|Year : 2019 | Volume
| Issue : 3 | Page : 147-154
Psychosocial aspects and personality dimensions among a sample of patients with irritable bowel syndrome
Hala M Abd Elaziz, Reda M Ismail, Hala T Mohammed, Shimaa Y Abd Elaziz
Department of Psychiatry, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
|Date of Submission||28-Jul-2019|
|Date of Acceptance||04-Aug-2019|
|Date of Web Publication||19-Nov-2019|
MD Shimaa Y Abd Elaziz
Department of Psychiatry, Faculty of Medicine for Girls, Al-Azhar University, Cairo
Source of Support: None, Conflict of Interest: None
Background Irritable bowel syndrome (IBS) is a chronic functional disorder of the gastrointestinal tract, a burden to society through total direct costs, reduced social functioning, and quality of life impairment.
Aim The aim of the study was to determine the associated psychosocial risk factors and personality traits in a sample of IBS patients.
Participants and methods A total of 100 patients of IBS were recruited from the Gastroenterology and Internal Medicine Outpatient Clinics Departments at Al Zahraa University Hospital during the period from January 2018 to August 2018 and 100 apparently healthy participants as the control group (aged 18–45 years) were subjected to clinical psychiatric assessment, Eysenck’s Personality Questionnaire, Stressor life events questionnaire, and Structured Clinical Interview for DSM-IV Axis I.
Results The total number of cases was 100 [25 (25%) men and 75 (75%) women] with a mean age of 34.18±6.4 years; there was statistical significance regarding age, sex, marital status, and high significance in family history of IBS, education, employment; 51% had long duration of illness of more than 5 years. High neuroticism score was detected in 63% of the patients versus (VS) 20% of the control group and 52% of the patients had low extroversion VS 16% in the control group. There was high statistical significance in family, economic, social, emotional, health, and personal stressors. Moreover, 66% of the patients had psychiatric comorbidity, high statistical significance with generalized anxiety disorder and hypochondriasis, and statistical significance with somatization, dysthymic disorder, mixed anxiety depression, and panic disorder.
Conclusion In this study, we found that IBS was associated with significant psychological distress and psychiatric comorbidities as psychosocial factors, so good assessment and early recognition will permit early intervention to improve outcome of the IBS and quality of life.
Keywords: irritable bowel syndrome, personality dimensions, psychosocial aspects
|How to cite this article:|
Abd Elaziz HM, Ismail RM, Mohammed HT, Abd Elaziz SY. Psychosocial aspects and personality dimensions among a sample of patients with irritable bowel syndrome. Egypt J Psychiatr 2019;40:147-54
|How to cite this URL:|
Abd Elaziz HM, Ismail RM, Mohammed HT, Abd Elaziz SY. Psychosocial aspects and personality dimensions among a sample of patients with irritable bowel syndrome. Egypt J Psychiatr [serial online] 2019 [cited 2019 Dec 13];40:147-54. Available from: http://new.ejpsy.eg.net/text.asp?2019/40/3/147/271303
| Introduction|| |
Irritable bowel syndrome (IBS) is a chronic functional disorder of the gastrointestinal tract (Lacy et al., 2016), it is estimated to affect ∼11% of the global population (Lovell and Ford, 2012).
In the general population, about 50% of IBS patients report psychological symptoms, and in healthcare-seeking samples 40–90% of IBS patients fulfill the diagnostic criteria for a psychiatric disorder (Surdea et al., 2012).
IBS is a painful condition associated with significant psychological distress and psychiatric comorbidities, like higher levels of anxiety and depression with negative impact on quality of life (Elsaied et al., 2017).
Early in life, genetics and environmental factors (e.g. family influences, abuse, major losses), may affect one’s psychosocial development (psychological state, coping skills) and/or the development of gut dysfunction. During life, psychosocial factors (stressful life events, psychological distress) may influence the digestive function, symptom perception, illness behavior, and consequently health outcome, daily function, and quality of life (Enck et al., 2016).
Early studies on personality factors in IBS patients were performed by using the Eysenck Personality Inventory (Muscatello et al., 2016). Palmer et al. (2006) evidenced that IBS patients were significantly more neurotic and less extroverted than the general population (established normative data), but significantly less neurotic and more extroverted than patients affected by psychoneurotic disorders (neurotic depression, anxiety phobic state, obsessional illness, hysterical disorder, or a combination of these).
| Aim|| |
The aim of this study was to determine the associated psychosocial risk factors and associated personality traits in a sample of IBS patients.
| Participants and methods|| |
The study was conducted on 100 patients of IBS recruited from Gastroenterology and Internal Medicine Outpatient Clinics Departments at Al Zahraa University Hospital during the period from January 2018 to August 2018 with age ranging from 18 to 45 years, after exclusion of those with organic causes for IBS, patients with impaired cognitive functions, patients with neurological diseases, and patients known to have psychiatric disorders. The study also included 100 apparently healthy participants as the control group.
