Dysfunctional metacognitive beliefs and gastrointestinal disorders. Beyond an ‘organic’/‘functional’ categorization in the clinical practice

Maria Catena Quattropani, Vittorio Lenzo, Walter Fries, Alessandra Belvedere



Background: Despite the role of metacognition in psychopathology, no studies have explored this construct in the area of gastrointestinal disorders. Moreover, for many times there was a categorization between organic and functional gastrointestinal disorders. The aim of this study was to compare dysfunctional metacognitive beliefs between patients with functional bowel disorders and patients with organic bowel disorders. The purpose of this work was also to examine the relations between metacognitions, alexithymia and symptoms of the patients on the basis of diagnosis.

Methods: A between-subject non parametric and correlational design was employed. We formed three clinical groups from a population of patients with gastrointestinal disorders and on the basis of the ‘organic’ and ‘functional’ diagnosis. All the participants underwent the Metacognitions Questionnaire 30, the Toronto Alexithymia Scale-20 and the Gastrointestinal Symptom Rating Scale.

Results: There were no significant differences between the three clinical groups on MCQ-30 and TAS-20 scores. However, there were significant correlations based on diagnosis of the gastrointestinal disorder between alexithymic features and metacognitive dysfunctional beliefs.

Conclusions: Our results underline the role of metacognitions for both patients with organic and functional gastrointestinal disorders. Moreover, the results highlight the importance to consider these aspects in patients with organic gastrointestinal disorder.


Keywords: alexithymia; Crohn’s disease; IBS;  metacognition; ulcerative colitis. 

Full Text:



