Negative Emotions in Irritable Bowel Sindrome: which differences among IBS Subtypes?

Antonio Bruno, Rocco Antonio Zoccali, Gianluca Pandolfo, Giovanni Genovese, Marzia Merlino, Walter Fries, Carmela Morace, Pierluigi Consolo, Carmela Mento, Maria Rosaria Anna Muscatello


There are conflicting data on peculiar negative emotional patterns in Irritable Bowel Syndrome subtypes.Our study was aimed to determine possible differences in depression, anxiety and anger in patients suffering from Irritable Bowel Syndromeconstipation, diarrhoea and mixed subtypes. The sample underwent a psychometric examination for the assessment of depression (Hamilton Rating Scale Depression), anxiety (Hamilton Rating Scale Anxiety), and anger (State-Trait Anger Expression Scale 2). Differences among groups were assessed using the Analysis of variance with Bonferroni post hoc comparisons, or the χ²-test if requested.
Diarrhoea subtype constipation subtype were included in the study.
The severity of depressive symptoms was “moderate” in patients with constipation subtype and “mild” in patients with diarrhoea mixed subtypes; no statistically significant differences were documented among subtypes. Severity of anxiety symptoms was “mild to moderate” in patients with constipation subtype (mean = 18.53 ± 7.7), and mild in patients with diarrhoea (mean = 13.35 ± 7.1) and mixed subtypes(mean = 13.25 ± 4.7); statistically significant differences among subgroups were found (Constipation vs Diarrhoea: p=0.004; Constipation vs. Regarding anger, significant differences among subgroups emerged at State Anger Feeling Angry and Anger In variables, both higher in constipation subtype group than in subtype group (State Anger Feeling Angry: p=0.002; Anger In: p=0.001). Patients with constipation subtypeconstitute a subgroup characterized by a discrete burden of negative emotions, mainly anxiety and anger.


Anger; Anxiety; Depression; Irritable Bowel Syndrome subtype; Negative emotions

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Beesley, H., Rhodes, J., Salmon, P. (2010). Anger and childhood sexual abuse are independently associated with irritable bowel syndrome. The British Journal of Health Psychology, 15, 389-399. doi: 10.1348/135910709X466496.

Bengtson, M.B., Aamodt, G., Vatn, M.H., Harris, J.R. (2015). Co-occurrence of IBS and symptoms of anxiety or depression, among Norwegian twins, is influenced by both heredity and intrauterine growth. BMC Gastroenterology, 15, 9. Bennett, E.J., Evans, P., Scott, A.M., Badcock, C.A., Shuter, B., Höschl, R., Tennant, C.C., Kellow, J.E. (2000). Psychological and sex features of delayed gut transit in functional gastrointestinal disorders. : 83-87. doi: 10.1136/gut.46.1.83.

Bennett, E., Evans, P., Dowsett, J., Kellow, J. (2009). Sphincter of Oddi dysfunction: psychosocial distress correlates with manometric dyskinesia but not stenosis. The World Journal of Gastroenterology, 15, 6080-6085. doi: 10.3748/wjg.15.6080

Brown, T.A., Chorpita, B.F., Barlow, D.H. (1998). Structural relationships among dimensions of the DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect, and autonomic arousal. The Journal of Abnormal Psychology, 107, 179-192.

Camilleri, M. (2014). Physiological underpinnings of irritable bowel syndrome: neurohormonal mechanisms. The Journal of physiology, 592, 2967-2980. doi: 10.1113/jphysiol.2014.270892

Cassano, G.B., Conti, L., Levine, J. (1991). Hamilton Rating Scale for Depression (HAM-D). In L. Conti (Ed.), Le Scale di Valutazione in Psichiatria [Rating Scales for Psychiatry] (pp. 413–418). Milano: UTET Periodici Scientifici.

Chapman, S. & Martin, M. (2011). Attention to pain words in irritable bowel syndrome: increased orienting and speeded engagement. British Journal of Health Psychology, 16, 47–0. Cho, H.S., Park, J.M., Lim, C.H., Cho, Y.K., Lee, I.S., Kim, S.W., Choi, M.G., Chung, I.S., Chung, Y.K. (2011). Anxiety, depression and quality of life in patients with irritable bowel syndrome. Gut and Liver, 5, 29-36. doi: 10.5009/gnl.2011.5.1.29.

Choi, Y.J., Hwang, S.W., Kim, N., Park, J.H., Oh, J.C., Lee, D.H. (2014). Association Between SLC6A4 Serotonin Transporter Gene Lainked Polymorphic Region and ADRA2A -1291C>G and Irritable Bowel Syndrome in Korea. Journal of Neurogastroenterology and Motility, 20, 388-99.

Comunian, A.L. (2004). STAXI-2—State-Trait Anger Expression Inventory. La misura della rabbia [The assessment of anger]. Firenze: OS Organizzazioni Speciali.

