Abstract
This study tested a preliminary model of the role of dissociation and somatization in linking abuse to irritable bowel syndrome (IBS). Outpatients with IBS (N = 64) or bowel symptoms explained by physical disease (N = 61) completed questionnaires to assess recollections of abuse as children or adults and current dissociation, somatization, and emotional distress. By comparison with physically diseased patients, patients with IBS recalled more sexual abuse as children and adults, more physical abuse as children, and more psychological abuse as adults. They were more anxious and depressed, and somatized and dissociated more. Analyses indicated a causal chain linking, in turn, abuse, dissociation, somatization, and IBS. The results are consistent with a model in which childhood abuse is linked to IBS because it causes a tendency to dissociate, and because dissociation causes a general increase in physical symptoms. Future research should identify factors that explain why a generally increased level of physical symptoms should, in some patients, lead specifically to IBS.
Similar content being viewed by others
References
Ali, A., Toner, B. B., Stuckless, N., Gallop, R., Diamant, N. E., Gould, M. I., and Vidins, E. I. (2000). Emotional abuse, self-blame, and self-silencing in women with irritable bowel syndrome. Psychosom. Med. 62: 76–82.
Arnold, R. P., Rogers, D., and Cook, D. A. G. (1990). Medical problems of adults who were sexually abused in childhood. BMJ 300: 705–708.
Atlas, J. A., Wolfson, M. A., and Lipschitz, D. S. (1995). Dissociation and somatisation in adolescent inpatients with and without a history of sexual abuse. Psychol. Rep. 76: 1101–1102.
Barsky, A. J., and Borus, J. F. (1999). Functional Somatic Syndromes. Ann. Intern. Med. 130: 910–921.
Bass, C., Bond, A., Gill, D., and Sharpe, M. (1999). Frequent attenders without organic disease in a gastroenterology clinic: Patient characteristics and health care use. Gen. Hosp. Psychiatry 21: 30–38.
Bernstein, C. R., and Putnam, F. W. (1986). Development, reliability and validity of a dissociation scale. J. Nerv. Ment. Dis. 174: 727–735.
Boyce, P., Gilchrist, J., Talley, N. J., and Rose, D. (2000). Cognitive-behaviour therapy as a treatment for irritable bowel syndrome: A pilot study. Aust. NZ J. Psychiatry 34: 300–309.
Briere, E. J., and Runtz, M. (1988). Differential adult symptomatology associated with three types of child abuse histories. Child Abuse Negl 4: 357–364.
Creed, F. (1992). Relationship of non-organic abdominal pain to psychiatric disorder and life stress. In Creed, F., Mayou, R., and Hopkins, A. (Eds.) Medical Symptoms Not Explained by Organic Disease, Royal College of Psychiatrists and Royal College of Physicians of London, London, pp. 9–16.
Deary, I. J. (1999). A taxonomy of medically unexplained symptoms. J. Psychosom. Res. 47: 51–59.
Derogatis, L. R., Lipman, R. S., Rickells, K., Ulenhuth, E. H., and Covi, I. (1974). The Hopkins Symptom Checklist [HSCL]: A self-report symptom inventory. Behav. Sci. 19: 1–15.
Drossman, D. A., Creed, F. H., Olden, K. W., Svedlund, J., Toner, B. B., and Whitehead, W. E. (1999). Psychosocial aspects of the functional gastrointestinal disorders. Gut 45(Suppl II): II25–II30.
Drossman, D. A., Lesserman, J. S., Nachman, G., Zhiming, L. I., Gluck, H., Toomey, T. C., and Mitchell, M. C. (1990). Sexual and physical abuse in women with functional or organic gastrointestinal disorders. Ann. Intern. Med. 113: 828–833.
Drossman, D. A., Li, Z., Leserman, J., Toomey, T. C., Yuming, J. B., and Hu, Y. J. B. (1996). Health status by gastrointestinal diagnosis and abuse history. Gastroenterology 110: 999–1007.
Drossman, D. A., McKee, D. C., Sandler, R. S., Mitchell, C. M., Cramer, E. M., Lowman, B. C., and Burger, A. L. (1988). Psychosocial factors in the irritable bowel syndrome. A multivariate study of patients and nonpatients with irritable bowel syndrome. Gastroenterology 95: 701–708.
Engel, C. C., Walker, E. A., and Katon, W. J. (1996). Factors related to dissociation among patients with gastrointestinal complaints. J. Psychosom. Res. 40: 643–653.
