Journal of Isfahan Medical School

Journal of Isfahan Medical School

The Structural Model of Difficulties in Emotion Rgulation, Psychological Problems, Somatization and Gastrointestinal Symptoms Intensity in Functional Gastrointestinal Disorders

Document Type : Original Article (s)

Authors
Mahnaz Aliakbari-Dehkordi 1
Ahmad Alipoor 2
Narges Mohammadi 3
Hamed Daghaghzadeh 4
1 Associate Professor, Department of Psychology, Payame Noor University, Tehran, Iran
2 Professor, Department of Psychology, Payame Noor University, Tehran, Iran
3 PhD Student, Department of Psychology, Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
4 Associate Professor, Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: Nowadays, bio-psycho-social model is the best model for the assessment and treatment of functional gastrointestinal disorders. This study aimed to evaluate the structural pattern of the relationships between the difficulties in emotion regulation, psychological problems (anxiety and depression), somatization and gastrointestinal symptoms intensity in patients with functional gastrointestinal disorders.Methods: 240 patients with functional gastrointestinal disorders were selected using convenience sampling method. They participated in the research by filling four questionnaires: Difficulties in Emotion Regulation Scale (DERS), Hospital Anxiety and Depression Scale (HADS), Modified Somatic Perception Questionnaire (MSPQ) and Gastrointestinal Symptom Rating Scale (GSRS). Data were analyzed using structural equation modeling method.Findings: The difficulties in emotion regulation had significantly direct effects on anxiety, depression and somatization, and indirect effect on gastrointestinal symptoms intensity (P < 0.001). Besides, the mediatory roles of anxiety and somatization in the relationship between the difficulties in emotion regulation and gastrointestinal symptoms intensity were supported.Conclusion: In sum, the results of the study emphasize the role of difficulties in emotion regulation in development of gastrointestinal symptoms intensity in these patients by increasing anxiety and somatization.
Keywords
Difficulties in emotion regulation
Psychological problems
Somatization
Gastrointestinal symptoms
Functional gastrointestinal disorders
  1. Woo DG, Kim H, Lim D, Seo DJ, Kong, Kong ID, et al. Relationship between Functional Gastrointestinal Disorders and Risk Factors: A Biomechanical Analysis. International Journal of Medical, Health, Biomedical and Pharmaceutical Engineering 2007; 1(2): 46-8.
  2. Micut R, Tanasescu MD, Dragos D. A review of the psychoemotional factors in functional dyspepsia. Revista Medicalå Românå 2012; 9(5): 278-86.
  3. Porcelli P, Sonino N. Psychological factors affecting medical conditions. A new classification for DSM-V. Adv Psychosom Med 2007; 28: 1-9.
  4. Jones MP, Crowell MD, Olden KW, Creed F. Functional gastrointestinal disorders: an update for the psychiatrist. Psychosomatics 2007; 48(2): 93-102.
  5. Creed F, Henningsen P, Fink P. Medically unexplained symptoms, somatisation and bodily distress: developing better clinical services. Cambridge, UK: Cambridge University Press, 2011.
  6. Monnikes H, Tebbe JJ, Hildebrandt M, Arck P, Osmanoglou E, Rose M, et al. Role of stress in functional gastrointestinal disorders. Evidence for stress-induced alterations in gastrointestinal motility and sensitivity. Dig Dis 2001; 19(3): 201-11.
  7. Levy RL, Olden KW, Naliboff BD, Bradley LA, Francisconi C, Drossman DA, et al. Psychosocial aspects of the functional gastrointestinal disorders. Gastroenterology 2006; 130(5): 1447-58.
  8. Wu JC. Psychological co-morbidity in functional gastrointestinal disorders: epidemiology, mechanisms and management. J Neurogastroenterol Motil 2012; 18(1): 13-8.
  9. Stanton AL, Danoff-Burg S, Cameron CL, Bishop M, Collins CA, Kirk SB, et al. Emotionally expressive coping predicts psychological and physical adjustment to breast cancer. J Consult Clin Psychol 2000; 68(5): 875-82.
  10. Eng PM, Fitzmaurice G, Kubzansky LD, Rimm EB, Kawachi I. Anger expression and risk of stroke and coronary heart disease among male health professionals. Psychosom Med 2003; 65(1): 100-10.
