IBS psychology, is there a real issue?

IBS psychology is important and there is an intimate link. There is evidence that up to 50% of sufferers studied have some degree of psychiatric disorder. This makes it a significant mental health issue. This should not be neglected and consideration should always be given to psychological therapies.

The psychology in Irritable Bowel Syndrome does have some evidence base to it. The inference that patients don't have nocturnal or night time symptoms would favour this. Also, the lack of response to medical therapies would also favour more than a physical link. Antidepressants have been used to good effect in some people.

The above has brought about the theory that there is an abnormal Brain-Gut interaction in people with IBS.

IBS psychology factors are linked with anxiety and depression, which are common, so referral to a psychologist maybe helpful in some people that demonstrate features of these conditions.

Antidepressants have been used, particularly the Tricyclic Antidepressants such as Amitriptyline. They do have side effects which can put people off taking them as well as the perceived stigma of taking such a drug. The lowest dose is normally used and has a demonstrated benefit. This minimises the common side effects such as dry mouth, blurred vision and difficulty passing urine. Drowsiness is a welcome side effect as it helps aid sleep and the drug should be taken at night. They are particularly effective in patients with abdominal pain predominance and diarrhoea. The newer antidepressants (SSRI's or Selective Serotonin Reuptake Inhibitors) have also been used, but studies with all these drugs have been small and often use is anecdotal.

Cognitive behavioural therapy or psychotherapy may be helpful. This maybe one to one therapy or group therapy trying to address the thoughts, feelings, emotions and physical symptoms of the sufferer. There have been several studies that have supported its use and are an ideal approach for people that would like to explore non-drug ways of dealing with their symptoms.

In summary, the psychology of IBS is clearly fascinating although studies of this link have been small. Therapy should be considered in all patients, particularly when conventional management has failed. IBS psychology should never be neglected.


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