by Dr. Amber Cohen, Psy.D., C.Psych
Living with a gastrointestinal autoimmune disease means navigating a daily minefield of unpredictable and often debilitating symptoms. These conditions occur when the body's immune system mistakenly identifies healthy cells as pathogens and attacks them. In the case of gastrointestinal autoimmune diseases, the digestive system is targeted, resulting in disrupted digestive function and uncomfortable symptoms. Common gastrointestinal autoimmune diseases include inflammatory bowel disease (IBD), celiac disease, and autoimmune gastritis.
These diseases are complex and often difficult to manage because they involve an ongoing inflammatory process that can damage the gut lining, disrupt nutrient absorption, and lead to systemic inflammation. As a result, individuals with gastrointestinal autoimmune diseases often experience chronic pain, fatigue, and other severe symptoms that significantly impair their quality of life.
Symptoms of Gastrointestinal Autoimmune Diseases
● Abdominal Pain: Abdominal pain is a common symptom in various autoimmune gastrointestinal diseases, such as celiac disease and Crohn’s disease. These diseases often involve inflammation or damage to the intestinal lining, causing significant discomfort or cramping. For example, Crohn's disease can cause deep, transmural inflammation, which leads to chronic pain in the abdomen.
● Diarrhea: Diarrhea is another hallmark of autoimmune diseases like inflammatory bowel disease (IBD), which includes both Crohn's disease and ulcerative colitis. It occurs due to inflammation and damage to the intestinal lining, reducing the ability to absorb water and nutrients, which can result in watery stools.
● Fatigue: Chronic fatigue often accompanies autoimmune diseases due to the ongoing immune response and inflammation. In diseases like celiac disease, malabsorption of nutrients like iron and B vitamins can exacerbate fatigue, leaving patients feeling constantly tired.
● Bloating: Bloating is frequently reported in conditions like celiac disease and small intestinal bacterial overgrowth (SIBO), both of which are autoimmune-related. In these cases, malabsorption or poor digestion leads to the fermentation of undigested food in the intestines, causing gas and bloating.
● Neurological Symptoms: Some autoimmune gastrointestinal diseases, such as celiac disease, can manifest neurological symptoms. These can include headaches, cognitive issues (like brain fog), and even peripheral neuropathy, often due to vitamin deficiencies caused by malabsorption.
● Vitamin and Mineral Deficiencies: Autoimmune conditions, particularly celiac disease and Crohn’s disease, can impair the body’s ability to absorb essential vitamins and minerals like vitamin D, B12, and iron. This deficiency can often lead to further complications, such as anemia or osteoporosis.
● Weight Loss: Unintended weight loss is a common symptom, particularly in diseases like celiac disease or Crohn’s disease, where malabsorption of nutrients leads to reduced caloric intake and absorption, despite maintaining or even increasing food intake.
The Connection Between Gastrointestinal Symptoms and Mental Health
Experiencing gastrointestinal flare-ups can be extremely distressing, especially when frequent trips to the bathroom or painful symptoms occur in social settings. These situations are not only stressful and feel embarrassing but can also be traumatic. Additionally, the anticipation of future flare-ups can heighten anxiety, while past digestive episodes may have been traumatic and can leave lasting emotional pain. Symptoms such as flashbacks, uncontrollable ruminating thoughts, nightmares, and intense emotional or physical reactions are common. This anxiety and trauma can significantly lower mood and make it challenging to enjoy activities that were once pleasurable.
The relationship between gastrointestinal symptoms and mental health is often bidirectional, as ongoing gastrointestinal (GI) issues can exacerbate mental health conditions like anxiety and depression, and these mental health issues can, in turn, worsen GI symptoms.
Anxiety and Stress: Experiencing frequent GI flare-ups can be highly distressing, particularly in social settings where symptoms such as diarrhea, cramping, and bloating might cause feelings of shame and social anxiety. This constant worry about potential symptoms can lead to heightened anxiety and even trauma-like symptoms. A study highlights how gut disorders like irritable bowel syndrome (IBS) are strongly associated with anxiety and stress, largely due to the unpredictability of symptoms and their impact on daily life.
