I’ve been fortunate to have trained both in gastroenterology and psychosomatic or biopsychosocial medicine, and so my focus tends to be on the interaction of the brain and gut. My practice often involves working with the most complex functional GI disorders, where the GI system is “out of sync” with regard to how the intestinal muscles function, how the nerves are working and how the brain is failing to regulate these systems. Therefore, these disorders must be understood from a biopsychosocial approach in order to integrate the role of biological, psychological, and social factors in understanding the illness for clinical care and research.
Patients with functional GI and motility disorders, like Irritable Bowel Syndrome (IBS), who have been to many high-quality practices are referred to us because they continue to have disabling symptoms and poor quality of life. On occasion we come up with new diagnoses and treatments; however, most often we attend to the educational and management aspects of conditions that have already been diagnosed. Yet patients may say, “No one has told me what I have,” which I interpret as a failure in communication. They say, “Nothing has worked for me.” And this is why it is important to understand what was prescribed, for how long, whether it was taken, and how much the patient was given the opportunity to become involved in their own care.
Because functional GI disorders, like Irritable Bowel Syndrome (IBS) are diagnosed by their symptom features (Rome III symptom-based criteria) rather than through laboratory studies, X-ray or endoscopy, the patients often feel that something else is being missed, or that without any of these findings their symptoms are psychosomatic or “in my head.” As a result, they need to be educated that these are real diagnoses. Furthermore because there is no one treatment (treatment is individualized to the patient’s particular symptom profile), they may feel “out of control” and unable to manage their symptoms. A vicious cycle then ensues: without feeling able to understand or control a condition that has great impact on their life, the patient becomes anxious and distressed, and that in turn leads to more symptoms. And so it continues.
At our clinic we work with our patients to get to know the illness, its impact and their psychosocial and coping resources to find the ways to break the vicious cycle. In addition to using state-of-the-art diagnostic and treatment methods when needed, we also help patients regain their sense of control over their illness and their life. We make the effort to provide a clear physiological explanation as to why they are having symptoms, and offer rationale for treatment based on this understanding. A major effort is to focus on helping patients become “empowered” so they can feel in control enough to manage their symptoms. Since these are chronic GI disorders, we explain that while “cure” may not occur, they can still regain their daily function and improve their quality of life. It’s not unusual for a patient with years of disability to come back feeling much better saying: “The symptoms are still there, but they don’t bother me as much.” That’s why a biopsychosocial approach is effective in treating patients with IBS and other functional GI disorders.
It’s important that we understand functional GI disorders not in terms of structural abnormalities diagnosed by a specific test or treated by a magic medication—but as disorders of improper functioning of the gastrointestinal system that are measured and understood in terms of the patient experience of illness. As such the patient very much needs to be a part of the plan of care.
Watch Video: Biopsychosocial Approach to Management of IBS Improving the Physician Patient Relationship
Dr. Douglas A. Drossman, MD