IBS and Mental Health: The Vicious Cycle

I have butterflies in my stomach. That left a bad taste in my mouth. This news is hard to swallow. As these common expressions show, the link between emotion and the digestive system is universal.1,2 But while everyone has felt a knot in the stomach, people with IBS react far more strongly to stress and anxiety. The modern way of thinking about gastrointestinal illness is using a “biopsychosocial model.” As the name suggests, this model proposes that illness is a result of interacting biological, psychological, and social factors.1 Looking at IBS this way makes it easier to understand how stress—a psychosocial factor—can influence the actions of the gut. The model helps to explain gaps between biomedical research and actual patient experience. Finally, this approach gets clinicians thinking about the range of factors that influence the illness—which might lead to better treatment. The brain-gut connection The network of neurons in the gut is so complex that it has been called the “second brain.”3 This brain in your gut is hardwired to the brain in your head, forming what is called the “gut-brain axis.”1 Your brain sends signals downward that influence gut function, and your gut sends signals upward that probably influence your mood. The idea that the gut has a physical reaction to emotional and stressful stimuli is not new.1 Crude experiments in the early 20th century showed that by changing a person’s emotional state, it is possible to affect blood flow to the gut and the movement of food and waste through the gut. Modern technology has enabled researchers to measure nerve signaling from the gut, evaluate the interaction between the immune and nervous system, measure pain perception, and perform functional brain imaging.1 Cutting edge research is underway to understand how gut bacteria communicate with the gut nervous system—and maybe influence our behavior!4 This field of research is called “neurogastroenterology” and it has provided important scientific evidence about gut and brain interaction.1 It is too early to know exactly what this research means for people with IBS. But these discoveries are certainly intriguing, given that IBS has been linked to a wide range of factors, including stress, gut bacteria, food intolerance, immune changes or inflammation, intestinal infection, and genetics.5 Stress: a trigger and a result Much has been written about the role of stress in IBS. It is well known that stress and anxiety affect many IBS patients: between 40% and 60% of people with IBS have an overlapping psychiatric disorder.5 Research shows that stress can be a trigger of symptoms and can also result from gastrointestinal distress. A number of experiments have shown that people with IBS have a greater gastrointestinal reaction to stress than people without IBS. For example, strong emotions and stress causes more problems with intestinal motility in people with IBS than without.1,2 People with IBS have a heightened experience of pain in the internal organs—called visceral hypersensitivity—which gets worse under stress. In lab experiments, researchers create stressful situations such as listening to unpleasant music, plunging a hand into cold water, or creating mental stress. In these situations, people with IBS become more sensitive to non-painful rectal stimuli than control subjects do.2 Stress may make the intestinal wall more permeable, letting bacteria or food particles pass into the bloodstream where they do not belong and causing pain and diarrhea.1 Given the role of stress in triggering IBS symptoms, stress management is one of the recommended treatments for IBS.6 Gut-to-brain communication appears to have a role in altered mental function.1 Increased motility and bowel inflammation or injury send signals to the brain that lead to greater feelings of pain, and contributing to anxiety and depression. Is stress a cause of IBS? Some evidence suggests that stress may have a role in the development of a functional bowel disorder.2 One theory is that in a susceptible person, chronic stress amps up central stress circuits. Over time, this causes the systems that help us cope with stress to become dysregulated. These systems become less effective at handling things such as infection, illness, and psychosocial stress. What might make a person susceptible to these changes? Genetics, traumatic early life experiences, and chronic stress are some possibilities.2 However, much more research in humans is needed to understand how stress causes changes in gastrointestinal function and nervous system responses. [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site" title="Sign up for emails from {{site-name}}:"] What does that mean, you might ask? What does my mental health look like? Does it look like anything? It is very rare for me to have a conversation with someone with IBS where the topic of mental health doesn’t come up. I’m sure that there are those of you that don’t necessarily think that mental health is a major factor in your IBS experience. One thing I’ve learned is that IBS comes in so many shapes and variations that no two people have the same root cause or experience. Do I believe my mental health is inextricably tied to my IBS? Yes, without a doubt. I am sure of it. Identify