# Stressful and Insecure Jobs Take a Toll on Health



## eric (Jul 8, 1999)

FYI http://story.news.yahoo.com/news?tmpl=stor...job_stress_dc_1


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## chrisgeorge (Feb 28, 2003)

And you think this needs to be posted in the cognitive/hypnotherapy forum?


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## eric (Jul 8, 1999)

Since stressors are a major factor in IBS, yes its supplying information.Many peoples jobs effect their IBS.


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## em.london (Dec 11, 2001)

When I was in Sales a few years ago my tum problems were alot worse due to my stress levels.Stress is one of my major triggers.


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## sickofsick (Nov 4, 1999)

Stress is a major trigger for me. Information such as this is both interesting and helpful.


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## eric (Jul 8, 1999)

As a lot of you already know I worked as a chef for 15 years in a extremely busy high end restaurant.At that time my IBS was totally out of control, it controled me, I did not control it.The doctor, without going into any detail about the close connections between the brain and the gut told me to reduce my stress levels. Had he explained more it would have save me a lot of pain and suffering.IT was an extremely hard decision to quite my job and start a new one and anxiety played a role with that, but in the long run it worked out and has been extremely benefical to my health and my IBS. It was no easy thing to do for sure, but the amount of pain and suffering those high stress levels caused were causing a lot of havoc and IBS symptoms and were detrimental to my health.In the long run it was a very positive move. I had to weight my health against my job and income at the time.


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## chrisgeorge (Feb 28, 2003)

All very interesting but perhaps this information belongs on another forum - maybe anxiety?As Jeff keeps asking, this forum is about cognitive behavioural therapy and hypnosis, not about stress or how everyone's doing. Lets keep it focused.


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## eric (Jul 8, 1999)

Chris george, Please, I don't need you to tell me what this forum is about, or what the focus of it is in regards to IBS. I helped create it and have spent the last four years on it. You have been here a very short time, less then six months and have alreay caused a bunch of trouble and negative energy.If you don't want to offer positive energy to it and feel its not for you, perhaps you shouldn't be posting here and continuing to try and stir up trouble.The comment on focus of the forum was in regards to people asking how my mom was for one and it regards to keeping it positive not negative.CBT and HT, stress, anxiety and IBS are all very related.


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## Jeffrey Roberts (Apr 15, 1987)

Lets everyone please make productive comments on this forum.If there is a particular topic that you do not want to read then don't open it up.Jeff


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## Guest (Nov 24, 2003)

I think stress control is one of the single most impacting factors when it comes to managing any illness or dysfunction.I could write a whole book on the topic of stress and how it has affected my life from day one.The hypnotherapy helped me through some pretty rough times before I was properly medicated. The one IBS symptom that it really helped was the gut pain. An additional perk was the validation of self-esteem and another was the tempering of the anxiety levels. We're all here to learn from each other and to support each other.Thank you for posting this thread and the article Shawn.Evie


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## eric (Jul 8, 1999)

