002
 Runtz / HEALTH CONCERNS AND CHILD MALTREATMENT
Exploratory factor analysis of the current data for
symptoms occurring during the premenstrual and
menstrual phases essentially replicated the original
eight-factor structure for each scale; these eight fac-
tors accounted for 56% and 57% of the variance in
menstrual and premenstrual symptoms, respectively.
The total scores for the premenstrual phase symp-
toms (MDQ-P) and menstrual phase symptoms
(MDQ-M) were used in addition to the two sets of
eight subscales. Internal consistency reliabilities for
the MDQ-P and MDQ-M were strong (Cronbachs
alpha = .95), and alphas for the subscales ranged from
.63 (MDQ-M Water Retention) to .90 (MDQ-P Nega-
tive Affect, with average reliabilities of .78 across the
subscales for each phase). See Table 1 for means and
standard deviations for the subscales and total scores
for each scale.
Correlations among the total scores of the three
main scales were as follows: MDQ-P and MDQ-M: r =
.83, MDQ-P and Health Symptom Checklist (HSC): r =
.49; MDQ-M and HSC: r = .51. Correlations among the
MDQ-P subscales ranged from .37 (Arousal and Pain)
to .77 (Behavior Change and Concentration), and
correlations among the MDQ-M subscales ranged
from .31 (Arousal and Autonomic) to .72 (Negative
Affect and Concentration). With regard to concur-
rent validity, both the MDQ-P and MDQ-M were cor-
related with discomfort with pelvic examinations (r =
.18, r = .14), symptoms interfering with sexual func-
tioning (r = .18, r = .13), and excessive menstrual
bleeding (r = .19, r = .24). All of these correlations are
significant at p < .001.
HSC. The HSC was developed for this study and was
based partially on the Psychosomatic Symptom
Checklist (PSC) SUNYA Revision (Attanasio,
Andrasik, Blanchard, & Arena, 1984), which is made
up of 17 health symptoms (e.g., headaches, back-
aches) rated on both frequency and intensity. The
PSC has utility as a measure of psychosomatic distress
and as a measure of treatment outcome (e.g.,
Holroyd, Andrasik, & Noble, 1980), yet it also appears
to be relatively independent of psychological symp-
toms such as depression and anxiety (Attanasio et al.,
1984). It has good test-retest reliability and was found
to be composed of a single factor (general psychoso-
matic distress) accounting for 67% of the total vari-
ance (Attanasio et al., 1984).
In developing the HSC, the basic format of the PSC
was adopted, and a number of additional items were
added, resulting in a total of 54 health symptom items.
A 6-month time frame was specified to assess both cur-
rent and relatively recent health concerns, and a 6-
point Likert-type scale that ranged from 0 (not at all)
CHILD MALTREATMENT / AUGUST 2002
245
to 5 (occurs daily) was used to estimate the frequency of
symptoms. Total scores for the HSC have a potential
range from 0 to 270; the actual range in this sample
was 0 to 132, and the mean score for the sample was
38.8 (SD = 21.4). Internal consistency reliability for
the HSC was good (Cronbachs alpha = .89), and the
longer HSC correlated strongly with the shorter PSC
(r = .90).
Validity of the HSC was demonstrated through cor-
relations (p < .001) with the following health-related
variables: disease conviction (i.e., belief in the serious-
ness of ones incapacity as a result of symptoms; r =
.40), the negative influence of health symptoms on a
variety of areas of functioning (social problems: r =
.25; sexual problems: r = .20; sleep problems: r = .35;
work or school problems: r = .32), use of prescription
medication (r = .13), use of nonprescription medica-
tion (r = .16), and visits to the doctor (r = .19).
A principal components analysis of the HSC was
conducted, and a five-factor solution (accounting for
32% of the variance) was found to provide the most
appropriate description of the data. The factors are as
follows: (a) Muscular/Skeletal ( = .79; items = 14;
e.g., backaches, joint pain, muscle stiffness); (b) Sen-
sory/Nervous System ( = .72; items = 12; e.g., tunnel
vision, fainting, temporary paralysis); (c) Stomach/
Abdominal ( = .76; items = 9; e.g., abdominal pain,
stomach aches, bloating); (d) Vaginal/Genital ( =
.69; items = 8; e.g., vaginal pain, genital pain, burning
sensation in sexual organs or rectum); and (e)
Allergies/Colds/Flu ( = .61; items = 8; e.g., stomach
flu, food intolerance, skin rashes). Intercorrelations
among the factors ranged from r = .39 to r = .56; all
were significant at p < .001. Means and standard devia-
tions for the total score and subscales are provided in
Table 1.
