If you have IBS-C, there’s a good chance that someone’s told you, “It’s all in your head!” Your symptoms are very real, but there is a close link between the disorder and common mental health conditions like depression and anxiety. One third of people with IBS also have anxiety or depression. People with depression are twice as likely to get IBS as those who aren’t depressed. And a recent study also found that rates of bipolar disorder, suicidal thoughts and attempts, and eating disorders are significantly higher in those with IBS compared to other adults.
What Do We Know About the Mental Health and IBS-C Connection?
We don’t know the exact cause of IBS. But recent research suggests that it and anxiety have similar biological causes. We do know that a person’s state of mind can trigger symptoms, especially when they’re stressed or having strong emotions. But it’s hard to pinpoint direct cause and effect since IBS symptoms themselves can cause stress, anxiety, and depression. Many of the symptoms overlap, including gastrointestinal problems, avoiding social situations, and feeling panicked or embarrassed.
That’s why the connection between mental health and IBS is sometimes described as a “vicious cycle”: A stressful event can lead to changes in bowel function, while those symptoms can in turn disrupt your work or social life and lead to anxiety or depression.
We also know there is a distinct relationship between IBS and sexual, physical, and verbal abuse. These experiences have a long-term impact on a person’s mental and gastrointestinal health. The chronic stress related to any traumatic experience can cause symptoms that develop into IBS. The link with is even stronger when the traumatic experience causes posttraumatic stress disorder (PTSD).
What’s Behind the Connection Between Mental Health and IBS-C?
Researchers are learning more about the link between psychological conditions and symptoms associated with IBS. Theories being studied include:
The brain-gut connection. The “gut-brain axis” is what’s known as a “bidirectional” communication network. Here’s how it works:
Your gut (intestinal system) is linked to your brain via a system of connections called the enteric nervous system (ENS). The ENS is made up of millions of nerve cells that line your entire GI tract from mouth to rectum. It controls the digestion process and also communicates with your brain.
Thanks to this two-way communication, what happens in your brain influences the activity in your gut. At the same time, what happens in your gut also influences your mood, cognition, and your mental health. That feeling of having butterflies in your stomach when you’re nervous or excited is just one example of the gut-brain axis doing its job.
Gastrointestinal causes. For decades, doctors suspected that anxiety and depression led to IBS symptoms like constipation and diarrhea. More recently, they’ve learned that the opposite may be true: Irritation in the GI system may actually trigger mood changes.
This may explain why a higher-than-normal percentage of people with IBS also have depression and anxiety. It also may be why certain mental health treatments, like cognitive behavioral therapy (CBT) and antidepressants, are effective in treating IBS. For example, antidepressants can affect the nerve cells your gastrointestinal system to lessen IBS symptoms.
Microbiome. A healthy GI system naturally contains different microbes, such as bacteria, fungi, and viruses. This collection of microbes is known as the microbiome.
The microbiomes of those with just IBS differ from the ones of those who have it along with mood disorders like depression and anxiety. Studies have found that adding helpful microorganisms to a person’s microbiome may improve both a person’s mood and their IBS symptoms.
Visceral hypersensitivity. Some people with IBS are more sensitive to discomfort in their visceral organs than others. These are the organs in your chest, belly, and pelvic cavity. This is known as visceral hypersensitivity. Around 40% of people with IBS have it. They may feel discomfort even when their organs are working normally. Some experts think this may play a part in the condition by causing the body to overreact to certain triggers. Or it may be that for these people, normal gastrointestinal symptoms just feel more painful.
Pain in these organs can both trigger and be triggered by emotional distress. Researchers don’t know for sure, but they think this may be related to mental health factors that include early trauma and psychological disorders.
How Is PTSD Related to IBS?
Posttraumatic stress disorder (PTSD) is a mental health condition caused by seeing or going through a terrifying event. Symptoms of PTSD include flashbacks, nightmares, and severe anxiety. People with PTSD may be more sensitive to the stresses of daily life. If they have IBS, it may be a reaction to those stressors.
Recent research shows a strong relationship between IBS and PTSD from firsthand wartime experience. The rate of IBS is higher in individuals who had multiple traumatic experiences on the battlefield.
Combining Care for IBS-C
Doctors used to focus solely on medicating the GI symptoms of IBS. Over time, they recognized the mental health aspect of the condition. They now most often use what’s known as an “integrated care model.” It combines medical treatment with diet and mental health care.
The two most beneficial psychotherapeutic treatments for lowering stress and reducing IBS symptoms are gut-focused cognitive behavioral therapy (CBT) and gut-directed hypnotherapy (GDH). In gut-focused CBT, a therapist helps you adjust your thinking and behavior as you deal with IBS. It’s most effective if your IBS-C is moderate to severe and hasn’t responded to treatment, or if you have feelings of depression or anxiety along with it.
Taking Control of Your Mental Health With IBS-C
IBS-C can cause unique stresses that affect your state of mind. You may feel self-conscious or uncomfortable about your body. But there are some things you can do to manage this stress to feel better both mentally and physically.
Keeping a personal daily diary can help you determine if your IBS is related to your mental health. It’s a good idea to track all details related to your symptoms, like:
- Diet
- Medication
- Exercise levels
- Stool characteristics
- How often you go to the bathroom
- Pain
- Emotional state
Eventually, patterns will show up that can help you and your doctor figure out the best treatment.
You can keep a diary on your computer or in a notebook or find one online. The International Foundation for Gastrointestinal Disorders has developed a downloadable version that you can use to get started.
There are also some practices used in therapy that you can do on your own that can be helpful. These include relaxation techniques, deep breathing, and progressive muscle relaxation.
Show Sources
Photo Credit: Stone/Getty Images
SOURCES:
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Baylor College of Medicine: “The gut-brain connection: How psychotherapy treats irritable bowel syndrome.”
Bladder & Bowel Community: “The Vicious Circle -- IBS and Stress.”
Johns Hopkins: “The Brain-Gut Connection.”
IBS Network: “Stress, Trauma and IBS.”
International Foundation for Gastrointestinal Disorders, “Stress and IBS,” “Psychological Treatments,” “Symptom Diary – An Easy Tool for You.”
Journal of Gastroenterology and Hepatology: “Systematic review with meta-analysis: The association between post-traumatic stress disorder and irritable bowel syndrome.”
Mayo Clinic: “Post-traumatic stress disorder (PTSD).”
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RACP: “New research uncovers major link between PTSD and gut problems.”
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