Research has shown that 54-95% of people with IBS suffer with psychiatric conditions such as generalised anxiety disorder (1, 2, 3).
The link between IBS and psychiatric conditions is only partly understood. BUT the good news is there are multiple ways to help manage them.
In this article I will explain the link between generalised anxiety disorder and IBS, as well as other mental health conditions.
Please note, this article is designed as an education tool only and not medical advice. If you are in anyway concerned over your mental health you should see your doctor for advice.
Table of Contents
The gut-brain axis
The gut-brain axis consists of bidirectional communication between the gut and the brain. This means that your brain can communicate with your gut and vice versa.
Ultimately, your mood can impact your gut AND your gut can impact your brain function.
The gut and brain βspeakβ to each other through your nervous system, hormones and even microbiota interactions.
It is not entirely understood how the gut-brain axis works just yet. But there are some very interesting findings facts about the gut-brain axis in IBS which I have listed below.
The Gut-Brain Axis in IBS
- When your body becomes βstressedβ it releases stress hormones as part of the fight or flight pathway. This element is normal, but if you have IBS then your brain may have a hyperactive response to these hormones.
- The level of stress hormones in someone with IBS can be higher than in someone who does not have IBS (4, 5 ,6).
- In people who have IBS, the vagus nerve and sympathetic nervous system appear to react differently (compared to those who do not have IBS) which can impact gut motility and sensitivity (6).
Depression and IBS
Around 37% of people with IBS are also thought to have depression but the exact link is unknown (7).
Interestingly, those with depression appear to have a difference in gut microbiome, so this could be one of the causes and there is research underway to see if probiotics could help in this area (8).
Generalised anxiety disorder and IBS
The term βanxiety disorderβ refers to specific psychiatric disorders that involve extreme fear for worry (9).
Some examples of anxiety disorders are;
- Generalised anxiety disorder
- Panic disorder and panic attacks
- Social anxiety disorder
Digestive symptoms have been shown to occur when you suffer with fear, anxiety or stress.
This is because your body has an inbuilt survival mechanism called a βfight or flightβ response which creates a number of changes in your body if it comes into contact with danger. These changes would allow you to βfightβ the danger or βflightβ away from it.
This is great if you are being attacked but when you have an anxiety disorder you can regularly experience anxiety for no ‘logical’ reason. If you suffer with an anxiety disorder, your body will often be in a fight or flight response which can impact your gut.
Unsurprisingly, up to 32% of people with IBS suffer with generalised anxiety disorder (10).
It is also common to experience anxiety in relation to the IBS symptoms which can in tern worsen the situation further. Research has shown that those who suffer with this type of anxiety have more depressive symptoms (11).
Video explaining generalised anxiety disorder
The impact of stress on IBS
The term βstressβ is thrown around very casually and some stress in life is pretty normal at times. But if you are finding that stress is an every day occurrence then it is time to take action.
In IBS, stress has been shown to increase gut sensitivity and motility (1, 2, 3). This can be one reason why you may find that the low FODMAP diet process was unable to resolve your symptoms.
Top Tip: sometimes you become used to running high stress levels and maybe unaware of your own mental state. Try asking someone close to you if they feel you are stressed, it can be a real eyeopener.
How to manage generalised anxiety disorder and other mental health conditions linked with IBS
Firstly, if you feel you are suffering in ANY way with your mental health, it is vital to speak to your doctor.
There are a wide range of therapies and medications that can help. We are all different and there is no one size fits all approach.
The below is a list of pharmaceutical or therapeutic management techniques that have been scientifically proven to help in IBS specifically.
- Cognitive Behavioural Therapy – is a form of psychotherapy whereΒ theΒ therapistΒ helpsΒ patientsΒ toΒ actively question their theirΒ irrationalΒ beliefsΒ and instead to form more rationalΒ beliefs, with a positive impact on their emotional, cognitive, andΒ behaviouralΒ response (10).
- Hypnotherapy – you can read more about hypnotherapy and IBS in this blog post.
- Mindfulness – this has been shown to reduce symptom severity and anxiety related to symptoms (11).
- Antidepressant medications – this has been advised by NICE when other βfirst lineβ medications such as laxatives do not work.
Summary
Mental health conditions are directly linked to IBS via the gut-brain axis. In order for you to manage this part of IBS it is vital to speak to your doctor as there are a range of treatments that can help to manage these issues.
References
10. Beck JS. Cognitive Behavior Therapy. Basics and Beyond. 2nd ed. New York: The Guilford Press, 2011
Kirsten Jackson is a UK registered Consultant Gastroenterology Dietitian and founder of The Food Treatment Clinic. She has undergone many qualifications to get where she is today, including a UK BSc Honours Degree in Dietetics and Post-Graduate Certificate in Advanced Dietetics. In addition to this, she has FODMAP Training from Kings College London University. Kirsten set up The Food Treatment Clinic in 2015 after first experiencing digestive problems herself. She felt that the NHS was unable to provide the support individuals needed and went on to specialise in this area before opening a bespoke IBS service. Kirsten also participates in charity work as an Expert Advisor for the IBS Network. In addition, she can be seen in publications such as Cosmopolitan and The Telegraph discussing IBS as an Official Media Spokesperson to the IBS Network.
A very interesting read. I wonder what the statistics of the number of women suffering from ibs and anxiety are compared to those of men?
Hi! Likely high but the data would be skewed as more women seek medical input so it is hard to get figures for mens health.
Another excellent article. 2 questions: ” which came first the anxiety or IBS,IBD, Leaky GUT, SIBO,SIFO,LIBO diagnosis< and so on" and Secondly, I would like to see more generalized Information if causation could be Viral-
I see little talk about this in Gastro circles much less psychological publications.
Epstein Barr getting much more attention these days and hopefully w PCR technology we will learn of other important viral players possibly.
Again great article.