Psychologic and psychiatric aspects of gastrointestinal disease

The 1990s have been characterized by an increasing understanding of the rol e of psychologic disturbance and social stress and particularly the signifi cance of a history of physical or sexual abuse as concomitants to chronic g astrointestinal disorders. Irritable bowel syndrome, functional abdominal p ain, esophageal motility disturbances, and other functional and motility di sorders of the gastrointestinal tract have been increasingly viewed as biop sychosocial illnesses with behavioral as well as somatic dimensions. The ap plication of the behavioral sciences to the study of gastrointestinal dysfu nction has generated tremendous advances in understanding these complex dis orders. Studies of psychiatric comorbidity have subsequently led to advance ments in treatment using psychopharmacological and psychotherapeutic modali ties. The ability to appreciate the significance of psychosocial variables in chronic gastrointestinal disorders has implications not only for improvi ng the treatment of patients with these common disorders, but also for impr oving the care of patients with a wide variety of chronic medical illnesses .