IS THE IRRITABLE BOWEL SYNDROME REALLY "PSYCHOSOMATIC"?

G. N. Christodoulou and B. Alevizos

Athens University Department of Psychiatry, Eginition Hospital
Vasilissis Sophias 74, Athens, Greece

The purpose of this paper is to compare the characteristics of two

illnesses thought to be typically "psychosomatic" and to look into their
similarities and differences. Of course, if one accepts the holistic
concept1 , all illnesses are psychosomatic but, to paraphrase George
Orwell's "Animal Farm" ("all animals are equal but some animals are more
equal than others"), all illnesses are psychosomatic but some psychosomatic
illnesses may he more psychosomatic than others. In other words the psycho-
social element may ill more pronounced in some illnesses than in others.
Irritable bowel syndrome (I.B.S.) and Peptic Ulcer (P.U.) are
considered as two of the most characteristic "psychosomatic" disorders of
the gastrointestinal tract. Both of them produce con~i§erable suffering and
disability and both have serious social consequences' •
In view of the notorious management difficulties of I.B.S. it was
thought that pointing out certain differences between P. U. and I. B. S.
might help in providing a more effective management of this condition.
The data necessary for the comparative evaluation of these two
conditions is derived from a study comparing adult peptic ulcer patients to
two groups of controls4 and a study comparing a group of patients with
I.B.S. to a group of paired controls 5 •
The first study concerned 34 male peptic ulcer in-patients of the
Hellenic Air Force General Hospital in Athens. All patients had duodenal
ulcer. These patients were compared to a) a group of 37 healthy male
controls from the personnel of the hospital and b) a group of 36 male
controls who were in-patients of the same hospital and were suffering from
illnesses unrelated to the gastro-intestinal tract.
Subjects and controls were submitted to Eysenck's Personality
Inventory, Foulds' Hostility Questionnaire, Langner's 22-items Question-
naire, the Hopkins Symptom Checklist, Zung's self-rating anxiety scale,
Spielberger's state-trait Anxiety Inventory, Zung's and Beck's rating
scales for depression and the 43-items Life Events Inventory by Holmes and
Rahe.

The patients were differentiated from one or both groups of controls

in a number of parameters. Nore specifically, they were found to be more

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G. N. Christodoulou (ed.), Psychosomatic Medicine
© Plenum Press, New York 1987
 Table 1. Stressful Life Events in Peptic Ulcer Patients and Controls

Life Events Score

Peptic Ulcer Patients 310.4 ± 168.6~ p(0.001
Healthy Controls 188 . 9 + 118. 4
Hospitalized Controls 212.0 + 125.6 p<0.01

neurotic and to have more anxiety- (trait and state), guilt and general
psychopathology. Additionally they had more stressful life events than the
controls (table 1).
These findings were grossly analogous to findings concerning children
and adolescents with peptic ulcer 2,6 • More specifically, thirty children
and adolescents (20 females, 10 males, aged 6-16 years) with radiologically
confirmed peptic ulcers matched in pairs for age, sex and socio 7 economic
status to a group of ulcer-free controls were submitted to personality
tests (Rorschach, dessin de famille, test P.N. by Corman) intelligence
tests (WISC) in addition to a structured psychiatric interview and a
structured "present psychiatric state" examination.
The patients had a greater frequency of introverted personalities and
psychopathological conditions, lovrer mean IQ, \wrse adaptation to school,
more anxious and overprotective parents and in 11 patients onset of
symptomatology was preceded by psychotraumatic events.
These findings agree with those mentioned earlier which concerned
adults with peptic ulce~and suggest that psychopathology, stressful life
events and personality characteristics are important pathogenetic
contributors in patients with peptic ulcer.
A further study concerned 40 patients with I.B.S. from the Department
of Gastroenterology of "Evangelismos" Hospital who were compared to 40
controls matched for age, sex, marital status and educational level. The
instruments used were the same as those of the study concerning adult
peptic ulcer patients with the addition of Schalling-Sifneos' Alexithymia
Questionnaire and the use of Eysenck's Personality Questionnaire in lieu of
the same author's Personality Inventory.

Table 2. General Psychopathology, Anxiety and Depression in I.B.S.

Patients and Controls

I.B.S. Patients Controls Statistical

Significance

22 Items 8.31 + 4.87 3.82 + 3.73 peO.OOl

State Anxiety 45.5 ± 14.4 37.9 + 13.1 peO.05
Trait Anxiety 48.9 + 13.3 40.0 ± 10.4 p(0.01
Zung Anxiety 41.7 ± 9.2 33.1 ± 9.2 peO.OOl
Zung Depression 42.0 + 9.0 34.1 ± 10.0 p(0.001

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