Childhood Maltreatment and Diabetes Relationship

kidhood Maltreatwork forcet and Diabetes RelationshipStudy RationaleThe primary goal of this muse is to conduct an empirical investigation of the association betwixt an first intent examineor such as childhood revilement and subsequent diagnosis of casing II diabetes in freehandedhood. This need will specifically explore if a relationship exists surrounded by the type and severity of childhood maltreatment encountered and participants diabetes-related quality of flavour. To provide a context for the current athletic field, background literature focusing on two dimensions that have received considerable attention in the psychological literature is initial thoroughly reviewed definition and effects of childhood maltreatment and the biopsychosocial aspect of causa II diabetes. The current studys purpose, hypotheses, method, and selective in createation analytic strategy will then be proposed.Background InformationChildhood MaltreatmentChildhood maltreatment refers to, whatever act or series of acts of commission or omission by a p atomic number 18nt or opposite caregiver that results in harm, potential for harm, or threat of harm to a child (Centers for Disease Control CDC, n.d., para. 1). In their report, Child Maltreatment Surveillance, Leeb, Paulozzo, Melanson, Simon, Arias (2007) defined acts of commission as deliberate and intentional use of words or actions that cause harm, potential harm, or threat of harm to a child. Examples of acts of commission embarrass forcible, sexual, and/or psychological horror. Acts of omission, on the other hand, are the failure to provide for a childs basic physical, frantic, or educational needs or to protect a child from harm (Leeb et al., 2007). Thus, acts of omission include physical, randy, medical checkup, or educational neglect, the failure to supervise or insufficient supervision, and/or exposure to a violent environment.According to the most recent publication by the U.S. Department of Health a nd Human Services (USDHHS) on childhood maltreatment, an estimated 905,000 children were determined to be victims of abuse or neglect (USDHHS, 2006). Specifically, 64.2 percent of child victims experienced neglect, 16.0 percent were physically treat, 8.8 percent were sexually abused, and 6.6 percent were emotionally or psychologically maltreated. The report put forwards that order of victimization by maltreatment type have fluctuated only slightly during the past several years.The long-term consequences of child maltreatment are world-shaking and include the risk of alterations of brain structure and function, sexual risk taking behaviors, eating disorders, suicidal intent and behavior, lower self-esteem, adjustment problems, internalizing problems (i.e. anxiety and depressive disorders), externalizing problems (i.e. personality disorders and substance abuse), adult trauma, continuation of intergenerational violence and/or neglect, and knowledgeal and cognitive disabilities (A nda, Felitti, Bremner, Walker, Whitfield, Perry, Dube, Giles, 2006 Arata, Langhinrichsen-Rohling, Bowers, OFarrill-Swails, 2005 Bardone-Cone, Maldonado, Crosby, Mitchell, Wonderlich, Joiner, Crow, Peterson, Klein, Grange, 2008 Johnson, Sheahan, Chard, 2003 Kaplow Widom, 2007 Kaslow, Okun, Young, Wyckoff, Thompson, Price, Bender, Twomey, Golding, Parker, 2002 Lewis, Jospitre, Griffing, Chu, Sage, Madry, Primm, 2006 Medrano, Hatch, Zule, Desmond, 2002 Smith, 1996 Sobsey, 2002 Taft, Marshall, Schumm, Panuzio, Holtzworth-Munroe, 2008). A consistent relationship between abuse history and poorer overall health has also been demo in a stratified, epidemiological audition of both men and women within the United States (Cromer and Sachs-Ericsson, 2006).Childhood Maltreatment and Physical Health ProblemsA consistent dose-relationship between abuse history, poorer overall health, and sustained losses in health-related quality of life has been well baseed (Cromer Sachs-Ericsson, 200 6 Golding, 1994 Corso, Edwards, Fange, Mercy, 2008). Childhood sexual abuse has been associated with physical complaints such as migraine, irritable bowel syndrome, fibromyalgia, and continuing pain (Goldberg, Pachas, Keith, 1999 Goodwin, Hoven, Murison, Hotopf, 2003 Ross, 2005 Walker, Keegan, Gardner, Sullivan, Bernstein, Katon, 1997). Further more(prenominal), using selective information from the National Corbidity Study, a nationally representative general tribe study, Arnow (2004) free-base that abused children were apt(predicate) to have pelvic and musculoskeletal pain as adults, and utilize health care services