Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-28T10:14:55.977Z Has data issue: false hasContentIssue false
  • English
  • Français

Bowel and Bladder-Control Anxiety: A Preliminary Description of a Viscerally-Centred Phobic Syndrome

Published online by Cambridge University Press:  19 August 2013

Sunjeev K. Kamboj ,
Christine Langhoff ,
Rosanna Pajak ,
Alex Zhu ,
Agnes Chevalier  and
Sue Watson
Sunjeev K. Kamboj*
Affiliation:
University College London, UK
Christine Langhoff
Affiliation:
University College London, UK
Rosanna Pajak
Affiliation:
University College London, UK
Alex Zhu
Affiliation:
University College London, UK
Agnes Chevalier
Affiliation:
University College London, UK
Sue Watson
Affiliation:
University College London, UK
*
Reprint requests to Sunjeev Kamboj, Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London WC1E 6BT, UK. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: People with anxiety disorders occasionally report fears about losing control of basic bodily functions in public. These anxieties often occur in the absence of physical disorder and have previously been recognized as “obsessive” anxieties reflecting a preoccupation with loss of bowel/bladder control. Motivated by our observations of the non-trivial occurrence of such anxieties in our clinical practice we sought to fill a gap in the current understanding of “bowel/bladder-control anxieties”. Method: Eligible participants completed an internet survey. Results: Bowel/bladder-control anxieties (n = 140) tended to emerge in the mid to late 20s and were associated with high levels of avoidance and functional impairment. There was a high prevalence of panic attacks (78%); these were especially prevalent among those with bowel-control anxiety. Of those with panic attacks, 62% indicated that their main concern was being incontinent during a panic attack. Significantly, a proportion of respondents (~16%) reported actually being incontinent during a panic attack. Seventy percent of participants reported intrusive imagery related to loss of bowel/bladder control. Intrusion-related distress was correlated with agoraphobic avoidance and general role impairment. Some differences were noted between those with predominantly bowel-, predominantly bladder- and those with both bowel and bladder-control anxieties. Conclusion: This preliminary characterization indicates that even in a non-treatment seeking community sample, bowel/bladder-control anxieties are associated with high levels of distress and impairment. Further careful characterization of these anxieties will clarify their phenomenology and help us develop or modify treatment protocols in a way that takes account of any special characteristics of such viscerally-centred phobic syndromes.

