Psychosocial Factors in the Irritable Bowel Syndrome

Drossman, Douglas A.; McKee, Daphne C.; Sandler, Robert S.; Mitchell, C. Madeline; Cramer, Elliot M.; Lowman, Betsy; Burger, Amy L.

doi:10.1016/s0016-5085(88)80017-9

Cited by 675 publications

(43 citation statements)

References 25 publications

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“…Positive expectations (i.e., expectations for decreased pain) produce a reduction in perceived pain (28.4%) that rivals the effects of a clearly analgesic dose of morphine (0.08 mg͞kg of body weight, an Ϸ25% reduction in pain) (53). These data provide a neural mechanism that can, in part, explain the positive impact of optimism in chronic disease states (54,55). Moreover, the potent pain modulation evoked by positive expectations underscores the potential of cognitive therapy for the treatment of pain.…”

Section: Discussionmentioning

confidence: 84%

The subjective experience of pain: Where expectations become reality

Koyama

McHaffie

Laurienti

et al. 2005

Proc. Natl. Acad. Sci. U.S.A.

620

408

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Our subjective sensory experiences are thought to be heavily shaped by interactions between expectations and incoming sensory information. However, the neural mechanisms supporting these interactions remain poorly understood. By using combined psychophysical and functional MRI techniques, brain activation related to the intensity of expected pain and experienced pain was characterized. As the magnitude of expected pain increased, activation increased in the thalamus, insula, prefrontal cortex, anterior cingulate cortex (ACC) and other brain regions. Pain-intensityrelated brain activation was identified in a widely distributed set of brain regions but overlapped partially with expectation-related activation in regions, including the anterior insula and ACC. When expected pain was manipulated, expectations of decreased pain powerfully reduced both the subjective experience of pain and activation of pain-related brain regions, such as the primary somatosensory cortex, insular cortex, and ACC. These results confirm that a mental representation of an impending sensory event can significantly shape neural processes that underlie the formulation of the actual sensory experience and provide insight as to how positive expectations diminish the severity of chronic disease states.functional MRI ͉ mental imagery ͉ placebo ͉ psychophysical T he experience of a sensory event is highly subjective and can vary substantially from one individual to the next (1). Much of this individual variation may result from the manner in which past experience and future predictions about a stimulus are used to interpret afferent information. Consistent pairing of environmental cues with sensory events provides a learned historical context that is critically important for the prediction and processing of future sensations (2, 3). However, expectations that are inconsistent with sensory information can dramatically alter the sensory experience. In the case of pain, positive expectations can powerfully reduce the subjective experience of pain evoked by a consistently noxious stimulus, whereas negative expectations may result in the amplification of pain (4-7). Furthermore, expectations in which there is a high degree of certainty as to the outcome may activate descending control systems to diminish pain, whereas expectations associated with uncertain outcomes may amplify pain (8).The prefrontal cortex (PFC), anterior insula, and anterior cingulate cortex (ACC) are activated during the anticipation of pain, but their exact role in pain expectation remains poorly delineated (9-12). Moreover, the neural mechanisms by which conscious predictions about the magnitude of pain influence the experience of pain remain poorly understood and largely unexploited in the treatment of pain. At the most fundamental level, expectation-induced modulation of pain must necessarily engage three neural processes. First, an active mental representation of an impending event must be formulated by incorporating past information with the present context and future implica...

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Section: Discussionmentioning

confidence: 84%

The subjective experience of pain: Where expectations become reality

Koyama

McHaffie

Laurienti

et al. 2005

Proc. Natl. Acad. Sci. U.S.A.