RESULTS
Child Maltreatment
Of the 775 women included in this study, 143
(18.5%) reported a history of CSA and 153 (19.7%)
reported a history of CPM prior to age 18. Among the
243 women (31.4% of the total sample) who met crite-
ria for either type of maltreatment, 53 (21.8% of mal-
treated women) experienced both CSA and CPM. A
total of 532 women (68.6%) did not report any
maltreatment.
CSA. Of the 143 women who met this studys crite-
ria for CSA, 50 (35% of the CSA group) indicated that
they had been sexually abused by a family member: 14
(10% of CSA) by a father or stepfather, 11 (8%) by
other adult male relatives, and the rest by other rela-
246 Runtz / HEALTH CONCERNS AND CHILD MALTREATMENT

TABLE 1: Means and Standard Deviations of Maltreatment Group Main Effects on Health Symptom Subscales

Total No No
Sample CSA CSA CSA Main CPM CPM CPM Main Effect
(N = 770) (n = 627) (n = 143) Effect (n = 618) (n = 152) Effect Size
2
Health Scale M (SD) M (SD) M (SD) F p M (SD) M (SD) F p

MDQ-P total 41.5 (27.7) 40.2 (26.8) 47.6 (30.5) 0.02 ns 38.5 (25.6) 54.9 (31.9) 17.61 .000 .03
Arousal 4.1 (3.9) 4.0 (3.9) 4.5 (3.7) 0.00 ns 3.9 (3.9) 4.8 (3.7) 2.11 ns .00
Autonomic 1.6 (2.5) 1.6 (2.4) 1.8 (2.6) 0.81 ns 1.4 (2.3) 2.6 (2.9) 16.58 .000 .02
Behavior Change 3.9 (3.9) 3.7 (3.7) 4.8 (4.6) 0.00 ns 3.4 (3.5) 5.7 (4.9) 13.68 .000 .02
Concentration 4.1 (5.1) 3.8 (4.9) 5.3 (5.8) 0.16 ns 3.5 (4.6) 6.5 (6.3) 12.52 .000 .02
Control 2.0 (2.9) 1.9 (2.8) 2.5 (3.4) 0.39 ns 1.7 (2.6) 3.4 (3.7) 21.95 .000 .03
Negative Affect 11.8 (7.8) 11.3 (7.6) 14.1 (8.5) 3.20 ns 11.1 (7.5) 14.9 (18.3) 10.13 .002 .01
Pain 8.3 (5.5) 8.2 (5.5) 8.9 (5.4) 0.01 ns 7.9 (5.3) 10.0 (5.8) 9.45 .002 .01
Water Retention 5.5 (3.8) 5.4 (3.7) 6.0 (4.0) 0.33 ns 5.2 (3.7) 6.8 (4.1) 7.45 .006 .01
MDQ-M total 44.4 (28.1) 43.5 (27.7) 48.4 (29.7) 0.35 ns 41.6 (26.4) 55.7 (32.0) 14.78 .000 .02
Arousal 4.1 (3.8) 4.0 (3.8) 4.5 (3.7) 0.25 ns 3.9 (3.7) 4.7 (4.0) 1.37 ns .00
Autonomic 2.4 (3.0) 2.4 (3.0) 2.6 (3.2) 0.09 ns 2.2 (2.9) 3.3 (3.4) 9.03 .003 .01
Behavior Change 5.3 (4.3) 5.2 (4.2) 5.8 (4.7) 0.06 ns 5.0 (4.0) 6.9 (4.8) 13.12 .000 .02
Concentration 4.4 (4.9) 4.2 (4.8) 5.2 (5.4) 0.19 ns 3.9 (4.5) 6.4 (5.8) 11.65 .001 .02
Control 2.1 (3.0) 2.0 (3.0) 2.4 (3.3) 0.14 ns 1.8 (2.8) 3.1 (3.7) 10.44 .001 .01
Negative Affect 10.7 (7.2) 10.4 (7.1) 11.7 (7.5) 0.21 ns 10.2 (7.0) 12.8 (7.6) 6.92 .009 .01
Pain 10.3 (5.8) 10.2 (5.8) 10.8 (5.7) 0.11 ns 10.0 (5.6) 11.8 (6.3) 7.13 .008 .01
Water Retention 5.0 (3.6) 4.9 (3.6) 5.2 (3.8) 0.21 ns 4.7 (3.5) 6.2 (3.9) 13.22 .000 .02
HSC total 38.8 (21.4) 38.1 (21.2) 42.1 (22.3) 0.21 ns 37.0 (20.1) 46.3 (24.9) 17.92 .000 .03
Muscular/Skeletal 16.7 (9.5) 16.4 (9.4) 17.9 (10.0) 0.60 ns 16.0 (9.1) 19.4 (10.6) 12.65 .000 .02
Nervous System 1.9 (3.0) 1.8 (2.9) 2.1 (3.2) 0.10 ns 1.7 (2.7) 2.6 (3.8) 7.96 .005 .01
Stomach/Abdominal 7.4 (5.3) 7.3 (5.3) 7.9 (5.6) 0.03 ns 7.1 (5.1) 8.7 (6.0) 4.86 ns .01
Vaginal/Genital 5.8 (4.6) 5.6 (4.6) 6.8 (4.6) 4.35 ns 5.4 (4.4) 7.2 (5.3) 14.27 .000 .02
