Posted 7/6/2008 12:18 PM (GMT 0)
Here are some excerpts from my dissertation on the IBD personality. This is my original writing, so it's not copying and pasting from any source. Since my dissertation was on stigma in IBD, this was an important part to review (as this thread has touched on). Thankfully this line of research has basically been rebuffed and generally doesn't happen any more. But yes Matthew, there was a time IBD was considered psychosomatic, as were other autoimmune diseases.
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While IBD currently is not considered a functional or psychosomatic GI illness, previous research and debate within the medical community involved the presence of an “IBD personality” which contributed to the illness and its symptoms. Early studies between the 1920’s and 1960’s concluded that IBD was more psychosomatic in nature (Sperling, 1960 in Hyphantis et al., 2005), or that psychological conditions had some causal role in IBD (Heltzer et al., 1984; Heltzer et al., 1982; Robertson et al, 1989). These studies yielded common characteristics among IBD patients, such as perfectionism, dependency, neuroticism, over-conscientiousness, and obsessive-compulsiveness. These early theories have since been refuted by research conducted by both gastroenterologists and psychiatrists, who instead believe IBD to be a multifaceted disease (Talal & Drossman, 1995; North et al., 1990) and are thus considered controversial.
Regardless of the controversy of the IBD personality, limited research continues to be conducted in this area. A more recent study by Hyphantis et al. (2005) examined the use of defense mechanisms in patients with IBD. They found that patients with CD tended to use “maladaptive action” more often than those with UC. Maladaptive action is the inability to act on their own behalf to better their current situation. Within this broader defense mechanism category, CD patients were more likely to use “consumption” and “pseudo-altruism” twice as often as UC patients were. In other words, CD patients are more likely to seek oral satisfaction via smoking, drinking, eating, or verbal demands while having an innate need to perceive themselves as kind, helpful, and never angry. According to this study, CD patients are also more likely to blame others for their problems, require others to complete tasks for them, and attempt to provoke anger in others.
The notion of the IBD personality has appeared in other lines of research as well. Vaughn, Leff, and Sarner (1999) examined expressed emotion in families with IBD and its impact on patient outcomes. Qualitative data analysis from family interviews yielded themes of criticism family members had toward patients. They found that 66% of critical comments were associated with personality traits of the patient: that they were perfectionists, overly conscientious, and worriers. Those family members who were not critical described similar personality traits with more a more positive tone: their relative with IBD was hardworking, industrious, and energetic. These qualities led them to take on too many responsibilities, which in turn contributed to their illness.
While the theory of an IBD personality is not overtly stigmatizing it may contribute to attributional views that the patient’s illness or symptoms are their fault or under their control, which is a contributing factor to illness stigma. Critical comments by family members toward a relative with IBD also included frustration with lack of treatment compliance, using alternative medicine, increased irritability, and non-disclosure of disease flare-ups out of concern of embarrassment or excessive resiliency (Vaughn, Leff & Sarner, 1999).
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