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.
