Goal frustration and life events in the aetiology of painful gastrointestinal disorder

Life events and difficulties were recorded for the year proceding onset of abdominal pain in 135 consecutive referrals to three gastrointestinal clinics, and for the equivalent time period in a matched, healthy community comparison series. Fifty-six patients were found to have an organic gastrointestinal disorder. Severely threatening events and major difficulties known to play a critical aetiological role in clinical depression, occurred with much the same frequency during the 38 weeks before onset of non- organic (‘functional’) gastrointestinal disorder. There was no such relationship between the severity of threat and organic disorder. A measure of ‘goal frustration’ reflecting the degree to which the subjects aims and ambitions were insurmountably obstructed by the occurrence of the event, was significantly associated with organic disorder. This finding may explain the often reported association between life stress and organic gastrointestinal disorder.