Allergies/Colds/Flu 5.4 (4.4) 5.4 (4.4) 5.4 (4.5) 0.15 ns 5.2 (4.3) 6.2 (4.8) 4.97 ns .01
NOTE: No CSA = no child sexual abuse; CSA = child sexual abuse; No CPM = no child physical maltreatment; CPM = child physical maltreat-
ment. MDQ-P total = premenstrual symptoms; MDQ-M total = menstrual symptoms; HSC total = Health Symptoms Scale.

tives younger than age 18 (e.g., 8% by a cousin, 7% by
a brother or stepbrother). Ninety-three women (65%
of the CSA group) had been sexually abused by some-
one outside of the family: 35 (25% of CSA) by a friend,
babysitter, or neighbor who was younger than age 18;
31 (22%) by a known adult male (e.g., teacher, family
friend); 17 (12%) by a boyfriend; and 10 (7%) by a
stranger. Although the average duration of the CSA
was 1.3 years (SD = 2.5), for 15% of the sexually abused
women the duration of the abuse ranged from 2 to 14
years. However, for many of the women, the sexual
abuse occurred with relative infrequency (e.g., with
regard to the most commonly experienced CSA be-
havior, 50% of the women experienced being
touched sexually on five or fewer occasions). The me-
dian age of the victim at the time of onset of the abuse
was 9 years (SD = 4.2), and the average age of the of-
fender was 24.7 years (median = 18 years, SD = 16.8).
Regarding CSA severity, for 74 women (52%), being
fondled or being made to fondle the offender was the
most severe CSA experienced3; for 54 women (38%),
the most severe level of CSA involved intercourse or
attempted intercourse; and for 10 women (7%), the
most severe CSA involved multiple perpetrators at
one time. Most women (99%; n = 137) defined their
experience as sexual abuse; the majority (85%; n =
121) had previously disclosed their abuse, and 28%
(n = 40) had previously sought counseling to help
them understand their sexual abuse experience.
CPM. Among the 153 women who had experi-
enced CPM, most of the physical maltreatment oc-
curred at the hands of a family member (87%):
Fathers or stepfathers were the main perpetrators of
CPM for 63 women (41% of CPM), followed by moth-
ers or stepmothers (n = 56; 37%) and siblings (n = 14;
9%). Other identified perpetrators of CPM included
boyfriends (n = 10; 7%), peers (n = 4; 3%), and strang-
ers (n = 3; 2%). The median age of the victim at the
onset of the maltreatment was 6 years (SD = 4.8), and
the median age of the offender was 31 years (SD =
11.5). Only 19% of the maltreatment occurred over a
period of less than 1 year, and the average duration of
the CPM was 6.8 years (SD = 4.9). The most common
experience of CPM, which occurred for 93 (61%) of
the physically maltreated women, involved moderate
levels of CPM (i.e., being slapped, pushed, or hit with

CHILD MALTREATMENT / AUGUST 2002


an object more than 20 times or being kicked or
punched 6 to 10 times). Seventy-three percent of the
maltreated women (n = 111) defined their experience
as physical abuse, and 22% (n = 34) had sought coun-
seling to help them understand their CPM experience.
