Covert psychiatric disturbance in patients with globus pharyngis

There is currently little agreement concerning the aetiology of globus pharyngis (née hystericus), and both physical and psychological factors have been suggested as primary causes of this common disorder. Using validated research questionnaires we tested the hypothesis that there is significant psychiatric morbidity in female globus patients but not in males. One hundred and twenty-one globus patients (90F, 31M) were tested on the Crown-Crisp Experiential Index (CCEI), the General Health Questionnaire (GHQ), the Hysteroid Obsessoid Questionnaire (HOQ) and the Eysenck Personality Questionnaire (EPQ). Female globus patients, but not males, have low extraversion scores and high GHQ scores when compared with age- and sex-matched ENT patient controls, and high mean levels of anxiety, depression and somatic concern on the CCEI. In females the mean total CCEI score was not significantly different from the mean of a psychiatric out-patient group. The males had total CCEI scores similar to a group with no psychiatric symptoms. Globus patients did not have hysteroid traits. We conclude that a substantial minority of globus patients has significant psychiatric morbidity. It is important to exclude mild, reactive-type depression and conversion disorder in these patients, in whom invasive physical investigations are inappropriate.