at a greater proportion in adulthood. However, a major limitation of these studies is exclusion of emotional and/or psychological abuse experienced in childhood. specially, results regarding the incidence of types of childhood maltreatment and diabetes have been mixed.DiabetesDiabetes is a chronic disease characterized by the deficiency or resistance to insuli n, a hormone needed to convert sugar, starches and other food into energy needed for daily living. As such, insulin deficiency compromises the body tissues access to essential nutrients for fuel or storage. According to the American Diabetes Association (ADA), there are 23.6 million children and adults in the United States, or 7.8% of the population, who have diabetes, many of which unaware that they have the disease (ADA, n.d., para. 2).Diabetes occurs in two primary forms. cause I diabetes is characterized by absolute deficiency and typically occurs forrader the age of 30. Type II diabetes, however, is typified by insulin resistance with varying degrees of deficiencies in the bodys ability to secrete insulin. Sedentary lifestyle and diet have been linked to the culture of Type II diabetes. Other risk factors for this type of diabetes include corpulency, pregnancy, metabolic syndrome, and various medications. Physiologic and emotional try out has also been thought to play a ke y role in the development of Type II diabetes specifically. Prolonged elevation of stress hormones, namely cortisol, glucagon, epinephrine, and growth hormone, maturations blood glucose levels, which in turn places adjoin demands on the pancreas. Such stress ultimately leads to the inability of the pancreas to keep up with the bodys need for insulin and high levels of glucose and insulin circulate in the bloodstream, setting the stage for Type II diabetes (Diseases, 2006).Role of Stress in the attack of Diabetes Animal StudiesResearchers have found that both a history and presence of existing stressors play a significant role in the onset and course of diabetes. Through the use of animal studies, seekers have been able to prospectively test the influence of stress on both types of diabetes. For example, Lehman, Rodin, McEwen, and Brinton (1991) investigated whether an environmental challenge promoted the expression of diabetes in bio-breeding rats. Researchers introduced a tri ad of stressors to the animals over a 14-week period, including rotation of the cage, vibration, and restraint in individual containers. They found that the administration of these stressors repeatedly increase the likelihood of the rats developing Type I diabetes as indicated by elevated blood sugar levels (Lehman et al., 1991).One of the first observations that stress could contribute to the expression of Type II diabetes was made during metabolic studies of the native North African sand rat (psammonys obesus). Once fed with laboratory chow and allowed to become obese, the North African sand rat will eventually develop Type II diabetes in response to an environmental stressor (Surwit, Schenider, Feinglos, 1992). Notably, Mikat, Hackel, Cruz, and Lebowitz (1972) administered an esophageal intubation of saline in an exploit to control the dietary intake of the sand rat. This tube feeding resulted in an alteration of glucose tolerance and comed the onset of Type II diabetes in the se rats. Similar research was done on the genetically obese (ob/ob) mouse, which is used as a prototype of Type II diabetes in humans because of its pattern of obesity, hyperinsulinemia, hyperglycemia, insulin resistance, and glucose intolerance (Surwit, Feinglos, Livingston, Kuhn, McCubbin, 1984). To study the effects of environmental stress and sympathetic nervous system arousal on plasma glucose in ob/ob mice, Surwit et al. (1984) designed two experimental conditions. In the first condition, 15 ob/ob mice were shaken in their cage at a rate of 200 strokes per minute for five minutes. In the second condition, 16 ob/ob mice were injected with epinephrine bitartrate, a chemical whose effects mimic those of the stress response. Plasma glucose levels in mice from both conditions were found to be significantly elevated. The researchers concluded that environmental stress was partially responsible for the expression of the diabetic phenotype in this animal model of diabetes.Role of St ress in the Onset of Diabetes Human StudiesData cooperateed on the impact of life events on Types I diabetes in a human sample has yielded inconsistent results. An early study by Grant, Kyle, Teichman, and Mendels (1974) examined the relationship between the occurrence of life events