Farley, M., and Keeney, J. (1997). Physical symptoms, somatisation and dissociation in women survivors of childhood sexual assault. Women Health 25: 33–45.
Fry, R. (1993). Adult physical illness and childhood sexual abuse. J. Psychosom. Res. 37: 89–103.
Golding, J. M. (1999). Sexual assault history and headache: Five general population studies. J. Nerv. Ment. Dis. 187: 624–629.
Green, B., and Blanchard, E. B. (1994). Cognitive therapy for irritable-bowel syndrome. J. Consult. Clin. Psychol. 62: 576–582.
Guthrie, E., Creed, F., Dawson, D., and Tomenson, B. (1991). A controlled trial of psychological treatment for the irritable bowel syndrome. Gastroenterol. 102: 739–740.
Guthrie, E., Creed, F., Dawson, D., and Tomenson, B. (1993). A randomised controlled trial of psychotherapy in patients with refractory irritable bowel syndrome. Br. J. Psychiatry 163: 315–321.
Haster, W. L., and Owyang, C. (1995). Irritable bowel syndrome. In Yamada, T.(Ed.), Textbook of Gastroenterology, 2nd ed., Lippincott, Philadelphia, pp. 1832–1855.
Heymann-Monnikes, I., Arnold, R., Florin, I., Herda, C., and Melfsen, S. (2000). The combination of medical treatment plus multicomponent behavioral therapy is superior to medical treatment alone in the therapy of irritable bowel syndrome. Am. J. Gastroenterology 95: 981–994.
Hu, L. T., Bentler, P. M., and Kano, Y. (1992). Can test statistics in covariance structure analysis be trusted? Psychol. Bull. 112: 351–362.
Kent, A., Waller, G., and Dagnan, D. (1999). A greater role of emotional than physical or sexual abuse in predicting disordered eating attitudes: The role of mediating variables. Int. J. Eat. Dis. 25: 159–167.
Kennerley, H. (1996). Cognitive therapy of dissociative symptoms associated with trauma. Br. J. Clin. Psychol. 35: 325–340.
Kroenke, K., and Swindle, R. (2000). Cognitive–behavioral therapy for somatization and symptom syndromes: A critical review of controlled clinical trials. Psychother. Psychosom. 69: 205–215.
Latimer, P. R. (1981). Irritable bowel syndrome: A behavioural model. Behav. Res. Ther. 19:475–483.
Leserman, J., Drossman, D. A., Tooney, T. C., Nachman, G., and Glogan, L. (1996). Sexual and physical abuse history in gastroenterology practice: How types of abuse impact health status. Psychosom. Med. 58: 4–15.
Levis, D. J. (1991). A clinician's plea for a return to the development of non-human models of psychopathology: New clnical observartions in need of laboratory study. In Denny, M. R. (Ed.), Fear, Avoidance and Phobias: A Fundamental Analysis, Erlbaum, Hillsdale, NJ, pp. 395–427.
Manning, A. P., Thompson, W. G., Heaton, K. W., and Morris, A. F. (1978). Toward a positive diagnosis of the irritable bowel. BMJ 2: 653–654.
Maynes, L. C., and Feinauer, L. L. (1994). Acute and chronic dissociation and somatized anxiety as related to childhood sexual abuse. Am. J. Fam. Ther. 22: 165–175.
Merckelbach, H., and Muris, P. (2001). The causal link between self-reported trauma and dissociation: A critical review. Behav. Res. Ther. 39: 245–254.
Mulder, R., Beautrais, A., Joyce, P., and Fergusson, D. (1998). Relationship between dissociation, childhood sexual abuse, childhood physical abuse and mental illness in a general population sample. Am. J. Psychiatry 155: 806–811.
Neumann, D. A., Himskamp, B., Pollock, V., and Briere, J. (1996). The long-term sequelae of childhood sexual abuse in women: A meta-analytic review. Child Maltreat 1: 6–16.
Nijenhuis, E. R. S., Spinhoven, P., van Dyck, R., van der Hart, O., and Vanderlinden, J. (1998). Degree of somatoform and psychological dissociation in dissociative disorder is correlated with reported trauma. J. Traum Stress 11: 711–730.
Parker, G., Tupling, H., and Brown, L. B. (1979). A Parental Bonding Instrument. Br. J. Med. Psychol. 52: 1–10.
