Written by Christina Gentile, PsyD, as told by Barbara Brody
First things first: stress does Not cause Crohn’s disease. But physical illnesses often overlap with mental illnesses. And Crohn’s is no exception. Research suggests that people with inflammatory bowel disease (such as Crohn’s disease and ulcerative colitis) are two to three times more likely than individuals with anxiety or depression.
Even if you don’t meet the official criteria for an anxiety disorder or major depression, living with Crohn’s disease can leave you feeling stressed, frustrated, upset, or afraid. Navigating a new diagnosis, having debilitating symptoms, and adjusting to changes in treatment can be very challenging.
Whether your mental health issues tend to be mild or more serious, don’t be surprised if they get worse when Crohn’s disease flares up. During a flare-up, you may be concerned about having emergency bloody diarrhea or flatulence. You may worry about whether you will be able to find a bathroom in time. You may be embarrassed by your symptoms. You may develop body image issues, which may prompt you to withdraw from social situations.
Fear of food and its effect on digestive symptoms is another common problem for people with Crohn’s disease. It’s normal to worry about how eating it might make your condition worse. But if you get so scared that you severely restrict your diet, you may be at risk of developing an eating disorder called avoidance/restriction eating disorder (ARFID). This can lead to malnutrition and unhealthy weight loss. It can have a negative effect on your relationships.
Whatever kind of mental health problems you’re facing, don’t ignore them. Help is available, and it can make you feel better both physically and emotionally.
gut connection
One reason Crohn’s disease is so closely linked to anxiety and depression is that your brain and gut are connected through the vagus nerve. Signals run in both directions along this path.
Although Crohn’s disease is an autoimmune disease that causes inflammation in the digestive system, what happens in your brain can definitely affect your digestive health. Research has shown that people with IBD who also suffer from anxiety or depression are more likely to have frequent episodes and tend to have a lower quality of life.
As a clinical health psychologist who specializes in gastroenterology, I try to understand how Crohn’s disease affects my patients’ daily lives. I will develop a treatment plan that uses skill-based training to help them better manage their flare-ups and improve their quality of life. Whenever I meet a patient, I teach them how to reduce and manage stress better. I also help them deal with negative thought patterns that may prevent them from adapting well to Crohn’s disease.
Learning how to manage the stress and anxiety related to their symptoms can reduce the risk of a flare-up. It can also help them deal with symptoms when they occur.
treatment options
Many different mental health treatment options may be helpful for people with Crohn’s disease who have anxiety, depression or difficulty coping with their diagnosis.
The most well-known treatment is cognitive behavioral therapy (CBT). It aims to identify and challenge negative thought patterns and behaviors that can increase stress, worsen mood or worry about gastrointestinal symptoms, or interfere with the management of Crohn’s disease.
Another approach is acceptance and commitment therapy (ACT). This has a slightly different focus. Emphasizes accepting what you cannot change (your Crohn’s disease and the discomfort that may come with it). It involves becoming more aware of your thoughts, emotions, and sensations. It also teaches you skills to improve your quality of life, even in the face of your symptoms.
Many people with Crohn’s disease also benefit from hypnosis directed from the gut. This includes deep relaxation techniques along with soothing imagery and verbal suggestions, aimed at calming the digestive system and managing pain.
Get the right help
If you are suffering emotionally because of Crohn’s disease, your first step should be to speak to a gastroenterologist, who may refer you to a mental health provider. Ideally, you’ll work with someone who has special training in gastropsychology, a clinical health psychology specialization that focuses on digestive diseases. You can also try searching for an expert near you in the Rome Foundation’s gastropsych registry.
If you can’t find this type of professional in your area, find a mental health professional who has experience with chronic health conditions, stress, and anxiety disorders. Your doctor may be able to recommend someone. Or check with your local hospital or health center.
Assuming that your mental health issues are mostly related to Crohn’s disease (and not part of a broader anxiety or depressive disorder), you will likely benefit fairly quickly from a skills-based treatment approach.
When you find a provider, be as direct as possible about what you hope to gain from the experience. Perhaps you want to focus on how your concerns about Crohn’s are preventing you from getting restful sleep. Or maybe you need to learn how to deal with the discomfort and pain without feeling stressed about it. Setting a clear and specific goal will help you get the most out of treatment so you can feel better faster.
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