Sexual and Physical Abuse History Questionnaire (SPAHQ)

Abstract

The Sexual and Physical Abuse History Questionnaire (SPAHQ) is a robust, self-report psychological instrument designed for the detailed assessment of an individual’s lifetime exposure to various forms of sexual abuse and physical abuse. Developed primarily for use in clinical research, the SPAHQ systematically captures traumatic events experienced across two distinct life stages: childhood (age 13 and younger) and adulthood (age 14 and older). It utilizes specific, non-ambiguous definitions to distinguish between different levels of violence, ranging from unwanted touching and exposure to forced sexual intercourse (rape) and life-threatening assault.

A key application of the SPAHQ has been establishing the critical link between early life adversity and subsequent physical health outcomes, particularly in populations suffering from functional gastrointestinal disorders. The instrument’s strength lies in its use of explicit definitions of abusive acts, allowing researchers to accurately quantify the prevalence, severity, and specific context of the trauma history for deeper analysis of clinical outcomes and the impact of specific types of violence.

Keywords

SPAHQ, sexual abuse, physical abuse, trauma history, childhood victimization, adult victimization, self-report questionnaire, psychosocial assessment, dose-response relationship, functional gastrointestinal disorders.

Authors

Douglas A. Drossman, Jane Leserman, Zhiming Li, G. Nachman, H. Gluck, T.C. Toomey, N.J. Talley, K.W. Olden, M.A. Barreiro, L. Glogau.

Purpose

The primary purpose of the SPAHQ is to offer researchers and clinicians a reliable and highly detailed methodology for quantifying the frequency, prevalence, and severity of specific traumatic experiences involving sexual and physical violence. Unlike briefer screening tools, the SPAHQ is structured to gather extensive contextual data, including the precise age of onset and cessation of the abuse, the relationship between the victim and the perpetrator, the use of weapons, and the resulting physical injuries.

This level of granularity facilitates sophisticated analysis of the dose-response relationship between distinct types of trauma and subsequent psychological or physiological health outcomes. The instrument proved fundamental in initial studies conducted within the domain of psychosomatic medicine, where it helped demonstrate the alarmingly high rates of abuse history among patients diagnosed with functional gastrointestinal disorders (FGIDs).

Construct

The SPAHQ measures the overarching psychological construct of lifetime exposure to severe interpersonal violence and abuse. This construct is systematically operationalized through two major, distinct domains: Sexual Abuse and Physical Abuse, with separate assessments conducted for experiences occurring during childhood (0-13 years) and adulthood (14+ years).

The detailed sub-constructs measured are highly specific to ensure clarity in reporting:

• Sexual Abuse: This domain is further categorized by the level of intrusion and severity, including non-contact attempts (exposure, threats), unwanted touch (fondling, oral sex, penetration attempts without force), and forced intercourse (rape, defined as vaginal or anal sex achieved through force or threat).
• Physical Abuse: This domain assesses the frequency of non-lethal violence (being hit, kicked, or beaten) and exposure to life-threatening attacks (assaults involving weapons or intent to kill or seriously injure).

Furthermore, the instrument captures crucial severity markers, such as the classification of resulting physical injury (none, minor, or serious) and the subjective level of fear reported by the respondent during the worst incident, thereby providing a multi-dimensional quantification of trauma intensity.

Validity

The validity of the SPAHQ was rigorously established, primarily within clinical cohorts, focusing specifically on female patients presenting with gastrointestinal symptoms. Validation efforts confirmed both the content validity and concurrent validity of the scale.

Content Validity is considered strong due to the instrument’s explicit, behaviorally specific language and its comprehensive scope, covering a broad spectrum of abusive behaviors. The scale’s ability to clearly differentiate between categories like unwanted exposure, touching, and forced intercourse ensures that the items accurately reflect the full domain of trauma history being assessed. Concurrent Validity was supported by empirical evidence demonstrating that patients reporting a history of abuse via the SPAHQ exhibited significantly increased rates of psychological distress, functional impairment, and specific symptom profiles compared to control cohorts without such a history, confirming the scale’s relevance to clinical outcomes. The foundational 1995 validation study by Leserman et al. specifically addressed the accurate measurement of abuse history in this clinically sensitive population.

