Emotional Antecedents of Perforation of Ulcers of the Stomach and Duodenum

Abstract

After a detailed psychiatric study of 20 patients representing consecutive admissions it is concluded that, generally, emotional factors were intimately involved in ulcer perforations. However, the importance of diet, alcohol, activity, and other concurrent disease also was noted. Perforation usually occurred as a climax to a period of emotional turbulence when the patient faced situations which, consciously or unconsciously, he felt to be grossly damaging to his self-esteem and to which he reacted, predominantly, with impotent rage. The perfection prodrome is described and interpreted as a depressive equivalent. The ulcer patient's ordinal position in his family as the youngest or middle child and his difficulties in relation to his father are emphasized. Particularly where no other serious disease coexists, perforation should be taken as presumptive evidence that the patient has tried unsuccessfully to resolve an emotional crisis and that appropriate psychiatric help probably is indicated as part of the total treatment.