Portegijs, P. J. M., Jeuken, F. M. H., van der Horst, F. G., Kraan, H. F., and Knottnerus, J. A. (1996). A troubled youth: Relations with somatization, depression and anxiety in adulthood. Fam. Pract. 13: 1–11.
Reilly, J., Baker, G. A., Rhodes, J., and Salmon, P. (1999). The association of sexual and physical abuse with somatization: Characteristics of patients presenting with irritable bowel and non-epileptic attack disorder. Psychol. Med. 29: 399–406.
Reiter, R. C., Shakerin, L. R., Gambone, J. C., and Milburn, A. K. (1991). Correlation between sexual abuse and somatization in women with somatic and non-somatic chronic pelvic pain. Am. J. Obstet. Gynecol. 165: 104–109.
Ross-Gower, J., Waller, G., Tyson, M., and Elliott, P. (1998). Reported sexual abuse and subsequent psychopathology among women attending psychology clinics: The mediating role of dissociation. Br. J. Clin. Psychol. 37: 313–326.
Saxe, G. N., Chinman, G., Berkowitz, R., Hall, K., Lieberg, G., Schwartz, J., and van der Kolk, B. (1994) Somatization in patients with dissociative disorders. Am. J. Psychiatry 151: 1329–1334.
Talley, N. J., Boyce, P. M., and Jones, M. (1998). Is the association between irritable bowel syndrome and abuse explained by neuroticism? A population based study. Gut 42: 47–53.
Talley, N. J., Fett, S. L., and Zinsmeister, A. R. (1995). Self-reported abuse and gastrointestinal disease in outpatients: Association with irritable bowel-type symptoms. Am. J. Gastroenterol. 90: 366–371.
Talley, N. J., Helgeson, S. L., Zinmeister, A. R., and Melton, L. J., III (1994). Gastrointestinal tract symptoms and self-reported abuse: A population-based study. Gastroenterology 107: 1040–1049.
Talley, N. J., Owen, B. K., Boyce, P., and Paterson, K. (1996). Psychological treatments for irritable bowel syndrome: A critique of controlled treatment trials. Am. J. Gastroenterol. 91: 277–286.
van Dulmen, A. M., Fennis, J. F. M., and Bleijenberg, G. (1996). Cognitive–behavioral group therapy for irritable bowel syndrome: Effects and long-term follow-up. Psychosom. Med. 58: 508–514.
van Ijzendoorn, M. H., and Schuengel, C. (1996). The measurement of dissociation in normal and clinical populations: Meta-analytic validation of the dissociative experiences scale (DES). Clin. Psychol. Rev. 16: 365–382.
Waldinger, R., Swett, C., Frank, A., and Miller, K. (1994). Levels of dissociation and histories of reported abuse among women out-patients. J. Nerv. Ment. Dis. 182: 625–630.
Walker, E. A., Gelfand, M. D., Gelfand, A. N., Creed, F., and Katon, W. J. (1996). The relationship of current psychiatric disorder to functional disability and distress in patients with inflammatory bowel disease. Gen. Hosp. Psychiatry 18: 220–229.
Walker, E. A., Gelfand, A. N., Gelfand, M. D., and Katon, W. J. (1998). Psychiatric diagnoses, sexual and physical victimisation, and disability in patients with irritable bowel syndrome or inflammatory bowel disease. Psychol. Med. 25: 1259–1267.
Walker, E. A., Katon, W. J., Neraas, K., Jemelka, R. P., and Massoth, D. (1992). Dissociation in women with chronic pelvic pain. Am. J. Psychiatry 149: 534–537.
Wessely, S., Nimnuan, C., and Sharpe, M. (1999). Functional somatic syndromes: One or many? Lancet 354: 936–939.
Whitehead, W. E., Bosmajjan, L., Zonderman, A. B., Costa, P. T., Jr., and Schuster, M. M. (1988). Symptoms of psychologic distress associated with irritable bowel syndrome. Comparison of community and medical clinic samples. Gastroenterology 95: 709–714.
Whitehead, W. E., and Schuster, M. M. (1985). Gastrointestinal Disorders: Behavioural and Physiological Bases for Treatment., Academic Press, London.
Zigmond, A. J., and Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiat. Scand. 67: 361–370.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Salmon, P., Skaife, K. & Rhodes, J. Abuse, Dissociation, and Somatization in Irritable Bowel Syndrome: Towards an Explanatory Model. J Behav Med 26, 1–18 (2003). https://doi.org/10.1023/A:1021718304633
Issue Date:
DOI: https://doi.org/10.1023/A:1021718304633