and the course of illness in a conference of 37 diabetic patients. Using Holmes and Rahes Schedule of recent Events (SRE), a scale in which 43 significant recent life events are assigned a numeric value of life change units as a measurement of life stress, Grant et al. (1974) found that of the 26 participants who had a compulsory correlation between undesirable life events and illness, 24 had a positive correlation between undesirable events scores and diabetic condition. This data suggests that negative events were primarily responsible between life events and changes in diabetic condition since the comprehension of neutral and positive events did not increase the magnitude of the correlations. D espite the significant results, this study had a number of limitations, including the manipulation of a small sample size, bar in establishing reliable criteria for assessing subtle changes in the diabetic condition, lack of sufficient time to elapse between assessments for significant life changes to occur, and the lack of delineation of the types of diabetes analyse (i.e. Type I vs. II).However, in a more recent meta-analysis, Cosgrove (2004) found no evidence to subscribe the hypothesis that life events cause or precipitate Type I diabetes. Using an electronic and manual literature search of appropriate key words (namely, diabetes and depression, diabetes and depressive, diabetes and life events, diabetes and stress) in the literature up to July 2003, Cosgrove (2004) aimed to establish whether there might be a link between depression, stress, or life events and the onset of Type I diabetes. A total of nine paper were found from the electronic and manual search. It was conclu ded that when the number and severity of life events was compared to controls in all nine reviewed studies, no differences were detected in the diabetics (Cosgrove, 2004). Though data from small, older studies and large, randomized studies showed that early losses in childhood increase the risk of developing Type I diabetes, no evidence was found to support the hypothesis that life events cause or precipitate this diagnosis. Meta-analyses with more recent studies have not been found studying the relationships between trying life events in both types of diabetes. As such, it is unknown whether links have since been found by other researchers.More consistent evidence was found supporting the notion that stressful circumstances precipitate Type II diabetes. In their study of environmental stress on Type II diabetics, McCleskey, Lewis, and Woodruff (1978) measured glucagon and glucose levels on 25 patients who were undergoing elective surgery, a physical stressor. Ten samples were obta ined during pre-operative, intra-operative, and post-operative periods for each patient. It was found that throughout the sampling period, diabetic patients had two times the amount of glucagon (a hormone produced by the pancreas that stimulates the increase of blood sugar levels) in their body compared to their non-diabetic counterparts (McCleskey, Lewis, Woodruff, 1978).This effect was also found in Pima Indians, who have an approximately 60% go on of eventually developing Type II diabetes, compared with 5% of the albumen population (Surwit, Schenider, Feinglos, 1992). The effects of a simple arithmetic task on blood glucose levels were studied in both Caucasian and Pima Indian samples. Surwit, McCubbin, Feinglos, Esposito-Del Puente, and Lillioja (1990) found that blood glucose was consistently higher during and following the stressful task in ten of 13 Pima Indians, concluding that altered glycemic responsivity to behavioral stressors anticipates the development of Type II d iabetes in individuals who are genetically predisposed to the disease (Surwit et al., 1990).Results from The Hoorn Study further illustrated the effects of stress on Type II diabetes. Mooy, De Vries, Grootenhuis, Boutner, and Heine (2000) examine data from a large population-based survey of 2,262 adults in the Netherlands upon which the researchers were able to explore whether chronic stress is positively associated with the prevalence of Type II diabetes. Analysis of data confirmed their hypothesis a high number of rather common major life events that are correlated with chronic psychological stress, such as closing of a spouse or relocation of residence, were indeed found to correspond to a significantly higher percentage of undetected diabetes (Mooy et al., 2000). Because the study was conducted in the Netherlands on a Caucasian, middle-aged population, it is uncertain whether these findings are generalizable to