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Patterns of interpersonal problems associated with irritable bowel syndrome
was neuroucism Conclusions: Specific psychological traits and age, but not eating disorder diagnosis or behaviours are largely predictive of FGID type and of multiple coexistent FGIDs.
last 3 months. School data were requested from individual public schools. Schools did not consistently distinguish illness-related absences fi:om other types, but they did categorize absences as excused or unexcused. Absences lbr vacations, religious observance, and sports events were not included in the analysis. Results: (1) School data were obtained for 135 children. (2) For cases and controls combined, school reports of average number of days missed in two school years correlated significantly with mothers' reports of days missed for colds in the last year (r = .446; p<.000) and days missed for GI symptoms in the last 3 months (r = .184; p=.033). (3) The agreement between mothers' responses and school data was at least as great for cases as it was for controls: for cold-related absences, rho = 0.53 vs. 0.38; for Gl-related absences, rho = 0.17 vs. 0.17; for disability from all causes, rho = 0.21 vs. 0.37 (4) The school data confirm that children of case mothers miss more school days than control children (11.8 vs. 8 2 days, t(135)=2.76, p<0.Ol). Conclusions: (1) Mothers' reports of child absenteeism show adequate agreement with school data, suggesting that they are valid. (2) Mothers' reports did not appear to be biased by' their owTt health status. (3) Given tire difficulty of obtaining school data and the poor quality of reporting standards~ it is more appropriate to use data provided by the mother to assess the impact of illness on school attendance. (Supported by RO1 HD36069 and RO1 DK31369)
T1430 History of Abuse Affects the Clinical Expression of Chronic Organic and Functional Gastrointestinal Disorders Flavia gaccini, Nadia Pallotta, Emma Calabrese, Patrizio Pezzotti, Enrico Corazziari it has been hytmthasized that a history' of physical and/or sexual abuse might predispose to the development of tunctional gastrointestinal disorders, and muhiple somatic complaints (1-4). We have previously (5) reported an equally high prevalence of lifetime physical and sexual abuse in Italian patients with chronic organic (COGID), and functional gastrointestinal disorders (FGID). Aim. To determine 1) the relatinnship between abuse history, and gastrointestinal (GI) and extra-Gl symptoms in patients with COG1D and FGID; 2) the relationship between abuse history and diagnosis of Somatization Disorder in patients with FGID. Subjects & Methods. Consecutive out-patients reterred for chronic G1 disorders filled in a selfadministered standardised questionnaire enquiring on gastrointestinal and extra-Gl symptoms and on epN3des, and type(s), of life-time physical and sexual abuse. The association between mmiber of symptonts and abuse history were evaluated using univariate and multivariate logistic models. Results. A total of 260 patients were requested to fill-ni a questionnaire; 13% of patients did not fill in the questionnaire. Functional GI disorders were diagnosed in 72.5% of patiems, and organm G1 diseases in 27.5% Thirty two percent of patients with organic and 31% with functional GI disorders reported a history" of sexual and/or physical abuse. History of physical plus sexual, sexual and childhood abuse, but not physical abuse only, were associated (p<0 01) with an increased number of G1 and extra-GI symptoms in both functional and organic disorders. Ten patients met the DSM-IV diagnostic criteria of Somatization Disorder; of these, 8 reported a history of severe physical and sexual abuse fhat has occurred, in all but one, during childhood. Conclusions. Abuse history 1) does not appear to predispose to tire development of FGID; 2) appears to affect the clinical expression of both hmctional and organic disorders Severe and childhood abuse appears to correlate with the diaguosis of Somatization Disorder. 1)Drossman DA et ah Aim lnt Med 1990; 2)Drossman DA et al. Gastroenterology 1996 3)Walker EA et al Psychol Med 1995; 4) Baccini F et al. Gastroenterology A1999
