Published online Jun 14, 2014. doi: 10.3748/wjg.v20.i22.6744
Revised: December 19, 2013
Accepted: March 5, 2014
Published online: June 14, 2014
Irritable bowel syndrome (IBS) is considered a biopsychosocial disorder, whose onset and precipitation are a consequence of interaction among multiple factors which include motility disturbances, abnormalities of gastrointestinal sensation, gut inflammation and infection, altered processing of afferent sensory information, psychological distress, and affective disturbances. Several models have been proposed in order to describe and explain IBS, each of them focusing on specific aspects or mechanisms of the disorder. This review attempts to present and discuss different determinants of IBS and its symptoms, from a cognitive behavioral therapy framework, distinguishing between the developmental predispositions and precipitants of the disorder, and its perpetuating cognitive, behavioral, affective and physiological factors. The main focus in understanding IBS will be placed on the numerous psychosocial factors, such as personality traits, early experiences, affective disturbances, altered attention and cognitions, avoidance behavior, stress, coping and social support. In conclusion, a symptom perpetuation model is proposed.
Core tip: Irritable bowel syndrome is a complex, biopsychosocial disorder usually developing under stress, which builds upon hypersensitization, underlined by physiological specificities and heightened neuroticism. Symptom onset is followed by inappropriate cognitive interpretations that can be accompanied by affective disturbances. We consider increased attention to visceral sensation and different manifestations of anxiety to be key components that may lead to symptom exacerbation and perpetuation. This applies to patients who express higher trait neuroticism and are more prone to interpret even mild somatic changes as serious symptoms. An individualized approach is necessary for each patient to estimate current physical and psychological status.