  11. Porcelli P, Bagby RM, Taylor GJ, de Carne M, Leandro G, Todarello O. Alexithymia as predictor of treatment outcome in patients with functional gastrointestinal disorders. Psychosom Med 2003; 65(5): 911-8.
  12. Gross JJ. The emerging field of emotion regulation: an integrative review. Review of General Psychology 1998; 2(3): 271-99.
  13. van Middendorp H, Geenen R, Sorbi MJ, van Doornen LJ, Bijlsma JW. Emotion regulation predicts change of perceived health in patients with rheumatoid arthritis. Ann Rheum Dis 2005; 64(7): 1071-4.
  14. Kassel JD, Bornovalova M, Mehta N. Generalized expectancies for negative mood regulation predict change in anxiety and depression among college students. Behav Res Ther 2007; 45(5): 939-50.
  15. Berking M, Wupperman P. Emotion regulation and mental health: recent findings, current challenges, and future directions. Curr Opin Psychiatry 2012; 25(2): 128-34.
  16. Liverant GI, Brown TA, Barlow DH, Roemer L. Emotion regulation in unipolar depression: the effects of acceptance and suppression of subjective emotional experience on the intensity and duration of sadness and negative affect. Behav Res Ther 2008; 46(11): 1201-9.
  17. Mennin DS, Heimberg RG, Turk CL, Fresco DM. Preliminary evidence for an emotion dysregulation model of generalized anxiety disorder. Behaviour Research and Therapy 2005; 43: 1281-310.
  18. Tull MT, Barrett HM, McMillan ES, Roemer L. A preliminary investigation of the relationship between emotion regulation difficulties and posttraumatic stress symptoms. Behav Ther 2007; 38(3): 303-13.
  19. Mazaheri M, Mohammadi N, Daghaghzadeh H, Afshar H. The effectiveness of emotion regulation intervention on emotional problems and quality of life among patients with functional gastrointestinal disorders. GOVARESH 2014; 19(2): 109-17. [In Persian].
  20. Ellard KK, Fairholme C, Boisseau C, Farchione TJ, Barlow DH. Unified protocol for the transdiagnostic treatment of emotional disorders: protocol development and initial outcome data. Cognitive and Behavioral Practice 2010; 17(1): 88-101.
  21. Marchesi C, Brusamonti E, Maggini C. Are alexithymia, depression, and anxiety distinct constructs in affective disorders? J Psychosom Res 2000; 49(1): 43-9.
  22. Porcelli P, Affatati V, Bellomo A, de Carne M, Todarello O, Taylor GJ. Alexithymia and psychopathology in patients with psychiatric and functional gastrointestinal disorders. Psychother Psychosom 2004; 73(2): 84-91.
  23. Iglesias M, Barreiro M, Vazquez I, Nieto L, Martinez I, Seoane M, et al. Prevalence of alexithymia in inflammatory bowel disease: relationship with sociodemographic and clinical parameters. Gastroenterology 2010; 138(5 (Suppl1)): S202.
  24. Fernandez A, Sriram TG, Rajkumar S, Chandrasekar AN. Alexithymic characteristics in rheumatoid arthritis: a controlled study. Psychother Psychosom 1989; 51(1): 45-50.
  25. Tuzer V, Bulut SD, Bastug B, Kayalar G, Goka E, Bestepe E. Causal attributions and alexithymia in female patients with fibromyalgia or chronic low back pain. Nord J Psychiatry 2011; 65(2): 138-44.
  26. Mazaheri M, Afshar H, Mohammadi N, Daghaghzadeh H, Bagerian R, Adibi P. The relation between the dimensions of alexithymia with depression and anxiety in patients with functional gastrointestinal disorders. J Res Behav Sci 2010; 8(2): 92-102. [In Persian].
  27. Sayar K, Solmaz M, Trablus S, Öztürk M, Acar B. Alexithymia in irritable bowel syndrome. Türk Psikiyatri Dergisi 2000; 11(3): 190-7.
  28. Sullivan M, Katon W. Somatization: The path between distress and somatic symptoms. APS Journal 1993; 2(3): 141-9.
  29. Lipowski ZJ. Somatization: the concept and its clinical application. Am J Psychiatry 1988; 145(11): 1358-68.
  30. Porcelli P, de Carne M, Fava GA. Assessing somatization in functional gastrointestinal disorders: integration of different criteria. Psychother Psychosom 2000; 69(4): 198-204.
  31. North CS, Downs D, Clouse RE, Alrakawi A, Dokucu ME, Cox J, et al. The presentation of irritable bowel syndrome in the context of somatization disorder. Clin Gastroenterol Hepatol 2004; 2(9): 787-95.
  32. Katon W, Kleinman A, Rosen G. Depression and somatization: a review. Part II. Am J Med 1982; 72(2): 241-7.