T1433 Psychological Influences on Sleep Quality in Women with Irritable Bowel Syndrome Monica E Jarrett, Robert L. Burr, Pamela Weisman, Margaret M. Heitkemper The purpose of this preliminary analysis of an ongoing study is to compare self-reported and polysomnographic indicators of sleep quality in women with IBS based on a history of mood and anxiety disorders. Methods: Women with IBS (n = 21) and Controls (n = 19), who were on average 31 +/- 8 years of age, cmnpleted questionnaires related to GI, sleep, and psychological symptoms. In a separate interview, they completed the Composite International Diagnostic Interview (CIDI), which determined if their symptoms meet the criteria tot a Depressive or Anxiety Disorder. During the luteal phase of their menstrual cycle they underwent a polysomnographic assessmem of their sleep in the sleep laboratory' for three nights. Data fi'om the 2nd night will be reported here. The macmstmcture indicators were compared (e.g., sleep efficiency, latency, fragmemation, and percentage of time in sleep stages). Results: Consistent with prior studies, women with IBS self-reported significantly (p < .03) poorer sleep in the prior month than Controls, whereas there were no significant differences ni the polysomnographic sleep characteristics between the IBS and Control groups (e.g., Sleep efflcmncy, IBS 88%, Controls 88%; Sleep onset latency, IBS 21 +,t- 15 rain., Controls 23 +A 32 rain). Of the women with IBS, 53% had a history' of depressive or anxiety disorders, as did 32% (p = .10) of the Controls. Within the IBS group, neither subjective nor polysomnographic indicators of sleep quality differed based on history, of mood or anxiety disorders. However, women with symptoms compatible with a current diagnosis (n = 12) spent a smaller percentage of time in slow wave sleep than those without current symptoms (n = 9) (12.7 +/-6.2 verses 19.1 +/- 7.6, p = 047), and sleep efficiency tended to be lower (86 +/- 6% verses 90 +/- 4%, p = .10). They did not differ in selfreported sleep quality. Conclusion. Symptoms of current depressive and anxiety disorders are related to the macrostmcture of sleep in the women with IBS although the differences are not reflected in self-reported sleep quality. Further analysis is needed of the microstmcture (e.g., alpha and delta EEG power) and home sleep-actigraphy to determine whether similar differences occur in these domains as well.
T1431 Factors that Predict Number of Sessions to Adapt to a Rotating Drum, Retention, and Transfer to Carsickness Manda J. Wil]iamson, Sara C. Higgins, Robert M. Stern The sensor), conflict theory of motion sickness hypothesizes tha~ the length of time to reach adaptation depends on receptivity to the motion, such that the stronger the initial response, the longer the time to produce adaptation. Additionally, transfer of adaptation from one situation to another depends on the similarity of the two provocative motion situations such that memory, for one conflict is recalled for another conflict from the neural store of conflict intortnation. The present analyses represent part of an on-going investigation into the likelihood of the occurrence of transferability of adaptation from optokinetic dram motion to motion of a car. The goal is to identify factors that predict number of sessions to reach adaptation, to retain adaptation one month following adaptation, and to test for transfer of adaptation from opt6kinenc motion to car motion. Method 12 carsick participants were adapted to optokinetic motion. Step-wise regression analyses were nan on the number of sessions to adaptatmn and transfer measures to identify tactors that predmt the two. Descriptive statistics are offered for the retention dependent measure; regression analyses will be run when a large~ sample size is obtained. The probability of entrance of a potential predictor was set at p < .10; exclusion was set at p> .15. Results: Potential predictors entered into the regression analyses for number of sessions to reach adaptation included Motion Sickness History (MSQ), change in skin conductance level (SCL), normal and ta&ygastrie activity after the first drum session, and Subjective Symptoms of Motion Sickness (SSMS) after the first session. Results suggested that initial subjective response to the optokinetic motion (SSMS) significantly predicted number of sessions to adaptation more so than the remaining predictors, W = 0.48, p<.01. Motion Sickness History (MSQ) significantly predicted transfer of adaptation, R:' = 0.38, p<~08, more so than predictors such as last SSMS, normal and tachygastric activity, and number of sessions to adaptation. All participants who returned for a one-month Mlow-up session successfullytolerated optokinetic motion for the maximum 16-minute exposure. Conclusion: As hypotheslzed~ initial reaction to optokinetic motion significantly predicted the number of sessions to reach adaptation, while overall susceptibility to motion sickness predicted transferability, of adaptation to carsickness, while retention of adaptation persisted otter one month.
