Walker E A, Katon W J, Roy-Byrne P P, Jemelka R P, Russo J
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle 98195.
Am J Psychiatry. 1993 Oct;150(10):1502-6. doi: 10.1176/ajp.150.10.1502.
Two reports have suggested a possible association between a history of sexual trauma and irritable bowel syndrome, but several factors in their study designs limited their generalizability. The authors used a more rigorous methodology to confirm this association.
They administered structured psychiatric and sexual trauma interviews to 28 patients with irritable bowel syndrome and 19 patients with inflammatory bowel disease and compared prevalence rates of sexual victimization in the two groups.
Compared with patients diagnosed as having inflammatory bowel disease, patients with irritable bowel syndrome had a significantly higher rate of severe lifetime sexual trauma (32% versus 0%), severe childhood sexual abuse (11% versus 0%), and any lifetime sexual victimization (54% versus 5%). The nine patients who had experienced severe lifetime victimization had significantly higher odds ratios for lifetime depression, panic disorder, phobia, somatization disorder, alcohol abuse, functional dyspareunia, and inhibited sexual desire than the 38 patients who had experienced less severe sexual trauma or no trauma. A logistic regression analysis showed that gender, the number of medically unexplained physical symptoms, and self-reported anxiety and hostility accounted for all of the variance in the victimized group.
These preliminary results suggest that sexual victimization may be an important factor in the development of irritable bowel syndrome in some patients. Future studies attempting to categorize subgroups of patients with irritable bowel syndrome should inquire into past histories of sexual victimization.
两份报告提示性创伤史与肠易激综合征之间可能存在关联,但它们研究设计中的若干因素限制了研究结果的普遍性。作者采用了更为严谨的方法来证实这种关联。
他们对28例肠易激综合征患者和19例炎症性肠病患者进行了结构化的精神科和性创伤访谈,并比较了两组性侵害的发生率。
与被诊断为炎症性肠病的患者相比,肠易激综合征患者有严重终身性创伤的比例显著更高(32%对0%),严重儿童期性虐待的比例显著更高(11%对0%),以及任何终身性侵害的比例显著更高(54%对5%)。与38例经历过不太严重性创伤或没有创伤的患者相比,9例经历过严重终身性侵害的患者在终身抑郁、惊恐障碍、恐惧症、躯体化障碍、酒精滥用、功能性性交困难和性欲抑制方面的优势比显著更高。逻辑回归分析表明,性别、医学上无法解释的身体症状数量以及自我报告的焦虑和敌意解释了受侵害组的所有差异。
这些初步结果表明,性侵害可能是部分患者肠易激综合征发病的一个重要因素。未来试图对肠易激综合征患者亚组进行分类的研究应询问其过去的性侵害史。