  33. Taylor G, Bagby R, Parker JDA. Disorders of affect regulation: alexithymia in medical and psychiatric illness. Cambridge, UK: Cambridge University Press; 1999.
  34. Waller E, Scheidt CE. Somatoform disorders as disorders of affect regulation: a development perspective. Int Rev Psychiatry 2006; 18(1): 13-24.
  35. Subic-Wrana C, Beutel ME, Knebel A, Lane RD. Theory of mind and emotional awareness deficits in patients with somatoform disorders. Psychosom Med 2010; 72(4): 404-11.
  36. Lumley MA. Alexithymia and negative emotional conditions. J Psychosom Res 2000; 49(1): 51-4.
  37. Lumley MA, Smith JA, Longo DJ. The relationship of alexithymia to pain severity and impairment among patients with chronic myofascial pain: comparisons with self-efficacy, catastrophizing, and depression. J Psychosom Res 2002; 53(3): 823-30.
  38. Bailey PE, Henry JD. Alexithymia, somatization and negative affect in a community sample. Psychiatry Res 2007; 150(1): 13-20.
  39. Rieffe C, Oosterveld P, Terwogt MM, Novin S, Nasiri H, Latifian M. Relationship between alexithymia, mood and internalizing symptoms in children and young adolescents: Evidence from an Iranian sample. Personality and Individual Differences 2010; 48(4): 425-30.
  40. Allen LB, Qian L, Tsao JC, Hayes LP, Zeltzer LK. Depression partially mediates the relationship between alexithymia and somatization in a sample of healthy children. J Health Psychol 2011; 16(8): 1177-86.
  41. Magni G, di MF, Bernasconi G, Mastropaolo G. DSM-III diagnoses associated with dyspepsia of unknown cause. Am J Psychiatry 1987; 144(9): 1222-3.
  42. Sharpe M, Carson A. "Unexplained" somatic symptoms, functional syndromes, and somatization: do we need a paradigm shift? Ann Intern Med 2001; 134(9 Pt 2): 926-30.
  43. Sayuk GS, Elwing JE, Lustman PJ, Clouse RE. High somatic symptom burdens and functional gastrointestinal disorders. Clin Gastroenterol Hepatol 2007; 5(5): 556-62.
  44. Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment 2004; 26(1): 41-54.
  45. Khanzadeh M, Saeediyan M, Hosseinchari M, Edrissi F. Factor structure and psychometric properties of difficulties in Emotional regulation scale. Journal of Behavioral Sciences 2012; 6(1): 23-4. [In Persian].
  46. Kaviani H, Seyfourian H, Sharifi V, Ebrahimkhani N. Reliability and validity of Anxiety and Depression Hospital Scales (HADS): Iranian patients with anxiety and depression disorders. Tehran Univ Med J 2009; 67(5): 379-85. [In Persian].
  47. Main CJ. The modified somatic perception questionnaire (MSPQ). J Psychosom Res 1983; 27(6): 503-14.
  48. Jansson-Frojmark M, MacDonald S. Exploratory factor analysis of the Modified Somatic Perception Questionnaire on a sample with insomnia symptoms. Psychol Health Med 2009; 14(1): 62-72.
  49. Revicki DA, Wood M, Wiklund I, Crawley J. Reliability and validity of the Gastrointestinal Symptom Rating Scale in patients with gastroesophageal reflux disease. Qual Life Res 1998; 7(1): 75-83.
  50. Mazaheri M, SadatKhoshouei M. Comparison between psychometric characteristics of Persian version of the gastrointestinal symptoms rating scale in functional gastrointestinal disorders and normal groups. GOVARESH 2012; 17(1): 18-24. [In Persian].
  51. Schumacker R, Lomax RG. A beginner's guide to structural equation modeling. London, UK: Routledge; 2009.
  52. Mechanic D. Adolescent health and illness behavior: review of the literature and a new hypothesis for the study of stress. J Human Stress 1983; 9(2): 4-13.
  53. Sayar K, Ak E. The predictors of somatization: a review. Bulletin of Clinical Psychopharmacology 2001; 11(4): 266-71.
  54. Locke GR, Weaver AL, Melton LJ, Talley NJ. Psychosocial factors are linked to functional gastrointestinal disorders: a population based nested case-control study. Am J Gastroenterol 2004; 99(2): 350-7.
  55. 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(4): 1140-56.
  56. Whitehead WE, Crowell MD, Robinson JC, Heller BR, Schuster MM. Effects of stressful life events on bowel symptoms: subjects with irritable bowel syndrome compared with subjects without bowel dysfunction. Gut 1992; 33(6): 825-30.
Journal of Isfahan Medical School
Volume 33, Issue 321 - Serial Number 321
January and February 2015
Pages 28-44

  • Receive Date 13 December 2014
  • Accept Date 06 April 2022