The personality pattern in peptic ulcer disease

摘要

Several studies over the last 60 years have suggested that peptic ulceration is associated with personality disorders. In 1934 Alexander concluded from a psychoanalytic study of 6 patients with duodenal ulcer and 3 with so-called gastric neurosis, that these patients had an unconscious, intrapsychic dependence/independence conflict. He suspected that this psychodynamic situation was the outstanding psychic factor in the etiology of duodenal ulcer. This conflict was given as the explanation for the impression of a number of authors of that time that 'personalities who are over-active in life, like to take responsibilities and make concentrated efforts are so often found among the peptic ulcer cases'. Hamilton (1950) claimed that although the literature on the subject was tremendous, the fact that most studies were small and selected and the personality assessments subjective, left the allegation of a distinct peptic ulcer personality open to question. He was the first to use a personality inventory in an investigation of a larger group of dyspeptic patients (duodenal ulcer, gastric ulcer and non-ulcer dyspepsia patients) and compare them with a control group of non-dyspeptics suffering from 'lengthy chronic illness'. Both groups were selected among hospital patients. Significant differences between the groups were found in only one dimension, which was said to correspond with 'anxiety neurosis'. This characterized the non-ulcer dyspeptics, with the duodenal ulcer group fairly close, and the gastric ulcer group coming half-way on towards the controls. Small & Cay (1973) found evidence of psychiatric symptoms in 68% of surgical peptic ulcer patients. Neurotic disturbance, anxiety and depression occurred in half the patients but using the same clinical method of assessment, it was found that peptic ulcer patients did not differ in extent or kind of emotional disturbance from other patients admitted to a gastro-intestinal unit or from a group of patients during convalescence after acute ischaemic heart disease. Consequently, they concluded that the clear evidence of psychiatric upset was due, not to the presence of an ulcer 'type', but to the disease and the stresses it imposed.