T1434 Patterns of Interpersonal Problems Associated with Irritable Bowel Syndrome Jefl'rey M Lackner, Michael B. Gurtman Although stress repmducibly alters gastrointestinal motility and sensation in IBS patients, the nature of stressors underlying IBS is poorly understood. Recent clinical and epidemiological research implicates interpersonal sire sots both in mediating the risk of onset of IBS (Gwee et al., 1999) and shaping its course (e.g., Bennett et al., 1998). ldentilying the types of interpersonal problems characterizing IBS patients thet~tbre has potentially important implications for the prevention and management of IBS. This study investigated the patterns of interpersonal problems in 109 consecutively referred patients (17% male, 83% female) who participated in an NIH funded psychological clinical trial for moderate to severe IBS. Patterns meeting Rome I1 criteria for IBS completed the Inventory of Interpersonal Problems Circumplex Scales (IIP-C). The IIP-C has eight subscales (Domineering/Controlling of others, Vindictive/Self-Centered, Cold/Distant, Socially Inhibited, Nonassertive, Overly Accommodating, Self Sacrificing and Intrusive/Needy) that form a circumplex of inte~rsonal problems around two principal dimensions: (1) a dimension of affiliation or nurturance ranging from hostile (cold) to friendly (warm) behavior; and (2) a dimension of control or dominance ranging from yielding (submissive) to controlling (dominatmg) behavior. The relative combination of affiliation and dominance defines different interpersonal behavior and problems. The interpersonal problem profile of IBS patients was marked, on average, by elevated scores on the Nonassertive (T score = 55; percentile rank = 72.5) and Socially Inhibited (T score = 53; percentile rank = 71) subseales. Trigonometric statistical procedures (Gunman, 1994, 1999) were also used to plot graphically patients' standardized scores from the lIPC octam scales. The mean angular location, or the peak-shift of the curve, from 0" fell at 263" on the circumplex graph, suggesting that IBS patients' most common problem involves an anxious, submissive, and unassertive interpersonal style (e.g. difficulty communicating needs to others; discomfort in authoritative roles, inability to be firm with and assertive with others). These results lend empirical validation to the presumptive link between a submissive interpersonal style and more severely aftected IBS patients (e.g., Toner et al., 2000). Secondary analyses did not support the notion that interpersonal problems differed across either IBS subtype or gender. [Supported by RO1 #51422 from the NIDDK]
T1432 Measuring the Impact of Gastrointestinal Illness on School Attendance Michelle D. Garner, Rona L. Levy, William E W1"litebead, Lynn S. Walker, Andrew D. Beld, Dennis L. Christie, Michael Von Korff School absenteeism is an important measure of the impact of iUnasses such as recurrent abdominal pain. Data on school attendance are readily obtained from parents, but may be biased by the parent's ox~ health slams. However, objective data from school officials is diNcult to Obtain and is often incomplete. Aims: (1) Using scbool records as a criterion, determine the validity of mother reports of missed school days; (2) determine whetber the reports of mc m~rs with irritable bowel syndrome (IBS) agree less well with school data than the reports of control mothers; and (3) assess the teasibility of using school attendance data as an outcome measure. Methods: Subjects were 296 children of 208 mothers with 1BS (case children) and 335 children of 241 mothers without IBS (controls), average age 11.8 years, 51% female. Mothers completed questimmaires that included questions on the number of missed school days in the last three months for gastrointestinal symptom& number of days m the last 12 months for cold symptoms, and disahility days for all illnesses in the
AGA Abstracts
A-532
