Do psychosocial factors define symptom severity and patient status in irritable bowel syndrome?

doi:10.1016/S0002-9343(99)00081-9

The American Journal of Medicine

Volume 107, Issue 5, Supplement 1, 8 November 1999, Pages 41-50

https://doi.org/10.1016/S0002-9343(99)00081-9 Get rights and content

Abstract

Psychological difficulties in patients with irritable bowel syndrome (IBS) are strongly related to symptom severity and patient status. This has important implications for clinical practice, and the design and conduct of clinical trials. Psychosocial factors (personality, psychiatric diagnosis illness behavior, life stress, psychological distress) distinguish patients with IBS from patients with no IBS. Psychosocial difficulties (e.g., history of physical or sexual abuse, maladaptive coping, or “catastrophizing”) predict poorer health outcome (greater pain scores, psychologic distress and poorer daily function, more days spent in bed, and more frequent physician visits and surgeries). When using the standardized Functional Bowel Disorder Severity Index, patients classified as severe are distinguished from moderates by several psychosocial difficulties and health-care use variables. In addition, whereas patients with severe illness report more pain, there is no difference from patients with moderate illness in terms of visceral sensation threshold. Given these data, it is important to consider psychosocial factors as predictive of symptom severity and clinical outcome, and this should be considered in clinical care and the design of clinical trials.

Section snippets

Do psychosocial factors distinguish patients with IBS from patients with no IBS?

Most patients with IBS do not see physicians,7, 8 and most who seek medical care are cared for in the primary care sector. It is only a very small proportion of patients with IBS with severe or refractory symptoms who get referred to major medical centers,2, 3 and it is these patients who receive most of the clinical investigation at significant financial cost.9

An important question is whether it is the severity of the symptoms per se or the mediating effects of psychosocial factors on symptom

Do psychosocial difficulties predict poorer health outcome?

Given that psychosocial factors predict patient status, we can now address their effect on other health outcomes. The research model we have used over the last 10 years to conceptualize and study this issue is shown in Figure 4. Early life factors (e.g., genetic predisposition and environmental factors) influence later psychosocial factors, physiologic functioning, their interaction via the CNS–enteric nervous system (ENS) axis and susceptibility to developing IBS. The combined and integrated

Do patients with more severe IBS have greater psychosocial difficulties than patients with less severe IBS?

The final question addresses whether psychosocial factors discriminate patients with severe IBS from those with less severe IBS. If this is true, then clinical trials evaluating a medication targeted to the gut may need to adjust for psychosocial factors or exclude patients with severe illness, because psychosocial disturbances will confound the results.

To address this from a research standpoint, we must do the following: (1) define and clinically categorize illness severity, (2) develop a

Summary and implications

In summary, multiple lines of evidence suggest that for patients with IBS, psychological difficulties are strongly related to symptom severity and patient status. This has important implications for clinical practice, because optimal patient care requires that the physician identify and address the psychosocial determinants of the clinical condition and its outcome.

There are also implications with regard to pharmaceutical treatment trials. First, the recruitment method (e.g., by advertising or

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Original ArticlesDo psychosocial factors define symptom severity and patient status in irritable bowel syndrome?

Abstract

Section snippets

Do psychosocial factors distinguish patients with IBS from patients with no IBS?

Do psychosocial difficulties predict poorer health outcome?

Do patients with more severe IBS have greater psychosocial difficulties than patients with less severe IBS?

Summary and implications

Gastroenterology

Gastroenterology

Gastroenterology

Gastroenterology

Gastroenterology

Gastroenterology

Gastroenterology

Gastroenterology

Am J Med

Gastroenterology

Gastroenterology

Psychosocial aspects of the functional gastrointestinal disorders

Gastroenterol Int

The irritable bowel syndromereview and a graduated, multicomponent treatment approach

Ann Intern Med

Physicians’ emotional reactions to patientsrecognizing and managing countertransference

Am J Gastroenterol

Psychosocial sound bitesexercises in the patient-doctor relationship

Am J Gastroenterol

Optimal design of treatment trials

Bowel habits in young adults not seeking health care

Dig Dis Sci

Assessing the impact of life changesdevelopment of the life experiences survey

J Consult Clin Psychol

Original Articles
Do psychosocial factors define symptom severity and patient status in irritable bowel syndrome?