The role of cumulative sexual trauma and difficulties identifying feelings in understanding female veterans' physical health outcomes Melissa A. Polusny, Ph.D., L.P. a,b,c, ⁎ , Kelly A. Dickinson, Ph.D., L.P. a , Maureen Murdoch, M.D., M.P.H. b,d,e , Paul Thuras, Ph.D. a,e a Department of Veterans Affairs Medical Center, Minneapolis, MN 55417, USA b Center for Chronic Disease Outcomes Research, Minneapolis, MN 55417, USA c Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN 55455, USA d Section of General Internal Medicine, Minneapolis VA Medical Center, Minneapolis, MN 55417, USA e University of Minnesota Medical School, Minneapolis, MN 55455, USA Received 14 February 2007; accepted 26 November 2007 Abstract Objective: To examine the role of alexithymia (difficulties identifying one's emotions) in understanding the link between PTSD symptoms and negative health outcomes in sexually victimized female veterans. We hypothesized that having experienced multiple types of sexual trauma across the lifespan, experiencing greater severity of PTSD symptoms, and reporting difficulties in identifying emotions would be associated with increased negative health outcomes. Method: Anonymous cross-sectional survey of a convenience sample of 456 female veterans enrolled in a VA clinic within the prior year. Data collected included demographics, lifetime trauma exposure, psychological and medical symptoms, emotion recognition problems (alexithymia), health-risk behaviors, and health care utilization. Results: A total of 57.5% of participants reported a lifetime history of sexual trauma. After controlling for sexual trauma history, PTSD symptoms, and other well-established predictors of health care utilization in the VA medical system such as pre-disposing, enabling and need- based factors, hierarchical regression analyses showed that alexithymia independently explained unique variance in participants' physical health complaints and in their odds of reporting at least one outpatient urgent care visit in the past year. Conclusions: These data suggest that emotion recognition problems may contribute to poorer health outcomes in sexually traumatized women veterans beyond what is explained by sexual trauma exposure, health risk behaviors and PTSD. Psychological interventions that enhance emotion identification skills for women who have experienced sexual trauma could improve health perceptions and reduce need for acute health care. Published by Elsevier Inc. Keywords: Sexual assault; Posttraumatic stress disorder; Physical health; Women veterans; Alexithymia Previous research has documented associations between sexual trauma and serious, negative long-term psychological and physical health problems [1]. For example, sexually victimized women are at increased risk for posttraumatic stress disorder (PTSD), depression, anxiety, substance abuse, eating disorders, personality disorders, suicidal behavior and somatization [2–4]. Other negative health outcomes asso- ciated with sexual trauma include poorer self-reported health status [5]; increased reports of medical symptoms [6,7], including reproductive health symptoms [8]; and increased rates of health care utilization [7–10]. Several possible explanations for understanding the link between sexual trauma and health outcomes have been proposed. Schnurr and Green [11] have proposed that PTSD, a common sequelae of sexual trauma, may be a major pathway through which trauma exposure affects health [8],a supposition supported by several independent investigations [12–15]. However, PTSD symptoms do not mediate all of Available online at www.sciencedirect.com General Hospital Psychiatry 30 (2008) 162 – 170 ⁎ Corresponding author. Minneapolis Veterans Affairs Medical Center, One Veterans Drive (116-A), Minneapolis, MN 54417, USA. Tel.: +1 612 725-2000x3965; fax: +1 612 727 5633. E-mail address: melissa.polusny@va.gov (M.A. Polusny). 0163-8343/$ – see front matter. Published by Elsevier Inc. doi:10.1016/j.genhosppsych.2007.11.006