396 Irritable Bowel Syndrome
rate of 74%. Of the sample, 195 were excluded because of a
history of psychosis or dementia, 252 were excluded because
they lived in a nursing home, 236 were excluded because
they had an organic medical disease or had undergone major
abdominal surgery. Using the Manning criteria, the authors
found that 17.7% of their sample had IBS, while another
56.6% experienced some GI symptoms. The sample was
41% male (1.44 to 1 ratio), with an average age of 53.
In another landmark study of functional GI disorders,
Drossman and colleagues (1993) used the U.S. Householder
Survey of Functional GI Disorders to ascertain the presence
of one or more functional GI disorders in a strati“ed random
sample of 8,250 U.S. householders. Return rate was 65.8%
(51% female, 96% White). Overall, 69.3% (3,761) respon-
dents reported one or more functional GI disorders, with IBS
being diagnosed (Rome Criteria) in 11.2% (606) of individu-
als. Females outnumbered males again, 1.88 to 1. The survey
further suggested that patients with IBS missed an average of
13.4 days of work or school in the past year because of their
symptoms.
Clearly, IBS is a widespread problem that affects between
19 and 34 million Americans, costs almost $8 billion annu-
ally in medical care, and leads to more than 250 million lost
work days each year. Thus, it continues to be important to re-
search this population to gain a better understanding of the
IBS patient.
Psychological Distress
While the etiology of IBS is not well understood, IBS has
typically been portrayed as a psychosomatic disorder with
some researchers implying that IBS patients are merely •neu-
roticsŽ who focus on their GI symptoms (Latimer, 1983). It
has been fairly well established in the IBS literature that the
individuals who seek treatment for their IBS symptoms tend
to be more psychologically distressed than the general popu-
lation. Folks and Kinney (1992) suggest that up to 60% of a
gastroenterologist•s patients have psychological complaints.
However, literature in this area is mixed. It has not always
been the case that IBS patients appear more psychologically
distressed than other patients with chronic illness. To better
understand this issue, we must look at the psychological dis-
tress in IBS sufferers both dimensionally and categorically.
Dimensional Measures of Distress
Several studies report that IBS patients show more distress
across a variety of psychological measures when they are
compared to groups with organic GI disease (Schwarz et al.,
1993; Talley et al., 1990, 1991; E. A. Walker, Roy-Byrne, &
Katon, 1990), and to healthy controls (Gomborone, Dews-
nap, Libby, & Farthing, 1995; Latimer et al., 1981; Talley
et al., 1990; Toner et al., 1998). However, this is not always
the case.
In 1981, Latimer and colleagues compared IBS patients to
patients with anxiety and mood disorders and found that there
were no signi“cant dif ferences on the Eysenck Personality
Inventory (EPI; Eysenck & Eysenck, 1968) dimensions of
neuroticism or extraversion. In 1995, Gomborone et al. com-
pared IBS patients to (a) patients with in”ammatory bowel
disease (IBD); (b) outpatients with major depression; and
(c) healthy controls. The psychiatric outpatients showed sig-
ni“cantly higher Beck Depression Inventory (BDI; Beck,
Ward, Mendelson, Mock, & Erbaugh, 1961) scores than the
IBS patients, who were signi“cantly higher than either
the IBD patients or healthy controls. Using Kellner•s (1981)
Illness Attitude Scale, both the IBS group and the depressed
outpatients showed more worry about illness, death phobia,
and greater effects of these symptoms than the other two
groups, with the IBS patients exhibiting the highest levels of
hypochondriacal beliefs and disease phobia.
In 1987, Blanchard and colleagues found that treatment-
seeking IBS patients were signi“cantly more depressed and
anxious, as measured by the Hamilton Scales (Hamilton,
1959, 1960), than either IBD patients or healthy controls
who did not differ. In 1990, Toner et al. found no differences
in BDI scores between depressed outpatients and IBS
patients. In another study, IBS patients were compared with
tension and migraine headache sufferers (a group also pur-
ported to have elevated psychological distress) on measures
of depression and anxiety (Blanchard et al., 1986). On the
BDI, both tension and migraine sufferers scored higher than
normal controls, while the IBS patients scored higher than all
three groups. On the State-Trait Anxiety Inventory (STAI;
Speilberger, 1983), similar “ndings emer ged, except that no
signi“cant dif ferences were revealed among the IBS and
tension headache groups. IBS sufferers also scored higher
than all three groups on the F scale of the Minnesota
Multiphasic Personality Inventory (MMPI; Hathaway &
McKinley, 1951). Only the IBS and migraine group differed
on the Life Events Survey (LES; Sarason, Johnson, & Siegel,
1978). This comparison of IBS patients to chronic headache
sufferers is extremely important because it suggests that a
pattern exists between •neuroticismŽ and psychosomatic dis-
orders, in general, rather than being speci“c to IBS.
Latimer et al. (1981) found that IBS patients scored sig-
ni“cantly higher on the STAI-Trait and BDI when compared
to normal controls. When we consider the Albany studies,
conducted over the past 15 years at our Center, BDI mean
scores are consistent with those of patients who are mildly