Psychosocial determinants of irritable bowel syndrome

Table 1 Psychological and social factors in irritable bowel syndrome

Environmental factors

Early life events

Upbringing environment

Incentives

Family function

Abuse history

Psychosocial stressors

Life events (divorce, unemployment, death of a close relative)

Daily hassles

Personality traits

Neuroticism, agreeableness, conscientiousness

Alexithymia

Health beliefs

Hypochondriacal beliefs

Illness representation

Perceived susceptibility

Coping strategies

Maladaptive coping (catastrophyzing, self-blame, substance abuse)

Negative emotions and psychiatric disorders

Mood disorders (major depression and dysthymic disorder)

Anxiety disorders (generalized anxiety disorder, panic disorder, posttraumatic stress disorder)

Somatization and somatoform disorders

Neurasthenia

Table 2 Environmental factors associated with irritable bowel syndrome

Prenatal traumatic events (e.g., nutrition in fetal life)

Early stressful life events (surgery, emotional, physical or sexual abuse)

Upbringing environment (low temperature, affluent childhood social class)

Family function (divorce, death of a parent)

Family history of abdominal pain, bowel dysfunction, inflammatory bowel diseases

Social learning (modeling)

Abuse history either in childhood or during adult life

Table 3 Psychosocial stressors and their relation to irritable bowel syndrome

Daily hassles, major life events (divorce, unemployment, or death of a close relative), and major social events (surviving holocaust, revolution, social changes) determine the onset of irritable bowel syndrome symptoms in susceptible individuals

Psychosocial stressors determine symptom exacerbation and health care seeking

Table 4 Personality traits and irritable bowel syndrome

Neuroticism and alexithymia are common in irritable bowel syndrome patients

Neuroticism is a predictor of illness perception and influences coping strategies

Examples of measurement tools: Toronto Alexithymia Scale (TAS-20), Neuroticism Extraversion Openness Personality Inventory[46]

Table 5 Health beliefs and coping with stress in relation to irritable bowel syndrome

Health beliefs in IBS may be irrational, leading to hypochondriacal attitudes

Coping strategies can be inefficient in IBS patients, patients often adopt maladaptive coping strategies such as catastrophyzing

Patients with a high degree of catastrophyzing report more severe pain

Measurement methods: CSQ, CISS, WCQ

IBS: Irritable bowel syndrome; CSQ: Coping strategies questionnaire; CISS: Coping inventory for stressful situation; WCQ: Ways of coping questionnaire.

Table 6 Comorbid psychiatric diagnoses and their relation to irritable bowel syndrome

Psychiatric symptoms and psychiatric diseases are frequent in IBS, especially in severe forms

Depression is the most common psychiatric disorder in IBS (approximately 30% of patients)

Generalized anxiety disorder is present in about 15% of patients

High gastrointestinal specific anxiety predicts symptom severity

High levels of somatization determine frequent use of health care services, a poor response to treatment and a poor health-related quality of life

Other psychiatric disorders in IBS patients: posttraumatic stress disorder, panic disorder, hypochondriasis, dysthymia, phobias, undifferentiated somatoform disorder, drug or alcohol problems

Patients with severe IBS may have more than one psychiatric disorder

Measurement methods: Symptom checklist-90-revised for overall psychological distress; state-trait anxiety inventory, beck depression Inventory

IBS: Irritable bowel syndrome.