last 3 months. School data were requested from individual public schools. Schools did not consistently distinguish illness-related absences fi:om other types, but they did categorize absences as excused or unexcused. Absences lbr vacations, religious observance, and sports events were not included in the analysis. Results: (1) School data were obtained for 135 children. (2) For cases and controls combined, school reports of average number of days missed in two school years correlated significantly with mothers' reports of days missed for colds in the last year (r = .446; p<.000) and days missed for GI symptoms in the last 3 months (r = .184; p=.033). (3) The agreement between mothers' responses and school data was at least as great for cases as it was for controls: for cold-related absences, rho = 0.53 vs. 0.38; for Gl-related absences, rho = 0.17 vs. 0.17; for disability from all causes, rho = 0.21 vs. 0.37 (4) The school data confirm that children of case mothers miss more school days than control children (11.8 vs. 8 2 days, t(135)=2.76, p<0.Ol). Conclusions: (1) Mothers' reports of child absenteeism show adequate agreement with school data, suggesting that they are valid. (2) Mothers' reports did not appear to be biased by' their owTt health status. (3) Given tire difficulty of obtaining school data and the poor quality of reporting standards~ it is more appropriate to use data provided by the mother to assess the impact of illness on school attendance. (Supported by RO1 HD36069 and RO1 DK31369)
T1430 History of Abuse Affects the Clinical Expression of Chronic Organic and Functional Gastrointestinal Disorders Flavia gaccini, Nadia Pallotta, Emma Calabrese, Patrizio Pezzotti, Enrico Corazziari it has been hytmthasized that a history' of physical and/or sexual abuse might predispose to the development of tunctional gastrointestinal disorders, and muhiple somatic complaints (1-4). We have previously (5) reported an equally high prevalence of lifetime physical and sexual abuse in Italian patients with chronic organic (COGID), and functional gastrointestinal disorders (FGID). Aim. To determine 1) the relatinnship between abuse history, and gastrointestinal (GI) and extra-Gl symptoms in patients with COG1D and FGID; 2) the relationship between abuse history and diagnosis of Somatization Disorder in patients with FGID. Subjects & Methods. Consecutive out-patients reterred for chronic G1 disorders filled in a selfadministered standardised questionnaire enquiring on gastrointestinal and extra-Gl symptoms and on epN3des, and type(s), of life-time physical and sexual abuse. The association between mmiber of symptonts and abuse history were evaluated using univariate and multivariate logistic models. Results. A total of 260 patients were requested to fill-ni a questionnaire; 13% of patients did not fill in the questionnaire. Functional GI disorders were diagnosed in 72.5% of patiems, and organm G1 diseases in 27.5% Thirty two percent of patients with organic and 31% with functional GI disorders reported a history" of sexual and/or physical abuse. History of physical plus sexual, sexual and childhood abuse, but not physical abuse only, were associated (p<0 01) with an increased number of G1 and extra-GI symptoms in both functional and organic disorders. Ten patients met the DSM-IV diagnostic criteria of Somatization Disorder; of these, 8 reported a history of severe physical and sexual abuse fhat has occurred, in all but one, during childhood. Conclusions. Abuse history 1) does not appear to predispose to tire development of FGID; 2) appears to affect the clinical expression of both hmctional and organic disorders Severe and childhood abuse appears to correlate with the diaguosis of Somatization Disorder. 1)Drossman DA et ah Aim lnt Med 1990; 2)Drossman DA et al. Gastroenterology 1996 3)Walker EA et al Psychol Med 1995; 4) Baccini F et al. Gastroenterology A1999
T1433 Psychological Influences on Sleep Quality in Women with Irritable Bowel Syndrome Monica E Jarrett, Robert L. Burr, Pamela Weisman, Margaret M. Heitkemper The purpose of this preliminary analysis of an ongoing study is to compare self-reported and polysomnographic indicators of sleep quality in women with IBS based on a history of mood and anxiety disorders. Methods: Women with IBS (n = 21) and Controls (n = 19), who were on average 31 +/- 8 years of age, cmnpleted questionnaires related to GI, sleep, and psychological symptoms. In a separate interview, they completed the Composite International Diagnostic Interview (CIDI), which determined if their symptoms meet the criteria tot a Depressive or Anxiety Disorder. During the luteal phase of their menstrual cycle they