other demographics in different geographic regions.Childhood Maltr eatment and DiabetesThus far, with the exception of one study, the research discussed has demonstrated a positive correlation between a variety of recent or current environmental stressors, such as anesthesia, surgery, cognitive tasks, death of a loved one, and other significant losses, and the onset of Type I and/or II diabetes in animals and human beings. However, the literature is somewhat limited as to the relationship between a past environmental stressor, namely childhood maltreatment, and Type II diabetes in adulthood.Numerous researchers examined the prevalence of medical problems in abused populations and have reported that diabetes is one of the most common health conditions among those who have experienced maltreatment. For example, using data drawn from the National Comorbidity Study conducted in the early 1990s, Sachs-Ericsson, Blazer, Plant, and Arnow (2005) examined the independent effects of childhood sexual and physical abuse on adult health status in a large commun ity sample of 5,877 men and women. Sachs-Ericsson et al. (2005) found that childhood sexual and physical abuse was associated with the one-year prevalence of serious health problems for both men and women. Specifically, participants who experienced any form of childhood abuse were more likely to report having a medical condition, including AIDS, arthritis, asthma, bronchitis, cancer, diabetes, high blood pressure, kidney or liver disease, neurological problems, stroke, gastrointestinal disorders, or any other serious health problem (Sachs-Ericsson et al., 2005). Though data from this epidemiological study likely represents the U.S. demographics, a number of limitations exist. Specifically, the researchers did not report the prevalence of each disorder endorsed and thus, the actual incidence of diabetes in the population sample is unknown. Furthermore, Sachs-Ericsson et. al (2005) did not look at additional forms of maltreatment, such as verbal abuse, emotional abuse, and neglect.Sim ilarly, Walker, Gelfand, Katon, Koss, Von Korff, Bernstein, and Russo (1999) found a significant association between childhood maltreatment and adverse adult health outcomes. In particular, the researchers administered a survey to 1,225 women randomly selected from the social rank of a large HMO in Washington State. Results indicated that women with childhood maltreatment histories were more likely to have an increased number of physician-coded ICD-9 diagnoses, collectioned together as high blood pressure, diabetes, dermatitis, asthma, allergy, acne, and abnormal menstrual bleeding. Though the group of women in this study who reported threshold levels of sexual maltreatment had the poorest health outcomes, a major limitation of this study is the uncertainty as to whether additional forms of maltreatment were concomitantly experienced. Specifically, the authors do not establish whether sexual abuse solely was the cause of poorer health or is largely callable to multiple forms of m altreatment in girls who were not properly protected in their early families. Moreover, Walker et al. (1999) do not differentiate between types of diabetes.Gender differences have been established in the association between physical abuse in childhood and overall health problems in adulthood. Analysis of data from 16,000 individuals interviewed in the National Violence Against Women Survey found that female abuse victims were at greater risk for health problems than their male counterparts (Thompson, Kingree, Desai, 2004). Furthermore, women with maltreatment history black market to have more distressing physical experiences, have an increased number of physician-coded diagnoses, and were more likely to engage in multiple health risk behaviors, including obesity a significant risk factor associated with Type II diabetes (Trickett, Putnam, Noll, 2005 Walker, Gelgand, Katon, Koss, Von Korff, Bernstein, Russo, 1999). Moreover, sexual irreverence history throughout ones lifespan w as also associated with chronic disease (i.e. diabetes, arthritis, and physical disability) in a sample of women from Los Angeles (Golding, 1994). Conversely, in their sample of 680 primary care patients, Norman, Means-Christensen, Craske, Sherbourne, Roy-Byrne, and beer mug (2006) found that the experience of trauma significantly increased the odds of arthritis and diabetes for men, era trauma was associated with increased odds for digestive disorders and cancer in women. Although the data suggests that childhood maltreatment is related to adverse health outcomes