620

408

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“…Major pathophysiological factors are visceral hypersensitivity [3], altered gastrointestinal motility [4, 5]and psychosocial factors [6]. The importance of dietary factors are more controversial [7]and not so well studied.…”

Section: Introductionmentioning

confidence: 99%

“…Since psychological factors are important in IBS [6], we also wanted to explore the relationship between perceived food-related symptoms and the presence of anxiety and/or depression. The subgroup of IBS, based on the predominant bowel pattern, has an impact on the choice of treatment.…”

Section: Introductionmentioning

confidence: 99%

Food-Related Gastrointestinal Symptoms in the Irritable Bowel Syndrome

Simrén¹,

Mansson²,

Langkilde³

et al. 2001

Digestion

444

462

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Background/Aims: Postprandial symptoms are common in patients with irritable bowel syndrome (IBS). However, existing studies have come to different conclusions about the role of food in the pathophysiology of IBS. We explored the prevalence of subjective food-related gastrointestinal (GI) symptoms and its relationship to clinical characteristics and psychological factors in IBS. Methods: 330 patients with IBS and 80 healthy volunteers completed a food questionnaire developed for this study. The subjects graded their subjective symptoms after 35 different foods and a food score was obtained by adding the item scores. The relationship between subjective food-related GI symptoms and referral status, IBS subgroup (predominant bowel pattern), sex, anxiety, depression and body mass index (BMI) was estimated. Results: In 209 (63%) of the patients the GI symptoms were related to meals. Gas problems and abdominal pain were the most frequently reported symptoms. Foods rich in carbohydrates, as well as fatty food, coffee, alcohol and hot spices were most frequently reported to cause symptoms. The food score was higher in patients than in controls (p < 0.0001). In the IBS group higher scores were observed in patients with anxiety (p = 0.005), and females (p < 0.001), but the results were unrelated to IBS subgroup, referral status or BMI. The BMI did not differ between groups. Conclusion: A majority of IBS patients consider their symptoms to be related to meals. Especially foods rich in carbohydrates and fat cause problems. Nevertheless, the majority of IBS patients are normal or overweight. Female sex and anxiety predict a high degree of food-related symptoms in IBS.

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“…Symptoms of pain, however, are not always correlated with increased gut contractility, and the perception of visceral sensations can be modified by strong emotions, psychological disturbances and cognitive experience [18]. Moreover, epidemiologic studies have shown that individuals with irritable bowel syndrome who do not seek medical treatment have psychological and personality profiles similar to healthy individuals [24, 25]. Nonetheless, the majority of patients with FGIDs have high prevalence rates of current and lifetime psychiatric disorders [18, 22], especially somatization disorder and anxiety and mood disorders, suggesting a general disturbance in affect regulation.…”

Section: Introductionmentioning

confidence: 99%

Alexithymia and Functional Gastrointestinal Disorders

Porcelli

Taylor

Bagby

et al. 1999

Psychother Psychosom

107

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Background: Although the alexithymia construct was derived from observations of patients with classical psychosomatic diseases, empirical studies have found only a moderate association between alexithymia and inflammatory bowel disease (IBD). Indeed, there is some evidence that alexithymia may be associated more strongly with functional somatic symptoms than with the psychosomatic diseases. The present study examined the relationship between alexithymia and functional gastrointestinal disorders (FGIDs) in a group of 121 FGID patients, and compared the results with findings from a group of 116 IBD patients and a group of 112 healthy subjects. Method: The subjects completed the 20-item Toronto Alexithymia Scale and the Hospital Anxiety and Depression Scale. Results: The FGID group was significantly more alexithymic than the IBD group, and the two gastrointestinal groups were more alexithymic than the normal healthy group. These differences remained even after controlling for the influence of education, gender, anxiety, depression and gastrointestinal symptoms. Conclusions: The finding of a high rate of alexithymia (66%) in the group of FGID patients is consistent with the propensity of these patients to somatization and to high levels of poorly differentiated psychological distress.

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Psychosocial Factors in the Irritable Bowel Syndrome

Cited by 675 publications

References 25 publications

The subjective experience of pain: Where expectations become reality

The subjective experience of pain: Where expectations become reality

Food-Related Gastrointestinal Symptoms in the Irritable Bowel Syndrome

Alexithymia and Functional Gastrointestinal Disorders

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