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Self-Concept in the Diethylstilbestrol Daughter

From the Adolescent Medicine Unit, Department of Pediatrics, University of California, San Francisco, San Francisco, California.

To evaluate the possible psychologic impact of diethylstil-bestrol (DES) in utero exposure on young women, the authors studied self-concept as a multifaceted construct in 25 known DES in utero exposed young women compared with 25 age-matched controls. Psychologic inventories used included Rosenberg's Self-Esteem Scale, Adjective Check List, Who Am I Test, Wyeth's Self-Satisfaction Ladder, and the Draw Yourself Test, as well as semi-structured personal interview. Diethylstilbestrol subjects differed significantly from controls on the adjective check list subscales of Defensiveness, Nurturance, and Affiliation (P < .05), as well as in the Draw Yourself Test, by omitting or obscuring body parts, especially sexual characteristics (P = .001). Subjects with known physical sequelae associated with DES were less satisfied with their lives (P = .05). On other measures of self-concept, no peer differences between DES subjects and controls were found. In fact, a trend for DES subjects to describe themselves more positively emerged. Most women also mentioned that they trusted physicians and were concerned about their future fertility and about the possibility of developing cancer. These findings suggest that young women exposed to DES may be using protective denial in their attempt to cope with their DES exposure. Physicians need to be aware of the possible psychologic impact of DES exposure, especially as more data become available regarding decreased fertility in these women and as new attention is focused on young men exposed to DES in utero.