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Increased Prevalence of Functional Gastrointestinal Disorders in Panic Disorder: Clinical and Theoretical Implications

Published online by Cambridge University Press:  07 November 2014

Abstract

Background:

Functional gastrointestinal disorders (FGID) are a group of disorders characterized by recurrent gastrointestinal distress for which no structural or biochemical cause can be discerned. Irritable bowel syndrome (IBS) is an FGID estimated to affect 10% to 25% of the United States population. IBS occurs in over 40% of individuals with panic disorder, and in patients with IBS, 25% to 30% have panic disorder, which has led to speculation about possible shared pathophysiology between the two. Less is known about the prevalence of other FGID in individuals with panic disorder.

Objective:

The purpose of this study was to examine the prevalence of IBS and all the other FGID in patients with current Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) panic disorder.

Introduction:

We assessed FGIDs in 73 treatment-seeking DSM-IV panic disorder patients via the Diagnostic Interview Questions for Functional Gastrointestinal Disorders and made descriptive comparisons with a large convenience sample from an already-completed United States Household Survey (USHS), which employed the same diagnostic criteria.

Results:

The prevalence of IBS and other FGIDs in both men and women with panic disorder were substantially higher than in the USHS respondents. Women with panic disorder had significantly more functional chest pain than men, but there was no gender difference in IBS. With the exception of functional anorectal and biliary disorders, the FGID prevalences were comparatively higher in panic disorder versus the USHS respondents.

Discussion:

This survey supports earlier reports of a high prevalence of IBS in individuals with panic disorder and also suggests that the prevalence of several other FGIDs were comparatively high as well. Methodological limitations precluded direct statistical analysis. It may be that commonly overlapping psychiatric and often-painful FGIDs, and extra-intestinal disorders increase the risk for comorbidity in already-affected individuals via shared pathophysiology. One potential model for which there is some evidence for a role in stress, panic disorder, FGIDs and several extra-intestinal functional conditions is dysregulation of corticotropin-releasing factor function.

Conclusion:

The prevalence of FGIDs in DSM-IV panic disorder was comparatively higher than in USHS respondent community sample, which used similar FGID diagnostic criteria. The cause for the apparent close association of panic disorder with FGID may represent shared pathophysiology. Increased understanding of the mechanism of the overlap may allow for improved treatment of the significant proportion of the population suffering from comorbid psychiatric and functional medical conditions.

