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The role of psychosocial factors in gastrointestinal disorders
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  1. I Wilhelmsen
  1. Department of Internal Medicine, Deaconess Home Hospital, 5009, Bergen, Norway
  1. Associate Professor I Wilhelmsen. Ingvard.wilhelmsen{at}meda.uib.no

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Psychosocial factors play a part in how symptoms are experienced and interpreted, they modify illness behaviour, and can influence treatment. However, they do not have any diagnostic value in functional gastrointestinal disorders; if you have anxiety you can still have an organic disease.

Psychological disturbances modify the experience of illness and illness behaviours such as health care seeking

It has been shown that there are no greater psychological disturbances in subjects with irritable bowel syndrome (IBS) than in the general population. Even in the 1980s, Sandleret al found that focusing on symptoms was one of the major factors causing patients with bowel dysfunction to seek medical advice.1 Further studies confirmed the finding that psychological factors are associated with patient status more than the bowel disorder itself.2 These findings were not confirmed in an Australian population based study3which was, however, a postal survey using self-administered questionnaires. In a British study, abdominal pain and diarrhoea differentiated consulters from non-consulters with symptoms of IBS.4

Psychosocial stress exacerbates gastrointestinal symptoms

Psychological stress or emotional responses to stress can affect gastrointestinal function, and the effects of different emotions on the gastrointestinal tract are well established5 (table1).

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Table 1

Effects of different emotions on the gastrointerstinal tract

What about functional gastrointestinal disorders—do psychological factors contribute substantially? IBS is the most prevalent of these gastrointestinal disorders. There are many studies from the 1980s and 1990s indicating that patients with functional dyspepsia (FD) or IBS have more anxiety, depression, and “psychosomatic triad” (hysteria, hypochondriasis, and depression) than normal controls. Our own data support these findings in patients with FD; for example, we found a high score for neuroticism and somatisation.6-8 However, no study has found a unique psychological profile or mechanism for symptom …

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