IBS – Psychological Factors

IBS - Psychological Factors

Experts believe that emotional stress plays a large role in creating or exacerbating the symptoms of IBS.  This is backed by the fact that studies have shown that constant stress from life events have either exacerbated IBS symptoms, or lead to the development of IBS in asymptomatic individuals who have had a prior GI infection.  The hormone cortisol, is released in the blood in response to stress.  Higher cortisol levels in the morning urine and saliva have been reported in those with IBS, indicating a state of chronic stress.  Stress makes the GI mucosa more permeable to substances and more susceptible to inflammation.

Patients with IBS have a higher prevalence of psychiatric disorders and report more frequent or debilitating illness than patients without IBS.  Those who are seen by a physician have a higher incidence of panic disorder, major depression, anxiety disorder, and hypochondriasis than control populations.  Also, a higher prevalence (42% to 61%) of physical and sexual abuse has been demonstrated in patients with IBS.  It is common to see other disorders that are associated with IBS.  These disorders include reflux disease, heartburn, fibromyalgia, chronic fatigue syndrome, chronic pelvic pain, temporomandibular jointn (TMJ) disorder, and interstitial cystitis.  There is also a high prevalence of somatization disorder (a history of unexplained physical complaints) in people with IBS.  Whether this is a coincidence or that the increased prevalence is due to IBS itself, will have to be investigated fully.  It has been suggested that people with IBS are more sensitive to gastrointestinal symptoms and are more vigilant in reporting their symptoms to physicians than others.

Physicians must be aware that many of the conventional treatments used to treat IBS, namely antidiarrheals, and anticonstipation agents, may not be successful in certain patients.  The psychological component to IBS cannot be ignored, and physicians must consider this when treating IBS patients.  A more integrative approach involving attention to the external stressors, emotions, and psychological factors that can affect IBS need to be implemented.


Cash BD, Chey WD. Irritable Bowel Syndrome: A Systematic Review. Clinics in Family Practice. 2004;6(3):647-669.

Hanaway PJ, ed. Irritable Bowel Syndrome. Second ed. Philadelphia: Saunders Elsevier; 2007. Rakel D, ed. Integrative Medicine.

Hayee B, Forgacs I. Psychological approach to managing irritable bowel syndrome. BMJ. May 26 2007;334(7603):1105-1109.

Whitehead WE, Palsson OS, Levy RR, Feld AD, Turner M, Von Korff M. Comorbidity in irritable bowel syndrome. Am J Gastroenterol. Dec 2007;102(12):2767-2776.