Defense Date


Document Type


Degree Name

Doctor of Philosophy



First Advisor

Melanie McGrath


Pediatric constipation can lead to various negative emotional and physical consequences including abdominal pain, painful defecation, toileting fears, anxiety about pain and intestinal dysfunction. In addition, constipation can lead to socially compromising and embarrassing situations due to associated overflow incontinence. These unpleasant physical and emotional symptoms may in tum lead to conditioned avoidance behaviors, which serve to further maintain the cycle of stool retention and constipation. Presently, there have not been any studies directly addressing the role of conditioned aversion in the etiology and maintenance of constipation. This study examined the psychometric properties of the Defecation Anxiety Scale (DAS)- a scale designed to assess subjective fear and anxiety that children with chronic constipation may experience regarding toileting. A reliable and valid measure of toileting fears for this population would be useful in determining the possible contribution of conditioned- aversion in the etiology and maintenance of chronic constipation.

Three samples of children were recruited to examine the reliability and validity of the measure: (1) children with chronic constipation, (2) a normal control sample from a wellness clinic, and (3) a pediatric asthma sample. The study population consisted of children between the ages of 5 and 16 years of age. Parents and children in each group completed the Defecation Anxiety Scale. Results indicated that parents and children in the constipation group had significantly higher scores in the DAS relative to either control group. Having experienced pain significantly impacted DAS scores. The number of subjects reporting painful bowel movements was significantly higher for the constipation group. A preliminary examination of the interrater reliability of the DAS showed that the scale has high stability across parent and child ratings for the constipation group. Internal consistency for the total score suggested a high level of reliability for the scale. The validity of the DAS was assessed via comparisons with previously standardized measures of anxiety. Correlations between general anxiety scores and the DAS were low for the ratings made by the constipation group; therefore, fear and anxiety tapped by the DAS is specific to toileting.


© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission


Included in

Psychology Commons