Handbook of Psychology

CHAPTER 17

Irritable Bowel Syndrome

EDWARD B. BLANCHARD AND LAURIE KEEFER

393

DEFINITIONAL, EPIDEMIOLOGICAL, AND
ASSESSMENT ISSUES 393
Clinical Criteria 393
Epidemiology 395
Psychological Distress 396
IBS Patient versus IBS Nonpatient 397
The Role of Life Stress 398
Role of Sexual and Physical Abuse in IBS 399
General Comments 400
RECURRENT ABDOMINAL PAIN IN CHILDREN 400
Prevalence 400
Etiology 401

Psychosocial Factors and RAP 401

Treatment of RAP 402

General Comments 403

PSYCHOLOGICAL TREATMENT OF IBS 403

Brief Psychodynamic Psychotherapy 403

Hypnotherapy 404

Cognitive and Behavioral Treatments 404

General Comments 406

CONCLUSIONS AND FUTURE DIRECTIONS 407

REFERENCES 408

In this chapter, we discuss de“nitional and epidemiological is-
sues and summarize information on various psychosocial is-
sues in IBS, describe and discuss recurrent abdominal pain
(RAP), a possible developmental precursor of IBS; and review
the literature on psychological treatments of IBS, focusing pri-
marily on what is known from randomized, controlled trials.

DEFINITIONAL, EPIDEMIOLOGICAL,
AND ASSESSMENT ISSUES

Irritable bowel syndrome (IBS), previously known as •spas-
tic colon,Ž is one of several functional disorders diagnosed by
gastroenterologists (GI). Functional gastrointestinal (GI) dis-
orders, in general, are •persistent clusters of GI symptoms
which do not have their basis in identi“ed structural or bio-
chemical abnormalitiesŽ (Maunder, 1998). IBS falls into the
subset of a functional boweldisorder, which also includes
functional diarrhea, functional constipation, functional bloat-
ing, and unspeci“ed functional bowel disorder (Drossman,
Corrazziari, Talley, Thompson, & Whitehead, 2000).

Irritable bowel syndrome has been de“ned and rede“ned by

the GI community over the years; however, two diagnostic fea-

tures have remained constant. First, IBS has always been a diag-

nosis ofexclusion,that is, the diagnosis is only warranted after

all other gastrointestinal diseases have been ruled out. Second,

none of the de“nitions of IBS have relied on a de“nitive test,

partly because the symptoms are both chronic and intermittent.

Thus, diagnostic criteria have been based on self-report of

symptoms and established patient symptom pro“les (Goldberg

& Davidson, 1997). As you will soon see, the de“nition of IBS

has been “nely tuned to better identify the IBS patient„yet, it is

still highly recommended that a physical examination, sig-

moidoscopy, and blood assays for complete blood count and

erythrocyte sedimentation rate be conducted, as well as an ex-

amination of a stool sample for parasites and occult blood

(Manning, Thompson, Heaton, & Morris, 1978; Talley et al.,

1986) to rule out other disorders prior to making a diagnosis of

IBS. We next trace the progression of the de“nitions of IBS, dis-

cuss the landmark studies supporting the de“nitions to date, and

end with a description of the most recent Rome II criteria.

Clinical Criteria

Originally, IBS was diagnosed according to •Clinical

CriteriaŽ that included recurrent abdominal pain or extreme

abdominal tenderness accompanied by disordered bowel

Preparation of this manuscript was supported in part by a grant from
NIDDK, DK-54211. Requests for further information should be
addressed to either author at: Center for Stress and Anxiety Disor-
ders, 1535 Western Avenue, Albany, NY 12203.