Skip to main content
SpringerLink
Log in
Book cover

The Massachusetts General Hospital Handbook of Behavioral Medicine pp 139–157Cite as

Gastrointestinal Disorders

  • Chapter
  • First Online:

  • 1210 Accesses

Part of the book series: Current Clinical Psychiatry ((CCPSY))

Abstract

Gastrointestinal (GI) disorders are common in the general population and can cause significant distress and impairment in functioning. In addition to structural and functional factors, there are also behavioral factors that can impact the experience or expression of a GI disorder, as well as a patient’s overall functioning. A behavioral medicine approach to GI problems, whether in a hospital or outpatient setting, can help a patient learn specific skills to better control and cope with the disorder. This chapter describes such a behavioral medicine approach to the GI disorders. First we describe the more common GI disorders. Next we discuss specific psychosocial skills that can be applied. We end with a detailed case illustration.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   59.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   79.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Everhart JE, Ruhl CE. Burden of digestive diseases in the United States part I: overall and upper gastrointestinal diseases. Gastroenterology. 2009;136(2):376–86. http://doi.org/10.1053/j.gastro.2008.12.015.

    Article  PubMed  Google Scholar 

  2. Center for Disease Control and Prevention. FastStats: digestive diseases. 2010. http://www.cdc.gov/nchs/fastats/digestive-diseases.htm.

  3. López San Román A, Bermejo F, Carrera E, Pérez-Abad M, Boixeda D. Adhesión al tratamiento en la enfermedad inflamatoria intestinal. Rev Esp Enferm Dig. 2005;97(4):249–57.

    Article  PubMed  Google Scholar 

  4. Mardini HE, Kip KE, Wilson JW. Crohn’s disease: a two-year prospective study of the association between psychological distress and disease activity. Dig Dis Sci. 2004;49(3):492–7. http://doi.org/10.1023/B:DDAS.0000020509.23162.cc.

    Article  PubMed  Google Scholar 

  5. Cámara RJA, Schoepfer AM, Pittet V, Begré S, von Känel R, The Swiss Inflammatory Bowel Disease Cohort Study (SIBDCS) Group. Mood and nonmood components of perceived stress and exacerbation of Crohn’s disease. Inflamm Bowel Dis. 2011;17(11):2358–65. http://doi.org/10.1002/ibd.21623.

    Article  PubMed  Google Scholar 

  6. Loftus EV, Guérin A, Yu AP, Wu EQ, Yang M, Chao J, Mulani PM. Increased risks of developing anxiety and depression in young patients with Crohn’s disease. Am J Gastroenterol. 2011;106(9):1670–7. http://doi.org/10.1038/ajg.2011.142.

    Article  PubMed  Google Scholar 

  7. Persoons P, Vermeire S, Demyttenaere K, Fischler B, Vandenberghe J, Van Oudenhove L, Pierik M, Hlavaty T, Van Assche G, Norman M, Rutgeerts P. The impact of major depressive disorder on the short- and long-term outcome of Crohn’s disease treatment with infliximab. Alim Pharmacol Therap. 2005;22(2):101–10. http://doi.org/10.1111/j.1365-2036.2005.02535.x.

    Article  CAS  Google Scholar 

  8. Schwarz SP, Blanchard EB, Berreman CF, Scharff L, Taylor AE, Greene BR, Suls JM, Malamood HS. Psychological aspects of irritable bowel syndrome: comparisons with inflammatory bowel disease and nonpatient controls. Behav Res Ther. 1993;31(3):297–304.

    Article  CAS  PubMed  Google Scholar 

  9. Porcelli P, Zaka S, Centonze S, Sisto G. Psychological distress and levels of disease activity in inflammatory bowel disease. Ital J Gastroenterol. 1994;26(3):111–5.

    CAS  PubMed  Google Scholar 

  10. Maunder RG, Lancee WJ, Hunter JJ, Greenberg GR, Steinhart AH. Attachment insecurity moderates the relationship between disease activity and depressive symptoms in ulcerative colitis. Inflamm Bowel Dis. 2005;11(10):919–26. http://doi.org/10.1097/01.mib.0000179468.78876.2d.

