Lecture – Functional Gastrointestinal Disorders and Psychiatry

Presented by Holly S. Peek, MD, MPH, McLean Hospital – McLean Forum lecture

Functional gastrointestinal disorders (FGIDs), such as irritable bowel syndrome, functional nausea, and chronic constipation, are disorders of the gut-brain interaction. Symptoms of FGIDs include problems with the movement of food and waste through the GI tract and heightened pain in the internal organs. FGIDs are also marked by changes in the gut’s immune system and bacteria, and in how the brain sends and receives messages from the gut.

FGIDs are commonly diagnosed with psychiatric illnesses, such as anxiety, depression, suicidality, and trauma. For example, chronic life stress is the main predictor of irritable bowel syndrome symptom severity. In many cases, patients with FGIDs are referred to mental health clinics.

In this lecture, Peek explains that these disorders have been misunderstood and stigmatized because of the difficulty in pinpointing a source of organic disease. Peek is the assistant medical director at McLean’s Klarman Eating Disorders Center.

Watch now to learn more about:

• Ways to identify and diagnose FGIDs
• The biopsychosocial model of FGIDs, including the gut-brain axis, and how this model can help explain the development of these conditions
• Common co-occurring psychiatric disorders
• How medications and psychotherapeutic treatments can treat FGIDs while also addressing coexisting mental health diagnoses

For many years, problems with the “thinking” brain and the “machine-like” body were considered separate. However, research beginning in the 1800s and continuing through the 20th century led to a better understanding of gut-brain interactions and how psychological conditions can impact the GI system.

Understanding this gut-brain axis is important, Peek says, because FGIDs are common in children and adults. These conditions can lead to great personal distress, low quality of life, and high medical costs.

Peek explores the relationship between the gut and the brain to explain how FGIDs can be diagnosed and treated. She explains how FGIDs can be seen through a biopsychosocial lens. This view considers the environmental and genetic factors that influence each patient.

The gut-brain axis model can inform psychiatric treatment approaches. Peek reports that medications and psychotherapies can help provide relief from both gastrointestinal and mental health symptoms. For example, CBT and gut-directed hypnotherapy have an evidence base for the treatment of FGIDs.