Type
Original Research
Copyright
Copyright © Cambridge University Press 2005

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References

REFERENCES

1.Kessler, RC, McGonagle, KA, Zhao, S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994;51:819.Google Scholar
2.Diagnostic and Statistical Manual for Mental Disorders. 4th ed. Washington, DC: American Psychatric Press, Inc; 1994.Google Scholar
3.Zaubler, TS, Katon, W. Panic disorder in the general medical setting. J Psychosom Res. 1998;44:2542.CrossRefGoogle ScholarPubMed
4.Roy-Byrne, PP, Stang, P, Wittchen, HU, Ustun, B, Walters, EE, Kessler, RC. Lifetime panic-depression comorhidity in the National Comorbidity Survey. Association with symptoms, impairment, course and help-seeking. Br J Psychiatry. 2000;176:229235.Google Scholar
5.Drossman, DA, Richter, JE, Talley, NJ, Thompson, WG, Corazziari, E, Whitehead, WE, eds. The Functional Gastrointestinal Disorders. Diagnosis, Pathphysiology and Treatment: A Multinational Consensus. New York, NY: Little, Brown and Company; 1994.Google Scholar
6.Drossman, DA, Richter, JE, Talley, NJ, Thompson, WG, Corazziari, E, Whitehead, WE, eds. Rome II—The Functional Gastrointestinal Disorders; Diagnosis, Pathophysiology and Treatment: A Multinational Consensus. 2nd ed. McLean, VA: Degnon Associates; 2000.Google Scholar
7.Agreus, L, Svardsudd, K, Nyren, O, Tibblin, G. Irritable bowel syndrome and dyspepsia in the general population: overlap and lack of stability over time. Gastroenterology. 1995;109:671680.CrossRefGoogle ScholarPubMed
8.Locke, GR 3rd. The epidemiology of functional gastrointestinal disorders in North America. Gastroenterol Clin North Am. 1996;25:119.CrossRefGoogle ScholarPubMed
9.Talley, NJ, Boyce, P, Jones, M. Identification of distinct upper and lower gastrointestinal symptom groupings in an urban population. Gut. 1998;42:690695.Google Scholar
10.Locke, GR 3rd. Prevalence, incidence and natural history of dyspepsia and functional dyspepsia. Baillieres Clin Gastroenterol. 1998;12:435442.CrossRefGoogle ScholarPubMed
11.Agreus, L. The epidemiology of functional gastrointestinal disorders. Eur J Surg. 1998;583(suppl):6066.Google Scholar
12.Chey, WD, Olden, K, Carter, E, Boyle, J, Drossman, D, Chang, L. Utility of the Rome I and Rome II criteria for irritable bowel syndrome in U.S. women. Am J Gastroenterol. 2002;97:28032811.CrossRefGoogle ScholarPubMed
13.Drossman, DA, Camilleri, M, Mayer, EA, Whitehead, WE. AGA technical review on irritable bowel syndrome. Gastroenterology. 2002;123:21082131.Google Scholar
14.Aaron, LA, Burke, MM, Buchwald, D. Overlapping conditions among patients with chronic fatigue syndrome, fibromyalgia, and temporomandibular disorder. Arch Intern Med. 2000;160:221227.Google Scholar
15.Whitehead, WE, Palsson, O, Jones, KR. Systematic review of the comorbidity of irritable bowel syndrome with other disorders: what are the causes and implications? Gastroenterology. 2002;122:11401156.CrossRefGoogle ScholarPubMed
16.Locke, GR 3rd, Zinsmeister, AR, Fett, SL, Melton, LJ 3rd, Talley, NJ. Overlap of gastrointestinal symptom complexes in a US community. Neurogastroenterol Motil. 2005;17:2934.CrossRefGoogle Scholar
17.Mayer, EA, Fass, R, Fullerton, S. Intestinal and extraintestinal symptoms in functional gastrointestinal disorders. Eur J Surg Suppl. 1998;(583):2931.Google Scholar
18.Lydiard, RB, Falsetti, SA. Experience with anxiety and depression treatment studies: implications for designing irritable bowel syndrome clinical trials. Am J Med. 1999;107:65S73S.Google Scholar
19.Walker, EA, Roy-Byrne, PP, Katon, WJ. Irritable bowel syndrome and psychiatric illness. Am J Psychiatry. 1990;147:565572.Google ScholarPubMed
20.Lydiard, RB, Fossey, MD, Marsh, W, Ballenger, JC. Prevalence of psychiatric disorders in patients with irritable bowel syndrome. Psychosomatics. 1993;34:229234.Google Scholar
21.Maunder, RG. Panic disorder associated with gastrointestinal disease: review and hypotheses. J Psychosom Res. 1998;44:91105.Google Scholar
22.Kaplan, DS, Masand, PS, Gupta, S. The relationship of irritable bowel syndrome (IBS) and panic disorder. Ann Clin Psychiatry. 1996;8:8188.Google Scholar