After obtaining informed consent from patients of both groups and ensuring confidentiality. both patients and the control group were subjected to the following:
- Medical and neurological history and examination.
- Clinical psychiatric assessment.
- Eysenck’s Personality Questionnaire for assessment of personality traits.
- Stressor life events questionnaire for assessment of stressful life events.
- Structured Clinical Interview for DSM-IV Axis I for diagnosis of comorbid psychiatric disorder.
Data were analyzed with (IBM SPSS, Armonk, NY: IBM Corp) version 23, χ2-test, independent t-test, and one-way analysis of variance test.
| Results|| |
This study is a cross-sectional comparative study; the sample of patients were recruited from patients who have been already diagnosed as IBS by a gastroenterologist and internal medicine specialists, attending to the Gastroenterology and Internal Medicine Outpatient Clinics at Al Zahraa University Hospital, while the control sample was recruited from apparently healthy participants, attendants with their patients at Al Zahraa University Hospital.
There was a statistically significant difference between cases and control group regarding all sociodemographic variables ([Table 1]).
Assessment of personality traits according to Eysenck’s Personality Questionnaire
There was a high statistically significant difference regarding neuroticism, extroversion, and statistical significance regarding psychoticism, lie score, but there was nonstatistical significance to crime score between both groups ([Table 2]).
Assessment of stressor life events using stressful life event questionnaire
There was a high statistically significant difference regarding family, economic, social, emotional, health, and personal stressors ([Table 3]).
The comorbidity of psychiatric disorders with irritable bowel syndrome using the Structured Clinical Interview for DSM-IV Axis I
Psychiatric comorbidities in case and control groups ([Table 4]).
There was a highly significant difference as regards the presence of psychiatric comorbidities and the results revealed statistical significance in generalized anxiety and hypochondriasis, somatization, dysthymia, mixed depression anxiety, and panic disorder but nonstatistically significant in major depressive episode, post-traumatic stress disorder, and obsessive compulsive disorder (OCD) between both groups.
The relation between neuroticism and sociodemographic data ([Table 5]).
There was a statistically significant difference between neuroticism and family history.
The relation between personality traits and psychiatric comorbidities in the patient group ([Table 6]).
|Table 6 The relation between personality traits and psychiatric comorbidities in the patient group|
Click here to view
There was a highly significant difference between psychiatric comorbidities and personality traits in high neuroticism and low extraversion.
The relation between stressor life events and psychiatric disorders ([Table 7]).
|Table 7 The relation between stressor life events and psychiatric disorders|
Click here to view
There was nonstatistical significance between psychiatric disorders and stressor life events.
| Discussion|| |
Psychological distress is recognized as an important factor in IBS (Van Oudenhove et al., 2010).
It was reported that IBS mainly occurs between the ages of 15 and 65 years, the first presentation of patients to a physician is usually in the 20–40-year-old age group (Lacy et al., 2016). The majority of IBS patients in this study were in the age group of between 30 and 39 years with a mean of 34.18±6.4 years (mean±SD). Another study by Bahareh et al. (2015) found that the average mean age was 36.5±9.4 years. However, the study of Danping et al. (2017) found that the mean age of the patients was 44.13±13.39. The higher results of the previous study than the current results can be explained by the wide range of age of their patients: 18–65 years.Researchers have hypothesized that sex hormones may affect the mechanisms that regulate the brain–gut–microbiota axis which is finally involved in the development of IBS (Pigrau et al., 2016).
Studies of Kibune Nagasako et al. (2016), Lovell and Ford (2012) and Modabbernia et al. (2012) showed that women outnumbered men by a ratio of almost 2 : 1. In this study the female : male ratio is 3 : 1. This was in agreement with the study of Susanta et al. (2016) who found that the female : male ratio is 3 : 1. The high prevelance of IBS in women than men could be explained on the basis of that one of the important etiologies in IBS is the psychological distress, and women are more liable to psychological distress in the child-bearing period, so IBS is more common in women than men. In addition to high follow-up rate of female patients to outpatient clinics of Al Zahraa University Hospital. Since most of the physicians working at Al Zahra University Hospital are women and this hospital is considered the catchment area of public region (Mainsheet Nasir, El Dwiqua and El-Waily) who prefer female physicians than male.
