Melissa Farley

Current and past history of domestic violence (DV), including physical, sexual, and emotional abuse is common among women patients seen in health care settings and is associated with a higher frequency of many health problems. However, the association of DV with self-assessed social functioning is less well known. We administered a telephone survey to a random sample of 391 women HMO members seen for a routine annual check-up. The survey included questions about current and past physical, sexual, and emotional violence and self-assessed social functioning and health status from the SF-36. We included questions about attitudes toward routine DV screening, likelihood of disclosure, and the health care setting as a resource. Seven percent of the women reported recent DV and 34% reported lifetime abuse. Abuse was related to limitations in social functioning (adjusted OR = 2.26). Among women with no recent history of abuse, those with a history of past physical (adjusted OR = 1.90), sexual (adjusted OR = 2.04), or emotional (adjusted OR = 2.20) abuse reported significantly poorer social functioning. Emotional abuse, even in the absence of a history of physical or sexual abuse, was strongly associated with limitations in social functioning (adjusted OR = 4.95). Most women believed it appropriate for clinicians to inquire routinely about DV (87%) and 83% believed that the health care setting was a source of help. Current and past DV, including emotional abuse, adversely affect social functioning. Therefore, clinicians in the health care setting have a unique and important opportunity to assist women victims of DV and abuse.

One hundred and thirty people working as prostitutes in San Francisco were interviewed regarding the extent of violence in their lives and symptoms of posttraumatic stress disorder (PTSD). Fifty-seven percent reported that they had been sexually assaulted as children and 49% reported that they had been physically assaulted as children. As adults in prostitution, 82% had been physically assaulted; 83% had been threatened with a weapon; 68% had been raped while working as prostitutes; and 84% reported current or past homelessness. We differentiated the types of lifetime violence as childhood sexual assault; childhood physical abuse; rape in prostitution; and other (non-rape) physical assault in prostitution. PTSD severity was significantly associated with the total number of types of lifetime violence (r = .21, p = .02); with childhood physical abuse (t = 2.97, p = .004); rape in adult prostitution (Student's t = 2.77, p = .01); and the total number of times raped in prostitution (Kruskal-Wallace chi square = 13.51, p = .01). Of the 130 people interviewed, 68% met DSM III-R criteria for a diagnosis of PTSD. Eighty-eight percent of these respondents stated that they wanted to leave prostitution, and described what they needed in order to escape.

Conceptual and methodological difficulties exist in assessing coping behaviors. This study investigated coping behaviors in 102 psychiatric outpatients. We used the Dissociative Experiences Scale, a 17-item posttraumatic stress disorder (PTSD) checklist; 2 measures of somatization (the Wahler Physical Symptom Inventory and the Physical Symptom Questionnaire), and 21 questions about subject involvement in positive and pathologic tension-reducing behaviors. Preliminary data suggest that dissociative symptoms, PTSD-like symptoms, and somatization are associated with a variety of positive and pathologic tension-reducing behaviors. The results suggest that psychiatric outpatients have an array of coping behavior: some are health-promoting, others are relatively self-destructive.

... Models of airfall deposits from Plinian eruption columns on Earth and Mars (eg, Wilson, 1980 and Wilson and Head, 1990) roughly equate the fallout distance with plume height, in absence of wind, and there is no reasonable grouping of eruption parameters on Mars that would ...

... This perspective, however, does not address the social stigma and enormous contempt aimed at ... Women in most jobs in West Bengal, India, were expected to permit sexual exploitation. ... prostitution from 5 countries, 72% reported current or previous homelessness ...

We investigated attitudes and behaviors associated with prostitution and sexual aggression among 101 men who buy sex and 101 age-, education-, and ethnicity-matched men who did not buy sex. Both groups tended to accept rape myths, be aware of harms of prostitution and trafficking, express ambivalence about the nature of prostitution, and believe that jail time and public exposure are the most effective deterrents to buying sex. Sex buyers were more likely than men who did not buy sex to report sexual aggression and likelihood to rape. Men who bought sex scored higher on measures of impersonal sex and hostile masculinity and had less empathy for prostituted women, viewing them as intrinsically different from other women. When compared with non-sex-buyers, these findings indicate that men who buy sex share certain key characteristics with men at risk of committing sexual aggression as documented by research based on the leading scientific model of the characteristics of non-criminal sexually aggressive men, the Confluence Model of sexual aggression.

