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Reported Sexual Abuse Predicts Impaired Functioning but a Good Response to Psychological Treatments in Patients With Severe Irritable Bowel Syndrome

From the School of Psychiatry and Behavioural Science (F.C., E.G., J.R., B.T.) and Section of Gastrointestinal Science (D.G.T.), University of Manchester, Manchester, UK; and University of Sheffield Centre for Human Nutrition, Northern General Hospital, Manchester, UK (L.F., N.R.); all on behalf of the North of England IBS Research Group (Chris Babbs, Joe Barlow, Chandu Bardhan, Francis Creed, David Dawson, Lakshmi Fernandez, Elspeth Guthrie, Stephanie Howlett, Linda McGowan, Jane Martin, Jim Moorey, Kierran Moriarty, Stephen Palmer, Joy Ratcliffe, Nicholas Read, Christine Rigby, Irene Sadowski, David Thompson, Barbara Tomenson).

Address correspondence and reprint requests to Francis Creed, FRCP, School of Psychiatry and Behavioural Science, Rawnsley Building, Oxford Road, Manchester M13 9WL, UK. E-mail: francis.creed{at}manchester.ac.uk

Objective: We assessed the effect of reported sexual abuse on symptom severity and health-related quality of life in patients with severe irritable bowel syndrome (IBS) undergoing psychological treatments.

Methods: IBS patients entering a treatment trial who reported prior sexual abuse were compared with the remainder in terms of symptom severity and health-related quality of life (SF-36) at trial entry and 15 months later. Analyses used ANCOVA with age, sex, marital status, and treatment group as covariates. We assessed possible mediators using multiple regression analysis.

Results: Of 257 patients with severe IBS, 31 (12.1%) reported a history of rape and 28 (10.9%) reported forced, unwanted touching. People who reported abuse were more impaired than the remainder on the SF-36 scales for pain (adjusted p = .023) and physical function (p = .029); these relationships followed a "dose-response" relationship and were mediated by SCL-90 somatization score. At 15 months follow-up, the associations between reported abuse and SF-36 scores were lost because people with reported abuse, especially rape, improved more than the remainder when treated with psychotherapy or paroxetine (selective serotonin reuptake inhibitor antidepressant); this improvement was mediated by change in SCL-90 somatization score.

Conclusions: In severe IBS, the association between self-reported sexual abuse and impaired functioning is mediated by a general tendency to report numerous bodily symptoms. A reported history of abuse is associated with a marked improvement following psychological treatment.

Key Words: irritable bowel syndrome • outcome • health-related quality of life • sexual abuse • somatization • psychotherapy

Abbreviations: IBS = irritable bowel syndrome; SF-36 = Short Form 36; SSRI = selective serotonin reuptake inhibitor; SCL-90 = Symptom Checklist (90 items); SPSS = Statistical Package for the Social Sciences; SEM = standard error of the mean; ANOVA = analysis of variance; ANCOVA = analysis of covariance.

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