23.Drossman, DA, McKee, DC, Sandler, RS, et al. Psychosocial factors in the irritable bowel syndrome. A multivariate study of patients and nonpatients with irritable bowel syndrome. Gastroenterology. 1988;95:701708.CrossRefGoogle ScholarPubMed
24.Sandler, RS, Drossman, DA. Bowel habits in young adults not seeking health care. Dig Dis Sci. 1987;32:841845.Google Scholar
25.Whitehead, WE, Bosmajian, L, Zonderman, AB, Costa PT, Jr, Schuster, MM. Symptoms of psychologic distress associated with irritable bowel syndrome. Comparison of community and medical clinic samples. Gastroenterology. 1988;95:709714.Google Scholar
26.Walker, EA, Katon, WJ, Jemelka, RP, Roy-Byrne, PP. Comorbidity of gastrointestinal complaints, depression, and anxiety in the Epidemiologic Catchmenr Area (ECA) Study. Am J Med. 1992;92:26S30S.Google Scholar
27.Lydiard, RB, Greenwald, S, Weissman, MM, Johnson, J, Drossman, DA, Ballenger, JC. Panic disorder and gastrointestinal symptoms: findings from the NIMH Epidemiologic Catchment Area project. Am J Psychiatry. 1994;151:6470.Google Scholar
28.Hochstrasser, B, Angst, J. The Zurich Study: XXII. Epidemiology of gastrointestinal complaints and comorbidity with anxiety and depression. Eur Arch Psychiatry Clin Neurosci. 1996;246:261272.Google Scholar
29.Howell, S, Poulton, R, Caspi, A, Talley, NJ. Relationship between abdominal pain subgroups in the community and psychiatric diagnosis and personality. A birth cohort study. J Psychosom Res. 2003;55:179–87.Google Scholar
30.Hudson, JI, Pope, HG Jr. Affective spectrum disorder: does antidepressant response identify a family of disorders with a common pathophysiology? Am J Psychiatry. 1990;147:552654.Google ScholarPubMed
31.Hudson, JI, Goldenberg, DL, Pope, HG Jr, Keck, PE Jr, Schlesinger, L. Comorbidity of fibromyalgia with medical and psychiatric disorders. Am J Med. 1992:92:363367.Google Scholar
32.Hudson, JI, Mangweth, B, Pope, HG Jr, et al. Family study of affective spectrum disorder. Arch Gen Psychiatry. 2003;60:170177.CrossRefGoogle ScholarPubMed
34.Henningsen, P, Zimmermann, T, Sattel, H. Medically unexplained physical symptoms, anxiety, and depression: a meta-analytic review. Psychosom Med. 2003;65:528533.Google Scholar
35.Drossman, DA, Li, Z, Andruzzi, E, et al. U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci. 1993;38:15691580.Google Scholar
36.First, MB, Spitzer, RL, Miriam, G, Williams, JB. Structured Clinical Interview for DSMIV Axis I Disorders. Washington, DC: American Psychiatric Press, Inc.; 1996.Google Scholar
37.Drossman, DA, Leserman, J, Nachman, G, et al. Sexual and physical abuse in women with functional or organic gastrointestinal disorders. Ann Intern Med. 1990;113:828833.Google Scholar
38.Walker, EA, Katon, WJ, Roy-Byrne, PP, Jemelka, RP, Russo, J. Histories of sexual victimization in patients with irritable bowel syndrome or inflammatory bowel disease. Am J Psychiatry. 1993;150:15021506.Google Scholar
39.Irwin, C, Falsetti, SA, Lydiard, RB, Ballenger, JC, Brock, CD, Brener, W. Comorbidity of posttraumatic stress disorder and irritable bowel syndrome. J Clin Psychiatry. 1996;57:576578.CrossRefGoogle ScholarPubMed
40.Talley, NJ, Boyce, PM, Jones, M. Is the association between irritable bowel syndrome and abuse explained by neuroticism? A population based study. Gut. 1998;42:4751.Google Scholar
41.Drossman, DA, Toner, BB, Whitehead, WE, et al. Cognitive-behavioral therapy versus education and desipramine versus placebo for moderate to severe functional bowel disorders. Gastroenterology. 2003;125:1931.CrossRefGoogle ScholarPubMed
42.Mayer, EA. The neurobiology of stress and gastrointestinal disease. Gut. 2000;47:861869.Google Scholar
43.Ringel, Y, Drossman, DA, Turkington, TG, et al. Regional brain activation in response to rectal distension in patients with irritable bowel syndrome and the effect of a history of abuse. Dig Dis Sci. 2003;48:17741781.CrossRefGoogle ScholarPubMed
44.Mayer, EA, Naliboff, BD, Chang, L. Basic pathophysiologic mechanisms in irritable bowel syndrome. Dig Dis Sci. 2001;19:212218.Google Scholar
