Social desirability and irritable bowel syndrome

Depressive and anxiety symptoms, dysfunctional attitudes and social aspects in irritable bowel syndrome and inflammatory bowel disease

OBJECTIVE

Biopsychosocial models for both organic and functional gastrointestinal (GI) disorders have been described in the recent literature. The objective of this study was to give further data to this model by assessing stressful life events, social support, psychopathological symptoms, and dysfunctional attitudes in irritable bowel syndrome (IBS), inflammatory bowel disease (IBD) and healthy subjects.

METHOD

Age- and gender-matched IBS and IBD patients presenting at a tertiary care gastroenterological center completed self-reported questionnaires on stressful life events, social support, depressive and anxiety symptoms and dysfunctional attitudes. For comparative purposes, data from an age- and gender-matched healthy control group were obtained.

RESULTS

No significant differences were found between the groups regarding stressful life events and social support. Both patient groups had higher depressive and anxiety symptoms compared to healthy subjects, and IBS patients had higher depressive scores compared to IBD patients. IBS patients had more dysfunctional attitudes compared to both IBD and healthy subjects, while IBD and healthy subjects did not differ on dysfunctional attitudes.

CONCLUSIONS

GI patient status is associated with depressive and anxiety symptoms, in addition IBS patients have more severe depressive symptoms and depressogenic dysfunctional attitudes. The fact that functional GI patients are characterized by more severe psychological, but not social parameters, supports the hypothesis that IBS might be related to the range of depressive disorders.

Characterization of health related quality of life (HRQOL) for patients with functional bowel disorder (FBD) and its response to treatment

BACKGROUND AND AIMS

Assessing health related quality of life (HRQOL) is becoming more important in research and clinical care. However, little information is available on the performance of HRQOL questionnaires for the functional bowel disorders (FBD). The aims of this study were to (a) understand the performance of the Sickness Impact Profile (SIP) and IBS-QOL for the functional bowel disorders at baseline and after treatment, (b) determine which HRQOL subscales best improve with treatment, (c) determine clinically meaningful improvement, and (d) determine the predictors of HRQOL at baseline and in response to treatment.

METHODS

Women with moderate to severe FBD were evaluated using both medical (desipramine vs placebo) and psychological (cognitive-behavioral therapy vs education) treatments. Clinical and psychosocial questionnaires along with the SIP and IBS-QOL were given at baseline and after 12-wk treatment.

RESULTS

(a) Patients with FBD experience functional limitations in social interactions, home management, and recreational activities, respond emotionally to the pain, feel helpless, out of control, depressed, and irritable, and perceive restrictions in lifestyle relating to toilet accessibility, and eating; (b) HRQOL is not different among the FBD diagnoses or IBS subgroups; (c) the IBS-QOL is more responsive to treatment than the SIP; (d) meaningful clinical improvement is 2.8 points for SIP and 14 for IBS-QOL; and (e) improvement is demonstrated primarily in psychosocial rather than physical domains. In addition, we found that expectation of benefit is greater for taking a pill over a psychological intervention, and the predictive effects of abuse history and pain on outcome is mediated by psychosocial factors.

CONCLUSIONS

The data support the value of the IBS-QOL over the SIP, and provide new information on the profile of impairment in FBD, and the ways in which medical and psychological treatments produce improvement in HRQOL.

Cleaning up the river: a metaphor for functional digestive disorders

The irritable bowel syndrome is characterized by abdominal pain, altered bowel habits and various other digestive symptoms. Emotional factors are important in some patients. I describe here a metaphor which links the altered motility of the digestive system to the emotional contents it may embody. A metaphor of a river is used to evoke both a smooth, coordinated flow through the normal digestive tract and a normal flow in the management of the patient's emotions. The possibility that some blockage has occurred in the river, resulting in perturbation of the normal flow is then suggested to the patient. This is followed by a suggestion for the patient to clear the blockage. This approach may lead patients to work on the emotional components of their symptoms, resulting in their subsequent resolution. I have used this approach with several patients and it proved very effective. This paper demonstrates the use of this metaphor in one of the patients.

Self-report measures among transplant candidates: the impact of evaluative situations

Experiment 1 was a between-subjects design comparing transplant candidates completing self-report measures under an evaluative versus an anonymous research condition. A cardiac disease group and a healthy community group served as controls. Transplant candidates in the anonymous research condition reported significantly more depression, anxiety, and negative affectivity as compared with transplant candidates in the evaluative condition and community controls. In contrast, the evaluative transplant group (a) did not differ from the community controls on any of the self-report measures, and (b) reported significantly less depression than cardiac disease controls. Experiment 2 was a within-subjects design with transplant candidates completing self-report measures under both an evaluative and an anonymous research condition. Significantly greater anxiety was reported under the anonymous research condition. Social desirability was significantly related to change in self-reported anxiety and depression across conditions, but was unrelated to change in endorsement of personality characteristics.

Emotional abuse, self-blame, and self-silencing in women with irritable bowel syndrome

OBJECTIVE

The purpose of this study was to investigate the presence of emotional abuse and two psychosocial constructs (self-blame and self-silencing) in a sample of women diagnosed with irritable bowel syndrome (IBS) relative to a comparison sample of women diagnosed with inflammatory bowel disease (IBD).

METHODS

Women diagnosed with IBS (N = 25) were compared with women diagnosed with IBD (N = 25) on measures of history of abuse, self-blame, and self-silencing.

