Long term psychological outcome for women with congenital adrenal hype
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《英国医生杂志》
1 Department of Mental Health, St George's Hospital Medical School, University of London, London SW17 0RE, 2 Department of Endocrinology, The Middlesex Hospital, London W1T 3AA
Correspondence to: J F Morgan jmorgan@sghms.ac.uk
Introduction
Women with congenital adrenal hyperplasia are psychologically well adjusted and do not show substantially increased psychiatric disorder or deficits of social adjustment compared with population data. Low levels of sexual activity and higher levels of non-heterosexual orientation are indicated, although legitimate normative data is lacking. Levels of disordered eating are not significantly different from population norms, despite increased exposure to sociocultural risk factors for eating disorders, though this may reflect a type II error.
Limitations of the study include the small sample size and the lack of a control group, which would have the same stresses as the congenital adrenal hyperplasia group but lack the stigmata of the illness. As such a control group does not exist, a descriptive comparison was made with the general population.
Although a previous study of childhood psychiatric morbidity in intersex people found increased prevalence of mental disorder,5 and accepting that some individuals with congenital adrenal hyperplasia may struggle to adapt, we conclude that the women with congenital adrenal hyperplasia in our small study are psychologically robust. Future studies must consider factors contributing to good psychological outcome, including timing of surgery and communication with parents and patients.
What is already known on this topic
Intersex children may have increased prevalence of psychiatric morbidity; research on adult psychological outcomes is limited despite fears that the condition may adversely affect psychosocial adjustment
What this study adds
Most women with congenital adrenal hyperplasia have good long term psychological outcome, with no dramatic increase in psychological morbidity, good social adjustment, and no deficit in self esteem
This article was posted on bmj.com on 26 January 2005: http://bmj.com/cgi/doi/10.1136/bmj.38334.427361.D3
Contributors: JFM, JHL, and GC originated and designed the study. JFM collected the data. JFM and HM analysed and interpreted the data and drafted the manuscript. GC, JHL, and JFM critically revised the manuscript. JHL supervised the study. JFM is guarantor.
Funding: No additional funding.
Competing interests: None declared.
Ethical approval: Research ethics committee for the Central Middlesex Hospital.
References
Creighton S, Minto C. Managing intersex. BMJ 2001;323: 1264-5.
Meyer-Bahlburg HFL. Gender and sexuality in classic congenital adrenal hyperplasia. Endocrinol Metab Clin North Am 2001;30: 155-71,VIII.
Cooper P, Osborn M, Gath D, Feggetter G. Evaluation of a modified selfreport measure of social adjustment. BJPsych 1992;141: 68-75.
Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the national comorbidity survey. Arch Gen Psychiatry 1994;51: 8-19.
Slijper FME, Drop SL, Molenaar JC, de Muinck Keizer-Schrama MD. Long term psychological evaluation of intersex children. Arch Sex Behav 1998;27: 125-45.(John F Morgan, senior lecturer1, Helen M)
Correspondence to: J F Morgan jmorgan@sghms.ac.uk
Introduction
Women with congenital adrenal hyperplasia are psychologically well adjusted and do not show substantially increased psychiatric disorder or deficits of social adjustment compared with population data. Low levels of sexual activity and higher levels of non-heterosexual orientation are indicated, although legitimate normative data is lacking. Levels of disordered eating are not significantly different from population norms, despite increased exposure to sociocultural risk factors for eating disorders, though this may reflect a type II error.
Limitations of the study include the small sample size and the lack of a control group, which would have the same stresses as the congenital adrenal hyperplasia group but lack the stigmata of the illness. As such a control group does not exist, a descriptive comparison was made with the general population.
Although a previous study of childhood psychiatric morbidity in intersex people found increased prevalence of mental disorder,5 and accepting that some individuals with congenital adrenal hyperplasia may struggle to adapt, we conclude that the women with congenital adrenal hyperplasia in our small study are psychologically robust. Future studies must consider factors contributing to good psychological outcome, including timing of surgery and communication with parents and patients.
What is already known on this topic
Intersex children may have increased prevalence of psychiatric morbidity; research on adult psychological outcomes is limited despite fears that the condition may adversely affect psychosocial adjustment
What this study adds
Most women with congenital adrenal hyperplasia have good long term psychological outcome, with no dramatic increase in psychological morbidity, good social adjustment, and no deficit in self esteem
This article was posted on bmj.com on 26 January 2005: http://bmj.com/cgi/doi/10.1136/bmj.38334.427361.D3
Contributors: JFM, JHL, and GC originated and designed the study. JFM collected the data. JFM and HM analysed and interpreted the data and drafted the manuscript. GC, JHL, and JFM critically revised the manuscript. JHL supervised the study. JFM is guarantor.
Funding: No additional funding.
Competing interests: None declared.
Ethical approval: Research ethics committee for the Central Middlesex Hospital.
References
Creighton S, Minto C. Managing intersex. BMJ 2001;323: 1264-5.
Meyer-Bahlburg HFL. Gender and sexuality in classic congenital adrenal hyperplasia. Endocrinol Metab Clin North Am 2001;30: 155-71,VIII.
Cooper P, Osborn M, Gath D, Feggetter G. Evaluation of a modified selfreport measure of social adjustment. BJPsych 1992;141: 68-75.
Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the national comorbidity survey. Arch Gen Psychiatry 1994;51: 8-19.
Slijper FME, Drop SL, Molenaar JC, de Muinck Keizer-Schrama MD. Long term psychological evaluation of intersex children. Arch Sex Behav 1998;27: 125-45.(John F Morgan, senior lecturer1, Helen M)