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Health-related quality of life (HRQOL) is a main outcome in irritable bowel syndrome (IBS), but most studies have been conducted on moderate-severe patients. We sought to ascertain the relative contribution of severity, anxiety, and personality to impairment of HRQOL in a sample representative of the entire IBS spectrum.IBS consulters, IBS nonconsulters, and controls were invited to complete questionnaires designed to measure severity of IBS (Functional Bowel Disease Severity Index), anxiety (State-trait Anxiety Inventory), personality (Minnesota Multiphasic Personality Inventory-2), and HRQOL [Short Form 36 (SF-36)]. The SF-36 scores of the study groups were compared, and a multiple regression model was constructed.Sixty-six IBS consulters, 70 nonconsulters, and 117 controls were studied. All 3 groups differed in terms of SF-36 physical (46.5±9.4 vs. 50.5±8.0 vs. 54.5±6.0) and mental composite scores (38.2±12.5 vs. 43.2±12.0 vs. 46.7±10.6). Although physical scores were linked to hypochondriasis (β=−0.39; P<0.001), severity of pain (β=−0.28; P<0.001), and age, mental scores were associated with state anxiety (β=−0.36; P<0.001) and trait anxiety (β=−0.40; P<0.001).HRQOL is impaired in all subgroups of IBS sufferers, with the degree of impairment depending mostly on symptom severity and psychologic factors (hypochondriasis and anxiety).