General Health Symptoms,
Menstrual Distress, and
Premenstrual Distress
To guard against Type I error due to multiple tests,
an adjusted alpha of .01 was used for all analyses. A
multivariate analysis of covariance (MANCOVA) was
conducted to compare women with a history of CSA
and CPM on the total scores of the three main health
scales: HSC, MDQ-M, and MDQ-P. Womens age and
stage of the menstrual cycle were used as covariates in
this analysis because younger women had higher
scores on the HSC (r = .09, p = .01) and lower scores
on the MDQ-P (r = .09, p =.02), and women who were
having their menstrual period at the time of the study
reported higher scores on the MDQ-M (r = .09, p =
.01). There was a significant main effect for CPM,
F(3,698) = 8.11, p < .001, 2 = .03. Post hoc univariate
analyses indicated that CPM was related to higher
scores on the MDQ-P, the MDQ-M, and the HSC (all
at p < .001; see Table 1). Neither CSA nor the CSA
CPM interaction was significantly related to the
health measures; CSA: F(3, 698) = .66, p = .58, 2 = .01;
CSA CPM: F(3, 698) = 3.38, p = .02, 2 = .01.
Three additional MANCOVAs (using age and
menstrual cycle stage as covariates when appropriate)
were conducted to further examine the relationships
between CSA and CPM relative to the subscales of the
three health symptom measures. A significant interac-
tion between CPM and CSA was found for the
subscales of the MDQ-P scale, F(8, 718) = 2.86, p =
.004, 2 = .03. Univariate post hoc analyses for the
interaction indicated significant relationships with
the following two subscales: Behavior Change, F(1,
725) = 11.70, p = .001, 2 = .02; and Concentration,
F(1, 725) = 15.36, p < .001, 2 = .02. Significant
multivariate main effects of CPM were found for all
three sets of health subscales: MDQ-P subscales, F(8,
718) = 3.28, p = .001, 2 = .04; MDQ-M subscales, F(8,
735) = 2.77, p = .005, 2 = .03; and HSC subscales, F(5,
753) = 4.01, p = .001, 2 = .03. As shown in Table 1, the
post hoc univariate analyses for CPM were significant
for seven of the eight subscales of both the MDQ-M
and the MDQ-P (all but Arousal) and for three of the
five HSC subscales (i.e., Muscular-Skeletal, Sensory-
Nervous, and Vaginal-Genital Symptoms). There was
no main effect of CSA in relation to the subscales of
the health measures.
CHILD MALTREATMENT / AUGUST 2002
Runtz / HEALTH CONCERNS AND CHILD MALTREATMENT 247
HSC items and child maltreatment. Because the HSC
was developed for this study, further analyses were
conducted to examine the relationship between indi-
vidual HSC items and both forms of child maltreat-
ment. Consistent with the previous analyses, the
MANCOVA (with age as the covariate) indicated that
CPM was significantly related to the HSC items at the
multivariate level, F(54, 703) = 1.59, p = .006, 2 = .11
(that is, 11% of the variance associated with the HSC
items was accounted for by CPM). Using an adjusted
alpha level of .01 for the post hoc univariate tests,
CPM was significantly related to higher scores on 9 of
the 54 HSC items: heart palpitations, F(1, 756) = 12.1,
p = .001, 2 = .02; numbing of body parts, F(1, 756) =
10.3, p = .001, 2 = .01; muscle weakness, F(1, 756) =
11.3, p = .001, 2 = .02; burning sensations in sexual or-
gans or rectum, F(1, 756) = 23.2, p < .000, 2 = .03;
chest pain, F(1, 756) = 7.3, p = .007, 2 = .01; blurred vi-
sion, F(1, 756) = 6.3, p = .01, 2 = .01; genital pain, F(1,
756) = 6.2, p = .01, 2 = .01; bleeding between periods,
F(1, 756) = 6.5, p = .01, 2 = .01; and general weakness,
F(1, 756) = 8.8, p = .003, 2 = .01. Neither CSA nor the
CSA CPM interaction was significantly related to the
individual HSC items in the multivariate analyses. Re-
garding the total number of HSC items endorsed,
women with a history of CPM reported experiencing a
greater number of physical symptoms (M = 20.8, SD =
10.4) compared to other women (M = 17.5, SD = 8.7),
F(1, 769) = 10.3, p = .001, 2 = .01. Neither the CSA
CPM interaction nor CSA was related to the total
number of symptoms endorsed on the HSC.
Child maltreatment characteristics and health symptoms.
Hierarchical multiple regression was employed to de-
termine if certain characteristics of CSA4 (e.g., sever-
ity, duration) would predict health symptoms among
the subgroup of women identified as having a history
of CSA while controlling for relevant demographics
and CPM. Analyses were conducted by regressing
each of the three health scales on six of the most po-
tentially relevant CSA characteristics (n = 125): dura-
tion, frequency (i.e., total frequency score across the
six CSA items), severity, intrafamilial CSA, onset of
CSA before age 13, and multiple CSA experiences
(i.e., with different offenders). Variables were se-
lected for these analyses on the basis of bivariate cor-
relations with the health variables as well as from
indications from the literature and a previous exami-
nation of this sample (see Runtz & Roche, 1999). In
all three analyses, age and CPM were entered at Step 1
(stage of menstrual cycle was also entered for the
MDQ-M analysis), followed by the set of CSA charac-
teristics entered on Step 2.
