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ORIGINAL ARTICLE Table of Contents   
Year : 2007  |  Volume : 13  |  Issue : 4  |  Page : 168-171
Personality characteristics and irritable bowel syndrome in Shiraz, Southern Iran


1 Department of Psychiatry, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
2 Gastroenterohepatology Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran

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Date of Submission23-Dec-2006
Date of Acceptance18-Jun-2007
 

   Abstract 

Background/Aims: Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder, and its definite etiology is still unclear. It has been shown that personality characteristics can affect the disease presentation and attitude of patient toward symptoms. This study was undertaken to evaluate the personality characteristics in patients with IBS in Shiraz, southern Iran. Materials and Methods: In a cross-sectional study, the personality characteristics of 60 patients with IBS and 55 healthy persons were compared using Minnesota II Multiphasic Personality Inventory (MMPI-2). The cases were selected from patients who were referred to the Mottahari clinic affiliated to the Shiraz University of Medical Sciences. Results: The patients recorded the highest scores on the hypochondriasis and psychoasthenia scales. The scores of the patient on the scales of lie, infrequency, hypochondriasis, depression and hysteria showed significant elevation in comparison to those of the control group. Furthermore, the scores on clinical scales in male subjects were higher for psychopathic-deviate, paranoia and social introversion scales in comparison to the males in the control group. Female subjects recorded lower scores on the social introversion scale in comparison to the females in the control group. Male subjects also recorded a higher score on the psychopathic-deviate, paranoia, psychoasthenia and social introversion scales in comparison to females. Female subjects had a relatively higher score on the masculinity/feminity scale. Based on the clinical interview using DMS-IV criteria, the most prevalent symptoms were anxiety and depression in patients with IBS. Conclusion: Due to the high prevalence of anxiety and depression in patients with IBS, psychotherapy and pharmacotherapy of these patients is recommended.

Keywords: Anxiety, depression, irritable bowel syndrome, personality characteristics, Southern Iran

How to cite this article:
Mousavinasab SM, Gorganinezhad-Moshiri M, Saberifirouzi M, Dehbozorgi G, Mehrabani D. Personality characteristics and irritable bowel syndrome in Shiraz, Southern Iran. Saudi J Gastroenterol 2007;13:168-71

How to cite this URL:
Mousavinasab SM, Gorganinezhad-Moshiri M, Saberifirouzi M, Dehbozorgi G, Mehrabani D. Personality characteristics and irritable bowel syndrome in Shiraz, Southern Iran. Saudi J Gastroenterol [serial online] 2007 [cited 2019 Jul 16];13:168-71. Available from: http://www.saudijgastro.com/text.asp?2007/13/4/168/36746


Irritable bowel syndrome (IBS) is the most common chronic gastrointestinal disorder and the seventh most common disease among all the outpatient diseases. [1] In spite of the primary reports on the low prevalence of this syndrome in Iran, some studies consider this syndrome as a common disorder in Iran. [2],[3],[4] Annually, around 3,500,000 medical visits, 2,200,000 prescriptions and 35,000 admissions in USA were due to IBS. [5] Based on various studies, each year this disease results in a huge loss of working days for the patients, with a resultant estimated economic burden between 1.6 billion to 40 billion dollars annually. [6]

Irritable bowel syndrome is a gastrointestinal system disorder characterized by changes in bowel motility and abdominal pain in the absence of unrecognizable physical disorders. [7] The definite cause of the disease is not yet clear; however, hyperalgesia (decreased pain threshold), abnormal intestinal motility and psychosocial factors are considered in the etiology of this disorder. [8] Recent community-based studies showed a large number of individuals suffering from IBS, although few patients seek health care. [5] These studies suggest that personality and psychological characteristics of individuals who refer to a physician differ in terms of health behavior in comparison to those who do not. Nowadays, in the field of internal medicine, particular attention has been given to personality characteristics for the people seeking health care. [9] Personality characteristics affect many psychiatric and medical disorders; therefore, in the diagnosis and treatment of psychotic and psychosocial problems, these should be considered in planning and monitoring of the disease. [10] Most case-control studies on personality patterns and stressful life events in life in relation to the behavior of patients suffering from IBS showed that these patients are more anxious, depressed, nervous and psychotic. [11] This study was conducted to determine the personality characteristics in patients with IBS during the planning of therapeutic modalities for these patients.


   Materials and Methods Top


In a cross-sectional study, the personality characteristics of individuals with IBS were determined. The study group was recruited from Mottahari Clinic affiliated to Shiraz University of Medical Sciences. Sixty consecutive patients fulfilling the Rome II diagnostic criteria for IBS [7] were recruited as the study group. Selected patients experienced abdominal pain for at least 12 weeks in the past 12 months (not necessarily continuous), which was accompanied by at least two of the following signs:

  1. Increase in pain with bowel movements.
  2. Change in the frequency of bowel movements.
  3. Change in the stool consistency.