Trauma and Emotional Reactions: Gastrointestinal disorders, particularly those involving chronic and severe symptoms like IBS, have a strong bidirectional relationship with mental health. Studies have shown that individuals experiencing frequent gastrointestinal flare-ups are at a higher risk for anxiety and depression due to the distress caused by unpredictable symptoms such as cramping, bloating, and diarrhea. This ongoing psychological burden can further worsen gastrointestinal symptoms, creating a vicious cycle. Research confirms that gastrointestinal disturbances not only contribute to heightened anxiety and depression but that these mental health issues, in turn, exacerbate gastrointestinal symptoms, reinforcing this cycle of physical and mental health interplay.
Depression: Depression is often seen in individuals suffering from chronic GI diseases. Malabsorption of nutrients, pain, and constant fatigue due to digestive issues can lead to depressive symptoms. A study analyzing the associations between gastrointestinal pain and mental disorders confirmed that chronic GI symptoms can lead to or exacerbate depression, primarily due to the continuous physical discomfort and social isolation these conditions may cause.
Microbiota-Gut-Brain Axis: The gut microbiome plays a crucial role in this connection. The gut-brain axis explains how gut health directly impacts mental health through neural, hormonal, and immune signaling pathways. Dysbiosis (imbalances in gut bacteria) is associated with both gastrointestinal disorders and mental health issues like anxiety and depression. Researchers are increasingly focusing on how interventions aimed at balancing gut microbiota might help alleviate both GI and mental health symptoms.
Anticipation of Symptoms: The unpredictable nature of flare-ups can lead to constant vigilance and fear of having an episode in public, reinforcing social withdrawal and further exacerbating anxiety. This anticipation and fear create a cycle that can be hard to break, where psychological stress exacerbates GI symptoms, and in turn, GI symptoms worsen mental health.
Behavioral Changes and Avoidance
The distress caused by gastrointestinal symptoms can give rise to behavioral changes. Individuals may start avoiding places and people due to fear of potential episodes or embarrassment from past incidents. While avoidance provides temporary relief, it reinforces anxious behavior by creating a false sense of safety, perpetuating a cycle that worsens anxiety.
Fear-Avoidance Model: Individuals suffering from gastrointestinal disorders often experience anxiety and fear around the unpredictability of symptoms, such as abdominal pain or diarrhea. As a result, they may begin to avoid situations, places, or even people to prevent possible feelings of embarrassment. This avoidance behavior provides temporary relief but reinforces anxiety, as it creates a false sense of safety and perpetuates a cycle of stress and avoidance. Studies have confirmed the ineffective nature of the fear-avoidance model in disorders like irritable bowel syndrome (IBS) and other functional gastrointestinal disorders (FGIDs). For example, altering avoidance behaviors can significantly improve both psychological well-being and gastrointestinal symptoms.
Impact on Social and Occupational Life: Avoidance behaviors linked to gastrointestinal symptoms, especially in conditions like IBS, can severely limit social and occupational functioning. Individuals often withdraw from social activities, leading to feelings of isolation, which can further exacerbate mental health problems like anxiety and depression. Social isolation reduces one’s quality of life, increases mental health symptoms and distress.
Reinforcement of Anxiety: While avoidance may temporarily prevent the stress of experiencing a flare-up in public or social situations, it ultimately reinforces the anxiety tied to gastrointestinal symptoms. By avoiding, one never learns how to manage the anxiety or symptoms in different settings, and the anxiety is forever in control.
Physical Health Impacts
The anxiety and trauma symptoms associated with digestive health issues not only affect mental health but also manifest physically. Individuals may experience sleep disturbances, muscular aches or pain, and further exacerbated digestive difficulties. The physical symptoms that arise due to chronic stress and anxiety can exacerbate existing digestive problems, creating a cyclical relationship between the mind and the gut. Here's a detailed breakdown of how these mental health challenges affect physical well-being:
Sleep Disturbances: Chronic anxiety can cause persistent disruptions in sleep patterns. In conditions like irritable bowel
syndrome (IBS), the interplay between anxiety and GI discomfort exacerbates sleep disturbances. Individuals experiencing chronic digestive issues often struggle with insomnia or poor-quality sleep. In turn, poor sleep worsens both gastrointestinal symptoms and mental health conditions. Research shows that gastrointestinal disorders are associated with a high prevalence of sleep disturbances, especially when comorbid with anxiety.
Muscular Aches or Pain: Chronic stress and anxiety often cause somatic symptoms, such as muscular tension and generalized aches. This is commonly reported by patients with functional gastrointestinal disorders (FGIDs). A study analyzing patients with IBS revealed that emotional distress led to increased muscle tension and pain. This muscular discomfort, in turn, perpetuates both physical and psychological symptoms, creating a negative feedback loop.
