This study examines the role of sexual and physical abuse and other psychosocial variables on the clinical outcome of patients with gastrointestinal (GI) disorders. Studies of normal subjects as well as psychiatric and medical patient groups have indicated that a history of abuse (present in 6%-62% of these samples (1)) is associated with both psychological sn physical dysfunction (2-5). Furthermore, medical patients with chronic functional illness (e.g., headaches (6), pelvic pain (7)), are significantly more likely to have histories of sexual and physical abuse than patients with organic disease. Our pilot study comparing patients with functional and organic GI illness, also suggests of greater prevalence of sexual abuse among thos with functional disorders. Furthermore, almost all physicians treating these patients were unaware of their patients' abuse histories. Based on these studies, we plan to comprehensively study 150 patients with functional GI illness and 75 patients with organic GI disease from a referral GI clinic. We propose that patients with functional GI illness (e.g., irritable bowel syndrome, chronic abdominal pain, nonuclear dyspepsia) will have a higher prevalence of sexual and physical abuse and more psychosocial disturbance than patients with organic GI disease (e.g., inflammatory bowel disease, peptic disease). We also propose that for these patients (and particularly for patients with functional GI illness), a history of abuse and other psychosocial disturbances will contribute to poorer clinical outcomes (e.g., pain reports, health care utilization, daily function) over the course of one year. Confirmation of our hypothesis will have important clinical implications: 1) physicians will become aware of the need to facilitate disclosure of a covert history of abuse in patients with functional GI illness, 2) an emphasis will be placed on developing behavioral and psychologic interventions rather than only biologic treatments for GI illness, and 3) the data we obtain in this study will help direct the focus of future behavioral research in GI disorders.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH046959-02
Application #
3386784
Study Section
Criminal and Violent Behavior Research Review Committee (CVR)
Project Start
1991-09-01
Project End
1995-08-31
Budget Start
1992-09-30
Budget End
1993-08-31
Support Year
2
Fiscal Year
1992
Total Cost
Indirect Cost
Name
University of North Carolina Chapel Hill
Department
Type
Schools of Medicine
DUNS #
078861598
City
Chapel Hill
State
NC
Country
United States
Zip Code
27599
Ringel, Yehuda; Drossman, Douglas A; Leserman, Jane L et al. (2008) Effect of abuse history on pain reports and brain responses to aversive visceral stimulation: an FMRI study. Gastroenterology 134:396-404
Jia, Huanguang; Li, Jim Z; Leserman, Jane et al. (2004) Relationship of abuse history and other risk factors with obesity among female gastrointestinal patients. Dig Dis Sci 49:872-7
Drossman, D A; Leserman, J; Li, Z et al. (2000) Effects of coping on health outcome among women with gastrointestinal disorders. Psychosom Med 62:309-17
Leserman, J; Li, Z; Hu, Y J et al. (1998) How multiple types of stressors impact on health. Psychosom Med 60:175-81
Leserman, J; Li, Z; Drossman, D A et al. (1998) Selected symptoms associated with sexual and physical abuse history among female patients with gastrointestinal disorders: the impact on subsequent health care visits. Psychol Med 28:417-25
Leserman, J; Li, Z; Drossman, D A et al. (1997) Impact of sexual and physical abuse dimensions on health status: development of an abuse severity measure. Psychosom Med 59:152-60
Drossman, D A; Li, Z; Leserman, J et al. (1996) Health status by gastrointestinal diagnosis and abuse history. Gastroenterology 110:999-1007
Leserman, J; Drossman, D A; Li, Z et al. (1996) Sexual and physical abuse history in gastroenterology practice: how types of abuse impact health status. Psychosom Med 58:4-15
Leserman, J; Drossman, D A; Li, Z (1995) The reliability and validity of a sexual and physical abuse history questionnaire in female patients with gastrointestinal disorders. Behav Med 21:141-50