Reflections & Insight

IBD – Biological or Emotional?

I have been asked many times, “Could I have caused my Inflammatory Bowel Disease because I am such an emotional person?” The answer is a definitive NO. Many years ago it was believed that IBD was part of a group of medical disorders that were characteristic of certain personality traits and specific biological markers. However, current research maintains the notion that the etiology of IBD is biological and not emotional. CCFA has addressed this issue of the role of emotional factors in the course of IBD. They state that:

Body and mind are inseparable and are interrelated in numerous and complex ways, something now recognized in medicine. In many centers, mind-body institutes are flourishing. It has been observed that at times of physical or emotional stress, patients may experience flare-ups of symptoms, such as increasing abdominal pain or diarrhea. This relates to changes in the physiologic functioning of the gastrointestinal tract, and decreased resistance to inflammation, rather than to increased inflammation. These effects, however, should be carefully separated from the primary cause of IBD, which is not emotionally based.

Clearly, we can say with certainty, that emotional factors DO NOT cause IBD. So now, let’s reverse the question. When a person is diagnosed with IBD or having a flare-up, what are the common emotional reactions? Much of this answer depends on the individuals’ coping style and resilience. For some, they MAY be able to coast through the disease as a minor inconvenience or disturbance in their daily functioning. However, for others, IBD poses a threat to their quality of life, social functioning, and even self-concept. It’s not uncommon for individuals to initially experience denial of the disease, anxiety, depression, or increased needs of dependency.

My dear colleague, the late Audrey Kron, MA, has outlined several emotional reactions that individuals have in response to their IBD. During times of flare-ups, a person can react with feelings of shame and embarrassment. They may be embarrassed by changes in appearance caused my some medications. Or possibly having “an accident” could cause significant embarrassment. Regardless of the cause of the embarrassment, an individual can feel “flawed” or different from others. These feelings can lead to isolation and depression. Others may react with fear and worrying excessively about how their chronic illness will affect their work, school, or functioning in general. This excessive worry can lead to various anxiety disorders from Generalized Anxiety to Panic Attacks and everything in between. Another feeling often triggered during times of flare-ups is anger. “Why me?” This powerful emotion usually gets displaced onto innocent family members. This process may create guilt in the person not feeling well. They may somehow begin to feel guilty that they’ve caused this disease and are hurting everyone in their lives. These are just a few examples of how having IBD can cause a multitude of emotional reactions. Not the other way around.

So then you may ask, “Ok, so I get myself all worked up and upset during episodes of flare-ups. What can I do to help myself get a grip and feel better? The answer, of course, is easier said than done, but very do-able. The answer is ACCEPTANCE. First of all, do not be hard on yourself. When first diagnosed, after you’ve worked through denial, by being able to grieve the loss of what was, you will be able to develop a new identity that incorporates some changes in your life. Also, educate yourself as much as you can, no matter how long you’ve lived with IBD. Ask your health-care team lots of questions. Make sure you fully understand your disease and its typical course. Information is power. Feel like a partner with your doctors. After all, you’re the one who feels your body from the inside out. Finally, keep a positive attitude. Someone once said to me how lucky she felt because of all of the wonderful people that came into her life after her IBD diagnose. She really taught me a lesson about gratitude. When you can take a step back and recognize all of the positives in your life, you’ll be able to manage the occasional flare-ups with much more ease and acceptance.

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