underwent a polysomnographic assessmem of their sleep in the sleep laboratory' for three nights. Data fi'om the 2nd night will be reported here. The macmstmcture indicators were compared (e.g., sleep efficiency, latency, fragmemation, and percentage of time in sleep stages). Results: Consistent with prior studies, women with IBS self-reported significantly (p < .03) poorer sleep in the prior month than Controls, whereas there were no significant differences ni the polysomnographic sleep characteristics between the IBS and Control groups (e.g., Sleep efflcmncy, IBS 88%, Controls 88%; Sleep onset latency, IBS 21 +,t- 15 rain., Controls 23 +A 32 rain). Of the women with IBS, 53% had a history' of depressive or anxiety disorders, as did 32% (p = .10) of the Controls. Within the IBS group, neither subjective nor polysomnographic indicators of sleep quality differed based on history, of mood or anxiety disorders. However, women with symptoms compatible with a current diagnosis (n = 12) spent a smaller percentage of time in slow wave sleep than those without current symptoms (n = 9) (12.7 +/-6.2 verses 19.1 +/- 7.6, p = 047), and sleep efficiency tended to be lower (86 +/- 6% verses 90 +/- 4%, p = .10). They did not differ in selfreported sleep quality. Conclusion. Symptoms of current depressive and anxiety disorders are related to the macrostmcture of sleep in the women with IBS although the differences are not reflected in self-reported sleep quality. Further analysis is needed of the microstmcture (e.g., alpha and delta EEG power) and home sleep-actigraphy to determine whether similar differences occur in these domains as well.
T1431 Factors that Predict Number of Sessions to Adapt to a Rotating Drum, Retention, and Transfer to Carsickness Manda J. Wil]iamson, Sara C. Higgins, Robert M. Stern The sensor), conflict theory of motion sickness hypothesizes tha~ the length of time to reach adaptation depends on receptivity to the motion, such that the stronger the initial response, the longer the time to produce adaptation. Additionally, transfer of adaptation from one situation to another depends on the similarity of the two provocative motion situations such that memory, for one conflict is recalled for another conflict from the neural store of conflict intortnation. The present analyses represent part of an on-going investigation into the likelihood of the occurrence of transferability of adaptation from optokinetic dram motion to motion of a car. The goal is to identify factors that predict number of sessions to reach adaptation, to retain adaptation one month following adaptation, and to test for transfer of adaptation from opt6kinenc motion to car motion. Method 12 carsick participants were adapted to optokinetic motion. Step-wise regression analyses were nan on the number of sessions to adaptatmn and transfer measures to identify tactors that predmt the two. Descriptive statistics are offered for the retention dependent measure; regression analyses will be run when a large~ sample size is obtained. The probability of entrance of a potential predictor was set at p < .10; exclusion was set at p> .15. Results: Potential predictors entered into the regression analyses for number of sessions to reach adaptation included Motion Sickness History (MSQ), change in skin conductance level (SCL), normal and ta&ygastrie activity after the first drum session, and Subjective Symptoms of Motion Sickness (SSMS) after the first session. Results suggested that initial subjective response to the optokinetic motion (SSMS) significantly predicted number of sessions to adaptation more so than the remaining predictors, W = 0.48, p<.01. Motion Sickness History (MSQ) significantly predicted transfer of adaptation, R:' = 0.38, p<~08, more so than predictors such as last SSMS, normal and tachygastric activity, and number of sessions to adaptation. All participants who returned for a one-month Mlow-up session successfullytolerated optokinetic motion for the maximum 16-minute exposure. Conclusion: As hypotheslzed~ initial reaction to optokinetic motion significantly predicted the number of sessions to reach adaptation, while overall susceptibility to motion sickness predicted transferability, of adaptation to carsickness, while retention of adaptation persisted otter one month.