248 Runtz / HEALTH CONCERNS AND CHILD MALTREATMENT

TABLE 2: Hierarchical Regression of Child Sexual Abuse (CSA) Characteristics on Premenstrual Symptoms

2
sr
a
Variable MDQ-P 1 2 3 4 5 6 7 8 B (Incremental)

Step 1 .01
1. Subject age .02 0.25 0.05
2. Child physical maltreatment .08 .18 6.97 0.11
Step 2 .15*
3. CSA < 13 years .09 .02 .01 9.74 0.14
4. CSA frequency .05 .10 .04 .14 1.79 0.23
5. Multiple CSA .09 .10 .09 .21 .14 0.68 0.01
6. Familial CSA .04 .08 .06 .35 .28 .24 5.58 0.09
7. CSA duration .30 .04 .18 .26 .44 .14 .39 4.53 0.39*
8. CSA severity .15 .01 .05 .37 .37 .05 .06 .02 12.88 0.27*
M 47.57 21.10 0.37 0.76 4.01 1.33 0.36 1.29 1.54
SD 30.51 6.66 0.48 0.43 3.76 0.55 0.48 2.54 0.63
2
R = .16
2
Adjusted R = .10
R = .40*
NOTE: MDQ-P = Menstrual Distress Questionnaire premenstrual phase symptoms.
a. MDQ-P is the dependant variable in the analysis.
*p < .01.

Only the equation predicting premenstrual symp-
toms was significant; CSA characteristics did not pre-
dict either general health symptoms or menstrual dis-
tress within the CSA subgroup. Table 2 displays results
of the MDQ-P regression analysis including the corre-
lations between the variables, the unstandardized
regression coefficients (B), the standardized regres-
sion coefficients (), the semipartial correlations
(sr2), and R, R2, and adjusted R2 after entry of all of the
predictor variables. In this analysis, R was not signifi-
cant after Step 1: With age and CPM in the equation,
R2 = .01, F(2, 123) = .82, p = .44. After Step 2, with all
the variables in the equation, R was significantly dif-
ferent from zero, R = .40, F(8, 117) = 2.81, p = .007, R2 =
.16 (that is, 16% of the variance in premenstrual
symptoms was accounted for by the CSA characteris-
tics). Of the variables in the equation at this point,
CSA duration ( = .39, p < .001) and CSA severity ( =
.27, p = .01) were significant predictors of MDQ-P. As
shown in Table 2, the addition of the CSA variables to
the equation resulted in a significant increment in R2
beyond that which was accounted for by a history of
CPM.
DISCUSSION
The current results suggest that childhood mal-
treatment experiences are associated with physical
health difficulties in university women. Although it
was expected that women with a history of CPM or
CSA would both endorse higher levels of physical
symptoms, it was apparent that in comparison to sex-
ual abuse, childhood physical maltreatment was most
clearly linked with a variety of physical health symp-
toms. Although CPM alone and CPM combined with
CSA both appear to be important in relation to later
health difficulties, on its own, sexual abuse was largely
unrelated to health problems in this sample. This was
an unexpected finding given the growing evidence in
the literature that suggests such a relationship (e.g.,
Walker et al., 1992, 1997) and given the previously
published findings from this very sample that showed
a significant association between CSA and mental
health symptoms (Runtz & Roche, 1999). Because
many of the studies that have found significantly
poorer health outcomes among sexually abused
women were conducted within medical or clinical
samples of women (e.g., Walker et al., 1997), the
absence of such a finding in the current study could
be related to the type of sample studied (i.e., health-
ier, middle-class women with less severe CSA
histories).
In the current sample, physical maltreatment in
childhood showed a general relationship with adult
physical health sequelae as it was linked with nearly
the entirety of physical health symptoms that were
measured in this study. Similarly, in the earlier exami-
nation of this sample, CPM was associated with all 10
clinical scales of the TSI (Runtz & Roche, 1999). In
regard to the current findings, general health symp-
toms occurring across a range of physical systems
(e.g., muscular-skeletal, abdominal, sensory) as well
as physical and emotional symptoms related to the
premenstrual and menstrual phases of womens cycle

CHILD MALTREATMENT / AUGUST 2002

 Runtz / HEALTH CONCERNS AND CHILD MALTREATMENT
were associated with CPM. Women who had experi-
enced physical maltreatment as children were also
more likely than others to suffer from a greater variety
of specific health symptoms (e.g., heart palpitations,
numbing of body parts) as well as to experience these
symptoms at a higher frequency than other women
during the past 6 months. These findings are consis-
tent with a growing body of research that has found
evidence of an association between early experiences
of physical victimization and later physical health
problems (e.g., Rapkin et al., 1990; Walker et al.,
1997).