    Article  PubMed  Google Scholar 

  11. Maunder RG, Greenberg GR, Hunter JJ, Lancee WJ, Steinhart AH, Silverberg MS. Psychobiological subtypes of ulcerative colitis: pANCA status moderates the relationship between disease activity and psychological distress. Am J Gastroenterol. 2006;101(11):2546–51. http://doi.org/10.1111/j.1572-0241.2006.00798.x.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Larsson K, Sundberg Hjelm M, Karlbom U, Nordin K, Anderberg UM, Lööf L. A group-based patient education programme for high-anxiety patients with Crohn disease or ulcerative colitis. Scand J Gastroenterol. 2003;38(7):763–9. http://doi.org/10.1080/00365520310003309.

    Article  CAS  PubMed  Google Scholar 

  13. Mussell M, Böcker U, Nagel N, Olbrich R, Singer MV. Reducing psychological distress in patients with inflammatory bowel disease by cognitive-behavioural treatment: exploratory study of effectiveness. Scand J Gastroenterol. 2003;38(7):755–62. http://doi.org/10.1080/00365520310003110.

    Article  CAS  PubMed  Google Scholar 

  14. Ali T, Hasan M, Hamadani M, Harly RF. Gastroparesis. South Med J. 2007;100(3):281–6. doi:10.1097/SMJ.0b013e31802f3795.

    Article  PubMed  Google Scholar 

  15. Camilleri M, Parkman HP, Shafi MA, Abell TL, Gerson L. Clinical guideline: management of gastroparesis. Am J Gastroenterol. 2013;108(1):18–37. http://doi.org/10.1038/ajg.2012.373.

    Article  CAS  PubMed  Google Scholar 

  16. Kim KH, Lee MS, Choi T-Y, Kim T-H, Ernst E. Acupuncture for symptomatic gastroparesis. Cochrane Database Syst Rev. 2012. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009676/abstract.

  17. Hasler WL, Parkman HP, Wilson LA, Pasricha PJ, Koch KL, Abell TL, Snape WJ, Farrugia G, Lee L, Tonascia J, Unalp-Arida A, Hamilton F. Psychological dysfunction is associated with symptom severity but not disease etiology or degree of gastric retention in patients with gastroparesis. Am J Gastroenterol. 2010;105(11):2357–67. http://doi.org/10.1038/ajg.2010.253.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Maleki D, Locke III G, Camilleri M, et al. GAstrointestinal tract symptoms among persons with diabetes mellitus in the community. Arch Intern Med. 2000;160(18):2808–16. http://doi.org/10.1001/archinte.160.18.2808.

    Article  CAS  PubMed  Google Scholar 

  19. Talley SJ, Bytzer P, Hammer J, Young L, Jones M, Horowitz M. Psychological distress is linked to gastrointestinal symptoms in diabetes mellitus. Am J Gastroenterol. 2001;96(4):1033–8. http://doi.org/10.1111/j.1572-0241.2001.03605.x.

    Article  CAS  PubMed  Google Scholar 

  20. Abell TL, Bernstein VK, Cutts T, Farrugia G, Forster J, Hasler WL, Mccallum RW, Oldn KW, Parkman HP, Parrish CR, Pasricha PJ, Prather CM, Soffer EE, Twillman R, Vinik AI. Treatment of gastroparesis: a multidisciplinary clinical review. Neurogastroenterol Motil. 2006;18:263–83. doi:10.1111/j.1365-2982.2006.00760.x.

    Article  CAS  PubMed  Google Scholar 

  21. Drossman DA, Talley NJ, Leserman J, Olden KW, Barriero MA. Sexual and physical abuse in gastrointestinal illness. Review and recommendations. Ann Intern Med. 1995;123:782–94.

    Article  CAS  PubMed  Google Scholar 

  22. Wagner EH, Glasgow RE, Davis C, Bonomi AE, Provost L, McCulloch D, Carver P, Sixta C. Quality improvement in chronic illness care: a collaborative approach. Jt Comm J Qual Improv. 2001;27:63–80.

    CAS  PubMed  Google Scholar 

  23. Fass R, Naliboff BD, Fass SS, Peleg N, Wendel C, Malagon IB, Mayer EA. The effect of auditory stress on perception of intraesophageal acid in patients with gastroesophageal reflux disease. Gastroenterology. 2008;134(3):696–705. http://doi.org/10.1053/j.gastro.2007.12.010.

