MMPI-2-RF characteristics of individuals with interstitial cystitis

https://doi.org/10.1016/j.jpsychores.2014.09.010Get rights and content

Highlights

  • We evaluated the MMPI-2-RF profiles of patients with interstitial cystitis.

  • Approximately 3/4 of those with interstitial cystitis had normal psychological profiles.

  • The remainder had profiles potentially consistent with somatoform disorders.

  • Psychological assessment should be performed with interstitial cystitis patients.

  • Psychological assessment could determine appropriateness for invasive treatments.

Abstract

Objectives

This study aimed to describe the psychological functioning of interstitial cystitis/bladder pain syndrome patients utilizing MMPI-2-RF scoring.

Methods

The MMPI-2 was administered to 60 individuals who reported a diagnosis of IC. Responses were scored in the MMPI-2-RF format. Fifty-one protocols were deemed valid.

Results

Elevations were discovered on scales FBS-r (symptom validity), RC1 (somatic complaints), and MLS (malaise). Participants were split into two groups based on extreme elevations on RC1; the high RC1 group produced higher scores on 39 scales including clinically significant elevations on 17 scales.

Conclusion

Over 25% of this sample had an emotional component to their physical concerns. This knowledge about the psychological characteristics of IC patients may have clinical utility for physicians and other treatment providers. The results argue strongly for psychological evaluation as a component of IC diagnosis and treatment. Those with significant emotional overlay to their somatic complaints may be best managed through psychological interventions and minimally invasive treatments.

Introduction

The primary symptom of interstitial cystitis (IC)/bladder pain syndrome (hereafter referred to as IC for brevity) is bladder discomfort. This bladder pain causes an urgent and/or frequent need to urinate [1]. In severe cases, patients may urinate up to 80 times per day [2] and describe a chronic, intense burning sensation in their bladders [3]. IC is estimated to affect between 2.7% and 6.5% of the female population of the United States, which is equivalent to 3.3 to 7.9 million women [4]. Although less common in men, it is estimated to affect 1.3% of the male population of the US [5]. The age of onset for IC is usually between 30 and 50, although some patients have reported symptoms of IC since childhood [6].

IC is usually diagnosed when medical testing for urinary tract infection, urinary stones, endometriosis, bladder cancer and other urinary diseases is negative. There are no specific tests for IC, making it a diagnosis of exclusion [1]. The cause of IC is unknown. IC was, and sometimes still is, believed by physicians to be a somatoform disorder. According to Cohen [7], journals published in the mid-20th century characterized those with IC as having a “psychosomatic syndrome.” IC patients also supposedly internalized anger and exhibited depressive symptoms. Similar views were still being expressed only 30 years ago. One urology textbook stated, “Interstitial cystitis is a disease that is taunting in its evasion of being understood…[it] may represent the end stage of a bladder that has been made irritable by emotional disturbance…a pathway for the discharge of unconscious hatreds” [8]. Even in 2006 [9], IC was grouped with several other disorders which are believed to be at least partly caused by psychological factors. More recently, IC has been grouped with other chronic pain disorders as a “central sensitivity syndrome” [10]. While the concept of central sensitivity syndromes includes the role psychological processes may have in the development of these disorders, it offers evidence for pathophysiological differences in the neural processing of pain as a primary cause.

Despite the long-suspected role of psychological factors in IC, no large-scale studies to date have been conducted examining the psychological functioning of interstitial cystitis patients using general measures of psychological functioning, such as the Minnesota Multiphasic Personality Inventory-2-Restructured Format (MMPI-2-RF). Instead, a number of studies have been conducted using more circumscribed measures to assess for symptoms of psychological distress, such as anxiety and depression [11]. While knowing the comorbidity of anxiety and depression with IC is valuable for treatment providers, such screeners tell us little about the overall psychological contribution to IC symptoms. The present study attempts to provide a description of the psychological functioning of IC patients by presenting data from all 50 MMPI-2-RF scales.

Section snippets

Participants

Participants for the study were recruited in person at support group meetings and conferences, through flyers at medical offices, and online through association websites and electronic mailing lists. A total of 60 persons participated in the study. All participants indicated that they had been diagnosed with IC. No specific method of diagnosis was utilized to determine inclusion in the study given that IC is considered a diagnosis of exclusion. These methods of recruitment were consistent with

Results

As the method of administration differed for some participants (i.e., over the phone rather than in person), analyses were first conducted to determine if these groups differed in any way. The groups did not differ on sex, race, education, length of diagnosis, current rating of pain, frequency of urination, or number of diagnoses of physical illnesses. The two groups did differ significantly on age (F = 16.76, p < .001), with those in the phone group being over fourteen years younger. It is

Discussion

This study was a preliminary examination of the psychological characteristics of IC patients. Analysis of MMPI-2-RF characteristics of participants as one group revealed elevations on FBS-r, RC1, and MLS. These comprehensive analyses, however, concealed significant differences between two groups of patients. While nearly three-quarters of participants produced essentially normal profiles, the remainder produced profiles significantly higher on 39 of the scales of the MMPI-2-RF, including

Conflicts of interest and source of funding

Author RF received a grant from the School of Professional Psychology at Forest Institute to fund this research. Author SA is affiliated with NASM which provided materials for this project. The remaining authors did not receive or contribute any financial resources to this project.

Acknowledgments

The authors would like to thank Neuropsychological Associates of Southwest Missouri (NASM) for supporting this project and Richard Frederick for his assistance with earlier revisions of this manuscript.

Note: The MMPI-2 profiles collected from this data were presented as a poster at the Society of Behavioral Medicine 30th Annual Meeting (2009), Montreal, Canada.

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    In other words, these organic and psychological factors appeared to be separable. Using a comprehensive assessment of psychological function, it has been reported that a subgroup of IC/BPS patients showed a profile of somatic and cognitive dysfunction as well as emotional and social problems [60]. Together, these findings lend support for the existence of a psychosocial subtype of IC/BPS with a distinct pathogenic pathway.

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