While functional disorders including irritable bowel syndrome (IBS) can have serious physiological symptoms, they seem to have no biological cause. Those with IBS tend to exhibit distinct patterns of thinking, which seem to contribute to the disorder. A common explanation for IBS comes from Deary, Chalder, and Sharpe and points to a vicious circle linking symptoms to catastrophic belief to heightened anxiety which reinforce perception of symptoms and strengthens this cognitive process. Research has shown that altering thinking patterns in IBS patients can also alter the symptoms. Here are 5 psychological features of IBS and tips on reducing them.
1. Attentional bias to pain
Martin and Chapman found people with IBS orient to pain words faster than neutral words while healthy controls orient to neutral words faster than pain words. This suggest that people with IBS find pain more salient, but it is unclear whether this causes the disease or is an effect.
Tip: Try to actively seek out positive stimuli (such as smiling faces) and train your mind to make the positive aspects more salient.
2. Illness schema
A diary study giving different prompts on different days found that the cues influenced the severity of IBS symptoms (Martin & Crane; 2003). Cues were designed to draw attention to IBS symptoms, neutral aspects of the condition (i.e time of doctor appointments), or leisure activities. Patients’ symptom severity significantly increased on days with IBS context cues and decreased for neutral cues.
Tip: If changing focus can change symptoms, try doing things to distract you from the illness.
3. Heightened illness vulnerability
While those with IBS develop sensitivity for GI symptoms, they also interestingly feel more vulnerable to other physical illnesses completely unrelated to IBS. A study comparing perceived lifetime risk of deep vein thrombosis of those with IBS to those with asthma (chronic illness control) and healthy controls, found people with IBS had the greatest perception of risk of illness (Martin & Crane; 2002).
Tip: Try to think of likely, common causes of a pain and eliminate that possibility before jumping to conclusions of a more serious, less likely illness.
4. Learned illness behaviors
Illness behaviors vary widely among people and include things like taking time from work and activities, eating special foods, and other unique things people do when sick. These behaviors are higher in those with functional disorders and research has found that greater parental reinforcement of this behavior during childhood leads to lower perceived resistance to illness in adulthood (Martin & Crane; 2002).
Tip: Try not to alter your behavior significantly when you feel symptoms. Since there isn’t much that will help with chronic illnesses, it may be best to continue with your normal routine if possible. (Obviously if symptoms are severe, it’s important to take proper care)
5. Comorbid conditions
About 50% of IBS patients also suffer from another psychiatric disorder, while those with inflammatory bowel disease are no more likely than the rest of the population to have a psychiatric disorder. This link specifically between IBS and psychiatric illnesses suggests psychotherapy could offer a solution to alleviate both IBS symptoms and other distressing illnesses possibly contributing.
Tip: If your condition is comorbid, cognitive behavioral therapy could be a good place to start since the illnesses could be amplifying one another.
These psychological factors are not meant to discount the serious nature of functional disorders; rather, they should be encouraging treatment through psychotherapy since traditional methods have shown little success.
Sources:
1. Deary, V. Chalder, T. & Sharpe, M. (2007). The cognitive behavioral model of medically unexplained symptoms: A theoretical and empirical review.
2. European Journal of Pain, 14,207–213.
3. Chapman, S.C.E. & Martin, M. (2011). Attention to pain words in irritable bowel syndrome: Increased orienting and speeded engagement. British Journal of Health Psychology, 16, 47-60.
4. Crane, C. & Martin, M. (2003). Illness schema and level of reported gastrointestinal symptoms in irritable bowel syndrome. Cognitive Therapy and Research, 27,185 – 203.
5. Crane, C. & Martin, M. (2002). Perceived vulnerability to illness in individuals with irritable bowel syndrome. Journal of Psychosomatic Research, 53, 1115-1122.
6. Crane, C. & Martin, M. (2002). Adult illness behavior: the impact of childhood experience. Personality and Individual Differences, 32, 785-798.