Of the patients group, 64% were married and they were in the age group of 30–39 years which is the age of the child-bearing period and most of the responsibilities lies on the women during this period, so the patient starts to be presented by somatic symptoms as a reaction to psychosocial stress and IBS is considered one of the important somatic symptoms disorder. Similar results were observed in the study of Cristina et al. (2018) in which the majority of the patients were married (46%).
Most of the patients are technically educated and this could be explained by that Al-Zahra University Hospital are the catchment area of many public areas in which most of the people do not complete their education and most of them prefer technical education in addition to the low socioeconomic standard of the people living in these areas. In the study of Modabbernia et al. (2012), they divided the patients as regards their educational level into underdiploma (46.4%) and diploma or higher (53.5%) which of significant relation.
Of our patients 60% were currently unemployed and 40% employed in comparing with the result of the control group which showed 40% are currently unemployed and 60% are employed. Similar result was proved in the study by Modabbernia et al. (2012); the results revealed 57.4% to be jobless and 43.6% had a job. The increased level of unemployment can explain the functional impairment among IBS patients and avoidance of daily activities including work particularly when symptoms were present. The inverse result was found by Susanta et al. (2016) who reported that 24% of his sample was currently unemployed and 76% employed. This could be explained by cultural attitudes and population differences.
This study showed that 56% of patients had a family history of IBS. This is similar to the findings of Saito et al. (2010) and Ibrahim (2016) It was proved by Hiam et al. (2017) that the majority of IBS patients (82.2%) had a family history of IBS. The inherited component in IBS, which was confirmed in twin and family studies, was reported in a review published in 2016 (Henstrom and D’Amato, 2016).
It has been found that 49% of the patients had duration of illness below 5 years and 51% had duration of illness above 5 years. However, in the study of Susanta et al. (2016) they reported that the duration of illness of less than 5 years was detected in 66% of the patients and more than 5 years in 34% of the cases. Since IBS is a chronic long-standing disease with periods of remission and exacerbation no specific cure for IBS had been found until now as well as IBS is of multifactorial etiology and this leads to long disease duration.
According to the Mental Health Foundation (2017), ‘Stress can be defined as the way you feel when you’re under abnormal pressure.’ This study revealed a high distribution of stressors among patient with IBS than control in which 75% of patients had emotional stressors, 74% had family stressors, 73% had personal stressors, 54% had social stressors, 43% had economic stressors, and 26% had health stressors.
The study of Susanta et al. (2016) revealed that 78% of the patients had stressors, and the result of each stressor was as follows: family 30% and financial 22% which was higher in IBS than control. The higher level of stressors among patients of our study than other studies could be explained by different methodology, different culture, different population, and different types of stressors.
High neuroticism is combined with weakness in compatibility, controlling impulses, and resisting against stress and by the way sustainability of people increases against physical disorders (IBS) (Kiamehr, 2002).
The results of this study revealed a higher level of neuroticism, psychoticism, lie score, and lower level of extraversion, crime in patients than in the control.
High neuroticism score was detected in 63% of the patients versus (VS) 20% of the control. This is in agreement with the study of Anna et al. (2018) using a different scale (NEO personality inventory of five factors), which showed that the rate of neurosis in people having IBS is more than normal individuals. Other studies by Sedigheh and Mohammad (2011) and Tayama et al. (2012) showed the same results.
Of the patients, 52% had low extroversion score VS 18% in the control. Findings of this study also indicated that IBS patients compared with healthy individuals scored lower in extroversion. This is in agreement with the study of Jones et al. (2013) in which extroversion score was lower in patients with IBS than control. This is also consistent with other studies of Sedigheh and Mohammad (2011), Wrzesinska and Kocur (2008) and Zoccali et al. (2006).
The low level of extroversion could be explained by the fact that extrovert individuals enjoy a positive emotional style, an ability to develop interpersonal interests, and high levels of activity and social interactions. Positive emotions help extrovert individuals to cope with stressful experiences well both physiologically and psychologically. However, a low level of extroversion among IBS patients has put them under pressure resulting from passivity, weak activity level, and weak social interactions and has intensified the symptoms of the disease among patients.
Psychiatric disorders and IBS appear to have bidirectional comorbidities. IBS seem to be influenced by anxiety and mood disorders (Adame and Rao, 2014).
