Identification with illness in patients with Irritable Bowel Syndrome and its relationship with somatic symptoms

Abstract

Background Irritable Bowel Syndrome (IBS) is a functional illness with symptoms of abdominal pain and bowel dysfunction. Little is known about the implicit psychological factors that contribute to symptom severity. To address this issue, models from cognitive psychology were deployed to predict that IBS patients will identify with their symptoms due to schema enmeshment. It was hypothesised that level of de-identification with health would correlate with symptom severity, illness duration, additional symptoms and somatosensory amplification. Methods This study had a cross sectional design with 42 IBS patients and 41 matched healthy participants. ‘Identification with illness’ was measured with the Implicit Association Task (IAT), a reaction-time task that measures associations implicitly, and thus avoids response biases. Participants completed questionnaires on illness duration, illness severity (GSRS-IBS), depression, anxiety and stress (DASS-21), additional symptoms (ASC), somatosensory amplification (SSAS) and alexithymia (TAS-20). Findings Patients with IBS implicitly de-identified with health compared to control participants F(1, 81) = 11.83, p < .001, d = .75), and the strength of de-identification was positively correlated with additional non-specific somatic symptoms (r(40) = .36, p < .05). Exploratory analysis revealed significant positive correlations between difficulty in identifying feelings (an aspect of alexithymia) and the relevance of illness in IBS patients (r(40)=.43) and healthy participants (r(39)=.37). Discussion Health de-identification is considered maladaptive because it could lead to an unnecessary increase in focus on symptoms. The illness/health IAT could be used to identify treatment responders and to investigate the mechanisms of change in psychological treatments for IBS.