Many of the studies of child maltreatment and
adult physical health status have either focused
entirely on CSA or have combined a variety of catego-
ries of child abuse into a single variable. In the former
case, researchers may have missed the opportunity to
observe the important relationship that physical vic-
timization may have with adult physical health. This is
particularly relevant given the likelihood that unmea-
sured physical maltreatment co-occurring with sexual
abuse could be contributing to the symptoms attrib-
uted solely to CSA. On the other hand, consolidating
a variety of types of child maltreatment into a single
category does not allow for differentiating among the
various sequelae that may be associated with each
form of maltreatment. The current study shows that
when both child physical and sexual maltreatment
are examined in the same study, the relationship
between CPM and physical health symptoms can be
greater than that associated with sexual abuse. This is
an especially important finding with regard to univer-
sity samples of women whose sexual abuse experi-
ences tend to be of lesser severity than those found in
clinical samples (Neumann et al., 1996); attention
needs to be paid to the possible role of CPM experi-
ences in the presentation of health concerns within
this population. Similarly, the relationship between
child maltreatment and health status is likely to be
greater in other samples of women; hence, this study
provides the basis for further examinations of these
variables within other groups (such as clinical and
community samples).
When child sexual and physical maltreatment
occurred together, the current results showed an
association with greater emotional distress during the
premenstrual phase of a womans cycle. In the cur-
rent sample, this corresponds to the experiences of
about 22% of the overall group of maltreated women.
Although this double victimization was associated
with premenstrual symptoms, it was not predictive of
general health symptoms. This suggests that the pres-
ence of sexual victimization in the context of physical
maltreatment may contribute to an experience of
CHILD MALTREATMENT / AUGUST 2002
249
symptoms related to the sexual or reproductive areas
of the body. Because it was the emotional and behav-
ioral premenstrual symptoms (rather than physical
symptoms such as pain and water retention) that were
associated with the combination of CSA and CPM,
this could suggest an emotional vulnerability in these
women that may be exacerbated at this phase of the
menstrual cycle (e.g., triggering of fears, worries, and
shame related to sexual and reproductive function-
ing; greater susceptibility to stress in relation to hor-
monal fluctuations). As these are mainly speculations,
these issues would need to be further examined in
future research.
When the subgroup of women with a history of
CSA was examined, sexual abuse of greater severity
(i.e., involving intercourse or attempted intercourse)
and longer duration was associated with greater
premenstrual distress even after controlling for the
presence of physical maltreatment. The fact that this
study showed that CSA was less likely than CPM to be
linked to health symptoms may be due partly to the
use of a multivariate methodology that examined
both physical maltreatment and sexual abuse concur-
rently. As mentioned above, because many women
experience both types of child maltreatment, studies
of only CSA may overestimate the relationship of sex-
ual abuse to physical health and psychological adjust-
ment by not separating out the potential influence of
CPM. This may be particularly likely when studying
university student samples.
An interesting comparison can be made in regard
to different types of symptoms assessed in relation to
child physical and sexual maltreatment within this
particular sample. A previously published examina-
tion of CSA and CPM in this sample showed that both
types of child maltreatment were associated with a
variety of mental health symptoms in adulthood
(Runtz & Roche, 1999). For instance, whereas the cur-
rent study showed that CPM (but not CSA) was consis-
tently associated with a range of physical health symp-
toms, the previous study demonstrated that CSA was
linked to depression, PTSD symptoms, sexual prob-
lems, and tension reduction behaviors (e.g., self-
harm, aggression, suicidality). Similar to the previous
findings, the current study also determined that more
severe CSA (i.e., CSA of longer duration and greater
physical intrusiveness) is an important aspect of the
victimization experience in relation to its association
with certain health difficulties (i.e., premenstrual
symptoms). That CSA was a considerably weaker pre-
dictor of health symptoms in this study suggests that
either the health measures used did not assess the par-
ticular health problems experienced by those women
in this sample with a history of CSA or that these sexu-
250 Runtz / HEALTH CONCERNS AND CHILD MALTREATMENT
ally abused women are physically healthier than simi-
lar women from other studies (despite also showing
significantly greater psychological difficulties than
nonabused women). It may also be the case that sexu-
ally abused university women are more likely to dem-
onstrate psychological difficulties rather than health
difficulties while their physically maltreated counter-
parts show symptoms in both domains.