Exacerbation of Digestive Symptoms: Anxiety-related responses, such as the release of cortisol, significantly impact digestive health by increasing gut inflammation, altering gut motility, and contributing to gut dysbiosis (an imbalance in the gut microbiome). This often worsens symptoms such as bloating, diarrhea, and abdominal pain. Stress-related exacerbation of digestive symptoms is a well-established phenomenon in both IBS and IBD.
Physical Illness Risk and Comorbidities: Chronic anxiety linked to gastrointestinal disorders often correlates with an increased risk of developing other physical health conditions, such as metabolic disorders or cardiovascular diseases. This relationship is mediated by the prolonged release of stress hormones like cortisol, which have detrimental effects on the body's immune and inflammatory responses. Studies have demonstrated a clear association between anxiety, GI disorders, and increased risks of other physical illnesses.
Body Hypervigilance: Body hypervigilance refers to an increased awareness and attentiveness to bodily sensations. Individuals who experience body hypervigilance tend to constantly monitor their physical state, often becoming overly preoccupied with minor or normal bodily sensations. This leads to heightened sensitivity where individuals become unusually sensitive to physical sensations, such as muscle twitches, heartbeats, or digestive noises. This leads to excessive monitoring where there is a frequent and intense focus on bodily functions, leading to repetitive checking or seeking reassurance. The result of this is often interpreting normal or minor body sensations as signs of a flare up. When individuals are constantly looking for a problem, they will find one.
Strategies for Coping with Traumatic Digestive Episodes
Experiencing a distressing digestive flare-up can provoke emotional pain that makes normal functioning challenging. Here are strategies to cope with these traumatic experiences:
● Accept Your Feelings: Identify and acknowledge your emotions, whether they are shame, embarrassment, anger, or something else. Allow yourself to experience these feelings without judgment. Validate yourself and your difficulties.
● Manage Stress: Traumatic events can elevate stress levels. Utilize relaxation techniques such as deep breathing, meditation, or yoga to help alleviate stress. Engage in activities that bring your joy.
● Reach Out for Support: Talk to a trusted friend, family member, or mental health professional about your experience and emotions. Sharing your feelings can provide relief and perspective.
● Create a Plan: Taking action can help reduce feelings of helplessness. Start by creating a plan for how you can be prepared in case another flare up happens. This could mean meeting with a friend you feel most comfortable with, bringing a change of clothes out, wearing loose clothing, bringing your medication out with you, etc. These adjustments aren’t perfect solutions, but they are better than avoidance and social isolation.
Therapeutic Approaches for Gut Health-Related Mental Health Issues
Clinical psychologists, social workers, and psychotherapists can provide relief from the anxiety and trauma associated with gastrointestinal autoimmune diseases. Effective therapeutic techniques include:
● Cognitive Behavioral Therapy (CBT): This therapy helps individuals understand the connection between their thoughts, feelings, and behaviours. It enables them to identify and reframe ineffective thought patterns related to their digestive health and avoidant behaviors.
● Eye Movement Desensitization and Reprocessing (EMDR): EMDR is used to reprocess traumatic memories associated with digestive flare-ups, providing both mental and physical relief.
● Mindfulness-Based Techniques: These techniques enhance one's ability to activate the parasympathetic nervous system, which helps ease anxiety related to digestive symptoms and promotes digestive system function.
Gastrointestinal autoimmune diseases impact both physical and mental health. The anxiety and trauma from flare-ups can be debilitating, however, help is available. Therapeutic approaches like CBT, EMDR, and mindfulness can offer relief from the mental health implications of digestive illnesses. By addressing both gut health and mental well-being, individuals can reclaim their quality of life and break the cycle of distress.
Meet the Author
Dr. Amber Cohen, Psy.D., C.Psych., is a Clinical Psychologist and the Owner and Director of The Cohen Clinic. She earned her Honours BA in Psychology from The University of Western Ontario and both her Master’s and Doctorate in Clinical Psychology from The Chicago School of Professional Psychology. Dr. Cohen has clinical training from the Faulk Center for Counseling and Keller Simon Healthcare and Associates. She specializes in Cognitive Behavioral Therapy, integrates Mindfulness and evidence-based methods, and is trained in EMDR. Her blog, "From Gut Health to Mental Health: Understanding Gastrointestinal Autoimmune Diseases," explores the link between gut health and mental well-being.
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