T1434 Patterns of Interpersonal Problems Associated with Irritable Bowel Syndrome Jefl'rey M Lackner, Michael B. Gurtman Although stress repmducibly alters gastrointestinal motility and sensation in IBS patients, the nature of stressors underlying IBS is poorly understood. Recent clinical and epidemiological research implicates interpersonal sire sots both in mediating the risk of onset of IBS (Gwee et al., 1999) and shaping its course (e.g., Bennett et al., 1998). ldentilying the types of interpersonal problems characterizing IBS patients thet~tbre has potentially important implications for the prevention and management of IBS. This study investigated the patterns of interpersonal problems in 109 consecutively referred patients (17% male, 83% female) who participated in an NIH funded psychological clinical trial for moderate to severe IBS. Patterns meeting Rome I1 criteria for IBS completed the Inventory of Interpersonal Problems Circumplex Scales (IIP-C). The IIP-C has eight subscales (Domineering/Controlling of others, Vindictive/Self-Centered, Cold/Distant, Socially Inhibited, Nonassertive, Overly Accommodating, Self Sacrificing and Intrusive/Needy) that form a circumplex of inte~rsonal problems around two principal dimensions: (1) a dimension of affiliation or nurturance ranging from hostile (cold) to friendly (warm) behavior; and (2) a dimension of control or dominance ranging from yielding (submissive) to controlling (dominatmg) behavior. The relative combination of affiliation and dominance defines different interpersonal behavior and problems. The interpersonal problem profile of IBS patients was marked, on average, by elevated scores on the Nonassertive (T score = 55; percentile rank = 72.5) and Socially Inhibited (T score = 53; percentile rank = 71) subseales. Trigonometric statistical procedures (Gunman, 1994, 1999) were also used to plot graphically patients' standardized scores from the lIPC octam scales. The mean angular location, or the peak-shift of the curve, from 0" fell at 263" on the circumplex graph, suggesting that IBS patients' most common problem involves an anxious, submissive, and unassertive interpersonal style (e.g. difficulty communicating needs to others; discomfort in authoritative roles, inability to be firm with and assertive with others). These results lend empirical validation to the presumptive link between a submissive interpersonal style and more severely aftected IBS patients (e.g., Toner et al., 2000). Secondary analyses did not support the notion that interpersonal problems differed across either IBS subtype or gender. [Supported by RO1 #51422 from the NIDDK]
T1432 Measuring the Impact of Gastrointestinal Illness on School Attendance Michelle D. Garner, Rona L. Levy, William E W1"litebead, Lynn S. Walker, Andrew D. Beld, Dennis L. Christie, Michael Von Korff School absenteeism is an important measure of the impact of iUnasses such as recurrent abdominal pain. Data on school attendance are readily obtained from parents, but may be biased by the parent's ox~ health slams. However, objective data from school officials is diNcult to Obtain and is often incomplete. Aims: (1) Using scbool records as a criterion, determine the validity of mother reports of missed school days; (2) determine whetber the reports of mc m~rs with irritable bowel syndrome (IBS) agree less well with school data than the reports of control mothers; and (3) assess the teasibility of using school attendance data as an outcome measure. Methods: Subjects were 296 children of 208 mothers with 1BS (case children) and 335 children of 241 mothers without IBS (controls), average age 11.8 years, 51% female. Mothers completed questimmaires that included questions on the number of missed school days in the last three months for gastrointestinal symptom& number of days m the last 12 months for cold symptoms, and disahility days for all illnesses in the
AGA Abstracts
A-532