This study, as is the case for all studies of university
students, is limited in its generalizability by the nature
of the population that was sampled. It has been
shown, by meta-analysis, that sexually maltreated
women from student samples tend to show less severe
levels of psychological maladjustment in comparison
to other groups (particularly in comparison to clinical
samples; Jumper, 1995; Neumann et al., 1996). On
the other hand, it has been suggested that it is clinical
samples that are anomalous (in their demonstration
of stronger associations between CSA and maladjust-
ment) and that student samples are more similar to
community samples than to clinical samples in terms
of adjustment (Rind, Tromovitch, & Bauserman,
1998). It has yet to be determined whether these dif-
ferences among sample types would also appear in
regard to the demonstration of physical health con-
cerns; however, it would be reasonable to assume that
individuals who are seeking help for a particular prob-
lem (whether it is a psychological or a physical diffi-
culty) would evidence a greater degree of suffering
than those who are not being sampled on the basis of
their help seeking. Whether the results from a study
of students would be similar to a community sample of
former victims of child maltreatment in terms of their
physical health has yet to be demonstrated. Finally,
even if the current sample of women with a history of
child maltreatment is a distinct group (relative to the
entire population of victims of child abuse), the fact
that they too report greater health concerns than
their nonvictimized counterparts points to the neces-
sity of acknowledging and addressing their concerns.
An issue that is related to the nature of this sample
is the relatively small effect sizes found between child
maltreatment and health concerns. For most of the
analyses, less than 10% of the variance in health could
be accounted for by child maltreatment (an excep-
tion is that 16% of variance in HSC item scores could
be attributed to CPM, and 11% of the variance in
MDQ-P scores among sexually abused women could
be accounted for by variables such as CSA duration
and severity). As indicated by Rind et al. (1998),
examinations of CSA among university students tend
to result in rather small effect sizes. Although this
does not mean that child maltreatment is an unim-
portant contributor to physical health status, it does
suggest that there are many other factors unac-
counted for in the present study that play a greater
role in the manifestation of womens health difficul-
ties. Although a number of demographic variables
were examined and relevant variables (such as age
and menstrual cycle phase) were used as covariates in
the analyses, many other potentially important vari-
ables were not examined. For example, mediating
variables such as family environment, supportive rela-
tionships, attachment style, and coping strategies may
have an important influence on the manifestation of
physical health concerns among former victims of
child maltreatment. Similarly, other forms of child
maltreatment (e.g., emotional abuse, physical and
emotional neglect, and witnessing violence in the
family) were not assessed in this study and would pro-
vide for a more thorough examination of the connec-
tion between child maltreatment and physical health
in adults. Similarly, because of the relatively privi-
leged nature of the sample, a full examination of the
role of poverty on physical health was not feasible.
Each of these areas will require further exploration
through other studies.
An additional limitation of this study involves the
specific measures employed to assess womens health
concerns and child maltreatment. Many of the health
items (particularly for the HSC) were written specifi-
cally for the present study to broaden the scope of
health symptoms assessed by existing checklists such
as the PSC. Although this and other modifications
made to the scales used limit the potential for direct
comparison to the original scales, the modified scales
were demonstrated to possess adequate reliability and
validity in this sample. Further examination of both
the original as well as the modified scales with other
populations will be useful to provide additional infor-
mation regarding the utility of these measures in the
field of victimization research. Similarly, the retro-
spective measurement of child abuse and maltreat-
ment through the use of questionnaires is an area
filled with difficulties. As demonstrated by Roosa,
Reyes, Reinholtz, and Angelini (1998), the manner in
which sexual abuse is defined can have a great influ-
ence on the nature of the results attained in studies of
long-term sequelae. The definition of CSA used in
this study is consistent with suggestions made by
Roosa et al.: That is, noncontact sexual maltreatment
was not included, sexually abusive experiences
between peers during adolescence were included in
the definition, and an examination of the spectrum of
abuse severity was conducted (in addition to using
dichotomous abuse variables).5
In addition, as with all retrospective studies of child
abuse sequelae, there is the problem of potential dis-
CHILD MALTREATMENT / AUGUST 2002
 Runtz / HEALTH CONCERNS AND CHILD MALTREATMENT
tortions of recall and the possibility of an overall nega-
tive outlook that might color both the likelihood of
reporting child victimization as well as health prob-
lems. The likelihood of the latter difficulty greatly
influencing the data may be diminished by the obser-
vation of different levels of endorsement of various
symptoms (i.e., victims of child maltreatment do not
appear to be simply endorsing all symptoms equally
or indiscriminately). Even if it were the case that
women with a history of child maltreatment had an
overall more negative outlook (and hence endorsed
greater symptoms), the presence of symptom com-
plaints in this population would still be relevant as
their symptoms may lead these women toward greater
use of health services. Although all self-report data are
vulnerable to potential distortions in responding, in
this study, whether the individuals actually suffer from
health problems to the extent reported or perceived
themselves to do so may not be a meaningful differ-
ence. The extent to which we perceive and respond to
our physical ills and concerns (be it by self-medicating
through use of nonprescription or alternative medi-
cines, making positive lifestyle changes, or taking on a
sick role that interferes with adaptive functioning)
is a relevant and important aspect of health and
wellness that is worthy of being addressed.