your mental health needs I know my mind and my body. I know that many other people with IBS feel the same way. IBS can be a reaction to years of anxiety and unmanaged stress coupled with the way we treat our bodies when we feel bad. So take a look inside and see what your mental health looks like. Is it happy, stable and friendly? Or is it anxious, frustrated, hopeless and angry? This brings me to the main point of this article. When people hear the term ‘mental health’ they very often immediately start thinking about mental illness. Schizophrenia, bipolar, personality disorders, etc. But mental health also includes major depressive disorder, anxiety disorders, and about a hundred other categories and sub-categories. Mental illness sounds scary and it can be. But just because you may ‘only’ have bad anxiety, doesn’t mean it is not an illness. Mental illness carries stigma very much like IBS. So let’s see what our mental health really looks like. Finding a balance between mental health and physical health Ultimately, mental health is exactly what the name suggests. Nothing more and nothing less. How healthy are you mentally? Do you ask yourself that question? You should. I have found that with IBS you tend to get consumed with all the things you need to do to help ‘fix’ your body. It takes a lot of time, money and energy and often leaves you too tired or fed up to look at the mental wellness piece. We can’t do that. There has to be a balance between those two parts of managing IBS. The mental and the physical are tied together in all things. Illness, love, work, sports and the list of life activities go on. There is no true physical wellness without mental wellness and vice versa. I believe this to be true. In my experience, visiting my therapist, meditation, coping skills, and medication is just as important to my management of IBS as is seeing my GI doc and working on my diet and exercise. I’d like to share something I’ve learned in my job as a counselor and social worker. When I first started in this field I think I truly believed that there was a sort of ‘Tier’ system with mental illness. You know, schizophrenia was the worst, followed by bipolar 1, followed by certain personality disorders. Depression and anxiety disorder were on the ‘bottom’ tier. I couldn’t have been more wrong. All of these things are spectrum disorders. There are people with generalized anxiety disorder and depressive disorder that suffer every bit as much and more than some people with schizophrenia. The reverse is also true. There is no one way, one rule, one treatment. Just like IBS. Point is, if you spend a little more time thinking about mental wellness, you might find your IBS will thank you for it. [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site"] I have written a few articles over the years about my IBS and depression, and I am proud to say that since I began this journey of advocating for myself and others with invisible illnesses, I continued to gain a better handle over my mental health. Now that’s not to say I’m completely depression-free; I’d be lying if I said that I still don’t experience depressive episodes every now and then. Let’s be honest, who seriously enjoys living with a debilitating condition that constantly finds ways to hold the sufferer back in life? When I was new to the invisible-illness community, I didn’t know how to take my condition serious enough to even advocate for myself, let alone for others. I felt so pitiful and miserable simply because I did not want to accept what I was going through, and instead, I fought hard to return to the days of feeling “normal” and “healthy”. Clearly, that act only lasted for so long until my condition started effectively affecting my quality of life and mental health in the worst of ways. IBS and depression When I finally came to terms with my IBS, I realized depression was deeply tied to how I felt due to my condition. It seemed to always come along for the ride during and after some of my worst flare ups. Therefore, I had to learn to live with both conditions, which for a newbie is obviously a very hard thing to do. It requires accepting the fact that you also have depression on top of having IBS. When I accepted both of those diseases, I began to notice all of the things they took from me without me being aware at the time. Because of my IBS and depression, I dropped out of college, lost a number of jobs, lost touch with many good friends, and have had deep issues with some family members. At one point, I lost all hope and any ounce of confidence in myself. So basically, learning to live with these conditions was similar to learning to find a reason to live every day. How I overcame depression It took me a while, a long while, but I realized a lot of my depression wasn’t just coming from IBS, but also from me. A lot of my mental anguish was self-inflicted simply because of my perception on my condition, and life in general. For instance, I used to compare myself a lot to other people who didn’t suffer from this horrible condition, and because of that I had a hard time keeping my self-esteem high, which eventually lead to a depressive state. One of the hardest things for me to learn was to stop comparing myself to others, and simply accept my shortcomings by finding