Where to Go Next to Manage IBS: Psychologist or Dietitian?
Until recently, many patients would have felt insulted by their physician at the suggestion of working with a psychologist or therapist to address their irritable bowel syndrome (IBS). The experience of IBS includes terrible abdominal pain, diarrhea, constipation, or both. While it is recommended that you have your symptoms assessed by a medical provider, how they go about giving you a diagnosis can vary. They may take your description of symptoms and feel comfortable giving the diagnosis of IBS. Or, they may recommend some testing, such as a colonoscopy, breath testing, labs, etc. Often with an IBS diagnosis, the medical workup is "negative."
The physician may then suggest:
- Over-the-counter medications (such as Miralax, Imodium or IBGard)
- Prescription medications (such as Linzess or Xifaxan)
- Neuromodulators (such as tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors ( SSRIs))
- Nutrition therapy (such as the low FODMAP diet) or
- Behavioral therapy (such as GI-specific cognitive behavioral therapy or medical hypnotherapy)
The options for treatment can be overwhelming and access to the treatment can also be a barrier. For those of you who have attempted the medication management route and are yet to receive adequate relief, you may be contemplating the next steps.
Do not overwhelm yourself
Because both types of treatment require time, effort, and resources, we don’t recommend attempting both at the same time. Here are some suggestions for deciding which direction to go next:
Consider working with a GI psychologist if
- You have anxiety related to your symptoms that is impacting your life. For example, you worry or avoid situations where bathroom access may be difficult
- You recognize that stress impacts your symptoms, or your symptoms cause you stress
If you are experiencing moderate to severe mood symptoms, you should seek out general mental health care to stabilize mood symptoms before seeking out the care of a GI psychologist who will focus treatment on your GI condition.
Consider working with a GI dietitian if
- You are skipping meals due to worry over the potential of GI symptoms.
- You have attempted dietary modifications and it hasn’t been helpful.
- You are attempting the low FODMAP diet (or any other restrictive diet for IBS) on your own with little success. Research shows the best outcomes with these diets are for those who have worked with a dietitian with expertise in GI conditions. Most people with IBS should not remain on any restrictive diet for a long-term, so working with an expert to expand your diet is important.
- You don’t feel that your mood or stress impacts your symptoms.
- There is a clear connection between the foods you are eating and your symptoms.
Once you have decided what direction you'd like to take, you will need to locate a provider.
GI behavioral therapy resources
Locate a GI psychologist or GI mental health provider using the Rome GI Psych Directory.
If a GI specialist is not in your area you can locate a mental health provider using PsychologyToday and filter your search for the following:
- Issues: Anxiety, Chronic Illness, Chronic Pain, Depression, Stress
- Type of therapy: Cognitive Behavioral Therapy (CBT), Acceptance and Commitment (ACT), Hypnotherapy
To access helpful GI psychology content related to IBS, check out GastroGirl.
GI nutrition and dietary therapy resources
To locate a dietitian with GI expertise, head to IFFGD Directory of Dietitians or the FODMAP Dietitian List.
Learn more about nutrition therapy in IBS.
Next steps in integrative care
IBS is a complicated diagnosis. It can require the guidance of multiple specialists. However, your treatment plan should not be overwhelming. The inclusion of a GI psychologist and/or GI dietitian should be considered based on your individual needs, interests, and treatment goals.
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