Psychosocial variables in irritable bowel syndrome: A review and proposal

Irritable bowel syndrome (IBS) is an uncertainly defined gastrointestinal disorder which accounts for a large proportion of all medical referrals from the general population. In the vast majority of cases of IBS, no organic pathology is found and the mortality rate is essentially nil. A number of psychological variables (notably depression and anxiety) and personality characteristics have been hypothesized to be significant in the etiology of the disorder, yet their role remains poorly understood. The lack of an adequate conceptual model may be the primary factor precluding a better understanding of IBS. The argument that IBS may represent a type of "learned-illness behavior" is examined. A multi-dimensional model of IBS, incorporating critical life events, hereditary factors, environmental facilitators, and self-maintenance processes is presented. The role of health psychologists in the evaluation and treatment of the disorder is discussed.