new and different ways to do the things I really wanted. For me, that was literally a key moment and realization that helped me slowly get out of my depressive-funk and start taking control over my life. I could go down a list of how I was self-inflicting my own depression in many other ways, but I feel the most important things to point out are the fact that I took accountability for my self-inflicted depression and realized how I needed to change my perception of the limitations placed upon my life. When I finally decided to do things my way, my attitude changed about my condition and dealing with depression became a lot easier overtime. I’ve used this once in an article and I’ll use it again, since it is one of my favorite quotes, “Change your mindset. Change your life.” For me, that’s the key to getting over many obstacles. [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site" title="Sign up for emails from IrritableBowelSyndrome.net:"],This month IrrititableBowelSyndrome.net is featuring discussions about coping with IBS related pain. If you take a quick look at my articles, you’ll see a good portion of them are about recovery, mental health and wellness. Because of this, I was anxious to put my two cents in with regards to this issue. While it is true that most serious illnesses may cause mental health related pain related to anxiety, depression and such, I truly believe that the psychological and emotional toll taken by IBS is unique and incredibly painful. It really becomes about creating a plan and learning to cope in the healthiest way you can. In the hopes that all of us engaged here on this site can relate to each other in some way, I will share my experience with the psychological and emotional pain that IBS can cause. IBS and mental health As I have mentioned before, I had anxiety and mental health related issues long before I was diagnosed with IBS. From what I understand, this is not uncommon amongst folks suffering with IBS. I had spent years getting my mental health under control and learned how to cope with the very real pain and suffering that living with mental illness can cause. I was so dedicated to my recovery and my wish to live a life free of anxiety, mood swings and depression, that I was able to become stable enough to work in social services, with a wish to support others struggling with the same types of problems. The point of all this, is that on that day I went to the GI doc and they told me I had IBS…I was very, truly; stable. Since then, I have found myself struggling again due to the many, many stressors that IBS places on your self-esteem, your physical ability to function and your sense of empowerment. No one wants IBS. Just the very nature of the disorder is disturbing. Even though I had been experiencing IBS symptoms prior to my diagnosis (obviously), once I started reading about IBS and the fact that it can’t be cured and all that…my heart just sank. After really bad flare ups I get blue and depressed. In between, I get worried and anxious about when it is going to happen again, what will happen if I eat the wrong food, what if I can’t have a normal relationship and on and on and on. This is NO WAY TO LIVE. So, how to cope you ask me? Well, I will try to explain my approach in a few words. How to cope? First things first, please try to judge your psychological symptoms honestly. I know that many people will seek help for anxiety and depression from their family doctors. While I’m sure many are equipped to deal with mild cases of nerves or the blues, they may not be the best option once things get past a certain point and these psychological and emotional symptoms become a constant part of your life. In this case, it is important to find a specialist. There is no shame in seeing a therapist or a psychiatrist. There is an overwhelming stigma associated with mental health issues, just as there is with IBS. See the specialist, work with the specialist and accept that it may take time and perhaps be a bit uncomfortable. Open yourself up to the help. Otherwise, please look into taking back your happiness by doing all the things we know we should do to keep ourselves well. Do not isolate; enjoy the outdoors. Do not couch potato; please exercise. Do not drink booze; drink good tea and water. Do not sit and worry; listen to music. You get the point. Someone said, ‘Stop hating yourself for what you are not and start loving yourself for what you are.’ I think this says it all. [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site" title="Sign up for emails from {{site-name}}:"] Mental and physical health are intrinsically linked. Managing the stresses of a physical condition can be mentally and emotionally exhausting. Here we share 10 strategies for coping when you’re feeling overwhelmed. 1. Breathing exercises Focusing on your breath is a technique used to lower stress and anxiety. There are many different forms of breathing exercises including belly breathing, nasal breathing, and timing and guiding your breath. 2. Guided meditation Don’t let the name turn you off! There’s a lot of ways to practice mindfulness and meditation, and finding the right one for you can help slow down racing thoughts, release worries, and focus the body. There can be a learning curve with meditation, so be sure to shop around - with practice it gets easier. 