Abstract
We hypothesized that patients who complain of dysphagia without demonstrable organic abnormality may have an underlying psychological dysfunction. We thus conducted a comprehensive assessment in three groups of patients with dysphagia. Dysphagia was classified as obstructive (Obst) when an obstructive lesion was present on esophagoscopy or barium swallow, motility-related (Mot) when abnormal motility was shown on esophageal manometry in the presence of normal esophagoscopy or barium swallow, or nonobstructive, nonmotility-related (NONM) when manometry and esophagoscopy or barium swallow were both normal. We prospectively evaluated 71 patients with Obst-dysphagia, 15 patients with Mot-dysphagia and 10 patients with NONM-dysphagia with a battery of standardized psychological tests including the Minnesota Multiphasic Personality Inventory (MMPI), the Symptom Checklist-90-Revised (SCL-90-R), and the Millon Behavioral Health Inventory (MBHI). The results indicate that patients with NONM-dysphagia have psychological attributes similar to those found in patients with Obst-dysphagia or Mot-dysphagia. Combination of scores for parameters such as somatization, depression, and anxiety could not distinguish among the three groups of dysphagia patients. We thus conclude that patients with NONM-dysphagia, as a group, have similar psychological profiles compared to patients with dysphagia due to organic causes.
Similar content being viewed by others
References
Richter JE, Bradley LA, Castell DO: Esophageal chest pain: current controversies in pathogenesis, diagnosis and therapy. Ann Intern Med 110:66–78, 1989
Vantrappen G, Janssens J: Angina and oesophageal pain—a gastroenterologists' point of view. Eur Heart J 7:828–834, 1986
DeMeester TR, O'Sullivan GC, Bermudez G, Midell AI, Cimochowski GE, O'Drobinals J: Esophageal function in patients with angina-type chest pain and normal coronary angiograms. Ann Surg 196:488–498, 1982
Vantrappen G, Janssens J, Ghillebert G: The irritable oesophagus—a frequent cause of angina-like pain. Lancet 1:1232–1234, 1987
Richter JE, Barish CT, Castell DO: Abnormal sensory perception in patients with esophageal chest pain. Gastroenterology 91:845–852, 1986
Clouse RE, Lustman PJ: Psychiatric illness and contraction abnormalities of the esophagus. N Engl J Med 309:1337–1342, 1983
Liss JL, Alpers D, Woodruff RA Jr: The irritable colon syndrome and psychiatric illness. Dis Nerv Syst 34:151–157, 1973
Young SJ, Alpers DH, Norland CC, Woodruff RA Jr: Psychiatric illness and the irritable bowel syndrome: practical implications for the primary physician. Gastroenterology 70:162–166, 1976
Talley NJ, Weaver AL, Zlnsmeister AR, Melton LJ III: Onset and disappearance of gastrointestinal symptoms and functional gastrointestinal disorders. Am J Epidemiol (in press)
Castell DO, Knuff TE, Brown FC, Gerhardt DC, Burns TW, Gaskins RD: Dysphagia. Gastroenterology 76:1015–1024, 1979
Ott DJ, Wu WC, Gelfand DW: Efficacy of radiology of the esophagus for evaluation of dysphagia. Gastrointest Radiol 6:109–110, 1981
Ott DJ, Richter JE, Chen YM, Wu WC, Gelfand DW, Castell DO: Esophageal radiography and manometry: correlation in 172 patients with dysphagia. AJR 149:307–311, 1987
Katz PO, Dalton CB, Richter JE, Wu WC, Castell DO: Esophageal testing of patients with noncardiac chest pain or dysphagia. Ann Intern Med 106:593–597, 1987
Kaplan PR, Ivans IM: A case of functional dysphagia treated on the model of fear of fear. J Behav Ther Exp Psychiatry 9:71–72, 1978
Stoylen IJ: Dysfagi: Behandling ved gradvis eksponering. (Dysphagia: Treatment by graduated exposure.). Tidsskr Nor Psykologforen 25:237–239, 1988
Klinger RL, Strang J: Psychiatric aspects of swallowing disorders. Psychosomatics 28:572–576, 1987
Koon RE: Conversion dysphagia in children. Psychosomatics 24:182–184, 1983
Bovier P, Hilleret H, Tissot R: A propos d'un cas de dysphagie fonctionnelle. (On a case of functional dysphagia.). Schweizer Arch Neurol Psychiatr 139:5–12, 1988
Lichstein KL, Eakin TL, Dunn ME: Combined psychological and medical treatment of oropharyngeal dysphagia. Clin Biofeed Health Int J 9:9–14, 1986
Black S: Dysphagia of pseudobulbar palsy successfully treated by hypnosis. N Z Med J 91:221–224, 1980
Dahlstrom WG, Welsh GS: An MMPI Handbook: A Guide to Use in Clinical Practice and Research. Minneapolis: University of Minnesota Press, 1960
Colligan RC, Osborne D, Swenson WM, Offord KP: The MMPI: A Contemporary Normative Study of Adults, 2nd ed. Odessa, FL: Psychological Assessment Resources, Inc. 1989
Derogatis LR: Symptom Checklist-90, Revised (SCL-90-R). Towson, MD: Clinical Psychometric Research, 1983
Millon T, Green CJ, Meagher RB: Millon Behavioral Health Inventory Manual, 3rd ed. Minneapolis, Minnesota: National Computer Systems, 1982
Richter JE, Obrecht WF, Bradley LA, Young LD, Anderson KO: Psychological comparison of patients with nutcracker esophagus and irritable bowel syndrome. Dig Dis Sci 31:131–138, 1986
Thompson JK: Diagnosis of head pain: an idiographic approach to assessment and classification. Headache 22:221–232, 1982
Williams DE, Thompson JK, Haber JD, Raczynski JM: MMPI and headache: a special focus on differential diagnosis, prediction of treatment outcome, and patient-treatment matching. Pain 24:143–158, 1986
Triadafilopoulos G: Nonobstructive dysphagia in reflux esophagitis. Am J Gastroenterol 84:614–618, 1989
Kjellen G, Svedberg JB, Tibbling L: Solid bolus transit by esophageal scintigraphy in patients with dysphagia and normal manometry and radiography. Dig Dis Sci 29:1–5, 1984
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Kim, C.H., Hsu, J.J., Williams, D.E. et al. A prospective psychological evaluation of patients with dysphagia of various etiologies. Dysphagia 11, 34–40 (1996). https://doi.org/10.1007/BF00385798
Issue Date:
DOI: https://doi.org/10.1007/BF00385798