Conti, L. (1999). Repertorio delle scale di valutazione in Psichiatria [The inventory of Rating Scales for Psychiatry]. Firenze: S.E.E. Societa` Editrice Europea di Nicodemo Maggiulli & C. Snc.

de Medeiros, M.T., Carvalho, A.F., de Oliveira Lima, J.W., Dos Santos, A.A., de Oliveira, R.B., Nobre E Souza, M.A. (2008). Impact of depressive symptoms on visceral sensitivity among patients with different subtypes of irritable bowel syndrome. The Journal of Nervous and Mental Disease, 196, 711–714. doi: 10.1097/NMD.0b013e318183f896.

Deschênes, S.S., Dugas, M.J., Fracalanza, K., Koerner, N. (2012). The role of anger in generalized anxiety disorder. Cognitive Behaviour Therapy, 4, 261-271. doi: 10.1080/16506073.2012.666564.

Engel, G.L. (1980). The clinical application of the biopsychosocial model. The American Journal of Psychiatry, 137, 535-544. doi: 10.1176/ajp.137.5.535.

Eriksson, E.M., Andrén, K.I., Eriksson, H.T., Kurlberg, G.K. (2008).Irritable bowel syndrome subtypes differ in body awareness, psychological symptoms and biochemical stress markers. The World Journal of Gastroenterology, 14, 4889-4896. doi: 10.3748/wjg.14.4889.

Evans, P.R., Bennett, E.J., Bak, Y.T., Tennant, C.C., Kellow, J.E. (1996). Jejunal sensorimotor dysfunction in irritable bowel syndrome: clinical and psychosocial features. Gastroenterology, 110, 393-404. doi:

Gao, J. (2013). Correlation between anxiety-depression status and cytokines in diarrhea-predominant irritable bowel syndrome. Experimental and Therapeutic Medicine, 6, 93-96. doi: 10.3892/etm.2013.1101.

Gross, J.J. & John, O.P. (2003). Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. Journal of Personality and Social Psychology, 85, 348-362. doi: 10.1037/0022-3514.85.2.348.

Guthrie, E., Creed, F., Fernandes, L., Ratcliffe, J., Van Der Jagt, J., Martin, J., Howlett, S., Read, N., Barlow, J., Thompson, D., Tomenson, B. (2003). Cluster analysis of symptoms and health seeking behaviour differentiates subgroups of patients with severe irritable bowel syndrome. Gut, 52, 1616-1622. doi:10.1136/gut.52.11.1616.

Hamilton, M. (1959). The assessment of anxiety states by rating. The British Journal of Medical Psychology, 32, 50-55. doi: 10.1111/j.2044-8341.1959.tb00467.x.

Hamilton, M. (1960). A rating scale for depression. The Journal of Neurology, Neurosurgery, and Psychiatry, 23, 56–62.

Jones, M.P., Chey, W.D., Singh, S., Gong, H., Shringarpure, R., Hoe, N., Chuang, E., Talley, N.J. (2014). A biomarker panel and psychological morbidity differentiates the irritable bowel syndrome from health and provides novel pathophysiological leads. Alimentary Pharmacology & Therapeutics, 39, 426-437. doi: 10.1111/apt.12608.

Kanazawa, M., Miwa, H., Nakagawa, A., Kosako, M., Akiho, H., Fukudo, S. (2016). Abdominal bloating is the most bothersome symptom in irritable bowel syndrome with constipation (IBS-C): a large population-based Internet survey in Japan. Biopsychosocial Medicine, 10, 19. doi: 10.1186/s13030-016-0070-8.

Longstreth, G.F., Thompson, W.G., Chey, W.D. (2006). Functional bowel disorders. Gastroenterology, 130, 1480-1491. doi: 10.1053/j.gastro.2005.11.061.

Mayer, E.A. & Tillisch, K. (2011). The brain–gut axis in abdominal pain syndromes. Annual Review of Medicine; 62, 381–396. doi: 10.1146/annurev-med-012309-103958.

McKinnon, A.C., Van Oudenhove, L., Tack, J., Jones, M. (2015). The association of personality, appraisal, catastrophising and vigilance with gastrointestinal symptom-specific anxiety. Journal of Health Psychology, 20, 456-465. doi:10.1177/1359105313503027.

Muscatello, M.R., Bruno, A., Pandolfo, G., Micò, U., Stilo, S., Scaffidi, M., Consolo, P., Tortora, A., Pallio, S., Giacobbe, G., Familiari, L., Zoccali, R. (2010). Depression, anxiety and anger in subtypes of irritable bowel syndrome patients. The Journal of Clinical Psychology in Medical Settings, 17, 64-70.doi: 10.1007/s10880-009-9182-7.

Muscatello, M.R., Bruno, A., Scimeca, G., Pandolfo, G., Zoccali, R.A. (2014). Role of negative affects in pathophysiology and clinical expression of irritable bowel syndrome.The World Journal of Gastroenterology, 20, 7570-7586. doi: 10.3748/wjg.v20.i24.7570.

Mykletun, A., Jacka, F., Williams, L., Pasco, J., Henry, M., Nicholson, G.C., Kotowicz, M.A., Berk, M. (2010). Prevalence of mood and anxiety disorder in self reported irritable bowel syndrome (IBS). An epidemiological population based study of women. BMC Gastroenterology, 10, 88. doi: 10.1186/1471-230X-10-88.

