Psychosomatic Medicine 4:5-61 (1942)
© 1942 American Psychosomatic Society

Emotions and Gastroduodenal Function

Experimental Studies on Patients with Gastritis, Duodenitis and Peptic Ulcer

¹ New York Hospital, and Departments of Medicine and Psychiatry, Cornell University Medical College, New York, N. Y.

The personality features and emotional reactions were investigated in a series of 30 unselected patients with peptic ulcer, and 3 patients with gastritis and duodenitis. The personality features of these patients were variable and the incidents precipitating the emotional reactions numerous. However, the reactions of intense anxiety, insecurity, resentment, guilt and frustration obtained in all. Also, compensating efforts to bolster self-esteem by a show of independence, self-sufficiency, and perfectionism were common. It was evident from the long duration of the personality disturbances that the mucosal lesion itself was not responsible for the major emotional conflicts.

In all of the patients with peptic lesions it was possible to demonstrate a chronological parallelism between the onset, recrudescence and course of gastroduodenal symptoms, and the occurrence of untoward emotional reactions. The situations that prompted these reactions were not necessarily dramatic or in the nature of crises, but because of the existing emotional frame within which they occurred they had important effects on the patients.

To demonstrate that the above described emotional states were relevant to the gastroduodenal dysfunction and peptic ulcers in the particular patients studied, situations were experimentally created which induced destructive emotional reactions and precipitated symptoms when the patient was free of symptoms. Moreover, if such affects, symptoms and tissue defects already existed, all increased in intensity during such experimental procedures. On the other hand, in situations which engendered feelings of emotional security and assurance, gastric function was restored toward normal and symptoms eliminated, in those with symptoms and abnormal function.

Thus, with the knowledge of the dominant emotions in these patients and some of the circumstances responsible for their being, situations were created in the laboratory which resulted in emotional and gastroduodenal changes like those occurring in the individual's day-to-day experiences. Records were made of the behaviour and utterances of the subject. Also simultaneously, records were made of the motility and secretions of the stomach and of the finger temperature and respiration. 165 observations were conducted on 26 subjects, 10 of whom had ulcers of the stomach or the duodenum, and 3 of whom had gastritis and duodenitis. 13 subjects were healthy and without complaints. The experiments revealed the following association of affective reactions and physiological function in the patients. Tension, anxiety, resentment, anger, guilt, obsequiousness and desperation, already present, accentuated or induced, were almost always accompanied by an increase in hydrochloric acid, mucous and pepsin secretions. Peristaltic activity became continuous, and contractions increased in magnitude. Respiration became more rapid and shallow, with frequent sighs. There was usually a drop in finger temperature. Often in patients with ulcer, pain of a burning and gnawing quality was precipitated and unusual amounts of bile and moderate amounts of fresh, unclotted blood appeared in the extractions. Similar changes occurred in a few instances during sleep following a period of affective stress. During and after interviews which engendered emotional security, functional over-activity decreased and approached the normal. A comparison of the individual physiological and emotional changes in normal subjects with those of patients with ulcer, gastritis and duodenitis, revealed similar patterns, but the changes in the pathological group were greater in magnitude and duration.

The facts of this study emphasize the occurrence in the same individual of the aforementioned destructive emotions coupled with increased motility and secretion and mucosal circulatory changes in the stomach and duodenum, followed by evidence of gastritis and duodenitis, and ultimately actual ulceration. This sequence suggests that the increased secretion, increased motility and disturbed circulation, mucosal erosions and ulcerations are phases of the same process differing only in the amount of tissue destruction in the stomach and duodenum.

In appraising the data of this study the relation between the emotions as described and the functional changes in the stomach and duodenum was not interpreted as cause and effect. Instead, both affects and gastroduodenal changes were viewed as coincident aspects of behaviour in reaction to life situations; behaviour in some instances compatible with health, and in others resulting in disease.

Note:
This investigation was aided by a grant from the Josiah Macy, Jr. Foundation.