in adulthood, they do not address as to why associations differed by gender.Analyzing data from the Midlife Development in the United States Survey (MIDUS), Goodwin and Weisberg (2002) sought to determine the association between childhood emotional and physical abuse and the odds of self-reported diabetes among adults in the general population. Their results revealed that self-reported diabetes occurred in 4.8% of its rep resentative sample of 3,032 adults aged 25-74 years. Childhood abuse was associated with significantly increased odds of self-reported diabetes, which persisted afterwards adjusting for differences in socio-demographic characteristics and mental health status (Goodwin Weisberg, 2002). Moreover, individuals who specifically reported maternal emotional abuse and maternal physical abuse had significantly higher rate of diabetes (Goodwin Weisberg, 2002).Furthermore, data gathered from a sample of 130 patients (65 abused, 65 non-abused controls) drawn from an adult primary-care practice in a small, affluent, predominantly Caucasian community in northern New England revealed that patients with a history of victimization were more likely to report diabetes or endorse symptoms of this illness than non-abused participants (Kendall-Tackett Marshall, 1999). Specifically, cardinal patients in the abused group reported diabetes, with none in the control group. Interestingly, those patients in the abused group did not have a significantly higher family history of diabetes than those in the non-abused group and a higher percentage of patients in the abused group reported having three of more symptoms than did those in the control group. Kendall-Tackett and Marshall (1999) assert that although only four people identified themselves as having diabetes, this number should be interpreted in the broader context of incidence of diabetes in the general population. Nonetheless, this finding could have been due to chance and many of the symptoms endorsed could have been related to other diseases (Kendall-Tackett Marshall, 1999). Additional limitations include the failure to differentiate between the types of abuse endured and the use of a non-empirically validated measure to gather data. Furthermore, the researchers did not specify which type of diabetes the participants were diagnosed with and did not indicate the severity of the disease.Data from the Adverse Childhood Experie nces Study (ACE), however, found alternative results. Researchers Felliti, Anda, Nordenberg, Williamson, Spitz, Edwards, Koss, and Marks (1998) mailed questionnaires round adverse childhood experiences to 9,508 adults who had completed a standardized medical evaluation at a large HMO in California. It was found that abuse and other types of household dysfunction were significantly related to the number of disease conditions, with the exception of diabetes. Specifically, when those who had experienced multiple forms of childhood maltreatment were compared to those with no experiences, the odds-ratio for the presence of diabetes was a non-significant 1.6 (Felliti et al., 1998). The researchers call back that their estimates of the long-term relationship between adverse childhood experiences and adult health are conservative. Specifically, it is likely that, consistent with well-documented longitudinal follow-up studies, that reports of childhood abuse were underestimated due to the premature mortality in persons with multiple adverse childhood exposures (Felliti et al., 1998).Similarly, in a sample of 1,359 community-dwelling men and women aged 50 years or older, Stein and Barrett-Connor (2000) found no relationship between sexual assault history in participants lifetime and reported rates of diabetes. Rather, a history of sexual assault was associated with an increased risk of arthritis and breast cancer in women and thyroid disease in men (Stein Barrett-Connor, 2000). In this study, the researchers posit that the possibility of response bias is a major limitation. Namely, Stein and Barrett-Connor (2000) consider the likelihood that previously assaulted respondents have a greater tendency to visit doctors, leading to the increased opportunities for health conditions to be detected. Additional limitations include the lack of consideration for other types of abuse encountered in childhood.The Link between Childhood Maltreatment and DiabetesThe above findings p rovide support for the hypothesis that childhood maltreatment whitethorn be associated with increased likelihood of the diagnosis of a medical condition, with the inclusion of diabetes in some studies. An essential