Personality traits and emotional patterns in irritable bowel syndrome

Table 1 Personality models

Model	Features
Biosocial[21]	Temperament: heritable differences in emotional reactivity and regulation, and in withdrawal/approach behaviors towards environmental stimuli.
	Character: aspects of personality that are shaped by learning and interaction with the environment.
Five factor[23]	Neuroticism: tendency toward negative emotions (anxiety, hostility, depression) with high reactivity to physiological changes, emotional instability, vulnerability to stress, and an inclination toward impulsive behaviors.
	Extraversion: attitude to experience positive emotions, warmth, excitement seeking, and activity.
	Openness to experience: tendencies toward imagination and fantasy, aesthetics, creativity, ideas and values, and thought flexibility.
	Agreeableness: pro-social, altruistic orientation towards others, trust, straightforwardness, and tender-mindedness.
	Conscientiousness: competence, order, self-discipline, and achievement striving.
Alexithymia[25]	A reduced ability to identify, describe and discern subjective emotions and feelings, poor imaginative thought and introspection, and a cognitive style that is concrete and externally oriented.
Type D[26]	Negative affectivity: stable tendency to experience negative emotions (feelings of dysphoria and tension, negative view of self, somatic symptoms, attention bias towards adverse stimuli).
	Social inhibition: stable tendency to inhibit the expression of emotions and behaviors in social interaction (feeling to be inhibited, tense and insecure when with others).

Table 2 Personality and irritable bowel syndrome

-Several personality traits and constructs, such as neuroticism, conscientiousness, and alexithymia, are closely associated with irritable bowel syndrome (IBS).

-Negative emotionality, a feature of neuroticism, can increase colonic motility; high levels of neuroticism, anxiety sensitivity, trait worry, and increased vigilance toward visceral sensations are common features of IBS patients and reliable predictors of IBS symptoms.

-The relationship between complaint severity reports and conscientiousness was modified by genetic variation in catechol-O-methyltransferase (COMT) which is involved in mediating sympathetic and dopaminergic tone through catecholamines degradation, thus participating in the complex affective, personality, and cognitive networks also involved in IBS pathophysiology and clinical expression.

-Potential mechanisms by which alexithymia could affect IBS severity include the core features of this personality construct, such as the tendency to focus on, intensify, and misinterpret bodily sensations and somatic sensations triggered by states of emotional arousal; moreover, higher pain intensity to rectal distension in alexithymic IBS patients than in non-alexithymic controls has been documented.

Table 3 Emotional patterns and irritable bowel syndrome

-Negative emotions, which are probably more entangled with neurobiological substrates, seem to have a key role in the brain-gut axis dysfunction which characterizes irritable bowel syndrome (IBS).

-Anger, anxiety, and depression have been consistently associated to visceral and pain hypersensitivity. In the presence of negative emotions, visceral sensations tend to be more noticeable and labeled as painful.

-Emotional arousal can augment colonic motility and diarrhoea; laboratory studies have provided evidence that anger-provoking conditions significantly increased colon motility in IBS patients, whereas anger suppression was associated with prolonged gastric emptying and delayed gut transit.

-A role for negative emotions in low-grade inflammation and altered immune activity in IBS has garnered support from studies demonstrating alterations on several inflammatory and immune parameters resulting in an imbalance of the proinflammatory and anti-inflammatory cytokines.