In our study, 66% of the patients had psychiatric comorbidity across their life time compared to 28% in the control group. The high prevalence of psychiatric disorders among patients and control groups could be explained by that people from developing countries report more somatic symptoms in comparison to developed countries and IBS is one of the somatic symptom disorders. Also, the changes that occur in their life since the Egyptian population faced different psychosocial stressors during the past several years and the fear of the stigma attached to mental illness prevent patients to seek psychiatric advice and instead they seek medical advice. The results of this study was in agreement with other studies: in the study of Anna et al. (2018) psychiatric comorbidities were found in 62% of the cases. Moreover, in the study of Hausteiner and Henningsen (2014) the prevalence of psychiatric disorders ranged from 40.0 to 60.0%.
This study shows higher prevalence of psychiatric comorbidities especially in anxiety, somatization, and depression which are more present among women (80.3%) VS men (19.7%). This could be explained by higher prevalence of anxiety disorders and depression in women in the general population as well as the role of female sex hormones in the development of stress and psychiatric disorders (World Health Organization, 2017).
Moreover, regarding the relation between the personality traits and sociodemographic characteristics, the results revealed that 71.4% of the female included in the study had high neurotic trait and 71.2% of female had low extroversion. It is well known that high neuroticism level are more common in women than men of normal population (World Health Organization, 2017). This was in agreement with the study of Alireza et al. (2008) and Trane et al. (2006) who found a significant difference in trait neuroticism and extroversion.
As regards the relation between psychiatric comorbidities and personality traits of the patients with IBS, there was high statistical significance: 75.8% of the patients had high neuroticism and 68.2% of patients with low extroverted traits developed psychiatric comorbidity. This result is in agreement with the study of Miranda et al. (2013) which revealed that neuroticism and stressful life events increase anxiety, so this insures the role of neuroticism and extroversion in the expression of psychiatric disorders in IBS.
| Conclusion|| |
In this study, we found that IBS is associated with significant psychological distress mainly in women, in the child-bearing period, unemployed with positive family history of IBS, and chronic duration of illness. Moreover, IBS is associated with psychiatric comorbidities especially anxiety, depression, and somatization, so close liaison between psychiatrist and other medical staff undoubtedly facilitates effective assessment and management and in turn can improve the quality of life and improve prognosis of IBS.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Adame E, Rao SS (2014). Brain and gut interactions in irritable bowel syndrome: new paradigms and new understandings. Curr Gastroenterol Rep 16:379.
Alireza F, Somi MH, Sarami F, Farhang S. (2008). Five personality dimensions in patients with irritable bowel syndrome. Neuropsychiatr Dis Treat 4:959–962.
Anna C, Cristiana N, Sonia C, Bernardo F, Stefano S, Pancetta A. (2018). The complex interplay between gastrointestinal and psychiatric symptoms in IBS: a longitudinal assessment. Pisa, Italy: Psychiatry Unit; Department of Clinical and Experimental Medicine, University of Pisa.
Bahareh B, Firouzabadi A, Farjam M, Fattahi MR, Kazemi MH. (2015). Frequency of different psychiatric disorders in patients with functional bowel disorders: a short report. Ann Colorectal Res 3:e27621.
Cristina S, Caserta A, Nisita C, Cortopassi S, Fani B, Salvadori S et al.
(2018). The complex interplay between gastrointestinal and psychiatric symptoms in irritable bowel syndrome: a longitudinal assessment. J Gastroenterol Hepatol 18:613–621.
Danping W, Xie Z, Xuesong Z, Zhigang H, Yufei S. (2017). Magnetic resonance imaging analysis of brain function in patients with irritable bowel syndrome. BMC Gastroenterol 17:148.
Elsaied HF, Khaled SS, ELHassanin MM, Mohamad AE. (2017). A study of sociodemographic factors and anxiety: depressive disorders among irritable bowel syndrome patients. Egypt J Psychiatr 38:97–104.
Enck P, Aziz Q, Barbara G, Farmer AD, Fukudo S, Mayer EA, Spiller RC. (2016). Irritable bowel syndrome. Nat Rev Dis Primers 2: 16014.
Hausteiner WC, Henningsen P (2014). Irritable bowel syndrome: relations with functional, mental, and somatoform disorders. World J Gastroenterol 20:6024–6030.
Henstrom M, D’Amato M (2016). Genetics of irritable bowel syndrome. Mol Cell Pediatr 3:7.
Hiam EF, Sherra KS, Mahmoud EH, Ebrahim MA. (2017). A study of sociodemographic factors and anxiety: depressive disorders among irritable bowel syndrome patients. Egypt J Psychiatr 38:97.
