Some psychosocial variables associated with functional gastrointestinal disorder (irritable bowel syndrome)

Abstract

The commonest disorder seen at gastroenterology Outpatient Clinics is the Irritable Bowel Syndrome (IBS), a painful and relapsing functional condition. Research to date into the aetiology of IBS has pointed to the importance of both irritative and psychogenic factors. The latter in particular have been the focus of numerous studies, the majority of which have documented elevated levels of psychoneuroticism in outpatient samples. The present study considered psychogenic and social stress factors in IBS and found that the improvements implemented with respect to the psychometrics administered, the statistical analysis used and the type of control groups employed enabled a clarification of the psychoneurotic status of IBS outpatients and individuals with unreported IBS. Although IBS does not appear to be associated with depression, anxiety, obsessive-compulsion or interpersonal sensitivity, as reported in earlier studies, it is hypothesised that the experience of IBS sensitises IBS sufferers to the psychological impact of any additional somatic symptoms that are experienced, and leads to feelings of worry and distress which manifest as somatic distress. It is argued that the actual reporting of IBS symptoms is a function of both socially-conditioned factors that facilitate reporting in women, and a sex-bias in diagnosis and treatment evident in physicians who refer more female patients to outpatient clinics. Social stress factors thought to be important in the development of psychological illness do not, however, appear to be important in the development of somatic distress found amongst individuals with IBS. Attention is drawn to the fact that much remains to be learnt regarding the role of irritative factors in IBS, and that organically-based pathological processes may operate in the aetiology of IBS. Finally suggestions are made with respect to patient management and future research.