Reliability

The reliability of the SPAHQ has been demonstrated through standard psychometric properties evaluation, particularly utilizing test-retest methodology. This approach confirmed the consistency and stability of respondents’ reporting of traumatic events over subsequent administrations, which is crucial for historical self-report measures.

The high reliability is partially attributable to the instrument’s thoughtful design. By employing unambiguous, behaviorally specific language and strictly separating events based on the respondent’s life stage (childhood versus adulthood), the SPAHQ minimizes reporting ambiguity concerning experiences of sexual abuse or physical violence. The inclusion of detailed questions regarding frequency and physical injury severity further contributes to the standardization and overall measurement consistency of the scale.

Factor Analysis

While the original source material does not explicitly document a formal, published factor analysis of the SPAHQ, the instrument is fundamentally structured around distinct theoretical domains. These conceptual factors—Sexual Abuse and Physical Abuse—are further sub-divided based on the severity and nature of the violence (e.g., attempts, touch, rape; or beating/hitting, life threat).

These inherent conceptual distinctions are actively utilized in research scoring and analysis, treating these domains as separate, yet related, dimensions of trauma exposure. This structural design implicitly supports a multi-factor model relevant to studying the differential impact of various abuse types on health and psychological functioning.

Instrument

Test Type: Self-report Questionnaire

Format: Mixed format, utilizing dichotomous (Yes/No) questions, detailed frequency scales (e.g., categorical counts or 0-3 frequency ratings), and severity ratings (e.g., physical injury scale ranging from 0 to 2).

Language Available: English (Original language).

Population Group: Clinical and General Adult Populations. It was primarily validated in female patients presenting with functional gastrointestinal disorders.

Age Group: Adults (typically 18 years and older), who report retrospectively on experiences occurring during childhood (ages 0-13) and adulthood (ages 14 and over).

Population Details: The SPAHQ is specifically engineered to be highly sensitive and comprehensive in capturing historical traumatic events. This makes it particularly valuable for sensitive clinical research settings where researchers are investigating the causal or correlational link between early life adversity and current psychological or physical health status.

Test Methodology: The respondent completes a series of highly specific, behaviorally anchored questions covering experiences of unwanted sexual contact, forced sexual acts, physical assault, and life threats. Responses are categorized and scored based on the specific age period during which the events occurred.

Keywords

Abuse assessment, trauma measurement, lifetime prevalence, Drossman, Leserman, psychosomatic medicine, self-report, violence quantification, retrospective analysis.

Authors

Author ORCID Identifier: Not specified in source material.

Affiliation Email addresses: Not specified in source material.

Correspondence Address: Not specified in source material.

Permissions & Fee and Test Year

The Sexual and Physical Abuse History Questionnaire (SPAHQ) was initially developed and utilized in research studies starting around 1990. The instrument is frequently made available for academic and non-commercial research use in conjunction with the primary validation papers. The original PDF of the scale is publicly accessible and can be downloaded here: www.karger.com/ProdukteDB/katalogteile/isbn3_8055/_98/_53/suppmat/p41-SPAHQ.pdf. Researchers requiring formal commercial licensing or clarification on usage fees should directly contact the primary authors, Douglas A. Drossman or Jane Leserman, or the copyright holders associated with the initial journal publications.

Reference’s

• Drossman DA, Leserman J. Nachman G, Li ZM, Gluck H, Toomey TC, et al. (1990). Sexual and physical abuse in women with functional or organic gastrointestinal disorders. Ann Intern Med. 1990; 113:828-33.
• Leserman. Jane, Drossman. Douglas A, & Li. Zhiming,. (1995). The reliability and validity of a sexual and physical abuse history questionnaire in female patients with gastrointestinal disorders. Behavioral Medicine, 21(3); 141-150.
• Leserman J, Drossman DA, Li Z, Toomey TC, Nachman G, Glogau L. (1996). Sexual and physical abuse history in gastroenterology practice: how types of abuse impact health status. Psychosom Med ;58(1):4-15.
• Drossman DA, Talley NJ, Leserman J, Olden KW, Barreiro MA. (1995). Sexual and physical abuse and gastrointestinal illness. Review and recommendations. Ann Intern Med. 1995;123(10):782-794.

