Thursday, 1 March 2007

When symptoms persist

Irritable bowel syndrome is a prevalent condition. Some estimates put its incidence in the UK as high as 13 per cent for women and 5 per cent for men. Around 1 in 10 cases occur after a gut infection.

Now, the BBC reports the following research:
Perfectionists are more prone to developing irritable bowel syndrome (IBS) after an infection, a study has suggested. University of Southampton researchers asked 620 people with gastroenteritis about stress and their illness. Those who pushed themselves or were particularly anxious about symptoms were more likely to develop IBS. Experts said the study, published in Gut, may explain why only some people develop IBS after a gut infection.
The conclusions from the paper are as follows:
Results suggest that patients with high stress and anxiety levels are more prone to develop IBS after a bout of gastroenteritis. Additional risk factors include a tendency to interpret illness in a pessimistic fashion and to respond to symptoms in an all-or-nothing manner
Something I find curious about this report is that when the BBC invites Professor Robin Spiller, an IBS expert from University Hospitals Nottingham and the editor of Gut, to comment, he says
"There is probably a complicated mechanism at work here." He said there were two potential explanations. "It might be that stress and anxiety affects the immune system. But it could also be that if you don't rest, it might do you more harm."
But it's not as though this is the first piece of research on the subject. My home town of Ilkley in West Yorkshire has a second author of a book on psychosomatic medicine. I met Nick Read, a consultant gasteroenterologist and a psychoanalytic psychotherapist, as we ran a session together at the Ilkley Literature Festival. In his book, Sick and Tired: Healing the illnesses doctors cannot cure (Phoenix 2005, page 121), Nick reports on research carried out by a colleague, Dr. Kok-Ann Gwee, which studied over 100 people admitted to hospital with acute gasteroenteritis.
Those in whom the symptoms persisted had suffered more anxiety or depression at the time of the acute illness and had experienced more traumatic life events during the six months prior to the gasteroenteritis.
Further studies showed this to be the case for other kinds of infection.
Emotional upset at the time of the acute illness predicted the persistence of the original symptoms. Or to put it a different way, it appeared as if the symptoms of the acute infection had been 'recruited' to express an unresolved emotional problem. (page 122)
So this would seem to rule out the 'lack of rest' theory.

I should add that Nick's book can be recommended for other reasons. Besides reporting on such large sample research, he also includes many vignettes of his patients, weaving their illnesses with their life stories.


sigfpe said...

I'm a long time sufferer from IBS. When listened to the "Start the Week" podcast, it made me a little unhappier about my condition. The problem is, every time I talk to a doctor about this issue I get the same old story: "it's exacerbated by stress so you need to reduce the stress in your life". And now I'm even more likely to hear this cop out.

Firstly, I rarely suffer from stress. Secondly, I've had this body for 40 years now and I'm intimately aware of the effect stress has on me. In fact, I acknowledge that stress affects my stomach, but with a completely different set of symptoms to IBS.

So my experience seems to be the opposite of the message you are communicating. In my experience doctors will reach for psychosomatic causes too often as an easy way out. Doctors can wash their hands of me by telling me I have a stress related problem. (They even tell me entertaining anecdotes about weddings, funerals etc.)

On the other hand, I have a great respect for your work David, so I will almost certainly try to read this book at some point.

david said...

"So my experience seems to be the opposite of the message you are communicating. In my experience doctors will reach for psychosomatic causes too often as an easy way out. Doctors can wash their hands of me by telling me I have a stress related problem."

I'll write a full post on 'stress' soon. But for the moment I'd like to note that if you look in the index of our book, against 'stress' you will see it refers you to pages 47-68. Glancing down four lines, next to 'critique of' you will also be referred to pages 47-68.

We have devoted over 20 pages to criticising this construction. Why? I'll explain briefly here, and then suggest you're right to see your doctors as fobbing you off.

1) It has a very widespread use, and yet its theoretical basis is very limited. Its model involves an organism threatened from the outside by objectively bad events.

The key experiments to go with the construct are ones where animals are put in awful situations. E.g., pregnant rats put in water without the chance to rest, given unpredictable electric shocks, etc. And sure enough this has serious effects on their organs, and has a subsequent long-lasting, damaging effect on their pups.

2) It's use by a doctor tends to close off the opportunity to deal with the specificity of their patient. It points you at best to try to fit yourself to the generic model of something being impacted on by 'objectively' bad events (divorce, death, job threats, etc.). This tends to point away from the particular meanings events have for you, and blocks out the notion that unconscious thoughts may play a role.

In sum, your doctors have not offered you much of a chance to explore the psychological dimension of your illness. Who knows? Perhaps there is nothing to find in your case. What I do know, however, is that for some people changes to their IBS condition have occurred through psychotherapeutic exploration. And couching their mental state in terms of stress is generally inappropriate.

One thing you might try if you're at all interested in the possible psychological dimension to your illness is to keep a journal, registering your thoughts about the day's events and associated memories, while also recording levels of symptoms. You may be able to perceive some patterns.

sigfpe said...

Thanks for an interesting response.

david said...

Gwee's articles on the persistence of sympoms appeared in Lancet vol. 347, pp. 150-3, and in Gut vol. 44, pp. 400-6.