398 Irritable Bowel Syndrome
complaints) using the MMPI and the McGill Pain Question-
naire (MPQ; Melzack, 1975). The IBS patients were
signi“cantly more distressed on measures of depression,
somatization, and anxiety than their nonpatient counterparts.
In addition, IBS patients complained of more severe and fre-
quent pain. However, Drossman and colleagues (1988) re-
sults have not been replicated in later studies.
There is evidence that the two groups, in general, do not
differ on measures of psychological distress. For example,
one study (Whitehead, Burnett, Cook, & Taub, 1996) divided
a large group of college undergraduates into (a) students who
met Manning Criteria for IBS and had seen a physician for
their symptoms in the past year (n84); (b) students
who met Manning Criteria for IBS but did not see a physician
in the past year (n 165); and (c) Nonsymptomatic controls
(n122). All groups completed the NEO Personality
Inventory (Costa & McCrae, 1985) as a measure of neuroti-
cism, the Global Symptom Index (GSI) from the SCL-90
(Derogatis, Lipman, & Covi, 1973) as a measure of overall
psychological distress, and the Short Form-36 (Ware, 1993),
a measure of quality of life.
First, the IBS patients and nonpatients did not differ from
one another on measures of neuroticism, overall psychologi-
cal distress, or on the mental health subscale of the SF-36.
However, both groups yielded scores signi“cantly higher
than the normal controls. However, the IBS patients appeared
to be more poorly functioning than the IBS nonpatients,
when subscales of the SF-36 were examined.
Another study used Rome Criteria to identify IBS patients
and IBS nonpatients in a sample of 905 college students
(Gick & Thompson, 1997). The STAI (Speilberger, 1983)
was administered to a portion of these participants, who were
matched on gender, and a group of non-GI disordered con-
trols. The two IBS groups were more trait anxious than the
controls, but did not differ from one another.
It is hard to draw “rm conclusions from these various
studies because the measures and samples used are not
the same across studies. Many IBS patients do tend to present
with some sort of psychological distress, and for that reason,
psychological treatment may be bene“cial. However, there is
some speculation that the severity of symptoms may be
the underlying factor among differences between patients and
nonpatients. This remains an important research question.
The Role of Life Stress
For many people, gastrointestinal symptoms develop during
moments of stress and anxiety (Maunder, 1998). While the
etiology of IBS remains unknown and understudied, psy-
chosocial stress is thought to play a key role in the onset,
maintenance, and severity of GI symptoms. Many health care
clinicians and IBS patients believe that stress exacerbates
their symptoms (Dancey & Backhouse, 1993; Dancey,
Whitehouse, Painter, & Backhouse, 1995), and many even
report that stress causestheir symptoms (Drossman et al.,
1982). IBS has conventionally been considered a good exam-
ple of a psychosomatic disorder, in which stress leads to so-
matic complaints (Whitehead, 1994). In a study comparing
IBS sufferers with continuous symptoms to IBS sufferers
who have symptom-free periods, Corney and Stanton (1990)
found that over half in the latter group attributed the recur-
rence of symptoms to stressful experiences. More than half of
the patients in both groups linked the initial onset of GI
symptoms to a speci“c stressful situation. Unfortunately,
these studies relied on retrospective data.
Historically, researchers have struggled with the particular
question of whether (a) stress leads to the symptoms (psy-
chosomatic hypothesis) or (b) the presenceof GI symptoms
creates stress for the IBS patient (somatopsychic hypothesis).
There are two main ways to look at the role of stress in the
IBS patient•s life. First, we can examine the presence of
major life events as they relate to symptoms using:1.The Social Readjustment Rating Scale (SRRS; Holmes &
Rahe, 1967), in which major life events in the preceding
year are weighted relative to their stressfulness, and
2.The Life Experiences Survey (LES; Sarason et al., 1978),
in which the individual•s appraisal of the stressful situa-
tion is taken into account.Another way of examining the role of stress in the onset
and maintenance of IBS is to look at the build-up of smaller,
everyday stressful events. In this case, the Daily Hassles and
Uplifts Scale (Kanner, Coyne, Schaefer, & Lazarus, 1981),
which acknowledges the stressfulness of minor annoyances
in everyday life, and the Daily Stress Inventory (Brantley &
Jones, 1989), a weekly form that patients rate the occurrence
and impact of 57 stressful events on a daily basis, are useful.Major Life Events and GI DistressWith respect to research on the occurrence of major life
events, there are few consistent results. When IBS patients
were compared to healthy controls, four studies found a
greater number of stressful life events in the IBS sample
(Blanchard et al., 1986; Drossman et al., 1988; Mendeloff,
Monk, Siegel, & Lillienfeld, 1970; Whitehead, Crowell,
Robinson, Heller, & Schuster, 1992). On the contrary, two
studies (Levy, Cain, Jarrett, & Heitkemper, 1997; Schwarz
et al., 1993) did not “nd these same dif ferences.