MENTAL FACTORS IN IBS: THE PSYCHOLOGICAL SYMPTOMS COULD BE LARGELY A RESULT OF THE PHYSICAL SYMPTOMS, RATHER THAN THE CAUSE OF THEM
Dr Pearson and Dr Rix point out that the level of psychiatric disorder in patients with a variety of other bowel complaints is much lower – only 34 per cent compared to 86 per cent. One factor in this difference is probably the attitude of the medical profession, since the other bowel complaints studied were all recognized conditions which are not dismissed as psychosomatic. Unpleasant symptoms are a lot easier to cope with if you know you have What-sisname’s Syndrome than if you’ve been told that it’s ‘all in your mind’.
The idea that the psychological symptoms could be largely a result of the physical symptoms, rather than the cause of them, is substantiated by one of the patients that Dr Pearson and Dr Rix studied. This patient was sensitive to yeast and reacted to it in very small amounts, so that she produced a positive reaction even with the minute quantities that they used for testing. This patient was put on a yeast-free diet, and given a second psychiatric assessment when her bowel symptoms had resolved. Before the diet her score on the psychiatric assessment was 20 – well over the critical score of 12 that indicates significant psychiatric disturbance. With IBS a thing of the past, her score was one – a marked improvement.
The usefulness of treatments such as psychotherapy and hypnotherapy in treating IBS is entirely compatible with this view. If such treatments could eradicate the symptoms in a large proportion of patients it would be a different matter, but they do not: in most patients, they simply reduce the symptoms to a more manageable level. For the patients who respond to such treatment, there is probably a subtle interplay of mental and physical factors – the distressing symptoms lead to anxiety or depression, and the disturbed state of mind makes the symptoms worse. In some patients, psychological disorders may be even more important.
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