Psychological Features in the Inflammatory Bowel Disease–Irritable Bowel Syndrome Overlap: Developing a Preliminary Understanding of Cognitive and Behavioral Factors

BACKGROUND: Inflammatory bowel disease (IBD) patients in clinical remission may experience ongoing symptoms, such as diarrhea and abdominal pain, attributed to IBD–irritable bowel syndrome (IBS) overlap. This study aims to characterize the psychosocial needs of patients with IBD–IBS overlap, particularly in regard to cognitive and behavioral functioning. METHODS: Adults with an established IBD diagnosis were recruited from a gastroenterology clinic. Participants completed self-report questionnaires about psychological functioning and quality of life. The Rome IV Diagnostic Questionnaire for Adults-IBS Module assessed IBS criteria. The treating gastroenterologist completed a clinician rating of IBD activity to determine clinical disease activity. Biomarkers of inflammation collected in routine care within 90 days of the research encounter were obtained via medical record review to further contextualize IBD activity status. Participants were separated into the following groups: “inactive IBD” (IBD activity rating indicating inactive disease and no IBS criteria met), “active IBD” (IBD activity rating indicating mild, moderate, or severe regardless of IBS criteria), or “IBD–IBS overlap” (IBD activity rating indicating inactive disease and IBS criteria met). RESULTS: One hundred and seventeen participants were recruited. Those with IBD–IBS overlap reported no significant differences in ratings of anxiety, depression, somatization, catastrophic thinking patterns, and behavioral avoidance, to patients with active IBD whereas participants with inactive IBD reported significantly lower ratings on these factors. However, a significant portion of participants with IBD–IBS overlap who were rated as inactive on IBD activity measures had laboratory or endoscopic findings indicating mild inflammation within 90 days of the research encounter. CONCLUSIONS: The study findings provide preliminary evidence that suggests patients with IBD–IBS overlap display similar rates of psychological distress, catastrophic thinking, and avoidance behaviors as those with active IBD. Those with mild ongoing inflammation despite meeting a definition for clinical remission may have similar psychological needs compared to those with moderate-to-severely active IBD. Incorporating a mental health provider with training in psychogastroenterology can help a patient with IBD learn how to effectively with these cognitive and behavioral patterns.