Stress, Anxiety Raise Risk That G.I. Illness Will Become Severe

About of gastroenteritis caused by bacteria or viruses can evolve into irritable bowel syndrome (IBS). And when this happens, personality factors seem to be involved, a new study suggests.

The research was conducted by Meagan Spence, Ph.D., an honorary lecturer in occupational medicine at the University of Auckland in New Zealand, and by Rona Moss-Morris, Ph.D., a professor of health psychology at the University of Southampton in England. Results were published in the August Gut.

The study included 620 individuals who had visited their primary care doctors because of symptoms of gastroenteritis and who had tested positive for the Campylobacter bacterium. At the time of diagnosis, the researchers had the subjects complete a questionnaire that included standardized measures of mood, perceived stress, perfectionism, negative illness beliefs, and illness behaviors. The researchers then followed the subjects for six months to determine whether any developed IBS. Forty-nine did. Finally, the researchers compared the psychological profiles of the 49 who developed IBS with the psychological profiles of the subjects who did not develop IBS.

They found that subjects who developed IBS had significantly higher levels of perceived stress, anxiety, and somatization at the time of Campylobacter diagnosis than did those who did not develop IBS. They also tended to see the consequences of having an infection as more distressing and as having a greater impact on their lives than did the subjects who did not get IBS. Furthermore, they were significantly more likely to remain active while acutely ill until they felt forced to rest—what the researchers called an “all-or-nothing response.”

Thus, perceived stress, anxiety, and unrealistic personal expectations appear to characterize those individuals who develop IBS following gastroenteritis, the researchers believe. And such an outlook may persist once a person has developed IBS, thereby perpetuating the condition.

In contrast, they found no more depression in the group that developed IBS than in the group that did not, contrary to what some retrospective studies have found. This is the result that may most interest psychiatrists, Spence told Psychiatric News. It suggests that “depression may not be as important as anxiety levels and more subtle psychological variables such as illness beliefs and perceived stress [in development of IBS]. This result has important implications for prevention and early intervention in the development of IBS.”

“I thought the study was very interesting,” Steven Field, M.D., a New York City gastroenterologist who is studying to become a psychodynamic psychotherapist, said in an interview. “I'm not surprised that [gastroenteritis-provoked IBS] is correlated more with anxiety than with depression. Most IBS patients tend to be more anxious than depressed, in my experience.”

When asked whether the results of the study also apply to IBS patients whose IBS is not triggered by a bout of gastroenteritis, Field said, “I think they do, because it shows that personality can be a substrate for the development of these symptoms.”

IBS patients could benefit from cognitive-behavioral therapy, Spence and Moss-Morris said. Field agreed. In fact, “cognitive-behavioral therapy is used in many instances for the treatment of IBS,” he said.

The study was funded by the University of Auckland.

An abstract of “The Cognitive Behavioral Model of Irritable Bowel Syndrome: A Prospective Investigation of Patients with Gastroenteritis” is posted at<http://gut.bmj.com/cgi/content/abstract/56/8/1066>.▪