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World J Gastroenterol. Jun 14, 2014; 20(22): 6744-6758
Published online Jun 14, 2014. doi: 10.3748/wjg.v20.i22.6744
Cognitive behavioral approach to understanding irritable bowel syndrome
Goran Hauser, Sanda Pletikosic, Mladenka Tkalcic
Goran Hauser, Department of Internal Medicine, Division of Gastroenterology, Clinical Hospital Centre Rijeka, 51000 Rijeka, Croatia
Sanda Pletikosic, Mladenka Tkalcic, Department of Psychology, Faculty of Humanities and Social Sciences, University of Rijeka, 51000 Rijeka, Croatia
Author contributions: Hauser G contributed ideas about the concept and writing of the paper; Pletikosic S contributed to the literature search, and writing and final revision of the paper; Tkalcic M contributed with planning the concept of the paper, and writing and final revision of the paper.
Supported by Ministry of Science, Education and Sport, Republic of Croatia, No. 009-0092660-2655
Correspondence to: Dr. Goran Hauser, Department of Internal Medicine, Division of Gastroenterology, Clinical Hospital Centre Rijeka, Krešimirova 42, 51000 Rijeka, Croatia.
Telephone: +385-51-658122 Fax: +385-51-658122
Received: October 28, 2013
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.

Keywords: Anxiety, Attention, Irritable bowel syndrome, Neuroticism, Stress

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.