Ng, C., Malcolm, A., Hansen, R., Kellow, J. (2007). Feeding and colonic distension provoke altered autonomic responses in irritable bowel syndrome. Scandinavian Journal of Gastroenterology,42, 441-446.

Rey de Castro, N.G., Miller, V., Carruthers, H.R., Whorwell, P.J. (2015). Irritable bowel syndrome: a comparison of subtypes. Journal of Gastroenterology and Hepatology, 30, 279-285. doi: 10.1111/jgh.12704.

Scully, P., McKernan, D.P., Keohane, J., Groeger, D., Shanahan, F., Dinan, T.G., Quigley, E.M. (2010). Plasma cytokine profiles in females with irritable bowel syndrome and extra-intestinal co-morbidity. The American journal of gastroenterology, 105, 2235–2243.doi:10.1038/ajg.2010.159.

Singh, P., Staller, K., Barshop, K., Dai, E., Newman, J., Yoon, S., Castel, S., Kuo, B. (2015). Patients with irritable bowel syndrome-diarrhea have lower disease-specific quality of life than irritable bowel syndrome-constipation. The World Journal of Gastroenterology, 21, 8103-8109.doi: 10.3748/wjg.v21.i26.8103.

Smith, T.W., Ruiz, J.M., Uchino, B.N. (2000). Vigilance, active coping, and cardiovascular reactivity during social interaction in young men. Health Psychology, 19, 382-392.

Sperber, A.D., Dumitrascu, D., Fukudo, S., Gerson, C., Ghoshal, U.C., Gwee K.A., Hungin, A.P., Kang, J.Y., Minhu, C., Schmulson, M., Bolotin, A., Friger, M., Freud, T., Whitehead, W. (2016). The global prevalence of IBS in adults remains elusive due to the heterogeneity of studies: a Rome Foundation working team literature review. Gut. doi: 10.1136/gutjnl-2015-311240.

Spiegel, B.M. (2009). The burden of IBS: looking at metrics. Current Gastroenterology Reports; 11, 265-269. doi:10.1007/s11894-009-0039-x.

Spielberger, C.D. (1999). Manual for the State-Trait Anger Expression Inventory-2. Odessa, FL: Psychological Assessment Resources.

Spiller, R. (2008). Serotonin and GI clinical disorders. Neuropharmacology, 55, 1072-1080. doi: 10.1016/j.neuropharm.2008.07.016.

Stasi, C., Bellini, M., Bassotti, G., Blandizzi, C., Milani, S. (2014). Serotonin receptors and their role in the pathophysiology and therapy of irritable bowel syndrome. Techniques in Coloproctology, 18, 613-621.doi: 10.1007/s10151-013-1106-8.

Sugaya, N., Kaiya, H., Kumano, H., Nomura, S. (2008). Relationship between subtypes of irritable bowel syndrome and severity of symptoms associated with panic disorder. Scandinavian Journal of Gastroenterology, 43, 675-681.doi: 10.1080/00365520701883478.

Suinn, R.M. (2001). The terrible twos - Anger and anxiety. Hazardous to your health. American Psychologist, 56, 27-36.

Thijssen, A.Y., Jonkers, D.M., Leue, C., van der Veek, P.P., Vidakovic-Vukic, M., van Rood, Y.R., Clemens, C.H., Masclee, A.A. (2010). Dysfunctional cognitions, anxiety and depression in irritable bowel syndrome. Journal of Clinical Gastroenterology, 44, e236-241.doi: 10.1097/MCG.0b013e3181eed5d8.

van der Veek, P.P., Van Rood, Y.R., Masclee, A.A. (2008). Symptom severity but not psychopathology predicts visceral hypersensitivity in irritable bowel syndrome. Clinical Gastroenterology and Hepatology, 6, 321-328. doi: 10.1016/j.cgh.2007.12.005.

Walter , S.A., Jones, M.P., Talley, N.J., Kjellström, L., Nyhlin, H., Andreasson, A.N., Agréus, L. (2013). Abdominal pain is associated with anxiety and depression scores in a sample of the general adult population with no signs of organic gastrointestinal disease. Neurogastroenterology & Motility, 25, 741-e576. doi: 10.1111/nmo.12155.

Welgan, P., Meshkinpour, H., Ma, L. (2000). Role of anger in antral motor activity in irritable bowel syndrome. Digestive Diseases and Sciences, 45, 248-251.doi: 10.1023/A:1005487821063.

Zigmond, A.S. & Snaith, R.P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 361-370.doi: 10.1111/j.1600-0447.1983.tb09716.x.

Zoccali, R., Muscatello, M.R., Bruno, A., Barillà, G., Campolo, D., Meduri, M., Familiari, L., Bonica, M., Consolo, P., Scaffidi, M. (2006). Anger and ego-defence mechanisms in non-psychiatric patients with irritable bowel syndrome. Digestive and Liver Disease,38, 195-200.doi: 10.1016/j.dld.2005.10.028.



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