Items of the Sexual and Physical Abuse History Questionnaire (SPAHQ)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

Circle for both as child and as adult.

As a child (13 and younger) ‚ As an adult (14 and over)

1a. Has anyone ever exposed the sex organs of their body to you when you did not want it? (As a child) Yes No‚ (As an adult) Yes No

1b. Has anyone ever threatened to have sex with you when you did not want it? (As a child) Yes No‚ (As an adult) Yes No

1c. Has anyone ever touched the sex organs of your body when you did not want this? (As a child) Yes No‚ (As an adult) Yes No

1d. Has anyone ever made you touch the sex organs of their body when you did not want this? (As a child) Yes No‚ (As an adult) Yes No

1e. Has anyone ever forced you to have sex when you did not want this? (As a child) Yes No‚ (As an adult) Yes No

1f. Have you had any other unwanted sexual experiences not mentioned above? (As a child) Yes No‚ (As an adult) Yes No

If yes‚ please specify:________________________________________________

Physical Abuse Items on the Questionnaire

2. When you were a child (13 or younger)‚ did an older person do the following:

a. Hit‚ kick‚ or beat you? 0 Never‚ 1 Seldom‚ 2 Occasionally‚ 3 Often

b. Seriously threaten your life 0 Never‚ 1 Seldom‚ 2 Occasionally‚ 3 Often

3. Now that you are an adult (14 or older)‚ has any other adult done the following:

a. Hit‚ kick‚ or beat you? 0 Never‚ 1 Seldom‚ 2 Occasionally‚ 3 Often

b. Seriously threaten your life 0 Never‚ 1 Seldom‚ 2 Occasionally‚ 3 Often

TRAUMA (TRA)

We know that many people have had unwanted “sexual” or violent experiences as children or adults. These experiences may be so upsetting that they may not have been discussed with anyone. Sometimes they are forgotten for long periods of time‚ and sometimes they are frequently brought to mind. Please try to remember whether any of the following has occurred to you.

1. Before your 13th birthday‚ did an adult or someone at least five years older than you ever touch the sex organs of your body when you did not want this? By touch we mean with hands‚ mouth‚ or objects on your sex parts‚ that is (males: penis‚ pubic area or anus; females: breasts‚ vagina‚ pubic area or anus).

0. NO 1. YES

2. Before your 13th birthday‚ did an adult or someone at least five years older than you ever make you touch the sex organs of their body when you did not want this? By touch we mean with hands‚ mouth‚ or objects on their sex parts.

0. NO 1. YES

3. Before your 13th birthday‚ did an adult or someone at least five years older than you ever have sexual intercourse (including vaginal or anal intercourse) with you when you did not want this?

0. NO 1. YES

IF NO TO QUESTIONS 1‚ 2 AND 3 THEN SKIP TO QUESTION 9

4. What was your age the first time any of these unwanted sexual experiences happened?

______ age (0-12 years)

5. What was your age the last time any of these unwanted sexual experiences happened?

______ age (0-12 years)

6. How many times (different days) did this happen before your 13th birthday? Circle number below.

1‚ 2‚ 3‚ 4‚ 5‚ 6‚ 7‚ 8‚ 9‚ 10‚ 11‚ 12‚ 13‚ 14‚ 15 or more

7. And when this happened‚ were you ever afraid that you might be killed or seriously injured? (Indicate for your worst incident)

0. NO 1. YES

8. When this worst incident happened‚ did you suffer:

No physical injuries……………………………………………………………..….. 0

Minor physical injuries (such as bruises and cuts not needing stitches)…………… 1

Serious physical injuries (stitches‚ broken nose‚ broken bones‚ or hospitalization).. 2

9. Since your 13th birthday‚ did anyone ever touch the sex organs of your body by using force or threatening to harm you? By touch we mean with hands‚ mouth‚ or objects on your sex parts‚ that is (males: penis‚ pubic area or anus; females: breasts‚ vagina‚ pubic area or anus).

0. NO 1. YES

10. Since your 13th birthday‚ did anyone ever make you touch the sex organs of their body by using force of threatening to harm you? By touch we mean with hands‚ mouth‚ or objects on their sex parts.

0. NO 1. YES

11. Since your 13th birthday‚ did anyone ever make you have sexual intercourse (vaginal or anal intercourse) by using force or threatening to harm you?