Agostini, A., Rizzello, F., Ravegnani, G., Gionchetti, P., Tambasco, R., Straforini, G., Ercolani, M., & Campieri, M. (2010). Adult attachment and early parental experiences in patients with Crohn’s disease, Psychosomatics, 51, 208-215. American Psychiatric Association. (2000). DSM-IV-TR – Diagnostic and Statistical Manual of Mental Disorders – text revision (4th ed.). Washington, DC: APA. Aszalós, Z. (2008). Neurological and psychiatric aspects of some gastrointestinal diseases. Orv Hetil, 149(44), 2079-86. Bagby, R.M., Parker, J.D.A., & Taylor, G.J. (1994a). The twenty-item Toronto Alexithymia Scale. I. Item selection and cross-validation of the factor structure. Journal of Psychosomatic Research, 38, 23-32. Bagby, R.M., Taylor, G.J., & Parker, J.D.A. (1994b). The twenty-item Toronto Alexithymia Scale. II. Convergent, discriminant, and concurrent validity. Journal of Psychosomatic Research, 38, 33-40. Bennett, P., & Wilkinson, S. (1985). A comparison of psychological and medical treatment of the Irritable Bowel Syndrome. British Journal of Clinical Psychology, 24, 215–216. Blanchard, E.B., Schwarz, S.P., Neff, D.F., Gerardi, M.A. (1988). Prediction of outcome from the self-regulatory treatment of irritable bowel syndrome. Behavior Research and Therapy, 26(2), 187-190. Bressi, C., Taylor, G. J, Parker, J. D. A., Bressi, S., Brambilla, V., Aguglia, E., Allegranti, S., Bongiorno, A., Giberti, F., Bucca, M., Todarello, O., Callegari, C., Vender, S., Gala, C., & Invernizzi, G. (1996). Cross validation of the factor structure of the 20-Item Toronto Alexithymia Scale: an Italian multicenter study, Journal of Psychosomatic Research, 41, 551-559. Brune, M. (2006). La “Teoria della Mente” nella schizofrenia: una rassegna della letteratura esistente. Psychotherapy Research, 69(2), 123-177. Cartwright-Hatton, S., & Wells, A. (1997). Beliefs about worry and intrusions: the metacognitions questionnaire and its correlates. Journal of Anxiety Disorders, 11, 279-296. Cooper, M.J., Grocutt, E., Deepak, K., & Bailey, E. (2007). Metacognition in anorexia nervosa, dieting and non-dieting controls: A preliminary investigation. British Journal of Clinical Psychology, 46, 113–117. Drossman, D.A. (2006). The functional gastrointestinal disorders and the Rome III process. Gastroenterology; 130, 1377-90. Garcia-Montes, J.M., Cangas, A., Pérez-Álvarez, M., Fidalgo, A.M., & Gutiérrez, O. (2006). The role of meta-cognitions and thought control techniques in predisposition to auditory and visual hallucinations. British Journal of Clinical Psychology, 45, 309-317. Gershon, M. (1999). The Second Brain: A Groundbreaking New Understanding of Nervous Disorders of the Stomach and Intestine. New York: Harper Perennial. Gick, M.L., & Sirois, F.M. (2010). Insecure attachment moderates women's adjustment to inflammatory bowel disease severity. Rehabilitation Psychology, 55, 170-179. Giusti, L., Mazza, M., Pollice, R., Casacchia, M., & Roncone, R. (2013). Relationship between self-reflectivity, Theory of Mind, neurocognition, and global functioning: An investigation of schizophrenic disorder. Clinical Psychologist, 17(2): 67–76. Graff, L.A., Walker, J.R., & Bernstein, C.N. (2009). Depression and anxiety in inflammatory bowel disease: a review of comorbidity and management. Inflammatory Bowel Disease. 15, 1105-1118. Gralnek. I.M., Hays, R.D., Kilbourne, A., Naliboff, B., & Mayer, E.A. (2000). The impact of irritable bowel syndrome on health-related quality of life. Journal of Gastroenterology, 119, 654-660. Heymann-Monikes, I., Arnold, R., Florin, I., Herda, C., Melfsen, S., & Monikkes, H. (2000). The combination of medical treatment plus multicomponent behavioral therapy is superior to medical treatment alone in the therapy of irritable bowel syndrome. American Journal of Gastroenterology, 95, 981-994. Hill, K., Varese, F., Jackons, M., & Linden, D.E.J. (2012). The relationship between metacognitive beliefs, auditory hallucinations, and hallucinations-related distress in clinical and non-clinical voice-hearers. British Journal of Clinical Psychology, 51, 434-437. Howell, S., Poulton, R., Caspi, A., & Talley, N.C. (2003). Relationship between abdominal pain subgroups in the community and psychiatric diagnosis and personality. A birth cohort study. Journal of Psychosomatic Research, 55, 179-187. Iglesias-Rey, M., Barreiro-de Acosta, M., Caamaño-Isorna, F., Vázquez Rodríguez, I., Lorenzo González, A., Bello-Paderne, X., & Domínguez-Muñoz, J.E. (2012). Influence of alexithymia on health-related quality of life in inflammatory bowel disease: are there any related factors? Scandinavian Journal of Gastroenterology, 47(4), 445-53. Khawaja, N.G. & Chapman, D. (2007). Cognitive predictors of worry in a non-clinical population. Clinical Psychologist, 11(1): 24–32. Kooiman, C.G., Bolk, J.A., Brand, R., Trijsburg, R.W., & Rooijmans, H.G.M. (2000). Is alexithymia a risk factor for unexplained physical symptoms in general medical outpatients? Psychosomatic Medicine, 62, 768-778. Kulich, K.R., Calabrese, C., Pacini, F., Vigneri, S., Carlsson, J., & Wiklund, I.K. (2004). Psychometric validation of the italian translation of the gastrointestinal symptom-rating scale and quality of life in reflux and dyspepsia questionnaire in patients with gastro-oesophageal reflux disease. Clinical