As anyone who lives with an inflammatory bowel disease (Crohn’s disease, ulcerative colitis, and indeterminate colitis, collectively called IBD) knows: the digestive problems only tell part of the story.
Patients with IBD may feel isolated or lonely. It’s not common to know another person who lives with the disease when diagnosed. Plus, the signs and symptoms can keep people at home, where it’s comfortable and easier to care for oneself, and away from work, school, and socializing.
It’s rather a perfect storm for having problems crop up with mental health.
How IBD Might Affect Mental Health
All the above factors and more can lead to many emotions. They can also contribute to depression and anxiety. (1) Addressing mental health is an important part of caring for IBD. These diseases affect the whole person, so it stands to reason that mental health care be part of a treatment plan.
Most people with IBD should probably be at least offered help from a mental health professional, but it’s not common outside of an IBD center. It may fall on us to do the work to establish care.
Anxiety and Depression in IBD
It’s important to make the point that anxiety and depression don’t cause IBD.
However, all the problems that come along with a diagnosis could lead to symptoms of anxiety and depression. This does make sense when you consider the symptoms, the stigma, the financial cost, and all the uncomfortable procedures and treatments.
What’s even more challenging is that symptoms of anxiety and depression can have a bi-directional affect. Meaning that the issues can go both ways and that mental health can also affect IBD.(2)
In one study, people with and without IBD were compared after being measured a clinical scale called the Hospital Anxiety and Depression Scale (HADS). The people living with IBD had a higher (meaning worse) score on the HADS than the people who did not have any form of IBD. Stress, being hospitalized, abdominal pain, and having current active disease were associated with more symptoms of anxiety and depression.(3)
What to Look for in a Provider
There are psychologists who specialize in digestive disease. They’re called gastropsychologists and they have special training to help folks who live with IBD or other GI disorders. This specialty is growing, but there are probably still not enough of these unicorns around to help everyone with IBD.
If you can’t find a gastropsych, you could look for a mental healthcare provider who specializes in other areas that may relate to IBD or identity, such as:
- Chronic illness
- Chronic pain
- Culturally competent care
- LGBTQ+ issues
- Trauma or medical trauma
It may take time to find “the right one.” If there’s time and availability, some people may want to touch base with a few different therapists to see who might be the best fit. Some therapists will offer a “get to know you” appointment to briefly meet and see if the relationship will work.
Where to Find a Mental Healthcare Provider
Patients may first want to start with their gastroenterologist. They may have a relationship with a therapist already and can make a referral.
Some people may also want to contact their insurance company and get some referrals to healthcare providers that are on their plan. Or, many health insurance companies have an online database that’s searchable without having to talk to anyone. A call to the office of the mental health provider can confirm that the services will be partially or wholly covered.
There are also some online databases available that are open for anyone to search. This includes:
- Association for Behavioral and Cognitive Therapies
- American Board of Professional Psychology
- American Psychological Association Practice Organization
- Psychology Today
- Rome Foundation Gastropsychologist Directory
Mental health services may be available both in-person and online. Taking therapy online or over the phone may be helpful to some people who don’t live near a therapist or are looking for care from a provider that’s not local to them.
Therapy Takes Many Forms
Some people may need brief therapy. Others might need to receive care for longer, or multiple times a week for a while. There are also specialized tools and techniques that go beyond talk therapy, such as cognitive behavioral therapy or gut-directed hypnotherapy. So, there’s a menu of options available to treat the problems that IBD brings into our lives.
What’s important is to get the ball rolling, to start working with a mental healthcare provider, and get a treatment plan and some goals put in place.
- Bannaga AS, Selinger CP. Inflammatory bowel disease and anxiety: links, risks, and challenges faced. Clin Exp Gastroenterol. 2015;8:111–117. doi:10.2147/CEG.S57982.
- Gracie DJ, Guthrie EA, Hamlin PJ, Ford AC. Bi-directionality of brain-gut interactions in patients with inflammatory bowel disease. Gastroenterology. 2018;154:1635-1646.e3. doi:10.1053/j.gastro.2018.01.027.
- Goodhand JR, Wahed M, Mawdsley JE, Farmer AD, Aziz Q, Rampton DS. Mood disorders in inflammatory bowel disease: relation to diagnosis, disease activity, perceived stress, and other factors. Inflamm Bowel Dis. 2012;18:2301–2309. doi:10.1002/ibd.22916.