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The British Journal of Psychiatry (2004) 185: 353
© 2004 The Royal College of Psychiatrists

Correspondence

Child sexual abuse and substance use disorders: role of psychiatric comorbidity

W. Langeland and W. van den Brink

Amsterdam Institute for Addiction Research, Academic Medical Center, University of Amsterdam, Tafelbergweg 25, 1105 BC Amsterdam, The Netherlands. E-mail: w.vandenbrink{at}amc.uva.nl

We read with interest the paper by Spataro et al (2004) considering associations between child sexual abuse and subsequent psychopathology using a prospective cohort design. This study clearly indicates a positive association between child sexual abuse and a range of mental disorders, although not substance use disorders. We think that the authors make an important point in their discussion that this latter absence of an association might be at least-partly due to their methodology for assessing psychiatric outcome. They implemented a diagnostic hierarchy in such a way that when substance use problems were accompanied by other psychiatric disorders, these comorbid conditions were counted and not the substance use.

It is important for the reader to know that substantial comorbidity between substance use disorders and other psychiatric disorders is consistently reported (e.g. Kessler et al, 1997a). Thus, one could suggest that this prospective study does not demonstrate an association between child sexual abuse and more pure forms of substance use disorders. This would be in line with other findings suggesting a lack of association between childhood trauma (including child sexual abuse) and pure substance use disorders, but a strong relationship between childhood trauma and psychiatric comorbidity in substance use disorders (Kessler et al, 1997b; de Graaf et al, 2002).

REFERENCES

  1. De Graaf, R., Bijl, R.V., Smit, F., et al (2002) Risk factors for 12-month comorbidity of mood, anxiety, and substance use disorders: findings from The Netherlands from The Mental Health Survey and Incidence Study. American Journal of Psychiatry, 159, 620 -629.[Abstract/Free Full Text]
  2. Kessler, R. C., Crum, R. M., Warner, L. A., et al (1997a) Lifetime co-occurrence of DSM - III - R alcohol abuse and dependence with other psychiatric disorders in the national comorbidity survey. Archives of General Psychiatry, 54, 313 -321.[Abstract/Free Full Text]
  3. Kessler, R. C., Davis, C. G. & Kendler, K. S. (1997b) Childhood adversity and adult psychiatric disorder in the US National Comorbidity Survey. Psychological Medicine, 27, 1101 -1119.[CrossRef][Medline]
  4. Spataro, J., Mullen, P. E., Burgess, P. M., et al (2004) Impact of child sexual abuse on mental health. Prospective study in males and females. British Journal of Psychiatry, 184, 416 -421.[Abstract/Free Full Text]




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