Which of the egg or the chicken, it is a bit the question that we can ask ourselves about the syndrome of irritable bowel (IBS) and mental disorders which often accompany it. The latest work seems to indicate that the influence can go in both directions: in some people, chronic stress can induce prolonged digestive disorders, in others, the origin is elsewhere and the psychic disorders are considered to result from the disturbances intestinal. In the first case, the subject will have every interest in including in his care program psychic therapy. In the second case, the improvement of the intestinal ecosystem by measures of hygiene of life (plus possibly a medication when it is necessary) will have great chances to improve concomitantly the psychic symptoms.
Faced with IBS situations that do not present clear biological determinism, research has turned to other factors, particularly under the impetus of the model biopsychosocial :
- the affective environment,
- the cultural background,
- parental beliefs and behaviors (which we often reproduce without our knowledge),
- possible traumas (especially those occurring early in life),
- chronic stress…
Parameters that are often part of the broader landscape in which an irritable bowel syndrome fits. For exemple, anxiety alone concerns between 30 and 50% of patients suffering from a gastrointestinal disorder, while in 33-42% among them, gastrointestinal disorders are one “family history”.
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On the usefulness of psychotherapies
Stress and limited understanding of our own biology are two important factors in the development of irritable bowel syndrome (IBS). Psychotherapy and cognitive behavioral therapy induce a reduction in physical symptoms, the impact of stress, and sensations such as vulnerability or dependency. Psychodynamic psychotherapy, which focuses on interpersonal conflict, helps to stem psychosocial influences. I’hypnotherapy seems particularly indicated in the most difficult cases to treat. Finally, the psychoeducation, which consists in explaining the pathology, contributes – associated with other approaches – to make the patient aware of the influence attributable to his social interrelations, thereby reducing his anxiety. These therapies show a durability of about one year, on average.
Personality traits specific to IBS
Of the psychological profiles or specific personality traits are frequently observed among people suffering from functional digestive disorders. Personality traits can be defined as the dynamic organization – within a person – that creates their own patterns of behavior, thought and emotion. Studies show that people prone to irritable bowel syndrome exhibit more often, and at a higher level, two particular personality traits:
- the neuroticismequalified as a tendency to negative emotions and emotional instability,
- l’alexithymiedifficulty in identifying, differentiating and expressing emotions.
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Studies find that patients with IBS are also more often prone to anxiety and depression – almost twice as many as the general population – and, to a lesser extent, at the anger and need to dominate (the permanent competitors). They are generally less inclined to socialize (children who have difficulty going to school, for example) and display lower self-esteem. These personality traits, which some works complete with hypersensitivity and impulsivity, would predispose to greater vulnerability to life events, generating disproportionate stress likely to impact the digestive tract. This deleterious influence would be exercised in particular through a weakened immunitycharacterized by elevated levels of inflammatory cytokines and decreased response to cortisol.
If the studies on the subject seem consistent, the authors readily point out that it is not possible to draw irrevocable and even less systematic conclusions from them, given their limited scope, their low statistical level and the arbitrary nature of the categorization of psychiatric disorders. However, it seems more than reasonable to start a psychiatric therapy in the context of a digestive disorder.
Exercise, again and again
Having physical activities is beneficial in case of irritable bowel syndrome (IBS). The movement induces a balancing massage of the digestive sphere. It calms the nerves (the vagus is often involved in IBS), alleviates the psychological factors involved in IBS, and helps normalize metabolism. Cycling, walking and yoga are particularly indicated to relieve the symptoms of IBS.