Drug Investigation, 24(4), 205-15. Larøi, F., Van der Linden, M., & Marczewski, P. (2004). The effects of emotional salience, cognitive effort and meta-cognitive beliefs on a reality monitoring task in hallucination-prone subjects. British Journal of Clinical Psychology, 43, 221-233 Moser, G. (2006). Psychosomatic aspects of bowel diseases. Zeitschrift für Psychosomatische Medizin und Psychotherapie, 52(2):112-26. O'Leary, E.M., Rucklidge, J.J., & Blampied, N. (2009). Thought-action fusion and inflated responsibility beliefs in obsessive-compulsive disorder. Clinical Psychologist, 13(3): 94–101. van Oosterhout, B., Krabbendam, L., Smeets, G., van der Gaag, M. (2012). Metacognitive beliefs, beliefs about voices and affective symptoms in patients with severe auditory verbal hallucinations. British Journal of Clinical Psychology, 51, 1-14. Palmier-Claus, J.E., Dunn, G., Taylor, H., Morrison, A.P., & Lewis, S.W. (2013). Cognitive-self consciousness and metacognitive beliefs: Stress sensitization in individuals at ultra-high risk of developing psychosis. British Journal of Clinical Psychology, 52, 26-41. Perona-Garcelàn, S., Garcià-Montes, J.M., Ductor-Recuerda, M.J., Vallina-Fernàndez, O., Cuevas-Yust, C., Pèrez-Alvarez, M., Salas-Azcona, R., Gòmez-Gòmez, M.T. (2011). Relationship of metacognition, absorption, and depersonalization in patients with auditory hallucinations. British Journal of Clinical Psychology, 51, 100-118. Porcelli, P. (2004). Psychological abnormalities in patients with irritable bowel syndrome. Indian Journal of Gastroenterology, 23, 63-69. Portincasa, P., Moschetta, A., Baldassarre, G., Altomare, D.F., & Palasciano G. (2003). Pan-enteric dysmotility, impaired quality of life and alexithymia in a large group of patients meeting ROME II criteria for irritable bowel syndrome. Journal of Gastroenterology, 9, 2293-2299. Prasko, J., Jelenova, D., & Mihal, V. (2010). Psychological aspects and psychotherapy of inflammatory bowel diseases and irritable bowel syndrome in children. Biomedical papers of the Medical Faculty of the University Palacky Olomouc Czechoslovakia, 154(4):307-14. Rees, C.A., & Anderson, R.A. (2013). A review of metacognition in psychological models of obsessive–compulsive disorder. Clinical Psychologist, 17(1): 1–8 Spada, M.M., Mohiyeddini, C., & Wells, A. (2008). Measuring metacognitions associated with emotional distress: Factor structure and predictive validity of the metacognitions questionnaire 30. Personality and Individual Differences, 45, 238-242. Surdea-Blaga, T., Băban, A., & Dumitrascu, D.L. (2012). Psychosocial determinants of irritable bowel syndrome. World Journal of Gastroenterology, 18(7): 616-626. World Journal of Gastroenterology. Svedlund, J., Sjödin, I., Dotevall, G. (1988). GSRS-A clinical rating scale for gastrointestinal symptoms in patients with irritable bowel syndrome and peptic ulcer disease. Digestive Diseases and Sciences, 33(2), 129-134. Tack, J., Fried, M., Houghton, L.A., Spicak, J., & Fisher, G. (2006). Systematic review: the efficacy of treatments for irritable bowel syndrome - a European perspective. Alimentary Pharmacology & Therapeutics, 24, 183–205. Tan, S., Moulding, R., Nedeljkovic, M. & Kyrios, M. (2010). Metacognitive, cognitive and developmental predictors of generalised anxiety disorder symptoms. Clinical Psychologist, 14(3): 84–89. Taylor, G.J., Bagby, R.M., & Parker, J.D.A. (1997). Disorder of affect regulation: Alexithymia in medical and psychiatric illness. Cambridge: Cambridge University Press. Thornton, S., McIntyre, P., Murray-Lyon, I. and Gruzelier, J. (1990), Psychological and psychophysiological characteristics in irritable bowel syndrome. British Journal of Clinical Psychology, 29, 343–345. Tkalcić, M., Hauser, G., Stimac, D. (2010). Differences in the health-related quality of life, affective status, and personality between irritable bowel syndrome and inflammatory bowel disease patients. European Journal of Gastroenterology & Hepatology, 22(7):862-7. Wells, A. (2007). Cognition about cognition: metacognitive therapy and change in Generalized Anxiety Disorder and Social Phobia. Cognitive and Behavioral Practice, 14, 18-25. Wells, A., & Carter, K. (2001). Further tests of a cognitive model of Generalized Anxiety Disorder: Metacognitions and worry in GAD, panic disorder, social phobia, depression, and non-patients. Behavior Therapy, 32, 85-102. Wells, A., & Papageorgiou, C. (1998). Relationships between worry, obsessive-compulsive symptoms, and meta-cognitive beliefs. Behaviour Research & Therapy, 39(9), 899-913. Wells, A., & Purdon C. (1999). Metacognition and Cognitive-Behavior Therapy: a special issue. Clinical Psychology and Psychotherapy, 6, 71-72. Wells, A., & Cartwright-Hatton S. (2004). A short form of the Metacognitions Questionnaire: proprieties of the MCQ-30. Behavior Research and Therapy, 42, 385-396. Wells, A., & Matthews, G. (1994). Attention and emotion. A clinical perspective. Hove, UK: Erlbaum. Wells, A., & Matthews, G. (1996). Modelling cognition in emotional disorder: The S-REF model. Behavior Research and Therapy, 34, 881-888. Wiklund, I. (1993). Aspects of quality of life in gastrointestinal disease: some methodological issues. Scan

DOI: http://dx.doi.org/10.6092/2282-1619/2014.2.955


  • There are currently no refbacks.