Psychologic aspects in proctalgia

Abstract

PURPOSE: One of the main problems in coloproctology is chronic idiopathic anal pain. The aim of this study was to investigate the psychosomatic components of proctalgia to identify which, if any, component is associated with this pain and to what extent. METHODS: Twenty patients with proctalgia were observed (mean age, 46 years). Psychologic consultations were required by the surgeons, because of persistent symptoms, to allow a better understanding of the problem and a more integrated therapy. The psychologic investigation consisted of three interviews and administration of the following tests: Institute for Personality and Ability Testing Anxiety Scale Questionnaire (1–10), Rorschach test (Klopfer and Davidson method), and Draw-A-Person test by Karen Machover. This sample was compared with a control group composed of 40 healthy subjects, homogeneous in age, social and working conditions, and investigation procedures. RESULTS: Patients showed depression and anxiety according to standard validated questions (Institute for Personality and Ability Testing Anxiety Scale Questionnaire) and personality disorders; they had a strong tendency to use primitive defense mechanisms and showed a lack of personality formation. CONCLUSIONS: Psychologic investigation allows a progressive clarification of all the components of anal pain. This might be useful not only for research purposes but also for a more effective approach to these patients.