Stress and personality in patients with chronic peptic ulcer.

The concept that stress and personality are associated with ulcer is widely held by lay persons and to some extent by the medical community. By means of epidemiological techniques and more precise terminology, the role of psychosomatic factors in ulcer disease has been more clearly defined. Regarding acute stress, the number of events experienced and the change and distress they are purported to produce has been found to be similar in ulcer patients and their controls matched on age, sex, and social class. However, chronic difficulties, i.e., events or circumstances that have persisted for > or = 6 months, are twice as common in duodenal ulcer patients as in controls. Events, either acute or chronic, are more strongly associated with duodenal ulcer if they contain a component involving personal threat or goal frustration. Associations that have been found between acute or chronic stress and duodenal ulcer have been relatively weak, with odds ratios of 2 to 3. For some patients, it is possible that depression and social incongruity may have played some role in initiating ulcer disease. Personality studies have shown that ulcer patients are more neurotic than controls, but the difference is small and there is no evidence to indicate an ulcer personality. As regards both stress and personality, gastric ulcer patients do not differ from duodenal ulcer patients.