    Article  PubMed  Google Scholar 

  24. Yoshida N. Inflammation and oxidative stress in gastroesophageal reflux disease. J Clin Biochem Nutr. 2007;40(1):13–23. http://doi.org/10.3164/jcbn.40.13.

    Article  CAS  PubMed  Google Scholar 

  25. McDonald-Halie J, Bradley LA, Bailey MA, Schan CA, Richter JE. Relaxation training reduces symptom reports and acid exposure in patients with gastroesophageal reflux disease. Gastroenterology. 1994;107(1):61–9.

    Article  Google Scholar 

  26. Kamolz T, Granderath FA, Bammer T, Pasiut M, Pointner R. Psychological intervention influences the outcome of laparoscopic antireflux surgery in patients with stress-related symptoms of gastroesophageal reflux disease. Scand J Gastroenterol. 2001;36(8):800–5. doi:10.1080/00365520117106.

    Article  CAS  PubMed  Google Scholar 

  27. Talley N, Napthali K. Cyclical vomiting syndrome. In: Lacy B, Crowell M, DiBaise J, editors. Functional and motility disorders of the gastrointestinal tract. New York: Springer; 2015. p. 101–10.

    Google Scholar 

  28. Magagna J. Psychophysiologic treatment of cyclic vomiting. J Pediatr Gastroenterol Nutr. 1995;21 Suppl 1:S31–6.

    Article  PubMed  Google Scholar 

  29. Reinhart JB, Evans SL, McFadden DL. Cyclic vomit in children: seen through the psychiatrist’s eye. Pediatrics. 1977;59(3):371–7.

    CAS  PubMed  Google Scholar 

  30. Tarbell S, Li BU. Psychiatric symptoms in children and adolescents with cyclic vomiting syndrome and their parents. Headache. 2008;48(2):259–66. http://doi.org/10.1111/j.1526-4610.2007.00997.x.

    Article  PubMed  Google Scholar 

  31. Fleisher DR, Gornowicz B, Adams K, Burch R, Feldman EJ. Cyclic vomiting syndrome in 41 adults: the illness, the patients, and problems of management. BMC Med. 2005;3(1):20. http://doi.org/10.1186/1741-7015-3-20.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Slutsker B, Konichezky A, Gothelf D. Breaking the cycle: cognitive behavioral therapy and biofeedback training in a case of cyclic vomiting syndrome. Psychol Health Med. 2010;15(6):625–31. http://doi.org/10.1080/13548506.2010.498893.

    Article  PubMed  Google Scholar 

  33. Graff LA, Walker JR, Bernstein CN. Depression and anxiety in inflammatory bowel disease: a review of comorbidity and management. Inflamm Bowel Dis. 2009;15(7):1105–18. http://doi.org/10.1002/ibd.20873.

    Article  PubMed  Google Scholar 

  34. Walker JR, Ediger JP, Graff LA, Greenfeld JM, Clara I, Lix L, Rawsthorne P, Miller N, Rogala L, McPhail CM, Bernstein CN. The Manitoba IBD cohort study: a population-based study of the prevalence of lifetime and 12-month anxiety and mood disorders. Am J Gastroenterol. 2008;103(8):1989–97. http://doi.org/10.1111/j.1572-0241.2008.01980.x.

    Article  PubMed  Google Scholar 

  35. Fuller-Thomson E, Sulman J. Depression and inflammatory bowel disease: findings from two nationally representative Canadian surveys. Inflamm Bowel Dis. 2006;12(8):697–707. http://doi.org/10.1097/00054725-200608000-00005.

    Article  PubMed  Google Scholar 

  36. Szigethy E, Carpenter J, Baum E, Kenney E, Baptista-Neto L, Beardslee WR, Demaso DR. Case study: longitudinal treatment of adolescents with depression and inflammatory bowel disease. J Am Acad Child Adolesc Psychiatry. 2006;45(4):396–400. http://doi.org/10.1097/01.chi.0000198591.45949.a4.

    Article  PubMed  Google Scholar 

  37. Szigethy E, Kenney E, Carpenter J, Hardy DM, Fairclough D, Bousvaros A, Keljo D, Weisz J, Beardslee WR, Noll R, DeMaso DR. Cognitive-behavioral therapy for adolescents with inflammatory bowel disease and subsyndromal depression. J Am Acad Child Adolesc Psychiatry. 2007;46(10):1290–98. http://doi.org/10.1097/chi.0b013e3180f6341f.