Patients older than 40 years were excluded from the study as endoscopy was required to reject neoplastic etiologies.

A psychiatric interview based on DMS-IV criteria was performed for both the groups to determine the disorder axis of IBS. The Minnesota II Multiphasic Personality Inventory (MMPI-2) is currently the most commonly employed standardized cytometric test for emotional adjustment and personality status. The instrument consists of four validity scales of: lie (L), infrequency (F) and correction (K) scales. It has the following 10 clinical scales: hypochondriasis (H), depression (D), hysteria (Hy), psychopathic-deviate (Pd), masculinity/feminity (MF), paranoia (Pa), psychoasthenia (Pt), schizophrenia (SF), hypomenia (Ma) and social introversion (Si) scales. These scales were used to determine the personality characteristics of patient and control groups. [12] It was translated into Persian by Mootabi et al. and the validity and reliability of the questionnaire were confirmed. [13] To answer MMPI-2, subjects were expected to be over 18 years of age and must have completed the 8 th grade of schooling.

Data were analyzed in relation to sex using SPSS software version 11.5 by Anova, Chi Square and t tests. A P value of less than 0.05 was considered to be significant.


   Results Top


The mean age of the control group was 27.26▒6.55 years and that of the study group was 28.80▒6.53 years. No significant differences were observed between the two groups (P=0.35). Moreover, there were no significant differences between the two groups in relation to marital status, occupation and income. The majority of individuals were in high-school educational level (35 subjects, 30.4%) and 1 subject (0.9%) was in the university educational level. The mean duration of the disease was 5.31 years in the age group of 2-22 years old.

Based on the clinical interview to determine the psychiatric disorders, patients with IBS had the maximum level of anxiety; generalized anxiety disorder was observed in 14 individuals (23.3%) and social phobia was found in 11 subjects (18.3%). Among the mood disorders, the most common ones were dysthymia in 12 individuals (20%) and mild forms of major depression disorder in eight persons (11.6%).

The score of the patients group on the frequency and lie scales was higher in comparison to the control group and was statistically significant (P<0.05).

Study group patients had a higher significant score on the clinical scales of psychopathic, depression and hysteria in comparison to the control group [Table - 1]. Comparison of the T scores of males between the patient and control groups showed that males in the study group had a higher score on the infrequency, depression, hypochondriasis, hysteria, psychopathic-deviation, paranoia and social introversion scales, which were statistically significant (P<0.05). Comparison of the T scores between the females of the patients and the control groups showed that those in the study group had a higher score on the depression, hypochondriasis and hysteria sclaes, which were statistically significant (P=0.01). In addition, the females in the study group had lower scores on the social introversion scale as compared with the control group, which were statistically significant (P=0.03). Comparison of T score between the female and male patients showed that male patients had significantly higher scores on the F scale of infrequency, psychopathic-deviation, paranoia psychoasthenia and social introversion scales, which was statistically significant (P<0.05). In masculinity/feminity scale, females had a higher score than males, which was statistically significant (P=0.0001).


   Discussion Top


In our study, anxiety and depression were the most prevalent signs (axis I disorders in patients with IBS). Similar findings were reported by other researchers. [14],[15],[16],[17] According to the results of MMPI-2, the higher score of patients was related to the hypochondriasis scale followed by psychoasthenia hypochondriasis, depression and hysteria scales. Similar findings were obtained in other studies. [18],[19] The high score for the hypochondriasis scale (T>60), indicates severe psychological factors in the study group, showing their anxiety with regard to their physical health. The high score on the psychoasthenia scale indicates a high level of anxiety and reflects obsessive compulsive personality in the study group.

In addition, the difference of the scores between the subjects and the controls on the depression and hysteria scales reveals particular traits including depression, lowered self-esteem and use of hysteric defense mechanisms in the patients with IBS.

Our results showed that males in the study group had higher scores on the psychopathic-deviate scale of psychosocial deviation in comparison to the males and females in the control group. The study group recorded a high score on the social introversion scale, which reflects that they are more isolated. These patients also recorded a relatively higher score for psychopathic deviation showing that these results do not indicate an antisocial personality disorder. They may demonstrate a dissatisfaction with life, familial and sexual problems and difficulties with the authorities. In our community, intrapersonal sensitivity, anxiety and introversion were found to be greater in males. Female patients recorded higher scores on masculinity/feminity scale in comparison to males in the patients group, which is a sign of traditional feminine rejection and probable anxiety and sexual problems in female patients.

With regard to the results of this study and the possible unavailability of a similar study in a larger population elsewhere, it is suggested that psychotherapy and pharmacotherapy should be considered in the overall evaluation and management of patients with IBS.


   Acknowledgment Top


We would like to thank the Office of Vice Chancellor for Research of Shiraz University of Medical Sciences for financial support and Center for Development of Clinical Research of Nemazee Hospital for statistical and typing assistance.