RESULTS

It was found that women in the IBS sample scored significantly higher on emotional abuse, self-blame, and self-silencing than did women in the IBD sample. These three variables were also found to be significantly intercorrelated in both the IBS and IBD samples. Finally, emotional abuse was significantly higher in IBS patients than in IBD patients beyond the differences accounted for by physical and/or sexual abuse history.

CONCLUSIONS

These findings empirically demonstrate an association between IBS and emotional abuse, as well as a possible connection with psychosocial variables, that may mediate the connection between emotional abuse and functional bowel symptoms. We suggest that these variables be further evaluated in the context of clinically relevant research on IBS.

Do psychosocial factors define symptom severity and patient status in irritable bowel syndrome?

Psychological difficulties in patients with irritable bowel syndrome (IBS) are strongly related to symptom severity and patient status. This has important implications for clinical practice, and the design and conduct of clinical trials. Psychosocial factors (personality, psychiatric diagnosis illness behavior, life stress, psychological distress) distinguish patients with IBS from patients with no IBS. Psychosocial difficulties (e.g., history of physical or sexual abuse, maladaptive coping, or "catastrophizing") predict poorer health outcome (greater pain scores, psychologic distress and poorer daily function, more days spent in bed, and more frequent physician visits and surgeries). When using the standardized Functional Bowel Disorder Severity Index, patients classified as severe are distinguished from moderates by several psychosocial difficulties and health-care use variables. In addition, whereas patients with severe illness report more pain, there is no difference from patients with moderate illness in terms of visceral sensation threshold. Given these data, it is important to consider psychosocial factors as predictive of symptom severity and clinical outcome, and this should be considered in clinical care and the design of clinical trials.

The development of a cognitive scale for functional bowel disorders

OBJECTIVE

The importance of psychosocial factors in patients with Functional Bowel Disorders (FBD) has been well-established. However, most psychosocial measures used in research with FBD patients were not designed or validated on this population. A recent international team report recommended that psychosocial measures be developed to increase our understanding and treatment of FBD. The purpose of this study was to develop a reliable and valid instrument designed specifically to assess cognitions of patients with FBD.

METHOD

An initial set of 204 scale items was generated from a large pool of thought diaries from patients diagnosed with FBD. Items were additionally refined using several methods, including consultation with a multidisciplinary team of international experts on FBD. The remaining 95 items were administered, along with a set of validating questionnaires, to a new sample of 75 FBD patients in Canada and the United States.

RESULTS

The findings indicate that the final 25-item scale has high reliability (Cronbach's alpha = .93; inter-item correlation = .36); high concurrent criterion validity evidenced by the correlation of the scale with a global rating of life interference caused by bowel symptoms (r = .71; p<.001); acceptable convergent validity evidenced by the correlation of the scale with the Dysfunctional Attitudes Scale (r = .38; p<.01); high content validity and face validity; and minimal social desirability contamination (r = .15; NS).

CONCLUSIONS

The Cognitive Scale for Functional Bowel Disorders is a valid and reliable scale that can be used as an outcome measure in evaluating the efficacy of different forms of psychotherapeutic intervention for FBD, and can also serve as a helpful assessment tool for health professionals working with patients diagnosed with FBD.

Cognitive-behavioral group therapy for patients with irritable bowel syndrome

This article is divided into two parts, the first of which focuses on a general overview of irritable bowel syndrome (IBS) and provides a rationale for the use of cognitive-behavioral therapy (CBT) for IBS based on both theoretical and research perspectives. This section includes a critical review of CBT therapies for IBS and provides a model of CBT for IBS. The second section provides the clinician with practical information concerning the application of cognitive-behavioral group therapy for IBS. Possible scripts and case examples are incorporated into this section to highlight factors that may arise in working with IBS patients relative to other clinical groups. The second section also contains themes that are suggested content areas for group sessions. Contingent on the formulation of the presenting or emerging issues and goals, the order and inclusion of themes can be changed to fit the particular needs of a given group. Finally, this section provides initial preliminary data from a randomized controlled study that is suggestive of the efficacy of cognitive-behavioral therapy for IBS.

Panic disorder associated with gastrointestinal disease: review and hypotheses

An association between panic disorder and functional gastrointestinal disease has emerged since the introduction of reliable diagnostic criteria, first for psychiatric disorders and more recently for functional gastrointestinal disorders. At the same time, a more rigorous review of methodology of older reports linking structural gastrointestinal diseases such as peptic ulcer and inflammatory bowel disease to psychiatric illness has cast doubt on the validity of their association. In this review original articles reporting an association between panic disorder and globus, functional chest pain of presumed esophageal origin, functional dyspepsia, and irritable bowel syndrome are critically reviewed and it is concluded that panic disorder is overrepresented in noncardiac chest pain and irritable bowel syndrome. Original reports of the prevalence of panic disorder in structural gastrointestinal disease are reviewed and it is concluded that they do not support an association with panic. Hypotheses explaining the statistical link of panic disorder and functional gastrointestinal disease are discussed.

Negative affect and the seeking of medical care in university students with irritable bowel syndrome: a preliminary study

In a preliminary study using only self-report measures, university students completed questionnaires about their bowel symptoms and trait anxiety. Results showed that students with irritable bowel syndrome (IBS) reported higher trait anxiety than asymptomatic controls. Among the students with IBS, there were no significant differences in trait anxiety between those who had sought medical care for IBS mostly from a primary care physician, and those who had not sought care for IBS. Students who had sought medical care for IBS reported being more bothered by the symptoms and were more concerned about their meaning than those students who had not sought care. The results are compared to other research with IBS patients referred to specialist clinics, and a distinction is made between initial vs. continued care seeking for IBS.