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The Relationship between PTSD and Irritable Bowel Syndrome

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Updated December 15, 2011

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Irritable bowel syndrome (IBS) is a digestive disorder that is more common than you may think. It is estimated that anywhere between 12 and 20% of the population has IBS, and it has been found to be more common among women than men.

IBS is associated with symptoms of chronic abdominal pain and major disturbance of bowel functioning. For example, IBS can involve episodes of urgent diarrhea, chronic constipation, or an alternating pattern of both. In IBS, there is some malfunction in how the intestines work, but this malfunction is not easily detected or well-understood.

The causes of IBS are not completely understood; however, there is some evidence that IBS may be connected with certain psychiatric disorders. For example, it has been found that people with IBS are more likely to have mood and anxiety disorders than people without IBS, and it appears that the psychiatric disorders occur first, followed by the IBS. This suggests that there is something about having certain psychiatric disorders that may increase risk for IBS.

One group of disorders that have been found to most likely to occur before IBS is anxiety disorders. One anxiety disorder that is gaining some attention with regard to IBS is posttraumatic stress disorder (PTSD). This is not entirely surprising given that research has found a strong link between stress and IBS.

PTSD and IBS

Few people have explored the connection between PTSD and IBS. However, it wouldn't be surprising to find higher rates of PTSD among people with IBS, as people suffering from IBS seem to have higher rates of exposure to traumatic events. For example, one study of 64 IBS patients found that 86% reported the experience of a past traumatic event (with the unexpected death of a relative or close friend being the most common event reported).

As one might expect, people with IBS have generally been found to have higher rates of PTSD than people without IBS. For example, one group of researchers from the Medical University of South Carolina found that a little over one-third of the 50 IBS patients involved in their study had a diagnosis of PTSD. Another study of 337 women veterans (113 with IBS and 224 without) by researchers at the Baylor College of Medicine in Houston, Texas, found that 22% of the women with IBS had PTSD, whereas only 11% of the women without IBS had PTSD.

How is Traumatic Exposure and PTSD Connected to IBS?

It is not entirely clear why the experience of a traumatic event or PTSD would lead to the development of PTSD. However, it is likely that the chronic stress response that can be associated with the experience of a traumatic event or PTSD negatively effects the gastrointestinal system.

In PTSD, the body's fight or flight response is frequently activated. One substance in the brain that is part of this response is corticotropin-releasing-factor (CRF). Among other things, CRF interacts within the colon to increase mucus and water secretion, as well as impacts motility. Consequently, high levels of CRF may contribute to the gastrointestinal symptoms observed among people with IBS.

Getting Treatment for PTSD and IBS

If you have PTSD and IBS, it is important to seek out some care. The stress associated with PTSD can worsen your symptoms of IBS, and likewise, the symptoms of IBS can increase your stress, causing your PTSD to worsen. Fortunately, there are a number of options.

One case study demonstrated that treating your PTSD can translate into an improvement in IBS. One of the most effective treatments for PTSD is exposure therapy; however, there are other options available as well. If you are looking for treatment providers who provide PTSD treatments, there are a number of websites that will help connect with you providers in your area.

In addition, there are a number of treatment options for IBS. You can learn more about IBS and its treatment from the About.com website for IBS.

Sources:

Cohen, H., Jotkowitz, A., Buskila, D., Pelles-Avraham, S., Kaplan, Z., Neumann, L., & Sperber, A.D. (2006). Posttraumatic stress disorder and other comorbidities in a sample population of patients with irritable bowel syndrome. European Journal of Internal Medicine, 17, 567-571.

Irwin, C., Falsetti, S.A., Lydiard, R.B., Ballenger, J.C., Brock, C.D., & Brener, W. (1996). Comorbidity of posttraumatic stress disorder and irritable bowel syndrome. Journal of Clinical Psychiatry, 57, 576-578.

Lydiard, R.B., & Falsetti, S.A. (1999). Experience with anxiety and depression treatment studies: Implications for designing irritable bowel syndrome clinical trials. American Journal of Medicine, 107, 65S-73S.

Sykes, M.A., Blanchard, E.B., Lackner, J., Keefer, L., & Krasner, S. (2003). Psychopathology in irritable bowel syndrome: Support for a psychophysiological model. Journal of Behavioral Medicine, 26, 361-372.

Weaver, T.L., Nishith, P., & Resick, P.A. (1998). Prolonged Exposure Therapy and irritable bowel syndrome: A case study examining the impact of a trauma-focused treatment on a physical condition. Cognitive Behavioral Practice, 5, 103-122.

White, D.L., Savas, L.S., Daci, K., Elserag, R., Graham, D.P., Fitzgerald, S.J., Smith, S.L, Tan, G., & El-Serag, H.B (2010). Trauma history and risk of the irritable bowel syndrome in women veterans. Alimentary Pharmacology and Therapeutics, 32, 551-561.

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