Keywords

Anxietyanxiety disordersphobiapanic disorderpanic disorder with agoraphobiavisceral sensationsbowel-control anxietybladder-control anxiety
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 43 , Issue 2 , March 2015 , pp. 142 - 157
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, (4th ed., text rev.) Washington, DC: APA.Google Scholar
Aziz, Q. and Thompson, D. G. (1998). Brain-gut axis in health and disease. Gastroenterology, 114, 559–578.Google Scholar
Beidel, D. C. and Bulik, C. M. (1990). Flooding and response prevention as a treatment for bowel obsessions. Journal of Anxiety Disorders, 4, 247–256.Google Scholar
Brewin, C. R., Gregory, J. D., Lipton, M. and Burgess, N. (2010). Intrusive images in psychological disorders: characteristics, neural mechanisms, and treatment implications. Psychological Review, 117, 210–232.Google Scholar
Brumovsky, P. R. and Gebhart, G. F. (2010). Visceral organ cross-sensitization: an integrated perspective. Automonic Neuroscience, 153, 106–115.Google ScholarPubMed
Chambless, D. L., Caputo, G. C., Bright, P. and Gallagher, R. (1984). Assessment of fear of fear in agoraphobics: the body sensations questionnaire and the agoraphobic cognitions questionnaire. Journal of Consulting and Clinical Psychology, 52, 1090–1097.Google Scholar
Cosci, F. (2013). “Bowel obsession syndrome” in a patient with chronic constipation. General Hospital Psychiatry. 35, 451.e1–e3.CrossRefGoogle Scholar
Clark, D. M. and Salkovskis, P. M. (in press). Panic disorder. In Hawton, K., Salkovskis, P. M., Kirk, J. and Clark, D. M. (Eds.), Cognitive Behaviour Therapy: a practical guide (2nd ed.). Oxford: Oxford University Press.Google Scholar
Eldridge, G. D., Walker, J. R. and Holborn, S. W. (1993). Cognitive-behavioral treatment for panic disorder with gastrointestinal symptoms: a case study. Journal of Behavior Therapy and Experimental Psychiatry, 24, 367–371.Google Scholar
Epstein, S. and Jenike, M. A. (1990). Urinary obsession: an atypical symptom of obsessive-compulsive disorder. Psychosomatics, 31, 450–452.Google Scholar
Francis, C. Y., Duffy, J. N., Whorwell, P. J. and Morris, J. (1997). High prevalence of irritable bowel syndrome in patients attending urological outpatient departments. Digestive Diseases and Sciences, 42, 404–407.Google Scholar
Gosling, S. D., Vazire, S., Srivastava, S. and John, O. P. (2004). Should we trust web-based studies? A comparative analysis of six preconceptions about internet questionnaires. American Psychologist, 59, 93–104.Google Scholar
Hatch, M. L. (1997). Conceptualization and treatment of bowel obsessions: two case reports. Behaviour Research and Therapy, 35, 253–257.Google Scholar
Helbig-Lang, S. and Petermann, F. (2010). Tolerate or eliminate? A systematic review on the effects of safety behavior across anxiety disorders. Clinical Psychology: Science and Practice, 17, 218–233.Google Scholar
Herbert, B. M., Muth, E. R., Pollatos, O. and Herbert, C. (2012). Interoception across Modalities: on the relationship between cardiac awareness and the sensitivity for gastric functions. PLoS ONE, 7. e36646. doi:10.1371/journal.pone.0036646Google Scholar
Hollifield, M., Finley, M. R. and Skipper, B. (2003). Panic disorder phenomenology in urban self-identified Caucasian-non-Hispanics and Caucasian-Hispanics. Depression and Anxiety, 18, 7–17.Google Scholar
IAPT National Programme Team (2011). The IAPT Data Handbook 2. London: Department of Health.Google Scholar
Jenike, M. A., Vitagliano, H. L., Rabinowitz, J., Goff, D. C. and Baer, L. (1987). Bowel obsessions responsive to tricyclic antidepressants in four patients. American Journal of Psychiatry, 144, 1347–1348.Google Scholar
Kircanski, K., Craske, M. G., Epstein, A. M. and Wittchen, H-U. (2009). Subtypes of panic attacks: a critical review of the empirical literature. Depression and Anxiety, 26, 878–887.CrossRefGoogle ScholarPubMed
Lelliot, P. and Bass, C. (1990). Symptom specificity in patients with panic. British Journal of Psychiatry, 157, 593–597.Google Scholar
Lelliot, P., McNamee, G. and Marks, I. (1991). Features of agora-, social, and related phobias and validation of the diagnoses. Journal of Anxiety Disorders, 5, 313–322.Google Scholar
Lydiard, R. B., Laraia, M., Fossey, M. and Ballenger, J. (1988). Possible relationship of bowel obsessions to panic disorder with agoraphobia. American Journal of Psychiatry, 145, 1324Google Scholar
Lyketsos, C. G. (1992). Successful treatment of bowel obsessions with nortriptyline. American Journal of Psychiatry, 4, 573.Google Scholar
Malykhina, A. P. (2007). Neural mechanisms of pelvic organ cross sensitization. Neuroscience, 149, 660–672.Google Scholar
Marks, I. M. and Mathews, A. M. (1979). Brief standard self-rating for phobic patients. Behaviour Research and Therapy, 17, 263–267.Google Scholar
Millions Hit by Toilet Phobia (2006). Retrieved on 21 January 2013, from http://news.bbc.co.uk/1/hi/6128738.stmGoogle Scholar
Moritz, S., Van Quaquebeke, N., Hauschildt, M., Jelinek, L. and Gönner, S. (2012). Good news for allegedly bad studies: assessment of psychometric properties may help to elucidate deception in online studies on OCD. Journal of Obsessive-Compulsive and Related Disorders, 1, 331–335.Google Scholar
Mundt, J. C., Marks, I. M., Shear, M. K. and Greist, J. M. (2002). The Work and Social Adjustment Scale: a simple measure of impairment in functioning. British Journal of Psychiatry, 180, 461–464.Google Scholar
Nicolson, P., Kopp, Z., Chapple, C. R. and Kelleher, C. (2008). It's just the worry about not being able to control it! A qualitative study of living with overactive bladder. British Journal of Health Psychology, 13, 343–359.CrossRefGoogle Scholar
Noyes, R., Cook, B., Garvey, M. and Summers, R. (1990). Reduction of gastrointestinal symptoms following treatment for panic disorder. Psychosomatics, 31, 75–79.Google Scholar
Pajak, R., Langhoff, C., Watson, S. and Kamboj, S. K. (2013). Phenomenology and thematic content of intrusive imagery in bowel and bladder obsession. Journal of Obsessive-Compulsive and Related Disorders, 2, 233–240.CrossRefGoogle Scholar
Porcelli, P. and Carne, M. (2008). Non-fearful panic disorder in gastroenterology. Psychosomatics, 49, 543–545.Google Scholar
Porcelli, P. and Leandro, G. (2007). Bowel obsession syndrome in a patient with ulcerative colitis. Psychosomatics, 48, 448–450.Google Scholar
Price, K., Veale, D. and Brewin, C. R. (2012). Intrusive imagery in people with a specific phobia of vomiting. Journal of Behavior Therapy and Experimental Psychiatry, 43, 672–678.Google Scholar
Raffa, S. D., White, K. S. and Barlow, D. H. (2004). Feared consequences of panic disorder: a qualitative and quantitative analysis. Cognitive Behaviour Therapy, 33, 199–207.Google Scholar
Sharma, V. (1991). Bowel obsessions and clomipramine. Canadian Journal of Psychiatry, 3, 233–234.Google Scholar
Thorpe, S. J. and Salkovskis, P. M. (1995). Phobic beliefs: do cognitive factors play a role in specific phobias? Behaviour Research and Therapy, 33, 805–816. 1995CrossRefGoogle ScholarPubMed
Van Hout, W. J. P. J. and Bouman, T. K. (2011). Clinical features, prevalence and psychiatric complaints in subjects with fear of vomiting. Clinical Psychology Psychotherapy. doi: 10.1002/cpp.761 [Epub ahead of print]Google Scholar
Wells, A. (1997). Cognitive Therapy of Anxiety Disorders: a practice manual and conceptual guide. Hoboken, NJ: John Wiley and Sons Inc.Google Scholar
Wittchen, H-U., Gloster, A. T., Beesdo-Baum, K., Fava, G. A. and Craske, M. G. (2010). Agoraphobia: a review of the diagnostic classificatory position and criteria. Depression and Anxiety, 27, 113–133.Google Scholar
Wittchen, H. U., Reed, V. and Kessler, R. C. (1998). The relationship of agoraphobia and panic in a community sample of adolescents and young adults. Archives of General Psychiatry, 55, 1017–1024.Google Scholar
Submit a response

Comments

No Comments have been published for this article.