question posed by this observation is by what mechanisms are adverse childhood experiences linked to health risk behaviors and adult diseases? A number of researchers have found that psychological stress, in particular, has been associated with the onset of Type II diabetes. This impact of stress on the etiology and course of Type II diabetes can be considered via the metabolic pathways by kernel of obesity and/or activation of the hypothalamic-pituitary-adrenal (HPA) axis, the gene-environment interaction, and the correlation of coping with diabetes and stressors.The stress response is a physiological coping response that involves the HPA axis, the sympathetic nervous system, the neurotransmitter system, and then insubordinate system. There is growing evidence that vic tims of various forms of abuse and stressors often experience biological changes, particularly in the neuroendocrine system implicated in the stress response, as well as the brain (Glaser, 2000 Goenjian, Pynoos, Steinberg, Endres, Abraham, Geffner, Fairbanks, 2003 King, Mandansky, King, Fletcher, Brewer, 2001 McEwen, 2000). The HPA axis is the primary mechanism studied in the literature on the neurobiology of stress and is estimated through the non-invasive measurement of cortisol in saliva samples. During psychological stress, cortisol is elevated beyond normal levels in response to adrenocorticotropic hormone from the pituitary, mobilizing energy stores, and facilitating behavioral responses to threat (Diseases, 2006). In the presence of prolonged stress, especially in which the individual has difficulty coping, this physiological response whitethorn occur to an atypical extent and prove harmful. Dienstbier (1989) asserts that prolonged and/or extreme stress can create a vicious cycle of pathology, as individuals with a history of abuse may become even more vulnerable in the face of new victimization because they become threat-sensitized, resulting in either an over- or under- response of the HPA system to new stressors. As Vaillancourt, Duku, Decatanzaro, Macmillan, Muir, and Schmidt (2008) cite, this process is best illustrated by Cicchetti and Rogoschs (2001) study of maltreated children attending a summer day camp. These authors found that in comparison to non-abused children, children who had been both sexually and physically abused, in addition to emotionally maltreated or neglected, exhibited higher morning cortisol levels, whereas a subgroup of children who had only been physically abused exhibited lower levels.Recent evidence suggests that increased cortisol concentrations may contribute to the prevalence of metabolic syndromes, such as Type II diabetes. For example, in their assessment of 190 Type II diabetic patients who volunteered from a popul ation study of 12,430 in suburban Germany, Oltmanns, Dodt, Schultes, Raspe, Schweiger, Born, Fehm, and Peters (2006), sought to assess the relationship between diabetes-associated metabolic disturbances and cortisol concentrations in patients with Type II diabetes. The target population comprised of men and women born between 1939 and 1958 who completed a postal questionnaire about their health status. Results demonstrated that in patients with Type II diabetes, those with the highest cortisol profiles had higher glucose levels and blood pressures (Oltmanns et al., 2006). Their findings suggest that HPA axis activity may play a role in the development of Type II diabetes-associated metabolic disturbances. Cartmell (2006) proposes a model by which this may occur. Namely, high levels of cortisol decreases metabolism of glucose and increase mobilization and metabolism of fats. This decreased metabolism of glucose contributes to increased blood glucose levels. Furthermore, increased blo od fat levels contribute to insulin resistance. This increase level of blood glucose and fats are characteristic symptoms of diabetes (Cartmell, 2006).Researchers Chiodini, Adda, Scillitani, Colleti, Morelli, Di Lembo, Epaminonda, Masserini, Beck-Peccoz, Orsi, Ambrosi, and Arosio (2007) extended the literature by studying HPA axis secretion of cortisol and chronic diabetic complications. An evaluation was conducted on HPA activity in a sample of 117 Type II diabetic patients with and without chronic complications and in a sample of 53 non-diabetic patients at a hospital in Italy. Chiodini et al. (2007) found that in diabetic subjects without chronic complications, HPA axis activity was comparable with that of non-diabetic patients, whereas in diabetic subjects with chronic complications, cortisol level was increased in respect to both