Handbook of Psychology

400 Irritable Bowel Syndrome

symptoms are reinforced via attention and nurturance, a
process of symptom ampli“cation and illness behavior lead to
the development of an IBS patient. It is unlikely that early
abuse forms a direct pathway to IBS„given that not all peo-
ple who are abused develop IBS, and not all IBS patients have
been abused. However, abuse may be associated with the
communication of psychological distress through somatic
symptoms (Drossman et al., 1995; Drossman, 1997).
As with almost all other research with IBS, the results are
not always consistent when it comes to abuse. Talley, Fett,
and Zinsmeister (1995) found no signi“cant dif ferences on
total physical and sexual abuse among those with functional
GI disorders and those with organic GI disorders. Drossman
and colleagues (1997) also failed to “nd signi“cant dif fer-
ences between functional and organic GI patients on presence
of sexual or physical abuse.
However, we must keep in mind that high frequencies of
sexual and physical abuse may not be unique to the irritable
bowel syndrome. Rather, abuse rates approaching 50% have
been reported by patients with other types of chronic or re-
current pain disorders, including headaches, “bromyalgia,
and chronic pelvic pain (Laws, 1993; Leserman et al., 1995).
For now, members of the GI community accept that there is a
high incidence of early abuse in the histories of GI patients,
both those with functional and organic disease.
Without a doubt, the presence of abuse and IBS make the
symptoms more refractory to treatment than usual, and may
also increase the likelihood of psychological disturbance
(Drossman et al., 2000). Further, Drossman et al. (2000)
states that

Abuse or associated dif“culties may: 1) lower the threshold of

gastrointestinal symptom experience or increase intestinal motil-

ity; 2) modify the person•s appraisal of bodily symptoms (i.e., in-

crease medical help seeking) through inability to control the

symptoms; and 3) lead to unwarranted feelings of guilt and re-

sponsibility, making spontaneous disclosure unlikely (p. 178).

It is also important to clarify the role that abuse plays in the
experience of GI distress especially when one is considering
the psychopathology often seen in treatment-seeking IBS pa-
tients. In an attempt to discern whether IBS patients who have
been abused are the same group of IBS patients with diagnos-
able psychopathology, we examined a population of 71 (57
female, 14 male) IBS patients seeking psychological treat-
ment at our center (Blanchard, Keefer, Payne, Turner, &
Galovski, 2002). While we found expected levels of child-
hood sexual and physical abuse (57.7%) and expected levels
of current Axis I psychiatric disorders (54.9%) in the sample,
contrary to our expectations, there were nosigni“cant associ-
ations between early abuse and current psychiatric disorder in

this population (Blanchard et al., 2002). These “ndings sug-

gest that those individuals with psychological distress are not

exactly the same group with a history of abuse. These “ndings

have important implications with respect to treatment.

General Comments

We have summarized the literature to date on IBS, with a

speci“c focus on psychosocial factors of assessment. When

diagnosing and assessing IBS, it is important to consider, in

addition to de“nitional and epidemiological issues, the possi-

ble role of psychological distress, treatment-seeking factors,

and the role of stress and early abuse in the manifestation of

IBS symptoms. Such factors may be important to address in

treatment, which we will discuss later in this chapter. Now,

we turn to a possible developmental precursor to IBS„

recurrent abdominal pain.

RECURRENT ABDOMINAL PAIN IN CHILDREN

While many patients describe GI distress dating back to their

childhood, IBS is not usually a diagnosis associated with

children and younger adolescents. There is, however, a func-

tional GI disorder that does occur in childhood that may have

some bearing on a future diagnosis of IBS„recurrent ab-

dominal pain (RAP). Apley and Naish (1958) proposed the

most commonly used de“nition of RAP: three episodes of

pain occurring within three months that are severe enough to

affect a child•s activities and for which an organic explana-

tion cannot be found.

Prevalence

RAP may be the most common recurrent pain problem of

childhood. It is usually recognized in children older than 6

years (Wyllie & Kay, 1993). Faull and Nicol (1986) found a

prevalence of almost 25% in an epidemiological study of 439

5- and 6-year-olds in northern England. A much earlier study

(Apley & Naish, 1958) reported a prevalence rate of 11%

among 1,000 children from primary and secondary schools.

Typically, the peak age for RAP is between 11 and 12 years

of age (Stickler & Murphy, 1979). With respect to gender, re-

sults are mixed. Faull and Nicol (1986) found equivalent

prevalence among 5- and 6-year-olds, but Apley and Naish

(1958) and Stickler and Murphy (1979) reported a higher in-

cidence among girls, much like that of adulthood IBS.

RAP sufferers miss several school days per year (Bury,

1987; Robinson, Alverez, & Dodge, 1990) and make frequent

visits to the pediatrician. P. A. McGrath (1990) estimates that