The findings of the present study have important
implications for professionals working with women in
a number of fields ranging from medicine and public
health to psychology, psychiatry, and social work. The
results suggest that women with a history of child mal-
treatment may be more likely than other women to
suffer from a variety of physical health concerns; this
may have implications for these womens use of tradi-
tional medical services, alternative health care, as well
as their use of medications and other medical treat-
ments. Studies like that of Walker et al. (1997) have
substantiated the higher usage and greater costs of
health care incurred by women with a history of child
abuse and neglect. Additional studies will be needed
to further explore the relationships between abused
womens experience of physical health symptoms and
conditions in relation to their contact and satisfaction
with the medical profession. It will be important to
determine if these womens health complaints are
treated any differently than similar presentations
among nonabused women would be treated or if the
women themselves perceive this to be the case. Ade-
quate and compassionate health services for women
with a history of child maltreatment should include
an awareness on the part of the health practitioner of
the role of previous victimization in the formation
and maintenance of health problems as well as the
mechanisms by which women cope with both their
CHILD MALTREATMENT / AUGUST 2002
251
history and their health conditions. As physicians and
other members of the medical professions are often
the first avenue of contact for individuals with both
physical and psychological concerns, this knowledge
could provide these professionals with the opportu-
nity to reflect on the manner in which victimized
women are treated by the medical profession and the
ways in which medical treatment for this population
can be improved, as well as ways in which access to psy-
chological services can be assured when needed.
NOTES
1. Participants responded to the following screening
question: When you were a child (under 18 years of age)
were you ever pressured into forced contact with the sexual
part of your body, with the sexual part of someone elses
body (or were too young to understand something sexual
had happened to you)?
2. The following screening question was used to assess
experiences of child physical maltreatment (CPM): When
you were a child (under 18 years of age) were you ever physi-
cally hit or assaulted by someone, including being slapped
or spanked by a parent? If the answer to this question was
affirmative and the severity of the womans experience in-
volved at least mild CPM (i.e., spanking on 20 or more occa-
sions, or being slapped, pushed, or hit with an object on 3 to
5 occasions), her experience was classified as CPM.
3. Further information regarding the derivation of the
child sexual abuse (CSA) severity variable can be found in
Runtz and Roche (1999).
4. A similar analysis was conducted for characteristics of
CPM (such as severity, frequency, recency) within the sub-
group of subjects with a history of CPM in relation to the
health scales; however, the multivariate analysis was not sig-
nificant at the alpha = .01 level.
5. In an attempt to explore alternative definitions of CSA
within this sample, the data were examined in the following
ways: intrafamilial CSA versus extrafamilial CSA, CSA prior
to age 14 and CSA between 14 and 18, and CSA involving in-
tercourse versus CSA without intercourse (each of these lev-
els was compared to those without CSA in addition to those
with CPM). The results of these analyses showed that defin-
ing CSA in any of these ways did not reveal significant rela-
tionships to the health variables.
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CHILD MALTREATMENT / AUGUST 2002
253
Marsha G. Runtz is an associate professor of clinical psychology
at the University of Victoria in British Columbia, Canada. Her
research and clinical work centers on the long-term effects of child
sexual and physical maltreatment and the exploration of variables
that mediate the relationship between child abuse and adult adjust-
ment. Most recently she has been examining the influence of victim-
ization on womens physical health and sexual well-being as well as
the role of coping strategies, social support, post-traumatic stress,
and adult attachment style as mediators of psychological and physi-
cal well-being.