Original articlesNeurotic butterflies in my stomach: The role of anxiety, anxiety sensitivity and depression in functional gastrointestinal disorders
Introduction
Recently, investigators have shown that functional gastrointestinal (FGI) symptoms are correlated with depression and anxiety. For example, Hochstrasser and Angst [1], in assessing young Swiss adults, showed that functional stomach complaints, but not intestinal complaints, were positively associated with major depression. Intestinal complaints were, however, positively correlated with brief, recurrent depressive states. Also, intestinal complaints were more consistently associated with anxiety syndromes, especially panic-like symptoms, than were stomach complaints. These findings are generally consistent with those of Lydiard et al. [2] who found that people with a history of panic disorder and panic attacks were more likely to endorse FGI symptoms, especially those associated with irritable bowel syndrome, than were people with other psychiatric disorders.
These findings are of particular interest considering that, in North America [3] and Sweden [4], approximately 70% of young adults have been found to experience at least one FGI symptom. Both Drossman [3] and Agreus et al. [4] showed that FGI symptoms occur more frequently in women than men, and tend to decrease with age. However, because these investigators used different diagnostic tools, direct prevalence comparisons are difficult to make and would be tentative at best.
To provide a consistent diagnostic framework for FGI disorders, the “Rome criteria” were developed and validated by a working group of the International Congress of Gastroenterology [5]. The process of developing the Rome criteria for these disorders was similar to the consensus process used by the American Psychiatric Association for DSM-IV [6]. The consensus committees identified six separate categories of FGI disorders based on anatomical location: (a) esophageal; (b) gastroduodenal; (c) bowel; (d) functional abdominal pain; (e) biliary; and (f) anorectal. Each category is further divided into specific disorders.
Drossman et al. [7] have developed the Research Diagnostic Questions for Functional Gastrointestinal Disorders, an easy-to-use self-administered instrument based on the Rome criteria. This instrument uses a series of yes/no questions to determine the presence or absence of symptoms associated with each FGI disorder. Using this instrument, Drossman et al. [8] assessed a stratified random sample of adult householders living in the USA. The data obtained from 5430 usable respondents showed that 69% had at least one identifiable FGI symptom. In addition to showing that women and younger respondents reported more FGI symptoms, they also found that people with symptoms of FGI disorders had more visits to physicians and missed more work days than those who did not.
One purpose of this study was to attempt to replicate the prevalence findings for young adults [8] using the diagnostic framework of the Rome criteria. As well, we sought to determine the relationship between FGI disorders (and symptoms) and both physician visits and psychological variables such as anxiety and depression. One specific psychological variable, anxiety sensitivity, was of particular interest. Although anxiety sensitivity, as measured by the Anxiety Sensitivity Index (ASI) [9], has been defined as a dispositional measure of fear of anxiety symptoms arising from the belief that they will have consequences that are socially, physically, or psychologically harmful, recent research has shown that anxiety sensitivity is predictive of distress in several other disorders such as chronic pain [10]. We were therefore interested in further assessing the role of AS in the distinct, yet often discomforting and painful, set of FGI disorders.
Section snippets
Participants
Eighty-nine female and 38 male first-year university students provided informed consent and served as participants. Participants were obtained via sign-up sheets posted near the Department of Psychology. All first-year psychology students are required to participate as subjects in several studies. They are free to sign up for studies that interest them. As a result, participant selection is not random. The percentage of female participants is approximately the same as that of women enrolled in
Results
Table I presents information on the proportion of participants who met criteria for any FGI disorder and for the specific disorders. Data are presented separately for men and women. Although the females reported more FGI disorders, these differences were not statistically significant (all ps>0.05). The overall results showed that 51.2% of the participants met criteria for one or more FGI disorders. The most frequently diagnosed classifications of FGI disorders, based on anatomical location,
Discussion
When the prevalence figures obtained in this study are compared with those obtained for younger subjects (ages 15–34) in the Drossman et al. [8] household survey, some notable differences occur. In comparison to our results, Drossman and colleagues found a substantially larger proportion of participants meeting criteria for aerophagia (26.9% vs. 6.3%), irritable bowel syndrome (13.5% vs. 6.3%), functional abdominal bloating (13.5% vs. 3.9%), and functional diarrhea (27.7% vs. 0.8%). However, we
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