Implications of Shame for Patient-Reported Outcomes in Bowel Disorders of Gut-Brain Interaction

Bowel disorders of gut-brain interaction (DGBIs) are a highly stigmatized group of disorders. Although the link between stigma and shame is acknowledged overall, few studies focusing on health-related stigma mention shame, and research on shame in bowel DGBIs is nonexistent. The aim of this study was to examine the implications of shame in bowel DGBIs.

Two Swedish population-based samples were included: a bowel DGBIs sample (n = 537) and a matched comparative sample without bowel symptoms (n = 1881). Participants completed an online survey with validated self-report scales. A cross-sectional mediation analysis via structural equation modeling and a moderation analysis were conducted to analyze the role of shame in the associations between bowel symptom severity and psychosocial outcomes.

The bowel DGBIs sample reported significantly higher levels of shame than the comparative sample. The mediation model, conducted with the bowel DGBIs sample, showed that shame was a mediator of the associations of bowel symptoms with general anxiety, depressive symptoms, quality of life, and activity impairment. Gastrointestinal-specific anxiety was not associated with any outcome of this model. Moderation results showed that shame was an exacerbator of the associations of bowel symptoms with higher severity of gastrointestinal-specific anxiety and depressive symptoms, and poorer quality of life.

Shame appears to be a particularly important emotion deriving from the experience of gastrointestinal symptoms in bowel DGBIs and influencing the associations between these symptoms and important patient-reported outcomes. An empathetic physician-patient relationship and psychological therapies may be helpful for individuals with bowel DGBIs experiencing high levels of shame.