 
   References Top

1.William L, Hasler WL, Chung-Owyan G. Irritable bowel syndrome. In: Yamad T, Kaplowitz N, Alpers D, editors. Textbook of Gastroenterohepatology. 4 th ed. Lippincott Willams and Walkins Co: Philadelphia; 2003. p.1817-38.  Back to cited text no. 1    
2.Bagheri-Lamkarani K, Malek-Makani L, Nami N. A Survey on diagnostic and treatment methods of irritable bowel syndrome undertaken by general physicians in Shiraz, southern Iran. Govaresh 2002;39:76.  Back to cited text no. 2    
3.Ghannad K, Emami R, Bashashati M, Tarrahi MJ, Attarian S. Irritable bowel syndrome: An epidemiological study from the west of Iran. Indian J Gastroentrol 2005;24:225-6.  Back to cited text no. 3    
4.Massarrat S, Saberi-Firoozi M, Solemani A, Himmelmann GW, Hitzges M, Keshavarz H. Peptic ulcer disease, irritable bowel syndrome and constipation in two populations in Iran. Eur J Gastroentrol Hepatol 1995;7:427-33.  Back to cited text no. 4    
5.Locke R. Natural history of irritable bowel syndrome and durability of the diagnosis. Rev Gastroentrol Disord 2003;3:12-4.  Back to cited text no. 5    
6.Bagheri-lankarani K, Kidjori J, Taghavi SA. Irritable bowel syndrome: Clinical manifestations and relation to lactase deficiency. Irn J Med Sci 1997;22:20-5.  Back to cited text no. 6    
7.Fock KM, Chew CN, Try LK, Peh LH, Chan S, Pang EP. Psychiatric illness, personality traits and the irritable bowel syndrome. Ann Acad Med Singapore 2001;30:611-4.  Back to cited text no. 7    
8.Fogel BS, Stoudemir A. Personality disorders in the medical setting. In: Greenberg DB, Fogel BS, editors. Psychiatric care of the medical patient. 2 nd ed. Oxford University Press: New York; 2000. p. 443-58.  Back to cited text no. 8    
9.Svrakic DM. Coninger C. Personality disorders. In: Sadock BJ, Sadock VA, Kaplan and Sadok's comprehensive textbook of psychiatry. 8 th ed. Lippincott Williams and Wilkins: Philadelphia; 2000. p. 443.  Back to cited text no. 9    
10.Herschbach P, Henrich G, von Rad M. Psychological factors in functional gastrointestinal disorders: Characteristics of the disorder or of the illness behavior? Psychosom Med 1999;61:148-53.  Back to cited text no. 10    
11.Hersen M, Bellack AS. Dictionary of behavioral assessment techniques. Pergamon Press: 1988. p. 302-5.  Back to cited text no. 11    
12.Mootabi F, Shahrami E. Psychometric characteristics of MMPI-2 in apparently healthy population in Tehran, Iran. Mater thesis for clinical psychology, Iran University of Medical Sciences, Tehran, Iran.  Back to cited text no. 12    
13.Goldberg J, Davidson P. A biopsychosicial understanding of the irritable bowel syndrome: A review. Can J Psychiatry 1997;42:835-40.  Back to cited text no. 13    
14.Hazlett-Stevens H, Craske MG, Mayer EA, Chang L, Naliboff BD. Prevalence of irritable bowel syndrome among university students the role of worry, neuroticism, anxiety sensitivity and visceral anxiety. J Psychosom Res 2003;55:501-5.  Back to cited text no. 14    
15.Blanchard EB, Keefer L, Galovski TE, Taylor AE, Turner SM. Gender differences in psychological distress among patient with irritable bowel syndrome. J Psychosom Res 2000;50:271-5.  Back to cited text no. 15    
16.Schuste MM. Diagnostic evaluation of the irritable bowel syndrome. Gastroentrol Clin North Am 1991;20:269-78.  Back to cited text no. 16    
17.Weinryb RM, Osterberg E, Blomquist L, Hultcrantz R, Krakau I, Asberg M. Psychological factors in irritable bowel syndrome: A population-based study of patients, non patients and controls. Scand J Gastroentrol 2003;38:503-10.  Back to cited text no. 17    
18.Tally NJ, Phillips SF, Bruce B, Twomey CK, Zinsmeister AR, Melton LJ 3 rd . Relation among personality and symptoms in nonulcer dyspepsia and the irritable bowel syndrome. Gastroenterology 1990;99:327-33.  Back to cited text no. 18    
19.Tanum L, Malt UF. Personality and physical symptoms in nonpsychiatric patients with functional gastrointestinal disorder. J Psychosom Res 2001;50:139-46.  Back to cited text no. 19    

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Correspondence Address:
Seyed M Mousavinasab
Department of Psychiatry, School of Medicine, Shiraz University of Medical Sciences, Shiraz
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-3767.36746

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