In class today we were told that irritable bowel syndrome is not psychosomatic, and therefore is not classified in the DSM-IV. Does anyone have any information otherwise? I always thought it was a real disease, but that it was mostly (fully?)psychological in etiology. I forget where I read this; but when I did a search on IBS, I only found a few references to its psychological etiology.
I can’t speak as an expert, but while it can be aggravated by psychological state, it is a quite real condition which exists independent of one’s stress level, etc. At a time when I had no major stressors in my life, I came down with a bout of it owing to lack of bulk in my diet – eating a certain amount of bulk, such as whole-grain breads, has prevented recurrence (except once when I neglected to eat adequate bulk). Perhaps Qadgop or DoctorJ may be able to add some more technical information to this anecdotal answer.
Whitehead has many papers on the psychosomatic aspect of IBS
Here’s a reference:
Whitehead, William E., Schuster, Marvin M. (1985), 1929- Gastrointestinal disorders : behavioral and physiological basis for treatment, Orlando : Academic Press
“Previous research has shown that IBS patients are higher in measures of Neuroticism or psychopathology (Whitehead & Schuster, 1985), although it is not clear whether that result is due to self-selection into medical care settings.”
The answer to this question might well depend on who you ask.
A lot of medical conditions are aggravated by stress. Anxiety can make it difficult to breathe. Stress can cause pain. In my view, many conditions, including irritable bowel syndrome and fibromyalgia clearly have a psychosomatic component. This does not mean they are purely psychological, especially when the mechanism of many diseases remains unclear.
Many patients with irritable bowel, fibromyalgia, etc. do not accept that stress is the major cause. A number of patient organizations (e.g.: IBS support groups) and groups of specialists (e.g. rheumatologists in fibromyalgia) spend a fair amount of money to lobby doctors that the basis of these possible psychosomatic conditions is due to a mechanical nerve problem. This is certainly plausible; any medical “syndrome” is called so since the group of symptoms is not understood. On the other hand, lots of money and secondary gain is at stake with insurance claims, missed work and greater public acceptance of mechanical (versus mental) disease. So patients do have a stake in supporting a mechanical view even if the disease IS largely psychosomatic.
It has become unfashionable in academia to refer to IBS as a psychosomatic condition. Yet, most gastroenterologists privately consider it to be psychosomatic, and any surgeon can tell you ten names for “psychic gut” that have gone in and out of fashion over the years. No doctor wants patients, who are genuinely suffering with these poorly understood conditions, to think the doctors are insensitive, or worse (as regrettably happens) disbelieving of their genuine pain. But I fully believe that for many patients with IBS stressors are a major factor – and many patients would be unhappy that I believe this.
Who knows? Maybe a real doctor like Qadgop or an intern like DoctorJ can tell you more.
Dr_Pap, MD, CCFP
Chief of Emergency Medicine
There are some who believe that IBS is aggravated or even caused by stress. An interesting book on this is The Second Brain : A Groundbreaking New Understanding of Nervous Disorders of the Stomach and Intestine
IANAD, but the Merck Manual says of IBS as well as several other conditions involving gastrointestinal discomfort that often, the problem is not necessarily/just that the patient’s gut is acting abnormally, but that the patient is abnormally sensitive to discomfort. I guess this could be called a psychosomatic aspect… I guess.
As an IBS sufferer I’ve read a lot of the literature, which comes down on every point of the compass.
I agree with much of what Dr_Paprika says. It’s a fair summary of the current state.
I do need to add that in recent years some real progress has been made in several areas. The internal structure of the intestines and the way that nerve signals are sent is much better understood. Partly because of this and partly because so many new ones are available, a host of medications can now be prescribed that actually work.
When you take a pill and your symptoms almost magically vanish (and then reappear when you go off the pill) it becomes extremely hard to be convinced that stress or psychological illnesses are the cause of the problem. The placebo effect is also negated when the pill, as has frequently been the case, has been prescribed for some other reason and just happens to clear up the IBS instead.