    Article  PubMed  Google Scholar 

  38. Szigethy E, Whitton SW, Levy-Warren A, DeMaso DR, Weisz J, Beardslee WR. Cognitive-behavioral therapy for depression in adolescents with inflammatory bowel disease: a pilot study. J Am Acad Child Adolesc Psychiatry. 2004;43(12):1469–77. http://doi.org/10.1097/01.chi.0000142284.10574.1f.

    Article  PubMed  Google Scholar 

  39. Díaz Sibaja MA, Comeche Moreno MI, Mas Hesse B. Tratamiento cognitivo-conductual protocolizado en grupo de las enfermedades inflamatorias intestinales. Revista Española de Enfermedades Digestivas 2007;99(10). http://doi.org/10.4321/S1130-01082007001000006.

  40. Ost LG, Sterner U. Applied tension. A specific behavioral method for treatment of blood phobia. Behav Res Ther. 1987;25(1):25–9.

    Article  CAS  PubMed  Google Scholar 

  41. Kabat-Zinn J. Mindfulness-based interventions in context: past, present, and future. Clin Psychol Sci Pract. 2003;10(2):144–56. doi:10.1093/clipsy/bpg016.

    Article  Google Scholar 

  42. Lee SJ, Maizels RM. Inflammatory Bowel Disease. Evolution, Medicine, and Public Health. 2014;2014(1):95. doi:10.1093/emph/eou017.

Resources (Websites, Books, etc.)

  • International Foundation for Functional Gastrointestinal Disorders (IFFGD). A nonprofit organization whose mission is to inform, assist, and support people affected by gastrointestinal disorders of function and motility, like gastroparesis. www.aboutGastroparesis.org

  • Digestive Health Alliance (DHA). The grassroots arm of IFFGD where individuals can interact and take action to improve treatments and help find cures for functional GI and motility disorders, like gastroparesis, through coordinated fundraising, advocacy, and awareness efforts. www.dha.org

  • Crystal Zaborowski Saltrelli CHC. Living (well!) with gastroparesis—answers, advice, tips and recipes for a healthier, happier life. This book is a comprehensive and easy to follow guide to navigating life after a gastroparesis diagnosis. Amazon.com

    Google Scholar 

  • Gastroparesis Patient Association for Cures and Treatments (G-PACT). A nonprofit organization dedicated to increasing awareness of gastroparesis and chronic intestinal pseudo-obstruction. www.g-pact.org

  • The Oley Foundation. A nonprofit organization whose mission is to enrich the lives of patients dependent on home intravenous (parenteral) and tube feeding (enteral) through education, outreach, and networking. www.oley.org

  • The National Institutes of Health (NIH), Gastroparesis Clinical Research Consortium (GpCRC). A network of medical centers, sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), established to improve understanding of the cause and natural course of gastroparesis and to advance the diagnosis and treatment of this disorder. www.jhucct.com/gpcrc

Download references

Author information

Authors and Affiliations

  1. Behavioral Medicine Service, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Jonathan A. Lerner Ph.D. & Julianne G. Wilner M.A.

Authors
  1. Jonathan A. Lerner Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Julianne G. Wilner M.A.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jonathan A. Lerner Ph.D. .

Editor information

Editors and Affiliations

  1. Department of Psychiatry Behavioral Medicine Service, Massachusetts General Hospital, Boston, Massachusetts, USA

    Ana-Maria Vranceanu

  2. Dept. of Psychiatric Oncology & Behavior, Massachusetts General Hospital Cancer Ce, Boston, Massachusetts, USA

    Joseph A. Greer

  3. Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA

    Steven A. Safren

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer Science+Business Media New York

About this chapter

Cite this chapter

Lerner, J.A., Wilner, J.G. (2017). Gastrointestinal Disorders. In: Vranceanu, AM., Greer, J., Safren, S. (eds) The Massachusetts General Hospital Handbook of Behavioral Medicine. Current Clinical Psychiatry. Humana Press, Cham. https://doi.org/10.1007/978-3-319-29294-6_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-29294-6_7

  • Published:

  • Publisher Name: Humana Press, Cham

  • Print ISBN: 978-3-319-29292-2

  • Online ISBN: 978-3-319-29294-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation