# Psychological abnormalities in patients with irritable bowel syndrome.



## eric (Jul 8, 1999)

Indian J Gastroenterol. 2004 Mar-Apr;23(2):63-9. Related Articles, Links Psychological abnormalities in patients with irritable bowel syndrome. Porcelli P. Psychosomatic Unit, IRCCS De Bellis Hospital, Castellana Grotte, Bari, Italy. porcellip###mail.media.it Irritable bowel syndrome (IBS) is a group of functional bowel disorders with different pathophyiological mechanisms but some common clinical features. It can be conceptualized within the biopsychosocial model of illness as a dysregulation of brain-gut axis and its relationships with psychosocial and environmental variables. Using advanced neuro-imaging techniques, it has been found that some brain centers (anterior cingulate cortex, limbic system, locus ceruleus) are active in mediating gut signals and that visceral hyperalgesia mediates perceptual sensitivity. Using new criteria for diagnosing psychosocial components of somatic illnesses, persistent somatization has been found as one of the main psychological factors that contributes to persistence of symptoms and poor treatment outcome in patients with IBS. Other psychological variables influencing symptom reporting have been identified in the constructs of health-care seeking, abuse, somatosensory amplification, and alexithymia. From a psychological viewpoint, IBS may be conceived as an abnormal cognitive processing of emotional and visceral stimuli, a tendency to perceive somatic stimuli as evidence of symptoms of disease, and to seek repeated and often unnecessary medical care.PMID: 15176539


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## poet (Nov 17, 2003)

Have you read the article? This guy sounds like a psychiatrist rather than a psychologist and some of the big words he uses are highly controversial.tom


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## SpAsMaN* (May 11, 2002)

Psychological factors?What is your point Eric?I think that there is unknown cellulars inflammation in our G.I. tract.Some day,they will show the discovery.Stress is not enough strong to create such a pain.Logic?


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## eric (Jul 8, 1999)

The cellular inflammation in IBS can be triggered by chronic phycological stress without a pathogen, remember the mast cell? A ton of work has gone into thois aspect and their is impairment of certain brain centers, like the Anterior Cingulate Cortex, which is involved in pain and emotions.


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## SpAsMaN* (May 11, 2002)

It sound so holistic Eric.Stress?This is a word who include a lot of parameters.My first bowel "stress" was the NSaids and my bowel never recover from that.


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## PooPooPooper (Apr 6, 2004)

Yeah, I'm skeptical about this abstract. I don't know how reputable this journal is either. I tried to find if they use a blind review process for submitted articles and couldn't find that info on their website or elsewhere on the net. This journal could be publishing these controversial findings just for hype and to get their name out there.Anne


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## poet (Nov 17, 2003)

My feeling they are about ten to fifteen years out of date in their views. This is certainly not news.tom


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## eric (Jul 8, 1999)

This is a major area of new research in IBS. This article is also not saying its "all in the head."It is however talking about how emotions and behavior can effect symtoms and through what pathways and why there important in treating IBS. How negative emotions and behvior can lead to poor health care seeking and why IBS education is important." Using advanced neuro-imaging techniques, it has been found that some brain centers (anterior cingulate cortex, limbic system, locus ceruleus) are active in mediating gut signals and that visceral hyperalgesia mediates perceptual sensitivity.""Hyperalgesia: Lowered threshold to pain.""Somatization: Psychological needs expressed as physical symptoms." http://www.iffgd.org/GIDisorders/glossary.html


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## poet (Nov 17, 2003)

I'm glad you read the article and cleared this up for us. It does dound a lot like what psychiatrists (not psychologists) were sayin ten to fifteen years ago, though.tom


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## kazzy3 (Apr 11, 2003)

I agree that continued negative thinking can lead to poor physical health, and positive thoughts can make you feel better. However I'm not sure what is being said in this article. Ibs can be worse during times of stress but the symptoms are not psychological, but from a problem in gut function, which recent studies have shown.


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## poet (Nov 17, 2003)

that's why I can't understand why eric posted this. It's probably going to confuse a lot of people. He ight not understand that all these scans show is activity and not where things happen. For example, if you kick a football, a pet scan is going to show some activity in the brain some where. That does not mean you kicked it with your brain.tom


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## eric (Jul 8, 1999)

There is impairment of the anterior cinculate cortex and IBS, where pain and emotions are processed and this is still directly connected to the problems seen in the gut and EC cells and mast cells in the gut and serotonin, which is a neurotransmitter that communicates from the gut to the brain and back.A big part of new IBS reseearch is understanding viceral hypersensitivity, and the workings of the brain gut axis and pathways.This is not saying its "all in the head", its saying there are physical abnormalities in brain functioning and IBS, which they have known for a while now and the need to learn and know more about it all. There is a very close biodirectional communication between the gut brain and the main brain going on all the time, the brain is in charge of very important gut functions.The ACC functioning in IBS is different then controls. It is very important for them to learn more about this and the implications of of it.


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## poet (Nov 17, 2003)

Last time I looked at a book on the brain the ACC was in the head. The limbic system was disdcovered by a psychologist (Paul MacLean) probably 100 years ago - not sure of the date. The psychistrists and psychologists you like to attack meant this when they said it IBS was partially in the head. tom


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## eric (Jul 8, 1999)

"psychologists you like to attack"what are you talking about I didn't attack any psychologist?I also very much understand its is not in the head as in made up, but the workings of psycophisological pathways between the gut brain and the main brain and the back and forth bidirectional communication."Neuroimaging has provided evidence of physiological differences between normal individualsand those suffering from IBS in the way a visceral stimulus (ie, rectal distention) is processed inthe brain.14,15 Initial data from positron emission tomography (PET) scans demonstratedincreased activation of the anterior cingulate cortex (ACC) among normal individuals, comparedto IBS patients. The ACC is a cerebral cortical area that is rich in opiate receptors and is thoughtto be a major component of cognitive circuits relating to perception as well as descending spinalpathways involving pain. More recently, fMRI was used to demonstrate increased activity in theACC, prefrontal (PF), and insular cortex areas, and in the thalamus of IBS patients compared tonormal individuals."







"The cause of IBS is yet to be determined. However, modern research understands IBS as a disorder of increased reactivity of the bowel, visceral hypersensitivity and dysfunction of the brain-gut axis. There are subgroups being defined as well, including post-infectious IBS which can lead to IBS symptoms. Other work using brain imaging shows that the pain regulation center of the brain (cingulate cortex) can be impaired, as well as good evidence for there being abnormalities in motility which can at least in part explain the diarrhea and constipation. So finding a specific "cause" of IBS has grown out of general interest in place of understanding physiological subgroups that may become amenable to more specific treatments. Hope that helps.Doug "The abnormalities in motility is in regards to the new research on serotonin receptors in the gut.American Gastroenterological Association Medical Position Statement: Irritable Bowel Syndrome" Pathophysiology of IBS symptoms TOP The symptoms of IBS have a physiological basis. Although no specific physiological mechanism is unique to, or characterizes IBS, there are at least 3 interrelated factors that affect symptoms to varying degrees in individuals with IBS: (1) altered gut reactivity (motility, secretion) in response to luminal (e.g., meals, gut distention, inflammation, bacterial factors) or provocative environmental (psychosocial stress) stimuli, resulting in symptoms of diarrhea and/or constipation; (2) a hypersensitive gut with enhanced visceral perception and pain; and (3) dysregulation of the brain-gut axis, possibly associated with greater stress-reactivity and altered perception and/or modulation of visceral afferent signals. Brain-gut axis dysregulation may also play a role in the subgroups of patients who have gut inflammatory and immune factors persisting following infection or inflammation of the bowel. Further studies are needed to characterize the precise role of these factors in IBS and to identify physiological subgroups more amenable to specific treatments.""Role of psychosocial factors in IBS TOP Although IBS patients show enhanced stress responsiveness, and more severe and prolonged impairment of bowel function related to various inciting factors, specific psychosocial factors are not characteristic of the disorder; they are not considered in diagnosis. However, their identification may help in planning psychological or psychopharmacological treatment, particularly for those with more moderate or severe symptoms, where psychosocial factors contribute to the clinical presentation.Psychological stress and other psychosocial factors may exacerbate gastrointestinal (GI) symptoms via alterations in gut motility, epithelial function, or perception of visceral stimuli or may modify illness experience and behaviors including pain reporting, physician visits, medication use, or the seeking of alternative medical treatment. A history of major life stress (e.g., abuse, family death, or divorce), comorbid psychiatric disorders, or maladaptive coping style strongly influence the clinical outcome. Because psychosocial factors affect health care seeking, patients with IBS seen at referral centers usually have greater psychological disturbances than patients seen in primary care or nonpatients in the community. Finally, IBS adversely affects health-related quality of life, including impairment of physical, psychosocial, emotional, and role function to a degree exceeding that found in most patients with other medical disorders.An integrative biopsychosocial model3 is needed to understand the multiple factors contributing to symptom generation and experience. The challenge faced by clinicians and investigators is to determine for each individual the degree to which each of these interacting factors are identifiable and remediable using current therapeutic options." http://www2.gastrojournal.org/scripts/om.d...e=fullfree&id=a also from a sincle case study last year.Gastroenterology. 2003 Mar;124(3):754-61. Related Articles, Links Click here to read Alterations of brain activity associated with resolution of emotional distress and pain in a case of severe irritable bowel syndrome. Drossman DA, Ringel Y, Vogt BA, Leserman J, Lin W, Smith JK, Whitehead W. UNC Center for Functional GI and Motility Disorders, Division of Digestive Diseases and Department of Radiology and Biomedical Engineering, University of North Carolina, Chapel Hill, North Carolina 27599, USA. Drossman###med.unc.edu BACKGROUND & AIMS: The association of psychosocial disturbances with more severe irritable bowel syndrome (IBS) is well recognized. However, there is no evidence as to how these associations might be mediated. Functional magnetic resonance imaging (fMRI) offers an opportunity to study whether activation of the cingulate cortex, an area involved with the affective and pain intensity coding might be linked to poorer clinical status with IBS. In this case report, we found an association between the severity of a patient's clinical symptoms and psychosocial state, with activation of the cingulate cortex. We also found that clinical and psychosocial improvement was associated with reduced cingulate activation. METHODS: Observational case report of a young woman observed for 16 years with a history of sexual abuse, psychosocial distress, and functional GI complaints. Psychosocial, clinical, and fMRI assessment was performed when the patient experienced severe symptoms and again 8 months later when clinically improved. RESULTS: During severe illness, the patient had major psychosocial impairment, high life stress, a low visceral pain threshold, and activation of the midcingulate cortex (MCC), prefrontal area 6/44, and the somatosensory cortex, areas associated with pain intensity encoding. When clinically improved, there was resolution in activation of these 3 areas, and this was associated with psychosocial improvement and an increased threshold to rectal distention. CONCLUSIONS: Activation of the MCC and related areas involved with visceral pain encoding are associated with poor clinical status in patients with severe IBS and psychosocial distress and appear to be responsive to clinical improvement. Publication Types: * Case ReportsPMID: 12612913


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## poet (Nov 17, 2003)

Maybe it's just one particular psychologist. You and others have made it a practice over the last few years to attack anything I say.tom


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## kazzy3 (Apr 11, 2003)

I do see the point eric. it is believed that brain function and gut function are connected and that a brain abnormality causes ibs. I don't think anyone was being attacked here, after all we are on the same side. We all want to understand the cause so that eventually there may be a cure. After all anything is possible when it comes to ibs.


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## poet (Nov 17, 2003)

kazzy3, I was refering to a period in the past where it seemed like eric and others were waiting to see whatever I posted as a psychologist so they could attack me. You'll also note that Dr. Bolen doesn't post here as much as she did, possibly for the same reason. Dr, Olafur Palsson also doesn't post very often.tom


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## eric (Jul 8, 1999)

Those doctors do not post here for other reasons which has nothing what so ever to do with me. I also don't appreciate you implying I had something to do with that Tom at all. We all now your were asked to take a break from the bb for arguing.I am very good friends with both those doctors and work with them and talk to them pretty often. Dr Pallson has been helping me for years now in understanding IBS and IBS and HT and helping to educate me and Dr Bolen and I have talked often and she has mentioned quite a few times that she is very happy with what I do in IBS education. One reason why I run her website.So this is plain rubbish.I will say this again one more time, there are abnormalities in brain function in IBS, that they need to figure out and that is a big area of new IBS research using fmri and pet scans to understand better how the brain and gut work and communicate, which is what the above article is referring too, from a psycological perspective. This is not out of date, old news or any such thing.It is important in regards to pain and IBS especially since all pain and gut sensations are processed in the brain.Kazzy, they see gut problems and more recently specific gut problems and brain abnormalities and those are issues they are trying to figure out more clearly.Before someone bashes the intital abstract I posted, it is very important to understand what its saying first.


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## poet (Nov 17, 2003)

whatexer you say, eic. we know you're always right.tom


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## leslie204 (Feb 1, 2003)

Hello Eric: the whole brain-gut interaction is definitely proven and very important. Keep posting stuff even if it seems small to you.Leslie


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## eric (Jul 8, 1999)

Thanks Leslie.Neurogastroenterol Motil. 2004 Jun;16(3):299-309. Related Articles, Links Brain activity during distention of the descending colon in humans.Hamaguchi T, Kano M, Rikimaru H, Kanazawa M, Itoh M, Yanai K, Fukudo S.Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Aoba, Sendai, Japan.Abstract Brain-gut interaction is considered to be a major factor in the pathophysiology of irritable bowel syndrome. However, only limited information has been provided on the influence of gastrointestinal tract stimulation on the brain. Our aim in this study was to determine the specific regions of the brain that are responsible for visceral perception and emotion provoked by distention of the descending colon in humans. Fifteen healthy males aged 22 +/- 1 participated in this study. Using a colonoscope, a balloon was inserted into the descending colon of each subject. After sham stimulation, the colon was randomly stimulated with bag pressures of 20 and 40 mmHg, and regional cerebral blood flow was measured by [(15)O] positron emission tomography. The subjects were asked to report visceral perception and emotion using an ordinate scale of 0-10. Colonic distention pressure dependently induced visceral perception and emotion, which significantly correlated with activation of specific regions of the brain including the prefrontal, anterior cingulate, parietal cortices, insula, pons, and the cerebellum. In conclusion, distention of the descending colon induces visceral perception and emotion. These changes significantly correlate with activation of specific regions in the brain including the limbic system and the association cortex, especially the prefrontal cortex.PMID: 15198652


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## eric (Jul 8, 1999)

Negative coping strategies can worsen gastrointestinal symptomsCertain ways of coping with gastrointestinal disorders can negatively affect health, according to a recent study of women. "The findings add to our growing knowledge of the contribution of psychosocial factors to health status among patients with gastrointestinal disorders," said lead author Douglas A. Drossman, MD, of the University of North Carolina, Chapel Hill. For one year, Drossman and colleagues followed the progress of 174 female study participants suffering from varying functional gastrointestinal disorders including irritable bowel syndrome, constipation, dyspepsia, and chest and abdominal pain, as well as other gastrointestinal diseases such as gastroesophageal reflux, liver disease, ulcerative colitis, and Crohn's disease. Study participants who tended to catastrophize, or hold deeply negative and pessimistic views of their illness, as well as participants who felt they had little power to decrease their symptoms were likely to have poorer health outcomes, the researchers found. The study findings appear in the May/June issue of Psychosomatic Medicine. A participant's tendency to catastrophize was measured by the degree to which she identified with statements such as "I feel it's never going to get any better," "I worry all the time about whether it will end," and "I feel my life isn't worth living." In addition to the maladaptive coping strategies of catastrophizing and having a low perception of power over symptoms, the researchers also found that a history of sexual abuse was a predictor of negative health results. "A history of sexual abuse may indeed set in motion or enhance the effects of these maladaptive coping strategies, since sexual abuse is associated both with a perceived inability to effect positive consequences in the environment and with hypervigilance to bodily sensations with an overinterpretation of their significance," said Drossman. The researchers' findings suggest that treatments like cognitive behavioral therapy, which helps patients replace maladaptive perceptions with more realistic ones, may help those whose negative coping strategies interfere with their recovery from gastrointestinal illness. The researchers, however, note that more research is needed to determine if cognitive behavioral treatments truly improve gastrointestinal symptoms, as well as to gain a more exact understanding of the relationship between coping strategies and gastrointestinal disorders. This study was funded by the National Institutes of Health. http://www.eurekalert.org/pub_releases/200...csc-2105100.php


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## Ichibod (Jun 11, 2004)

A lot of things read on this topic espescially those dealing with the brain-gut axis and the role of serotonin, and thank you eric for posting it, i already knew. What surprised me however was the statement that psychological factors could actually damage cells in the gut. I never knew there was such a concrete connection between psychology an physiology. Eric, do you have more articles dealing with the issue.


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## poet (Nov 17, 2003)

check out the article I posted on zen. Most of the psychological research on this was published in the fifties and sixties before psychological research was considered 'good' enough to be listed in medline. Or ask your local college library to run a search on psychological abstracts.tom


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## Ichibod (Jun 11, 2004)

Has this evidence really been published in peer-reviewed magazines? I thought it was becoming common sense that negative mental processes could influence the severity of symptoms in sickness, but not the sickness itself. But this theory spins the wheel around again.I'll check your sources, tom. thanks for the info.


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## poet (Nov 17, 2003)

You could also check some of the recent work coming out of Ricard Davidson's lab at the U of Wisconsin and recent stuff by Naliboff (sp?) from UCLA. They should give references to early work. I tink somethin by tem may have been psyed here in the last six months or so.tom


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## Guest (Jun 22, 2004)

Wisconsin always has been pretty progressive, hasn't it?It doesn't matter who knew what first or how they came to know it.... the point is that the more we know about it, the better we can treat it, no?


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## kazzy3 (Apr 11, 2003)

Absolutely Essence. The more research is done, the more they can find out. I'm glad to know they're trying. Ibs has been brushed aside for so long because it is not life threatening. It is however life altering, big time. The more they find, the more we learn and hopefully we can find effective treatments.


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