PSYCHOSOCIAL ASPECTS OF FUNCTIONAL GASTROINTESTINAL DISORDERS

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Esophageal Motility Disorders

A classic study of the association of psychiatric diagnoses with esophageal motility disorders was reported by Clouse and Lustman. 12 These investigators performed psychiatric evaluations on 50 consecutive patients before motility testing and then used the manometric test data (without knowledge of the psychiatric findings) to classify them as having a nonspecific esophageal motility disorder, an organic esophageal motility disorder such as achalasia, or no motility disorder. In the nonspecific

STRESS

Stress is widely believed to cause or to exacerbate gastrointestinal motility disorders because (1) laboratory experiments have documented alterations in motility and transit time in response to experimental stressors and (2) patients with motility disorders report more stressful events in their lives and believe that stress is associated with exacerbations of their symptoms. 18, 89 The following sections review what is known about the effects of stress in each region of the gastrointestinal

CHILDHOOD SOCIAL LEARNING

Whitehead and colleagues 93 reported that patients with functional bowel disorder were more likely than controls to report that when they were sick as children, their parents gave them gifts and special privileges. The authors argued that these gifts and privileges act as reinforcers of illness behavior and lead to an enduring tendency to notice and report more somatic symptoms. Another laboratory made similar observations. 44 A subsequent study 85 extended these findings by showing (1) that

SUMMARY AND CONCLUSIONS

Increased numbers of psychiatric diagnoses and increased levels of psychological distress are seen in the majority of medical clinic patients with gastrointestinal motility disorders. In IBS, psychological symptoms are believed to be comorbid conditions, which do not cause the motility disorder but which do influence the patient's decision to consult a physician. In functional dyspepsia, psychological symptoms are present in many patients, but their role is not known; the available data suggest

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    Address reprint requests to, William E. Whitehead, PhD, Division of Digestive Diseases, Campus Box 7080, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7080

    This article was supported in part by grants KO5 MH00133 and RO1 DK31369.

    *

    From the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

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