0. NO 1. YES

IF NO TO QUESTIONS 9‚ 10 AND 11 THEN SKIP TO QUESTION 17

12. What was your age (after your13th birthday) the first time any of these forced touching or intercourse experiences happened?

______ age (13 years or older)

13. What was your age the last time any of these forced touching or intercourse experiences happened?

______ age (13 years or older)

14. How many times (different days) did this happen after your 13th birthday? Circle number below.

1‚ 2‚ 3‚ 4‚ 5‚ 6‚ 7‚ 8‚ 9‚ 10‚ 11‚ 12‚ 13‚ 14‚ 15 or more

15. And when this happened‚ were you ever afraid that you might be killed or seriously injured? (Indicate for your worst incident)

0. NO 1. YES

16. When this worst incident happened‚ did you suffer:

No physical injuries……………………………………………………………..….. 0

Minor physical injuries (such as bruises and cuts not needing stitches)…………… 1

Serious physical injuries (stitches‚ broken nose‚ broken bones‚ or ospitalization).. 2

17. Have you had any other forced or unwanted sexual experiences not mentioned above?

NO ………………………….. SKIP TO Question 24……………………………………… 0

YES………………………………………………………………………………………… 1

18. Can you please briefly describe that experience. ________________________________________________

19. What was your age the first time any of these other forced or unwanted experiences happened?

______ age

20. What was your age the last time any of these other forced or unwanted experiences happened?

______ age

21. How many times (different days) did these other forced or unwanted experiences happened? Circle number below.

1‚ 2‚ 3‚ 4‚ 5‚ 6‚ 7‚ 8‚ 9‚ 10‚ 11‚ 12‚ 13‚ 14‚ 15 or more

22. And when this happened‚ were you ever afraid that you might be killed or seriously injured? (Indicate for your worst incident)

0. NO 1. YES

23. When this worst incident happened‚ did you suffer:

No physical injuries……………………………………………………………..….. 0

Minor physical injuries (such as bruises and cuts not needing stitches)…………… 1

Serious physical injuries (stitches‚ broken nose‚ broken bones‚ or hhospitalization) .. 2

24. For any unwanted or forced sexual experiences mentioned so far‚ please indicate who did this.

(Circle all that apply.) If no unwanted or forced sexual experiences‚ go to question 25.

PARENT‚ STEPPARENT‚ GUARDIAN………………………………………..1

OTHER ADULT LIVING IN YOUR HOME (e.g.‚ mother’s boyfriend)………2

SPOUSE/PARTNER (CAN BE AN EX)…………………………‚……………..3

BROTHER………………..…………………………………………..……………..4

OTHER FAMILY MEMBER…………………………………………………….5

BOYFRIEND/GIRLFRIEND…………………………………………………….6

OTHER TEENAGER……………………………………………………….……7

OTHER ADULT YOU KNOW……………………………………………….…8

OTHER ADULT YOU DON’T KNOW…………………………………………9

ANYONE ELSE………………………………………………….………………10

Another type of stressful event people sometimes experience is being physically attacked by another person.

25. Not including physical abuse that may have occurred during the sexual abuse noted previously‚ has anyone‚ including family members or friends‚ ever attacked you with the intent to kill or seriously injure you?

NO ………………………….. SKIP TO Question 31……………………………………… 0

YES…………………………. ………………………………………………………………….. 1

26. Was a weapon used in any attack? A weapon includes any object that could seriously injure someone including a gun‚ knife or other object.

NO WEAPON ………….. ……………………………………………………………………… 0

YES……………………………………………………………………………………………….. 1

27. What was your age the first time any of these attacks happened?

______ age

29. How many times (different days) did these attacks happen? Circle number below.

1‚ 2‚ 3‚ 4‚ 5‚ 6‚ 7‚ 8‚ 9‚ 10‚ 11‚ 12‚ 13‚ 14‚ 15 or more

30. When the worst attack happened‚ did you suffer…

No physical injuries…………………………………………………… ………….……..0

Minor physical injuries (such as bruises and cuts not needing stitches)…….…1

Serious physical injuries (stitches‚ broken nose‚ broken bones‚ or hospitalization) ……….2

31. Not including physical attacks already indicated previously‚ has anyone (including family members or friends) ever beat you up‚ hit you‚ kicked you‚ bit you‚ or burned you? Only include experiences that were outside the range of normal “spanking” or kids fighting.

