Psychosocial factors in irritable bowel syndrome

Irritable bowel syndrome (IBS) is the most common gastrointestinal disorder encountered by primary care physicians and gastroenterologists with an estimated prevalence of 8% to 17% in the general population. This paper provides a review of available literature in the field of psychogastroenterology, that supports the biopsychosocial model as the basis for understanding and treatment of IBS, as well as epidemiological and clinical data associated with the influence of psychosocial factors on the gut physiology, symptom presentation, behavior related to health conditions and the final outcome of disorder. The psychological assessment of IBS patients, compared with normal subjects or other medical patients, shows a high prevalence of stress reports, abnormal personality features, psychiatric diagnoses and illness behavior. Psychosocial factors are important with regard to their effects on the gut physiology, their modulation of the symptom experience, their influence on illness behavior, their impact on the outcome and the choice of therapeutic approach. Psychological factors, such as the type of personality, health believes, the history of previous physical or sexual abuse may play an important role in determining health care-seeking behavior. The examination of psychosocial histories of the IBS patients suggested that many of the IBS features might be more characteristics of patient's coping and adoption patterns than of the very disease. The psychiatrist may be of assistance by treating IBS as a biological vulnerability that worsens with psychological distress, providing proper diagnosis and treatment of coexisting psychiatric disease and maladaptive illness behavior, and developing multimodal treatment plan including psychotherapeutic and pharmacological management.