Irritable bowel syndrome (IBS) is the leading cause of gastroenterologist consultations worldwide and is among the top 10 reasons for visiting a GP. Furthermore, it is the most common functional gastrointestinal disorder (FGID). It is estimated that 4 to 20 percent of the world population (depending on the study cited) suffers this disease, including 16 of every 100 Mexicans.
IBS is classified among the FGIDs because it is not caused by structural (tumors or masses) or biochemical abnormalities (at least it has not been found any with diagnostic methods available today). It is manifested by the presence of pain or discomfort in the abdomen, particularly by abdominal distension, associated with changes in bowel movements such as constipation, diarrhea or a combination of both.
Initially, IBS was thought to be a psychosomatic condition resulting from psychological disorders such as anxiety, depression and stress. Then it was attributed to intestinal motility (bowel movements) difficulties, visceral sensitivity problems (how it is transmitted or perceived pain in the intestine), and later to an alteration of the communication between the brain and intestine that also would alter intestinal motility and visceral sensitivity.
Subsequently, it was suggested that its origin was related to an inflammatory process that could not be diagnosed with histology techniques implemented during routine biopsies. Other studies reported that it is a result of inadequate conditions of the intestinal tract’s microbiota. However, the most accepted theory now a day is that IBS is more likely to be a multifactorial disease, and each and every one of previously mentioned causes are involved.
This characteristic makes difficult to treat the condition. Since each patient has a predominant factor, the treatment most be individualized: prescribed according to the predominant symptom in each patient.
A cross-cultural study, coordinated by Charles and Mary-Joan Gerson, of Division of Gastroenterology at Mount Sinai School of Medicine in New York, focused in understanding the relationship between symptoms caused by IBS in patients and attachment style in relationships, catastrophizing and negative pain beliefs.
This is the third cross-cultural study of the condition performed by the group of scientists, which included men and women of Mexico, United States, Italy, Romania, China, Iran and India; with an average age of 39 years old; and from high socioeconomic and educational level.
From each location, 50 patients and 20 people who did not have this digestive functional disorder (control subjects) were included. All patients required medical attention because their condition significantly impacts their quality of life and daily activities.
Attachment style, catastrophizing and negative pain beliefs linked to IBS
Attachment theory is a psychological model that attempts to describe the dynamics of long-term interpersonal relationships between humans. Attachment has its origins in childhood when the child learns to relate to their primary caregiver and, therefore, to develop socially and emotionally. During adulthood, four main attachment styles have been identified: secure, anxious-preoccupied, dismissive-avoidant and fearful-avoidant.
Securely attached people are able to identify someone that can help them if they need it. The anxious-preoccupied type feels separation anxiety and does not feel reassured when the other person returns. Dismissive-avoidant type tends to maintain some emotional distance from others, and fearful-avoidant wants the proximity of someone, but this is compromised by fear.
According with Max Schmulson, one of the experts who collaborated on the research and professor at the School of Medicine (FM) of the National Autonomous University of Mexico (UNAM), it is currently known that an anxious or avoidant attachment can be associated with diseases that impact significantly the quality of life of patients. So far, he said, attachment style has never before been studied in relation to IBS.
On the other hand, for this study, catastrophizing refers to the attitude of a person who feels that cannot adapt to a health problem (in this case IBS) or that it is impossible to improve. And finally, negative pain beliefs are related with believing that it is impossible to control it or is caused by something the patient is doing.
After analyzing the role of these three factors, the experts concluded that anxious and avoidance attachment styles have an indirect negative influence on the severity of the condition.
As for catastrophizing and negative pain beliefs, an analysis was made from which we saw that they are mediators between anxious and avoidant attachments and the severity of the syndrome.
Furthermore, Schmulson explained that they found that attachment, catastrophism and negative pain beliefs vary from one geographic region to another, which means that there are cultural factors that influence in hoe a person relates and at the same time in how expresses the disease.
The study was recently published in the journal Neurogastroenterology & Motility, entitled “A cross-cultural investigation of attachment style, catastrophizing, negative pain beliefs, and symptom severity in irritable bowel syndrome.”
Source: DGCS UNAM