NO ………………………….. SKIP TO Question 38……………………………………… 0

YES…………………………. ………………………………………………………………….. 1

32. Was a weapon used in any attack? A weapon includes any object that could seriously injure someone including a gun‚ knife or other object.

NO WEAPON ………….. ……………………………………………………………………… 0

YES…………………………. …………………………………………………………………… 1

33. What was your age the first time any of these physical attacks happened?

______ age

34. What was your age the last time any of these physical attacks happened?

______ age

35. How many times (different days) did these physical attacks happen? Circle number below.

1‚ 2‚ 3‚ 4‚ 5‚ 6‚ 7‚ 8‚ 9‚ 10‚ 11‚ 12‚ 13‚ 14‚ 15 or more

36. When this happened‚ were you ever afraid that you might be killed or seriously injured? (Indicate for your worst incident)

0. NO 1. YES

37. When the worst attack happened‚ did you suffer…

No physical injuries…………………………………………………… ………….……..0

Minor physical injuries (such as bruises and cuts not needing stitches)………….…1

Serious physical injuries (stitches‚ broken nose‚ broken bones‚ or hospitalization) ……….2

38. For any physical attacks or beatings mentioned so far‚ who attacked you? (Check all that apply) If no physical attacks‚ skip this question and go to question 39.

PARENT‚ STEPPARENT‚ GUARDIAN……………………………………….. 1

OTHER ADULT LIVING IN YOUR HOME (e.g.‚ mother’s boyfriend)………. 2

SPOUSE/PARTNER (CAN BE AN EX)……………………………………….. 3

BROTHER ………………………………………………………………… 4

OTHER FAMILY MEMBER…………………………………………………… 5

BOYFRIEND/GIRLFRIEND…………………………………………………… 6

MILITARY COMBAT……………………………………….…………………. 7

OTHER CHILD OR TEENAGER…………………………….…………….….. 8

OTHER ADULT YOU KNOW ………………………………………………… 9

OTHER ADULT YOU DON’T KNOW (NOT MILTARY COMBAT)…..….. 10

OTHER (SPECIFY) ____________________________________……………. 11

Attempts: (positive response to any of the 5 items below)

“By using force or threatening to harm you‚ has anyone ever:

1) made you watch a sexual act‚

2) tried to touch the sex parts of your body‚ but did not succeed‚

3) tried to make you touch the sex parts of their body‚ but did not succeed‚

4) tried to make you have sex‚ but he did not succeeded‚ and

5) attempted any other sexual experience not involving contact?

Touch: (positive response to any of the 5 items below)

Has anyone ever succeeded in touching the sex parts of your body by using force or threatening to harm you? By touch we mean;

1) with their hands‚ touched or fondled your sexual organs (breast‚ pubic area‚ anus)‚

2) with their mouth or tongue on your vagina or anus (oral sex)‚ and

3) putting fingers or objects in your vagina or anus?

Has anyone ever succeeded in making you touch the sex parts of their body by using force or threatening to harm you? By touch we mean:

1) made you touch or fondle their genital area‚ and

2) made you put their penis in your mouth (oral sex)?

Rape: (positive response to any of the 2 items below)

Has anyone made you have vaginal or anal sex by using force or threatening to harm you? By sex we mean:

1) vaginal intercourse (man putting his penis in your vagina)‚ and

2) anal intercourse (man putting his penis in your anus)?

Physical

Being beat‚ hit‚ or kicked: (positive response to item below)

Has anyone—including family members of friends—ever beat you up‚ hit you‚ kicked you‚ bit you‚ or burned you‚ regardless of when it happened or whether you ever reported it or not? (Include experiences that were outside the range of normal “spanking” or kids fighting).”

Life threat: (positive response to any of the 2 items below)

1) Has anyone—including family members of friends—ever attacked you with a gun‚ knife‚ or some other weapon‚ regardless of when it happened or whether you ever reported it or not?

2) Has anyone—including family members of friends—ever attacked you without a weapon‚ but with the intent to kill or seriously injure you?