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Globus Sensation and Psychopathology in Men: The Vietnam Experience Study

From the MRC Epidemiology Resource Centre (C.R.G.), University of Southampton, Southampton General Hospital, Southampton, UK; Department of Otolaryngology and Head and Neck Surgery (J.A.W.), Freeman Hospital, Newcastle University, Newcastle Upon Tyne, UK; Department of Psychology (I.J.D.), Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, UK.

Address correspondence and reprint requests to Catharine Gale, MRC Epidemiology Resource Centre, (University of Southampton) Southampton General Hospital, Southampton SO16 6YD, UK. E-mail: crg{at}mrc.soton.ac.uk

Objective: To assess whether globus is associated with psychopathology in men. Globus—a persistent sensation of having a lump in the throat with no detectable physical cause—has long been thought a predominantly female disorder. Several small studies, based wholly or largely on women, suggested that globus is associated with higher levels of depression, anxiety, and somatic concern.

Methods: Participants were 4240 male U.S. veterans who underwent detailed medical and psychological examinations in middle age. Psychological health was assessed by structured diagnostic interview and the clinical scales of the Minnesota Multiphasic Personality Inventory (MMPI). The MMPI includes an item on the presence of globus.

Results: The prevalence of globus was 6.4%. Men with globus had an increased risk of being diagnosed with somatization disorder, odds ratio (OR) = 5.92, 95% Confidence Interval (CI) = 3.22, 10.9l; major depression, OR = 4.98, 95% CI = 3.63, 6.67; generalized anxiety disorder, OR = 3.70, 95% CI = 2.75, 4.90; posttraumatic stress disorder, OR = 3.50, 95% CI = 2.54, 4.76; and drug abuse or dependence, OR = 1.89, 95% CI = 1.15, 3.13; and they scored significantly higher on nine of the ten MMPI clinical scales. Globus was also associated with lower cognitive ability, socioeconomic and educational disadvantage, a higher pulse rate, and increased likelihood of being on antihypertensive medication.

Conclusions: Globus is linked with a wide range of psychopathology in men, notably depression and somatization disorder. Men presenting with globus might have developed that particular symptom to "represent" other, related and treatable psychopathology, which should also be investigated.

Key Words: globus sensation • depression • somatization

Abbreviations: MMPI = Minnesota Multiphasic Personality Inventory; ENT = ear, nose, and throat; DIS = Diagnostic Interview Schedule; PTSD = posttraumatic stress disorder.