# Emotional abuse and IBS



## eric (Jul 8, 1999)

FYI:The Relationship Between IBS and Emotional Abuse: The Relationship Between the Media and Investigators From: USA Today, January 31, 2000Title: Irritable bowel syndrome begins with the pastBy: Maribel Villalva, USA TODAYLead Paragraph: The cause of irritable bowel syndrome has baffled doctors over time, but astudy's authors suggest that the digestive disorder is symptomatic of emotional abuse. The Relationship Between IBS and Emotional Abuse: The Relationship Between the Media and Investigators Commentary - Douglas A. Drossman, M.D. February 8, 2000Some of you may have noticed the growing attention by the media toward articles and stories onirritable bowel syndrome (IBS). On January 31, USA Today posted two articles: one relating toKelsey and Camille Grammer's support for educating the public on IBS, and the other relating toan article, soon to be published, that shows an association between emotional abuse and IBS. Ingeneral, studies that evaluate the role of life stress, including psychological diagnoses and abusehistory are difficult to perform, and are very susceptible to miscommunication andmisinterpretation. It is because the opening statements of the USA Today article were inaccurateand misleading, and because readers may then misunderstand the intended scientific message,that I would like to provide my perspective on this issue.Dr. Alisha Ali in Toronto performed the research study under the direction of Dr. Brenda Toner,who is director of Women's Mental Health at the University of Toronto, and an internationalauthority on Women's Health issues and irritable bowel syndrome. The study looked at thefrequency of emotional abuse (e.g., psychological maltreatment) as well as other psychosocialfactors among women seen by gastroenterologists at a referral medical center who carried adiagnosis of IBS or inflammatory bowel disease (ulcerative colitis or Crohn's disease). Theauthors found that there was a higher frequency of abuse and psychosocial factors in the womenwith IBS than those with inflammatory bowel disease, and that this did not relate to otheremotional factors like depression. This is an important study to begin to sort out the role forpsychological and social factors in affecting health in women with IBS.The title of the USA Today article was: "Irritable Bowel Syndrome begins with the past." Theopening statement was: "The cause (emphasis added) of irritable bowel syndrome has baffleddoctors over time, but a study's authors suggest that the digestive disorder is symptomatic ofemotional abuse." These statements are not only inaccurate, but they reflect a failure to conveythe authors' intended message. It is clearly stated by the study's authors in their article that: 1) ". .. we cannot infer causality . . . and we are not able to conclude that any form of abuse precedesIBS symptoms," and that 2) " . . . the investigation included only patients seen in tertiary settings(i.e., at a medical center where more difficult medical presentations are seen or referred) . . .and therefore may be associated with health care seeking rather than IBS per se."These are important qualifications. Furthermore, from our previous research that evaluated theinfluence of sexual and physical abuse on women with gastrointestinal disorders, we found thatabuse leads to poorer health and greater health care utilization, and this is true for anygastrointestinal diagnosis. In other words, abuse doesn't cause these disorders, but if it exists ina woman who also has IBS (or any gastrointestinal diagnosis), it makes the condition worse. Itmay lead to a lower pain threshold, or more difficulty coping with the disorder, and therefore anincreased need to get help from physicians, eventuating in more doctors visits. So, of course, at areferral medical center, we would expect to see more women with histories of abuse, becausetheir symptoms are much harder to manage. From other studies we know that the frequency ofphysical and sexual abuse is higher among women in referral centers than in primary care or thecommunity in general, and the same may also be true for women with emotional abuse.The growing attention of the media toward IBS and other functional GI disorders is a"double-edged sword." It can increase public awareness, and ultimately influence funding forresearch to better understand and treat patients with these disorders. In that regard, the researchby Drs. Ali and Toner suggests to me the importance of psychological methods likecognitive-behavioral treatment that can help women with more severe symptoms associated withpsychological and social factors gain the confidence to better self-manage their medicalcondition. On the other hand, reporters who write articles for the general public have aresponsibility to accurately convey the information. If not, their errors may adversely influenceour efforts to raise public consciousness and financial support for research about IBS and otherfunctional GI disorders. Douglas A. Drossman, M.D. Co-Director, UNC Center for Functional GI and Motility Disorders University of North Carolina at Chapel Hill------------------ http://www.ibshealth.com/ www.ibsaudioprogram.com


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## JeanG (Oct 20, 1999)

This is a very interesting and useful article, Eric. I have been suspicious of the media for jumping on the bandwagon with IBS and whatever current research is, and twisting the results. Dr. Drossman shows here how easily it is to do.I am not a big fan of the media, in any case. I quit watching tv years ago because of all the extra hype. I read newspapers now and do my own research. It still doesn't always guarantee accuracy, but at least I am not influenced by the voices, faces, etc. of the commentators on tv.Ok, off my bandwagon now.







JeanG


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## Mike NoLomotil (Jun 6, 2000)

Res Ipsa Loquiter.There is without a doubt a clear subset of IBS victims whose stress/anxiety component is exacerbated by emotional and subconscious adaptive responses to abuse of several types.I have had the unhappy exeperience of working with many of these infortunate patients.In a primary care setting, it is common to examine (esp. among females) patients whose disease process has been exacerbated by issues with spouse, family and friends, and that many of these unfortunate patients require therapy for the physiologic effects of these behavioral issues. As we know there are several effective ways of providing this.I did persoanlly find the suggestion, when I originally read all the referenced material, that suggested one could infer the origins of IBS to be this source, to be another of theose where one does a "LOL x 10" reflexively. MNL__________________ www.leapallergy.com


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