3. Exercise, diet, and vitamins Emotional wellbeing is both body and mind. Though it’s important to note that these are not cures, how you nourish your body can affect the way you feel. Movement, whether high impact or low, can decrease stress and increase energy. 4. Sleep There’s no underestimating the importance of sleep. It gives your body and mind the time it needs to recharge and can increase emotional resilience. A good night’s sleep doesn’t come easy to everyone, so finding a schedule for you and even consulting a specialist might be helpful. 5. Laughter: take a break Laughter is the best medicine? Distraction in the form of entertainment or humor can help relieve the day-to-day physical and mental stress. If you’re in the midst of a stressful situation or environment, you may want to try physically removing yourself and seeking a calmer place. 6. Nature therapy You’ve probably noticed the joy that comes with taking a walk through the trees, but it may come as a surprise that natural environments really can have an impact on our minds. Being surrounded by nature can provide both an escape and a point of focus when you’re feeling overwhelmed, allowing you to focus on something bigger than ourselves. 7. Acupressure You’ve probably heard of acupuncture. Acupressure has a similar goal, to release tension, center thoughts, and focus your energy. They both have origins in Eastern medicine. Acupressure uses precise pressure and finger placement over specific points along the body that are known to target stress and anxiety. You can try doing it yourself, or ask a friend or loved one to help you. 8. Thought exercises We all have days when negative thoughts consume us. These techniques can help to redirect these thoughts. Some exercises involve journaling, affirmations, gratitude, and list-making. For example, you might make a list of your strengths or repeat a positive mantra. 9. Seek out support Even with these tools in hand, there will be times when it’s difficult to cope on your own. Support can come in lots of different forms. Family, pets, friends, online communities, meetups and support groups - all of these resources can provide a strong foundation for the times when you need reinforcements. 10. Volunteer to help others Reaching out beyond your social network to help out others can give you a sense of purpose. It allows you to use your skills and energy to make a difference in someone else’s life. Volunteering can take many forms, such as letter writing, donating, or offering your time to a local nonprofit. Further resources Sometimes coping becomes impossible to manage on your own, even with the help of loved ones. There is professional help available: Psychotherapy Medication Resources [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site" title="Sign up for emails from IrritableBowelSyndrome.net:"],What is a mood disorder? According to MentalHealth.gov, mood disorders are affective disorders that may involve the following feelings:1 Feeling sad all the time Losing interest in important parts of life Fluctuating between extreme happiness and extreme sadness The most common mood disorders are:1 Depression Bipolar disorder Seasonal affective disorder (SAD) Self-harm Depression is likely the most common mood disorder among people with IBS. Depression can interfere with everyday life and the feelings do not go away. Some symptoms of depression include:2 Sadness Change in weight Difficulty sleeping or oversleeping Loss of energy Feelings of worthlessness Thoughts of death or suicide Depression is a serious medical illness. If you are experiencing any of the symptoms of depression, please seek medical or psychiatric help to improve your mental health. How common are mood disorders in people with IBS? Psychiatric disorders have been associated with the development of IBS. In particular, people with mood disorders have a higher likelihood of developing functional gastrointestinal disorders with more severe symptoms, lower health-related quality of life, and higher chance of recurring symptoms following treatment. Mood disorders are present in up to 66% of patients with IBS.3 People with a lifetime diagnosis of IBS are also more likely to report a lifetime diagnosis of a mood disorder.4 Several different studies have shown the presence of depression in all IBS subtypes. However, depression may be more prevalent in people with constipation predominant IBS or mixed IBS.5 Why is there a connection between IBS and mood disorders? The reason for the relationship between IBS and psychiatric disorders is not clearly understood.6 To date, there is no evidence to support a genetic connection between Major Depressive Disorder and IBS.4 It is believed that people with IBS have personality traits that affect the way they perceive and become distressed by bodily issues, which results in depression. Interestingly, people with depression who suffer from IBS are more likely to be vocal about their symptoms and seek medical help for their IBS, as opposed to people who are depressed but experiencing IBS related symptoms.6 [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site" title="Sign up for emails from {{site-name}}:"]

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