By Christina Gentile, PsyD, as told to Barbara Brody
First things first: Stress does not cause Crohn’s disease. But physical ailments often overlap with mental ones. And Crohn’s is hardly the exception. Research suggests that people with inflammatory bowel disease (such as Crohn’s and ulcerative colitis) are two to three times more likely than members of the general population to struggle 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 might make you feel stressed, frustrated, upset, or scared. Navigating a new diagnosis, having debilitating symptoms, and adjusting to changes in treatment can be very challenging.
Whether your mental health problems tend to be mild or more serious, don’t be surprised if they get worse when your Crohn’s is flaring. During a flare, you might feel anxious about having urgent, bloody diarrhea or flatulence. You may worry about whether you’ll be able to find a bathroom in time. You could feel embarrassed about your symptoms. You may develop body image issues, which might prompt you to withdraw from social situations.
Fear of food and its effect on GI symptoms is another common issue for people with Crohn’s. It’s natural to be concerned about how eating might worsen your condition. But if you get so scared that you drastically restrict your diet, you may be at risk for an eating disorder called avoidant/restrictive food-intake disorder (ARFID). That can lead to malnutrition and unhealthy weight loss. And it can take a toll on your relationships.
Whatever kind of mental health issues you’re facing, don’t ignore them. Help is available, and it can make you feel better physically and emotionally.
The Gut-Brain Connection
One reason Crohn’s disease is so closely connected to anxiety and depression is that your brain and your gut are linked through your vagus nerve. Signals run in both directions along this pathway.
Although Crohn’s is an autoimmune disease that causes inflammation in your GI tract, what’s going on in your mind can certainly affect your digestive health. Research has shown that people with inflammatory bowel disease who also have anxiety or depression are more likely to get frequent flares and tend to have a lower quality of life.
As a clinical health psychologist who specializes in digestive diseases, I try to understand how Crohn’s disease affects my patients' daily lives. I'll come up with a treatment plan that uses skills-based training to help them better manage flare-ups and improve their quality of life. When I meet with a patient, I teach them how to reduce stress and manage it better. I also help them deal with negative thinking patterns that may keep them from coping well with their Crohn’s disease.
Learning how to manage stress and anxiety related to their symptoms can reduce their risk of flares. It can also help them cope with symptoms when they do occur.
Several different mental health treatment options may be helpful for people with Crohn’s who are having anxiety, depression, or trouble coping with their diagnosis.
The best-known treatment is cognitive behavioral therapy (CBT). It aims to identify and challenge negative thought patterns and behaviors that can increase stress, lead to worsening mood or anxiety over GI symptoms, or interfere with managing Crohn’s disease.
Another approach is acceptance and commitment therapy (ACT). This has a slightly different focus. It emphasizes accepting what you can’t change (your Crohn’s disease and the discomfort that might come with it). It involves becoming more mindful of your thoughts, emotions, and gut sensations. It also teaches you skills to improve your quality of life, even in the face of your symptoms.
Many people with Crohn’s also benefit from gut-directed hypnosis. This involves deep relaxation techniques combined with soothing images and verbal suggestions, aimed at calming your digestive system and managing pain.
Getting the Right Help
If you’re struggling emotionally because of Crohn’s disease, your first step should be to talk to your gastroenterologist, who may refer you to a mental health provider. Ideally, you’ll work with someone who has special training in gastropsychology, a discipline within clinical health psychology that focuses on digestive diseases. You can also try searching for an expert near you at the Rome Foundation's gastropsych registry.
If you can’t find this type of specialist in your area, look for a mental health professional who has experience with chronic health conditions, stress, and anxiety disorders. You 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 having Crohn’s (and not part of a broader anxiety or depressive disorder), you’ll probably benefit fairly quickly from a skills-based treatment approach.
When you find a provider, be as direct as possible about what you hope to get out of the experience. Maybe you want to focus on how your anxieties over Crohn’s are keeping you from getting restful sleep. Or maybe you need to learn to cope with discomfort and pain without getting stressed about it. Setting a clear and specific goal will help you make the most of therapy so you can feel better faster.