Psychological characteristics of women presenting with breast pain

doi:10.1016/S0022-3999(01)00196-9

Journal of Psychosomatic Research

Volume 50, Issue 6, June 2001, Pages 303-307

https://doi.org/10.1016/S0022-3999(01)00196-9 Get rights and content

Abstract

Objective: Extensive evidence links unexplained physical symptoms in adults with childhood abuse. This study investigated a possible link between unexplained breast pain, recalled childhood abuse and emotional and somatic distress. Methods: Consecutive female out-patients presenting with breast pain were categorised as treatment-resistant (n=20), newly diagnosed and requesting treatment (n=37), or newly diagnosed but reassured and not seeking treatment (n=32) and compared with pain-free patients with breast lumps (n=31). Results: All breast pain groups were more anxious and depressed, somatised more and recalled a higher incidence of emotional abuse by comparison with breast lump patients. Logistic regression confirmed that emotional abuse and anxiety were independently associated with breast pain. Conclusion: Clinical management of patients who present breast pain should be sensitive to the evidence that pain is a marker of emotional abuse in some women and is associated with widespread somatic and emotional distress.

Introduction

Breast pain is a common complaint among women presenting to breast clinics and general practice [1]. However, only a few sufferers seek treatment [1], [2].

Although early descriptions of breast pain emphasised a psychosomatic origin [3], [4] research into its aetiology has been dominated by hormonal theories [5], [6]. However, recent studies have shown increased anxiety and depression among breast pain patients compared to controls [7], [8], [8]. Indeed, in many patients complaining of severe breast pain who are resistant to treatment, emotional distress is at clinical levels [8], [8], [10]. Research into unexplained physical symptoms other than breast pain has been extensive. In particular, a high prevalence of recalled childhood abuse has been associated with several functional disorders [11], [12], [13], [14], [15], [16]. Furthermore, where victims of abuse are identified in nonclinical samples, they have elevated levels of physical symptoms and health care utilisation [17].

The present study determined whether a history of child sexual abuse was associated with unexplained breast pain. In addition, we assessed emotional distress and aspects of somatic distress to test the hypothesis that childhood abuse leads women to present with breast pain because it increases adult emotional or somatic distress [16]. To distinguish effects associated with consulting with breast pain from those associated with seeking treatment we studied women with breast pain who sought treatment and those who did not as well a breast lump comparison group.

Sexual abuse is a marker for physical and emotional abuse and poor parenting [18], which we therefore also examined. Finally, because of evidence that women seeking treatment for breast pain report more psychological distress in the luteal phase of the menstrual cycle than the follicular phase, assessments were repeated 6 weeks after first contact to compare these phases.

Section snippets

Patients and procedure

Female patients (n=130) presenting with cyclical or noncyclical breast pain were approached consecutively in a breast clinic at a general teaching hospital. They were categorised as: treatment-resistant (continued breast pain despite drug treatment for a minimum of 6 months), newly treated (attending their first consultation and requesting treatment following reassurance as to the absence of malignancy), reassured (attending their first consultation and declining treatment following exclusion

Sample

Ten subjects declined to take part before reading the questionnaire (one treatment-resistant, three newly treated, three reassured and three breast lump). The sample comprised: 20 treatment-resistant, 37 newly treated, 32 reassured and 31 breast lump patients. Mean age was 37 years (range 18–52), 96 (89%) were employed or in full-time study; 76 (64%) were married or living with a partner, 33 (28%) were nulliparous. The groups did not differ on any of these variables.

Comparison of groups on psychological status

Analyses of variance

Discussion

This study confirms previous reports of elevated anxiety and depression in patients with unexplained breast pain [7], [8], [8] and shows high levels of somatisation also. These variables characterised patients who consulted with breast pain and not just those who sought treatment. Understandably, seeking treatment was associated with particularly high state-anxiety and disease concern. Differences between groups were unrelated to the menstrual cycle. Indeed, high trait-anxiety in all pain

Acknowledgements

We thank Professor S. Leinster for assistance in designing the study and Mrs. S. Holcombe and the nursing staff for their enthusiastic cooperation and assistance in data gathering.

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View full text

Psychological characteristics of women presenting with breast pain

Abstract

Introduction

Section snippets

Patients and procedure

Sample

Comparison of groups on psychological status

Discussion

Acknowledgements

Lancet

Obstet Gynecol Clin North Am

Gen Hosp Psychiatry

Gastroenterology

Pain

J Psychosom

J Psychosom Res

J Psychosom Res

Am J Obstet Gynecol

The treatment of cyclical mastalgia

Breast News

Cyclical mastalgia; clinical and mammographic observations in a screened population

Br J Surg