A Dissertation Submitted To Huazhong University Of Science And Technology For The Degree Of Doctor Of Medicine

Background A strong association between family function and irritable bowel syndrome (IBS) has been observed. Most of these studies focus on the association between IBS and childhood abuse or social learning from parental illness behavior, which may be only two marks of many family dysfunctional factors. Parental rearing styles, as a comprehensive mark for family function, may provide new clues to the etiology of IBS.Aims To explore which dimensions of parental rearing styles are risk factors or protective factors for irritable bowel syndrome (IBS) in adolescents.Methods2320adolescents were recruited from one middle school and one high school randomly selected from Jiangan District (an urban district in Wuhan City in Middle China). Data was collected using two Chinese versions of validated self report questionnaires including Rome III diagnostic criteria for pediatric IBS and the Egna Minnen Betraffande Uppfostran:One’s Memories of Upbringing (EMBU) for perceived parental rearing styles.Results96subjects diagnosed as pediatric IBS were compared with1618controls. The IBS patients reported less both paternal and maternal emotional warmth (all P<0.01) and more both paternal and maternal punishment, over-interference, rejection and overprotection (only for father)(all P<0.01) than the controls. Furthermore, the IBS patients had higher total scores of parental rearing styles (all P<0.001) than the controls. With univariate logistic regression, standardized regression coefficients and odds ratios of parental rearing variables were calculated.Conclusion Parental emotion warmth is a protective factor for IBS in adolescents and parental punishment, over-interference, rejection and overprotection are risk factors for IBS in adolescents. Background Many studies have reported an association between irritable bowel syndrome (IBS) and high levels of neuroticism. Neuroticism has been considered as the most significant personality of IBS patients. But most of these researches are about adults and researches related to adolescents and children are rare.Aims We aimed to explore the relationship between neuroticism and IBS in adolescents.Methods2320adolescents were recruited from one middle school and one high school randomly selected from Jiangan District (an urban district in Wuhan City in Middle China). Data was collected using two Chinese versions of validated self report questionnaires including Rome Ⅲ diagnostic criteria for pediatric IBS and neuroticism subscale of the Junior Eysenck Personality Questionnaire (JEPQ) for neuroticism.Results High school students have higher neuroticism scores than middle school students (P<0.001). Females have higher neuroticism scores than males (P<0.001). Adolescents in single-parent families have higher neuroticism scores than adolescents in both-parent families (P<0.001). IBS group had higher neuroticism scores than non-IBS group (P<0.001). The odds ratio and standardized regression coefficient of neuroticism for IBS were calculated by Logistic regression.Conclusion Neuroticism is a risk factor for IBS in adolescents. Background Parental rearing styles have a significant impact on adolescent psychosocial development. Our previous research indicated that there was a strong association between dysfunctional parenting styles and irritable bowel syndrome (IBS) in adolescents. Dysfunctional parenting styles correlate with many psychiatric disorders in adults and adolescents, such as high scores of neuroticism. Many studies determine that adult IBS patients have higher neuroticism scores than controls. Similarly, our previous study reported a strong association between IBS adolescents and neuroticism.Aims We aimed to determine whether the association between parental rearing styles and IBS in adolescents could be mediated by neuroticism.Methods2320adolescents were recruited from one middle school and one high school randomly selected from Jiangan District (an urban district in Wuhan City in Middle China). Data was collected using three Chinese versions of validated self report questionnaires including Rome III diagnostic criteria for pediatric IBS, neuroticism subscale of the Junior Eysenck Personality Questionnaire (JEPQ) for neuroticism, and the Egna Minnen Betraffande Uppfostran:One’s Memories of Upbringing (EMBU) for perceived parental rearing styles.Results1547adolescents in both-parent families were finally analyzed.80IBS patients were compared with1467controls. With univariate Logistic regression, standardized regression coefficients and odds ratios of parental rearing variables and neuroticism were calculated. Parental emotional warmth was a protective factor for IBS adolescents (all P<0.01) and parental punishment, rejection, over-interference and overprotection (for father only) were risk factor for IBS in adolescents (all P<0.01). Neuroticism was a risk factor for IBS in adolescents (P<0.001). Parental emotional warmth (all P<0.001) was negatively correlated with neuroticism and parental punishment, rejection, over-interference and overprotection (for father only) were positively correlated with neuroticism (all P<0.001). However, in the second stage of hierarchical Logistic regression, after controlling for neuroticism, four parental rearing variables (paternal over-interference, paternal overprotection, maternal emotional warmth and maternal punishment) lost significance (all P>0.05). Based on multivariate Logistic regression, paternal rejection, maternal over-interference, school level and neuroticism were independent risk factors for IBS in adolescents (all P<0.05).Conclusion The association between parental rearing styles and IBS in adolescents may be partly explained by neuroticism. Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder. IBS is characterized by chronic abdominal pain and abdominal bloating associated with at least two of the following three features:abdominal pain or abdominal bloating improved with defecation, onset associated with a change in frequency of stool, onset associated with a change in form of stool. The diagnosis of IBS should be excluded any infection, inflammation, tumor and other organic diseases.IBS is common in the general population, primary care clinics and tertiary hospitals. In the general population, its prevalence is almost10%-20%, affecting people of all ages. IBS leads to a low quality of life for the patients and the serious cases may suffer from unemployment, school dropouts and disabilities. At the same time IBS also bring huge economic and social burden, and cause the waste of medical resources.IBS is a multifactorial disease and its pathogenesis and precise mechanism remain unknown. A lot of researches show that genetics, psychological and social factors, immune, intestinal infection, intestinal flora imbalance involve in the pathogenesis of IBS. The biopsychosocial model of IBS has been developed to bring a better comprehensive understanding of the interaction of these factors. Brain-gut axis is the core of this model, and biopsychosocial factors play an important role in the onset of IBS, gut dysfunction, illness experiences and its clinical outcome. In this review, an introduction of the biopsychosocial model was made at first.Many researches have found that psychosocial factors significantly influence the onset of IBS, its clinical manifestations and clinical outcomes. It is indicated that many IBS patients have early life risk factors including dysfunctional parental rearing styles, childhood trauma and so on. Also, patients with IBS are usually accompanied with high neuroticism scores, alexithymia scores and various clinical psychiatric comorbidities. Anxiety disorder, depression disorder and somatization disorder are the most common psychiatric comorbidities in IBS patients. In addition, IBS patients usually have dysfunctional health believes such as hypochondirasis and catastrophyzing. When confronted with abdominal complaints, IBS patients are likely to adopt poor coping strategies such as illness behavior. Some daily life stressors may also contribute to the pathogenesis of IBS and its clinical manifestation and outcomes. In this paper, we reviewed the psychosocial factors and psychopathologies in IBS.Psychosocial factors have a significant impact on the etiopathogenesis of IBS which is a multifactorial disease. Psychotherapies play an important role in treating IBS. In this paper we reviewed the related literature and made an introduction of the cognitive behavioral therapy (CBT) and hypnotherapy.Morita therapy is a special kind of psychotherapy, with Eastern cultural characteristics, which can effectively treat anxiety disorder. In the end of this review, we made an introduction of Morita therapy and make a model of the pathogenesis of IBS which was based on Morita therapy.