Psychosocial aspects of the functional gastrointestinal disorders

The functional gastrointestinal disorders (FGID) are the most frequent cond itions seen in gastroenterology practice and comprise a major portion of pr imary care. Psychosocial factors are important in these disorders with rega rd to: (1) their effects on gut physiology; (2) their modulation of the sym ptom experience; (3) their influence on illness behavior; (4) their impact on outcome; and (5) the choice of the therapeutic approach. This paper prov ides a review and consensus of the existing literature by gastroenterologis ts, psychiatrists, psychologists, physiologists, and health services invest igators. Evidence is provided to support the biopsychosocial model as a bas is for understanding and treating these disorders, and epidemiological and clinical information on the relations of psychosocial factors to gut physio logy, symptom presentation, health behavior, and outcome is offered. Featur es of motility, personality, abuse history, health concerns, and treatment- seeking differ between patients with FGID and healthy controls, but they ar e not specific to FGID. They occur in other patients with chronic medical c onditions and/or psychiatric disorders. Review of treatment trials indicate s clear support for psychotherapeutic treatments, especially in the long te rm, as well as some evidence for the benefit of antidepressants in FGID, ev en in the absence of improvements in mood.