MENTAL FACTORS IN IBS: PSYCHOLOGICAL PROBLEMS
Doctors with an interest in food intolerance take a different view – that the psychological problems, where they exist, are largely a result of the illness, or of its rejection by the medical profession, or a mixture of the two. But they would agree that anxiety, tension or depression can make the physical symptoms worse.
It is not difficult to imagine how a disorder such as irritable bowel syndrome could affect a patient psychologically. For those with diarrhoea – one form of IBS – the symptoms are highly disruptive to normal life. Any outing revolves around the need to find a lavatory at short notice, and many outdoor activities, such as hiking or climbing, are virtually impossible. Apart from the pain which many patients suffer, the continual diarrhoea does great damage to the self-image and feelings of self-disgust are common. If the diarrhoea comes and goes, there is an understandable tendency to blame ‘germs’ and a neurotic concern about food hygiene may result. Where constipation is the predominant symptom, there may be considerable discomfort which again is damaging to morale.
Given these difficulties, it is hardly surprising that many patients with IBS show signs of neurotic depression and anxiety neurosis. Lack of understanding by family members and doctors is likely to compound the problem. Dr Joseph Miller, a clinical ecologist working in Alabama, writes: ‘These patients are not basically neurotic, but they are less able to cope with daily problems because their symptoms distract and bewilder them. They shop for relief from physician to physician, their self-esteem diminishes, and their anxieties increase when they are told repeatedly that their symptoms are “only due to nerves”. They receive symptomatic and supportive care rather than specific treatment. Many… become secondarily depressed from the feeling of being hopelessly trapped.’
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