45.Mayer, EA, Craske, M, Naliboff, BD. Depression, anxiety, and the gastrointestinal system. J Clin Psychiatry. 2001;(62 suppl 8):2836.Google Scholar
46.Mayer, EA, Collins, SM. Evolving pathophysiologic models of functional gastrointestinal disorders. Gastroenterology. 2002;122:20322048.Google Scholar
47.Drossman, DA, Creed, FH, Olden, KW, Svedlund, J, Toner, BB, Whitehead, WE. Psychosocial aspects of the functional gastrointestinal disorders. Gut. 1999;45(suppl 2):II25II30.Google Scholar
48.Drossman, D. Psychosocial factors and the disorders of GI function: what is the link? Am J Gastroenterol. 2004;99:358360Google Scholar
49.Boyce, PM, Koloski, NA, Talley, NJ. Irritable bowel syndrome according to varying diagnostic criteria: are the new Rome II criteria unnecessarily restrictive for research and practice? Am J Gastroenterol. 2000;95:31763183.Google Scholar
50.Saito, YA, Locke, GR, Talley, NJ, Zinsmeister, AR, Fett, SL, Melton, LJ 3rd. A comparison of the Rome and Manning criteria for case identification in epidemiological investigations of irritable bowel syndrome. Am J Gastroenterol. 2000;95:28162824.Google Scholar
51.Mearin, F, Badia, X, Balboa, A, et al. Irritable bowel syndrome prevalence varies enormously depending on the employed diagnostic criteria: comparison of Rome II versus previous criteria in a general population. Scand J Gastroenterol. 2001;36:11551161.Google Scholar
52.Lau, EM, Chan, FK, Ziea, ET, Chan, CS, Wu, JC, Sung, JJ. Epidemiology of irritable bowel syndrome in Chinese. Dig Dis Sci. 2002;47:26212624.Google Scholar
53.Hungin, AP, Whorwell, PJ, Tack, J, Mearin, F. The prevalence, patterns and impact of irritable bowel syndrome: an international survey of 40,000 subjects. Aliment Pharmacol Ther. 2003;17:643650.Google Scholar
54.Hillila, MT, Farkkila, MA. Prevalence of irritable bowel syndrome according to different diagnostic criteria in a non-selected adult population. Aliment Pharmacol Ther. 2004;20:339345.Google Scholar
55.Bommelaer, G, Poynard, T, Le Pen, C, et al. Prevalence of irritable bowel syndrome (IBS) and variability of diagnostic criteria. Gastroenterol Clin Biol. 2004;28(6-7 pt 1):554561.Google Scholar
56.Manning, AP, Thompson, WG, Heaton, KW, et al. Towards positive diagnosis of the irritable bowel. BMJ. 1978;ii:653654.Google Scholar
57.Kane, FJ Jr, Strohlein, J, Harper, RG. Nonulcer dyspepsia associated with psychiatric disorder. South Med J. 1993;86:641646.Google Scholar
58.Beitman, BD, Mukerji, V, Lamberti, JW, et al. Panic disorder in patients with chest pain and angiographically normal coronary arteries. Am J Cardiol. 1989;63:13991403.Google Scholar
59.Schmulson, MJ, Valdovinos, MA. Current and future treatment of chest pain of presumed esophageal origin. Gastroenterol Clin North Am. 2004;33:93105Google Scholar
60.Olden, KW. The psychological aspects of noncardiac chest pain. Gastroenterol Clin North Am. 2004;33:6167.Google Scholar
61.Deary, IJ, Wilson, JA. Problems in treating globus pharyngis. Clin Otolaryngol Allied Sci. 1994;19:5560.CrossRefGoogle ScholarPubMed
62.Eriksen, HR, Ursin, H. Subjective health complaints, sensitization, and sustained cognitive activation (stress). J Psychosom Res. 2004;56:445448.Google Scholar
63.Afari, N, Buchwald, D. Chronic fatigue syndrome: a aeview. Am J Psychiatry. 2003;160:221236.Google Scholar
64.Ringel, Y, Sperber, AD, Drossman, DA. Irritable bowel syndrome. Annu Rev Med. 2001;52:319338.Google Scholar
65.Habib, KE, Gold, PW, Chrousos, GP. Neuroendocrinology of stress. Endocrinol Metab Clin North Am. 2001;30:695728;vii-viii.Google Scholar
66.Tsigos, T, Chrousos, GP. Hypothalamic–pituitary–adrenal axis, neuroendocrine factors and stress. J Psychosom Res. 2002;53:865871.Google Scholar
67.Naliboff, BD, Mayer, M, Fass, R, et al. The effect of life stress on symptoms of heartburn. Psychosom Med. 2004;66:426434.Google Scholar
68.Clauw, DJ. The pathogenesis of chronic pain and fatigue syndromes, with special reference to fibromyalgia. Med Hypotheses. 1995;44:369378.Google Scholar