FYICME Diagnosis, Pathophysiology, and Treatment of Irritable Bowel SyndromeRead this comprehensive update for primary care physicians on irritable bowel syndrome, by Kevin W. Olden, MD."IntroductionDefinitionIrritable bowel syndrome IBS, in its essence, can be defined as a combination of abdominal pain or discomfort and altered bowel habit. The alteration in bowel habit can take the form of altered stool frequency ie, diarrhea or constipation or altered stool form in terms of thin, overly hard and firm, or soft and even liquid stools. Symptoms that are commonly associated with IBS include passage of clear or white mucus with a bowel movement, sensation of incomplete evacuation after having a bowel movement, and relief of abdominal pain or discomfort transiently after defecation and abdominal bloating. Patients with IBS have traditionally been described as being "constipation predominant," "diarrhea predominant," or as having an alternating pattern of constipation and diarrhea ie, so-called "alternators". Although the research on the exact epidemiology of these 3 variants of IBS is incomplete, our best understanding is that each type is represented approximately equally in the overall IBS population. Abdominal pain or discomfort is a sine qua non for the diagnosis of IBS. The pain or discomfort most commonly occurs in the left lower quadrant, but can be found anywhere in the abdomen; however, isolated pain or discomfort above the level of the umbilicus is uncommon in patients with pure IBS. This combination of altered bowel habits with abdominal pain or discomfort separates IBS from other functional bowel disorders, such as functional dyspepsia, functional constipation, functional diarrhea, or functional abdominal bloating, to name a few.In addition to gastrointestinal symptoms, IBS has been associated with a number of extraintestinal conditions, such as fibromyalgia, sexual dysfunction, urinary symptoms, and certain psychiatric disorders in excess of non-IBS controls. These latter findings have implications both for further supporting the diagnosis of IBS, as well as for helping to define the level of disability of the patient who presents with IBS with extraintestinal manifestations.""Pathophysiology of IBSThe pathophysiology of IBS is a work in progress. Roughly 200 years after its initial description by the English physician William Powell, our understanding of what causes IBS symptoms remains incompletely understood. For most of the second half of the 20th century, tremendous attention was paid to the concept of altered gut motility as a cause of IBS symptoms.20 However, several difficulties are apparent in this approach. First, although altered motility of the colon and small bowel can be demonstrated in patients with IBS, there is a very poor correlation between IBS symptomatology and the presence of alterations in gastrointestinal motility. 21 Likewise, drugs that alter gastrointestinal motility alone, such as antispasmodic 22,23 and prokinetic drugs like metoclopramide and cisapride, 24,25 have not been shown to be of any significant benefit in relieving IBS symptoms.The third dilemma facing investigators in this area is that no pathognomonic pattern of gut dysmotility can be identified specifically with IBS, as opposed to other functional or organic disorders of the gut. 20 Altered motility, as occurs in IBS, is currently seen as one of many epiphenomena associated with the disorder, as opposed to being a cause of the disorder itself.In the early 1980s, it was discovered that upon balloon distention in the rectum, individuals suffering from IBS were more sensitive to distention than were individuals who did not suffer from IBS. 26 This means that IBS patients feel discomfort at lower levels of balloon inflation in the rectum and lower bowel than do normal controls. This finding has been replicated in numerous studies, and the concept of "visceral" hypersensitivity has been established. 27 A second level of investigation in this area is the fascinating finding that individuals with IBS not only have a unique local response in the rectum to visceral stimulation, but they also tend to process signals in the brain differently from non-IBS controls. Mertz and others 27 have shown that IBS patients have differential responses in the anterior cingulate cortex and other areas of the brain when stimulated with rectal or sigmoid colon distention, compared with controls. These findings have been replicated by other investigators. 28 These data certainly suggest the possibility of a "brain-gut axis" where peripheral symptoms are processed in the end organ ie, the colon, and then neural signals are carried via visceral afferents to the spinal cord, and then to the brain, where they are subject to additional processing.29 It is this brain-gut axis that has received considerable attention recently in IBS research. The findings of enhanced visceral sensitivity in the colon and rectum, as well as altered processing of signals in the brain, have provided new insight. Regarding the pathophysiology of IBS, the altered processing of neural sensation in IBS patients logically raises the question as to which neurotransmitters play a role in this abnormal signal transmission.A large number of neuropeptides are involved in the regulation of both gastrointestinal motility and sensation in the gut. These include motolin, gastrin, peptide Y, cholecystokinin, serotonin, and others.Serotonin has received the most interest for a number of reasons. The first reason is the dramatic impact that modulation of serotonin has had on psychiatric disorders. The development of selective serotonin reuptake inhibitor SSRI medications in the late 1980s revolutionized the practice of psychiatry. The ability to treat depression with far fewer side effects than seen with earlier drugs made depression treatment more acceptable both to patients and physicians. The success of these medications led to increased interest in the role of serotonin in the nervous system. The second reason is that almost all ie, more than 90% of the serotonin contained in the body is found in the gut and not in the central nervous system.29 This fact raises the reasonable question of whether modulation of serotonin action in the gut could influence IBS and other functional bowel symptoms.Serotonin 5-HT is an interesting molecule. There are at least 15 subtypes of the 5-HT molecule. 5-HT1 and 5-HT2 are contained almost exclusively in the central nervous system. These are the target neurotransmitters for the SSRIs. The subtypes of serotonin contained in the gut consist mainly of 5-HT3 and 5-HT4, which has led to the development of drugs designed specifically to act on these serotonin subtypes see detailed discussion in the Management section below. Identifying the role of serotonin in the pathophysiology of IBS symptomatology has led to the investigation of other neurotransmitters. Cholecystokinin antagonist and various neurokinin antagonists are all actively being investigated for their potential to influence IBS symptomatology. 30 This has led to a whole new era of gastrointestinal pharmacology based on a brain-gut axis. The opportunity to develop interventions at the level of the bowel, spinal cord, and brain based on this pathophysiologic conceptual model is considerable.""Diet and Lifestyle ModificationIBS is not caused by stress. Likewise it is not caused by any particular dietary indiscretion. However, stress can clearly influence outcomes and severity of IBS, as it can in many other diseases. 31 Identifying stressors in a patient's life and urging the patient to develop coping strategies can be key in helping improve overall symptomatology and sense of well being. *The patient who is working 60 hours per week in a job that he or she truly does not enjoy needs to have the courage to look at the situation and consider it as part of the overall clinical "problem." * Likewise, pressure points in one's family relations, economic situation, or other psychosocial variables need to be evaluated as part of the overall treatment of IBS. Most patients can accomplish this simply by recognizing these stressors and promoting positive life changes. Some patients may benefit from counseling or psychotherapy to help them work through this process.32 Likewise, patients who have significant severe psychosocial issues, such as a history of being physically or sexually abused, or patients with diagnosable psychiatric disorders accompanying their IBS, such as depression or severe anxiety disorders like panic disorder may benefit from psychotherapy. 33 The literature supporting the efficacy of behavioral approaches in this setting is quite positive. 34 Cognitive behavioral therapy, hypnosis, and relaxation therapy have all been effectively applied to the treatment of IBS, particularly in patients with severe symptomatology. 35,36,37The issue of diet is more convoluted. Recent studies suggest that although individual patients may have "food triggers," there is no definitive evidence that suggests that food allergies or food intolerance to large food groups, such as meats or grains, are associated with either the development or the exacerbation of IBS symptoms. Patients should be encouraged to eat a healthy diet and to avoid only foods that they know specifically can trigger symptoms. Extensive testing, such as radioallergosorbent RAST or immunoglobulin E IgE or IgA testing, for gut-based food allergies is usually nonproductive in IBS patients." http://www.medscape.com/viewarticle/463481_4 There is a lot more to this article and a great section on diagnoses.


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## Guest (Nov 24, 2003)

More excellent information, Shawn. Keep it coming...







The medication I take for Dyslimbia (Depakote) has an effect on 5-HT. The result has been that my IBS has improved since going on the med.I also need to note that I have several food intolerances, although I do not know if they would be considered allergies, which seem to negatively affect my IBS. I also note that taking antihistamines helps with feelings of bloating and with distention.


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