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Sunday, October 1, 2017

The IBD Personality

5:26 AM Posted by Tiffany Taft , , , ,
Let me tell you about the IBD personality.  The antiquated and debunked theory that, due to certain personality structures or tendencies, a person will develop a destructive disease of the digestive system.

Surely we must go WAY back in the medical literature to find people who write about this!

I first learned about the IBD personality during my dissertation.  My project was the first study evaluating disease-related stigmatization in IBD patients.  You can read the publication here but the entire dissertation is about 150 pages long and who has time for that?  Let's just say you have to do a thorough literature review for a dissertation.  In that review, I came across research, published research, on the IBD personality.

I was floored.  Really, people of the 1940s?
I have encountered few calm, phlegmatic persons with this disease. Many of them were emotional, sensitive, rather excitable people. -  Dr. Bockus, 1945
Then again, compared to other prevailing medical theories of the time this wasn't really that bad.  I recently listened to a "The Dollop" podcast on Dr. Henry Cotton, a psychiatrist in the early 20th century who believed focal infection caused mental illness.  So he'd do things like pull out people's teeth, including his own wife and children, and when that didn't work, moved on to remove people's stomachs and colons and thyroid glands (?).

Funny, a lot of them didn't get any better.

However, Dr. Cotton was considered a pioneer in his field, the American Medical Association backed his work and the New York Times published an article on his work's virtues when it started to come under scrutiny. AND his practices were used up until the 1950s.

Maybe I should slow my roll about an IBD personality.

Now, if you do a Pubmed search for "IBD personality" you'll get some hits from recent research that doesn't imply IBD is caused by personality traits, rather personality traits can affect how a person responds to having IBD emotionally and socially.  That I get.  Our personalities do determine how we respond to anything, to a degree.
Dr. Riemer, 1960, believed Crohn's disease was a new disease from the "tensions of our times" and patients turned anger at the external world into internal anger, focused on the gut. He called this "entrail aggression."
So, what types of personality traits do patients with IBD have?
  • obsessive-compulsive behavior 
  • neuroticism
  • introversion
  • dependency
  • anxiety
  • overconscientiousness
  • repressed rage that cannot be appropriately expressed
  • perfectionism
The focus appeared to be more on ulcerative colitis than Crohn's disease, but both underwent personality inquiry and differences emerged.  I'll get to that in a minute.  Even Dr. Burrill Crohn, whom the disease is named after, wrote in his 1949 book:
The personality of the ileitis case is more stable than that of the patient suffering from ulcerative colitis or peptic ulcer .... The nervous, or rather, psychic manifestations of this disease are sometimes so manifest that they overwhelm the somatic manifestations .... The evident psychic and nervous symptoms that accompany ileitis often lead to delayed cognition of the true causes of the symptoms.... However ileitis can hardly be classed as a psychosomatic disease; occurrences or recurrences do not follow upon psychic shock as evidently as they can be observed in ulcerative colitis, with obvious relationship of cause to effect.
Other suggestions include patients with Crohn's disease have a constant desire "to be rid of'' events in their lives.  They repeatedly say they want to be done with school exams, with graduation, with a divorce, etc. And this personality trait can be acted out through the physical symptom, diarrhea.

That's right, Crohn's patients, you have diarrhea due to your deep aversion to tasks not being done.
The unconscious significance of cramps and diarrhea is a way of omnipotently controlling frustrating objects by squeezing them through the intestines and by devaluing them and getting rid of them as feces. - Dr. Sperling, 1960
Moving on.

Crohn's patients also tend to be in the middle.  As kids, when parents would argue, people with Crohn's attempt to act as peacemaker.  Crohn's patients repeatedly enter into conflict situations to try to resolve them, first with their own parents, then between boss and co-worker, spouse and in-law, etc.

So, Crohn's patients have diarrhea and, I assume pain, because they want tasks to be done except for those involving being a referee in conflicts.  Then it's game on, people.

We didn't forget about you, ulcerative colitis patients. You tend to withdraw from conflict. UC patients are also inclined towards introjection, or the unconscious incorporation of the traits of others into your own. You also tend to be neat and tidy, perhaps to an OCD extent.
Most of the housewives in the series were of the "neat and fussy" variety. The males were prone to express themselves by their care in personal appearance and dress. One of the patients became highly disturbed if anyone disarranged her toilet articles. One can only speculate as to whether the diarrhea is a subconscious symbolic method of expressing one's resentment at a neat and clean world which has betrayed one.  - Dr. Sullivan, 1935
Neat...and fussy....variety.  Someone wrote that in a medical journal.  Just putting that out there.

In the 1970s, things started to get offensive.  The creation of the Minnesota Multiphasic Personality Inventory, or MMPI, allowed psychiatrists and psychologists to give a True-False questionnaire to gauge several aspects of personality.  We still use the MMPI today, in its revised form.  I can say, however, I've never given it to an IBD patient.
Dr. Ford and his colleagues concluded that Crohn's patients use their illness to gain attention from their parents and to try to prevent loss - loss of love, loss of family unit (e.g., divorce).
You get the idea.

An unfortunate effect of this early, yet decades-long, theory of the psychological cause of IBD is a pendulum swing that resulted in gastroenterologists, and even some patients, essentially ignoring or denying mental health as part of the IBD patient experience.  Thankfully, the pendulum is swinging back to a place of integrated, multidisciplinary care that includes mental health.  But old ideas die hard, so patients need to continue to express desires for help without fear of judgment that it's them causing their disease, not a defunct immune system.

If I had to guess, IBD wasn't the only disease to be attributed to personality flaws.  But for some reason, people in the early to mid-1900s were kinda obsessed about poop and gastrointestinal functioning, so it may have gotten more attention than other conditions.

The good news is the last published study on the IBD personality was in 2017, thankfully in a pay-to-publish journal so it's essentially regarded as crap.

What I'm saying is this IBD personality nonsense is totally in the past. ¯\_(ツ)_/¯

--T2