With doctors for many years sticking an IBS label on any digestive distress they couldn’t otherwise explain, it’s little wonder that some cases do not turn out to be physical defects. I for one am fully convinced that in most cases, however, the psychosomatic explanation has become quackery.
I used to have stress alot worse than I do now. I had chronic insomnia and would be up until 7am everyday and my depression and anxiety were worse than they are now. And I had IBS, I couldn’t eat any citrus fruits and more than 8oz of milk made me sick. However after I took care of the stress not only did the insomnia go away but the depression and anxiety went down a good deal and the IBS cleared up. I can eat dairy and citrus fruits w/o any restrictions now.
I recently read IBS could be due to too much bacteria too.
I suffer from it pretty bad, and mine is not at all associated with stress. Certain things in my diet can really make it go crazy – thats about the only catalyst that seems to have any effects on mine.
As opposed to an imaginary doctor like yourself?
Patient: I’m dying! Where’s the Doctor!?
Nurse: You’ve got to believe in him before he will appear.
Patient: Fine! Anything! What’s his name?
Nurse: We call him “Dr. Paprika”. You’ve also go to clap to show you believe in him.
Patient: Like Tinkerbell?
Nurse: Just like!
What you are describing is a god, not a doctor 
I’ve suffered from IBS for years, and while I’m aware that stress aggrevates it, there are other things that trigger it. I avoid lemons, oranges, tomatoes, chilli, curry, very fatty foods, onions and large amounts of milk and that keeps it mostly under control. If I have a small amount of a “forbidden” food once in a while, it generally doesn’t have too much of an effect, but if I overindulge in any of them (or even have the slightest little bit of chilli) then I pay for it. However, no matter how well I eat and how low my stress levels are, it will flare up for no apparent reason every so often.
Another IBS person. I find that it doesn’t correlate with my stress level at all (perhaps it’s worse when I am sleep-deprived). For me, it’s well-controlled with plenty of soluble fiber supplements.
A friend of mine with IBS tried biofeedback because his doctor told him his body was habituated to respond a certain way. He was able to control it somewhat but he still needed medication, albeit less than before.
Hands up another one here…
Stress is one minor factor. Diet, alcohol, caffiene, sleep patterns all play a more important role. Basically, if I gave up my entire life as it exists, I’d be cured. :mad:
There’s no need to make a specific disorder for every physical ailment that may be due to psychological aspects. IBS may be due to either real physical problems or psychological stressors and often both.
IBS can be diagnosed as simply an Undifferentiated Somatform Disorder. If you have your DSM handy you’ll notice one of the most frequent complaints is gastrointestinal pain and nausea.
Once the possibilities of other causes for the IBS have been ruled out (ie: general medical conditions, effects of injury, substance abuse, or side effects from medication) the diagnosis of USD may apply.
Right! Not a doc like Doc Pap, who just sits around all day and night in the ER, saving lives thru swift action and diagnostic acumen! 
Ironically a few hours after I made that post up there I had my first flareup of IBS in years. It was brought on by Indian food I ate on friday. So yeah its both psychosomatic and physiological but the IBS caused by dairy and citrus that I used to have is gone now.
Not sure what kind of class this was, but I just don’t understand this statement.
The DSM-IV contains everything, medical, psychological, judicial, whatever.
There are many sections on various physical diseases & symptoms, and other sections on mental diseases.
There’s even a section containing the codes to assign for “death as result of a judicially ordered execution”.
There are codes for obsolete diseases which have not had a recorded case for over 30 years (like smallpox).
Pretty much everything’s in there, somewhere. It’s possible that “irritable bowel syndrome” is not listed on it’s own, but as a subset of something else. (Most insurance companies require DSM or ICD codes on medical records before they will pay for treatment. Often the code assigned determines how much the insurance company will pay for. You can bet that doctors whot treat IBS have appropriate codes to assign for this.)