We interviewed 100 women prostituting in Vancouver, Canada. We found an extremely high prevalence of lifetime violence and post-traumatic stress disorder (PTSD). Fifty-two percent of our interviewees were women from Canada's First Nations, a significant overrepresentation in prostitution compared with their representation in Vancouver generally (1.7-7%). Eighty-two percent reported a history of childhood sexual abuse, by an average of four perpetrators. Seventy-two percent reported childhood physical abuse, 90% had been physically assaulted in prostitution, 78% had been raped in prostitution. Seventy-two percent met DSM-IV criteria for PTSD. Ninety-five percent said that they wanted to leave prostitution. Eighty-six percent reported current or past homelessness with housing as one of their most urgent needs. Eighty-two percent expressed a need for treatment for drug or alcohol addictions. Findings are discussed in terms of the legacy of colonialism, the intrinsically traumatizin...

We tested the hypothesis that a history of trauma (especially sexual trauma) was associated with a reduced likelihood of having had medically appropriate cervical cancer screening. A case-control study using mailed self-report questionnaires. The questionnaires were completed by an age-stratified random sample of adult women members of a large health maintenance organization. The sample included 364 women who had received medically appropriate cervical cancer screening and 372 who had not. We defined cases as women who, according to their medical record, had not had cervical cancer screening within 2 years before the study. Controls were defined as women who had been screened. We evaluated exposures to trauma that we hypothesized to be associated with the case/control state. Women who had been sexually abused in childhood were less likely to have had a Pap smear within the past 2 years (36.0% vs. 50.4%, P =.050). Other traumatic events were associated with Pap testing in bivariate a...

The authors summarize four studies on dissociation among women in prostitution, and discuss clinical aspects of the relationship between trauma, dissociation and prostitution. Dissociative disorders are common among those in escort, street, massage, strip club and brothel prostitution, and are frequently accompanied by posttraumatic stress disorder, depression, and substance abuse. These in turn are linked to high rates of childhood

This study investigated the relation between history of sexual abuse, somatization, and dissociation in 53 women with a self-reported history of sexual assault in childhood and in 30 women who did not report such a history. Dissociation and reporting of chronic physical symptoms were positively correlated in subjects who had a history of sexual abuse, but this relation did not occur in subjects who reported no history of sexual abuse. The more perpetrators a subject reported, the greater the number of reported chronic physical symptoms. As the age of onset of abuse neared puberty, the more the subjects reported childbirth complications. The relation between somatization and dissociation is discussed.

In the recent literature on prostitution, there has been a focus on HIV which has tended to exclude discussion of the physical and sexual violence which precedes and which is intrinsic to prostitution. The literature of two time periods (1980-84 and 1992-1996) is critically reviewed in order to describe this trend.The normalization of prostitution in the medical and social sciences

For four groups of women: no abuse, physical abuse alone, combined sexual and physical abuse, and unclear about memories of abuse, we examined the associations between childhood sexual and physical abuse, chronic physical symptoms in adulthood, PTSD, and health care utilization. Of a randomly selected sample of 600 adult femalc members of a health maintenance organization, 86 (14%) chose to participate. Women with a history of physical and sexual abuse in childhood reported significantly more cardiovascular, immune, musculoskeletal, neurologic, and reproductive symptoms than those without this history. While the Sexual/Physical Abuse group had the most chronic physical symptoms, medical visits, emergency room visits, prescriptions, and severe PTSD, the Unclear Memory group consistently ranked second on these same measures--higher than either Controls or the Physical Abuse group. Findings underscore the importance of screening for trauma history among patients seen in medical clinics, and the importance for psychotherapists of attending to patients' physical as well as psychological symptoms of childhood trauma.

We estimated the prevalence of trauma history and relapse in a sample of 959 patients at two outpatient chemical dependence clinics of a managed healthcare organization. A large majority (89%) reported a history of at least one traumatic event. The most common traumatic events were serious accidents, being robbed, seeing someone killed or seriously injured, and partner violence. One third of the patients had a history of substance abuse disorder relapse. There were gender and ethnic differences in the types of traumatic events reported. There were ethnic differences in relapse rates, which were highest among African American and multicultural patients. The types of traumatic events reported differed in patients of various sexual orientations. Bisexual patients had the highest rates of relapse, even when trauma exposure was controlled. Clinical implications of the findings are discussed.

... Dr Farley reported receiving author royalties for Prostitution and Trafficking in Nevada: Making the Connections (Prostitution Research and Education, 2007) and Prostitution, Trafficking, and Traumatic Stress (Routledge, 2003). ... 7. Farley M,; Cotton A,; Lynne J,; et al. . ...