diabetic subjects and control subjects. Though the design of their study did not look for a cause-effect relationship, Chiodini et al. (2007) purport that higher levels of cortisol, either due to a constitutive HPA axis activation or secondary to a chronic stress condition, may predispose an individual to the development of chronic diabetic complications.Type II diabetes is now a well-recognized syndrome characteristic of hyperglycemia, insulin resistance, obesity, dyslipidemia, and hypertension (Sridhar Madhu, 2001). One theory that purports the biological plausibility of a stress-diabetes association has been formulated by Swiss researcher, Dr. Per Bjrntorp. Bjrntorp (1997) postulated that stress could be responsible for sympathetic nervous system activation, hormone abnormalities, and obesity. This theory states that perceived psychological stress with a defeatist or helplessness reaction leads to an activation of the HPA axis. This in turn results in endocrine abnormalities, including increased cortisol and decreased sex steroid levels that disrupt the actions of insulin. In addition, this hormonal imbalance causes viscera l adiposity, which plays an important role in diabetes and cardiovascular disease by contributing to the development of insulin resistance (Cartmell, 2006).Researchers of The Hoorn Study described above tested Bjrntorps theory and found only partial support (Mooy et al., 2000). Specifically, the accumulation of visceral fat did not seem to be the major mediating factor between stress and diabetes and fasting insulin concentration, which is an appraisal of insulin resistance, was not higher in the individuals in their sample who had experienced more stressful events.Study SignificanceThe significance of this study is its potential to provide medical practitioners with information regarding the impact of past psychosocial factors, such as childhood maltreatment, on the current physical health of Type II diabetics. Diabetes and its complications affect a significant portion of the United States population and has become the fifth leading cause of death in the country (Florida Departme nt of Health, 2008). As researchers continue to look for the cause(s) of diabetes and methods to treat, prevent, or cure the disorder, it is vital that practitioners take a holistic and comprehensive approach to assessing the diabetics life. As long as abuse and other potentially damaging experiences in childhood contribute to the development of risk factors, then these childhood exposures should be recognized as the basic causes of morbidity and mortality in adult life (Felliti et al., 1998). Major limitations of past literature include lack of specificity of type of diabetes, family history, and self-reported diabetes without data on physiological measures. In addition to replication, future studies should include detailed studies on diabetes-type, a ruling-out of serious medical conditions that could potentially act as confounds, and identify maltreatment subtypes experienced.This study aims to uncover a relationship between childhood maltreatment and adult physical health, namel y with Type II diabetes, so as to assist with screening and intervention. If doctors caring for adults who suffer from a medical condition associated with diabetes are unaware of this relationship, they will neither obtain early maltreatment history nor make appropriate patient referrals leading to higher health care utilization and poorer outcomes (Arnow, 2004 Springer, Sheridan, Kuo, Carnes, 2003).Research Questions and HypothesesThis study aims to answer the following questions Is a history of childhood maltreatment associated with diabetes-related quality of life? If so, is a decrease in diabetes-related quality of life associated with an increase in the types of childhood maltreatment experienced? It is hypothesized that the more types of abuse endured during childhood (i.e. physical, emotional, and/or sexual, neglect, and/or the witnessing of family violence), the more chronic and severe an individuals diabetes will be and the greater impact of their illness on their reported quality of life.MethodParticipantsData will be collected from individuals with Type II diabetes, recruited from psychiatric practices regain in Plant City and Tampa, Florida. Participants will be recruited from these sites due to likelihood that patients receiving psychiatric care have a history of childhood maltreatment. Participants will be included in the study if they are aged 40 and older, as non-insulin dependent diabetes appears after this age. Participants will be excluded fro