Definitional, Epidemiological, and Assessment Issues 399If we compare IBS patients to IBS nonpatients (those
with symptoms who do not seek treatment), Drossman and col-
leagues (1988) found more negative life events and greater
weighted scores for the IBS nonpatients. Levy and colleagues
(1997) found no such differences. E. J. Bennett and col-
leagues (1998) found a signi“cant relation between the num-
ber of functional GI symptoms (IBS, functional dyspepsia,
etc.) and the number of endured chronic life stressors.
Finally, in 1986, we found higher scores on the Holmes
and Rahe (1967) Social Readjustment Rating Scale (SRRS)
for IBS patients than healthy controls (see Blanchard et al.,
1986), but in 1993, we found no differences on the same scale
when IBS patients were compared to healthy controls
(Schwarz et al., 1993).
Minor Life Stressors and GI Distress
We have begun to look at the role that everyday annoyances
play in the lives of IBS patients. Unfortunately, the literature
in this area is even less complete. IBS patients have not been
compared to other groups in any of the following studies.
In an effort to track symptoms and stress levels, Suls,
Wan, and Blanchard (1994) used a prospective daily diary
and performed an elegant analysis that controlled for prior
symptom levels. They ultimately concluded that daily stress
levels did notincrease IBS symptoms. Dancey and col-
leagues (1995) found similar results, such that an increase in
severity of stress did not occur prior to an increase in IBS
symptom severity. However, they did “nd that an increase in
IBS symptom severity was likely to precedean increase in
patient report of common hassles. Note that neither of these
studies supports the notion that stress causesGI distress;
rather, most of the evidence thus far is consistent with a con-
current relation between stress and GI distress. In addition, to
our knowledge, no study has included GI ”are-ups as a life
stressor, limiting our understanding of what may be evidence
supporting the somatopsychic hypothesis mentioned earlier.
While stress is likely to play some role in the experience
of GI symptoms, it is unlikely to be the only etiological
explanation of IBS.
Role of Sexual and Physical Abuse in IBS
There is an abundance of literature examining the psycho-
logical (Beitchman, Zucker, Hood, 1992; Greenwald,
Leitenberg, Cado, 1990) and somatic (Lechner, Vogel, Garcia-
Shelton, Leichter, & Steibel, 1993; Leserman, Toomey, &
Drossman, 1995) correlates of past abuse in a variety of pain
and other chronic disorders. Studies have demonstrated that
somatization, dissociation, and ampli“cation of symptoms are
common coping methods seen in women who have experi-
enced childhood abuse (Wyllie & Kay, 1993). Leserman and
colleagues (1996) reported that, in general, women with a sex-
ual abuse history reported more pain, more somatic symptoms,
more disability days, more lifetime surgeries, more psycholog-
ical distress, and worse functional disability than healthy con-
trols. Similarly, women with penetration experiences (actual or
attempted intercourse or objects in the vagina) had more med-
ical symptoms and higher somatization scores than less se-
verely abused counterparts (Springs & Friedrich, 1992). Some
investigators have interpreted such “ndings to mean that child-
hood abuse may lead to de“cits in help-seeking, and a ten-
dency to gain attention through the •safe domainŽ of physical
symptoms (Wilkie & Schmidt, 1998). From a physiologic
standpoint, trauma to the genital region may •downregulateŽ
the sensation of visceral nociceptors, increasing sensitivity to
both abdominal and pelvic pain (Mayer & Gebhart, 1994).
Drossman and colleagues (Drossman, Leserman, et al.,
1990) have researched the occurrence of early abuse in the
IBS population and have suggested that female patients with
functional GI disorders report higher levels of early sexual
and physical abuse than comparable female patients with a
variety of organic GI disorders. In this study, 31% of 206 fe-
male GI clinic attendees diagnosed with functional GI disor-
ders reported rape or incest as compared to 18% of those with
organic diagnoses. In both Europe and the United States,
other studies found similar results, with frequencies between
30% and 56% (Delvaux, Denis, Allemand, & French Club of
Digestive Motility, 1997; Scarinci, McDonald-Haile, Brad-
ley, & Richter, 1994; Talley et al., 1995; E. A. Walker, Katon,
Roy-Byrne, Jemelka, & Russo, 1993). Rape (penetration),
multiple abuse experiences, and perceived life-threatening
abuse were associated with the poorest health status
(Leserman et al., 1996). Walker et al. found a greater fre-
quency of history of sexual abuse among IBS patients (54%)
than patients with IBD (5%). In the previously described
Olmstead County Survey study, Talley and colleagues (1994)
also found a signi“cantly greater sexual abuse history among
patients with IBS (43.1%) than in the other groups (19.4%),
and a higher incidence of any abuse (sexual or physical)
among IBS patients (50%) when compared to non-IBS indi-
viduals (23.3%).
Drossman, Talley, Olden, and Barreiro (1995) have sug-
gested that there is a pathway linking childhood abuse and
adult functional GI disorders. Basically, they propose that IBS
patients are physiologically predisposed to manifest GI symp-
toms, especially if they are psychologically distressed. When
the trauma experienced during childhood abuse is added to the
picture, the beginnings of GI symptoms emerge (more specif-
ically, complaints of abdominal pain). When these somatic