69.Clauw, DJ, Chrousos, GP. Chronic pain and fatigue syndromes: overlapping clinical and neuroendocrine features and potential pathogenic mechanisms. Neuroimmunomodulation. 1997;4:134153.Google Scholar
70.Kiecolt-Glaser, JK, McGuire, L, Robles, TF, Glaser, R. Psychoneuroimmunology and psychosomatic medicine: back to the future. Psychosom Med. 2002;64:1528.Google Scholar
71.Charney, DS. Psychobiological mechanisms of resilience and vulnerability: implications for successful adaptation to extreme stress. Am J Psychiatry. 2004;161:195216.Google Scholar
72.McKewen, BS. Mood disorders and allostatic load. Biol Psychiatry. 2003;54:200207.Google Scholar
73.McKewen, BS. Early life influences on life-long patterns of behavior and health. Ment Retard Dev Disabil Res Rev. 2003;9:149154.Google Scholar
74.Stam, R, Akkermans, LM, Wiegant, VM. Trauma and the gut: interactions between stressful experience and intestinal function. Gut. 1997;40:704709.Google Scholar
75.Collins, S.M., Stress and the Gastrointestinal Tract IV. Modulation of intestinal inflammation by stress: basic mechanisms and clinical relevance. Am J Physiol Gastrointest Liver Physiol. 2001;280:G315G318.Google Scholar
76.Tache, Y, Martinez, V, Million, M, Wang, L. Stress and the gastrointestinal tract III. Stress-related alterations of gut motor function: role of brain corticotropin-releasing factor receptors. Am J Physiol Gastrointest Liver Physiol. 2001;280:G173G177.CrossRefGoogle ScholarPubMed
77.Fukudo, S, Nomura, T, Hongo, M. Impact of corticotropin-releasing hormone on gastrointestinal motility and adrenocorticotropic hormone in normal controls and patients with irritable bowel syndrome. Gut. 1998;42:845849.Google Scholar
78.Sagami, Y, Shimada, Y, Tayama, J, et al. Effect of a corticotropin releasing hormone receptor antagonist on colonic sensory and motor function in patients with irritable bowel syndrome. Gut. 2004;53:958964.Google Scholar
79.Anisman, H, Merali, Z. Cytokines, stress and depressive illness: brain-immune interactions. Ann Med. 2003;35:211.Google Scholar
80.Raison, CL, Miller, AH. When not enough is too much: the role of insufficient glucocorticoid signaling in the pathophysiology of stress-related disorders. Am J Psychiatry. 2003;160:16541665.Google Scholar
81.Miller, AH, Pariante, CM, Pearce, BD. Effects of cytokines on glucocorticoid receptor expression and function. Glucocorticoid resistance and relevance to depression. Adv Exp Med Biol. 1999;461:107116.Google Scholar
82.Watkins, LR, Maier, SF. The pain of being sick: implications of immune-to-brain communication for understanding pain. Annu Rev Psychol. 2000;51:2957.CrossRefGoogle ScholarPubMed
83.Al-Chaer, ED, Traub, RJ. Biological basis of visceral pain: recent developments. Pain. 2002;96:221225.Google Scholar
84.Heim, C, Ehlert, U, Hellhammer, DH. The potential role of hypocortisolism in the pathophysiology of stress-related bodily disorders. Psychoneuroendocrinology. 2000;25:135.Google Scholar
85.Bennett, EJ, Tennant, CC, Piesse, C, Badcock, CA, Kellow, JE. Level of chronic life stress predicts clinical outcome in irritable bowel syndrome. Gut. 1998;43:256261.Google Scholar
86.Licinio, J, Wong, ML. The role of inflammatory mediators in the biology of major depression: central nervous system cytokines modulate the biological substrate of depressive symptoms, regulate stress-responsive systems, and contribute to neurotoxicity and neuroprotection. Mol Psychiatry. 1999;4:317327.Google Scholar
87.Harter, MC, Conway, KP, Merikangas, KR. Associations between anxiety disorders and physical illness. Eur Arch Psychiatry Clin Neurosci. 2003;253:313320.Google Scholar
88.Kessler, RC. Mental Health and Chronic Pain: The National Comorbidity Survey. Abstract presented at: Annual Meeting of the Anxiety Disorders of America; March 12-15, 2004; Miami, Fla.Google Scholar
89.Gorman, JM, Kent, JM, Sullivan, GM, Coplan, JD. Neuroanatomical hypothesis of panic disorder, revised. Am J Psychiatry. 2000;157:493505.Google Scholar
90.Ploghaus, A, Becerra, L, Borras, C, Borsook, D. Neural circuitry underlying pain modulation: expectation, hypnosis, placebo. Trends Cogn Sci. 2003;7:197200.Google Scholar