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Psychologic considerations in the irritable bowel syndrome.
1Johns Hopkins University School of Medicine, Baltimore, Maryland.
Gastroenterology Clinics of North America
|June 1, 1991
Summary
Psychological distress is common in Irritable Bowel Syndrome (IBS) patients but doesn't cause bowel symptoms. Instead, distress influences healthcare seeking, with both conditions often co-occurring and warranting separate treatment.
Area of Science:
- Gastroenterology
- Psychiatry
- Behavioral Medicine
Background:
- Irritable Bowel Syndrome (IBS) is frequently associated with psychological distress and psychiatric diagnoses among patients seeking medical care.
- Previous assumptions suggested IBS is a psychophysiological disorder, leading to psychological treatment recommendations.
- However, recent evidence indicates that psychological symptoms do not cause IBS but influence healthcare-seeking behavior.
Purpose of the Study:
- To re-evaluate the relationship between psychological distress and Irritable Bowel Syndrome (IBS).
- To clarify the role of psychological factors in IBS presentation and treatment.
- To differentiate between causal and correlational links in IBS symptomology.
Main Methods:
- Analysis of studies comparing psychological symptoms in IBS patients versus the general population.
- Review of evidence on the impact of psychological distress on symptom perception and healthcare utilization in IBS.
- Examination of treatment outcomes for psychological interventions in IBS management.
Main Results:
- Psychological distress is common in IBS patients but not significantly higher in community-based individuals with IBS symptoms.
- Psychological symptoms appear to influence the decision to seek medical consultation for bowel dysfunction, rather than causing it.
- Psychological distress and IBS symptoms often coexist as comorbid conditions, both requiring management.
- Psychological treatments, including antidepressants, psychotherapy, hypnosis, and behavior therapy, can effectively reduce IBS symptom severity.
Conclusions:
- The association between psychological distress and IBS in clinic patients is likely due to comorbid conditions and influenced healthcare-seeking behavior, not direct causation.
- Both bowel dysfunction and psychological distress in IBS patients warrant independent treatment.
- Psychologically oriented treatments are valuable adjuncts to medical management for IBS, improving symptom control and patient well-being.