The long term effects of childhood sexual abuse: rationale for and experience of pharmacotherapy with nefazodone.

Studies estimate that 1 in 6 women and 1 in 10 men experience childhood sexual abuse (CSA). Whilst ill-health is not an inevitable consequence, approximately 20% of victims go on to have serious long-term pathology. This is reflected in an excess incidence of CSA survivors in problem populations, be they medical, forensic or psychiatric. Four groups of research studies suggest that PTSD-related mechanisms might be a major mediating factor in the development of symptoms: 1. There is high incidence of PTSD following sexual trauma; 2. Psychometric studies show evidence of impaired limbic functions; 3. There is evidence of neuroendocrine disturbances similar to those seen in war veterans with PTSD; 4. MRI studies show evidence of hippocampal atrophy. There is a growing database of studies showing that drugs that act as seroionergic modulators are effective in the treatment of PTSD. Drugs such as nefazodone which block 5HT2 receptors and inhibit the uptake of serotonin may be of particular value. Studies suggest that trauma-related issues are not always addressed in patients with a history of abuse. Given the problems posed, there is a need to review their treatment in the light of emergent knowledge. Further research is needed to validate these findings.