Ibrahim NK (2016). A systematic review of the prevalence and risk factors of irritable bowel syndrome among medical students. Turk J Gastroenterol 27:10–16.
Jones MP, Oudenhove LV, Koloski N, Tack J, Talley NJ et al.
(2013). Early life factors initiate a ‘vicious circle’ of affective and gastrointestinal symptoms: a longitudinal study. United European Gastroenterol J 1:394–402.
Kiamehr J (2002). Standardization short form questionnaire NEO FiveFactor and emotional structure amongstudents of humanities universities Tehran. MA. Dissertation.Tehran: Allameh Tabatabei University, Department of psychology; 8–52.
Kibune Nagasako C, GarciaMontes C, Silva Lorena SL, Mesquita MA. (2016). Irritable bowel syndrome subtypes: clinical and psychological features, body mass index and comorbidities. Rev Esp Enferm Dig 108:59–64.
Lacy BE, Mearin F, Chang L, chery WD, Lembo AJ, Simren M, Spiller R. (2016). Bowel disorders. Gastroenterology 150:1393–1407.
Lovell RM, Ford AC (2012). Effect of gender on prevalence of irritable bowel syndrome in the community: systematic review and meta-analysis. Am J Gastroenterol 107:991–1000.
Miranda MA, Palsson OS, Whitehead WE (2013). Which psychological factors exacerbate irritable bowel syndrome? Development of a comprehensive model. J Psychosom Res 74:486–492.
Modabbernia MJ, Mansour-Ghanaei F, Imani A, Mirsafa-Moghaddam SA, Sedigh-Rahimabadi M. (2012). Anxiety-depressive disorders among irritable bowel syndrome patients in Guilan, Iran. BMC Res Notes 5:112.
Muscatello MR, Bruno A, Mento C, Zoccali RA. (2016). Personality traits and emotional patterns in irritable bowel syndrome. World J Gastroenterol 22:6402.
Palmer RL, Stonehill E, Crisp AH, Waller SL, Misiewicz JJ. (2006). Psychological characteristics of patients with the irritable bowel syndrome. Postgrad Med J 50:416–419.
Pigrau M, Rodiño-Janeiro BK, Casado-Bedmar M, Lobo B, Vicario M, Santos J, Alonso-Cotoner C. (2016). The joint power of sex and stress to modulate brain-gut-microbiota axis and intestinal barrier homeostasis: implications for irritable bowel syndrome. Neurogastroenterol Motil 28:463–486.
Saito YA, Schoenfeld P, Locke GR 3rd (2010). The epidemiology of irritable bowel syndrome in North America: a systematic review. Am J Gastroenterol 97:1910–1915.
Sedigheh Z, Mohammad AB (2011). Comparison of personality characteristics of individuals with irritable bowel syndrome and healthy individuals. Procedia Soc Behav Sci 30:84–88.
Surdea BT, Băban A, Dumitrascu DL (2012). Psychosocial determinants of irritable bowel syndrome. World J Gastroenterol 18:616–626.
Susanta SK, Mishra S, Sarkar S, Bang LG, Panigrahi M. (2016). Comparison of psychiatric morbidity in patients with irritable bowel syndrome and non-ulcer dyspepsia. Ind Psychiatry J 25:29.
Tayama J, Nakaya N, Hamaguchi T, Tomiie T, Shinozaki M, Saigo T et al.
(2012). Effects of personality traits on the manifestations of irritable bowel syndrome. Biopsychosoc Med 6:20.
Trane AN, Locke GR et al.
(2006). Personality difference in patients with irritable bowel syndrome. Neuropsychiatr Dis Treat 4:965.
Van Oudenhove L, Vandenberghe J, Demyttenaere K, Tack J. (2010). Psychosocial factors, psychiatric illness and functional gastrointestinal disorders: a historical perspective. Digestion 82:201–210.
World Health Organization (2017). Gender and mental health. In: Wilkinson R, Marmot M, editors. Social determinants of health: the solid facts. 2nd edition. Geneva: World Health Organization.
Wrzesinska MA, Kocur J (2008). The assessment of personality traits and coping style level among patient with irritable bowel syndrome and non neuclear dyspepsia. Psychaitr Pol 5:709–717.
Zoccali R, Muscatello MR, Bruno A, Barilla G, Campolo D, Meduri M et al.
(2006). Anger and ego-defence mechanisms in non-psychiatric patients with irritable bowel syndrome. Digestive and liver disease 38:195–200.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]