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Biopsychosocial Aspects of Functional Gastrointestinal Disorders: How Central and Environmental Processes Contribute to the Development and Expression of Functional Gastrointestinal Disorders
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In this paper, we provide a general framework for understanding the functional gastrointestinal disorders (FGID) from a biopsychosocial perspective. More specifically, we provide an overview of the recent research on how the complex interactions of environmental, psychological, and biological factors contribute to the development and maintenance of the FGID. We emphasize that considering and addressing all these factors is a conditio sine qua non for appropriate treatment of these conditions. First, we provide an overview of what is currently known about how each of these factors - the environment, including the influence of those in an individual's family, the individual's own psychological states and traits, and the individual's (neuro)physiological make-up - interact to ultimately result in the generation of FGID symptoms. Second, we provide an overview of commonly used assessment tools which can assist clinicians in obtaining a more comprehensive assessment of these factors in their patients. Finally, the broader perspective outlined earlier is applied to provide an overview of centrally acting treatment strategies, both psychological and pharmacological, which have been shown to be efficacious to treat FGID.
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“chronic stress, psychological symptoms, negative beliefs about symptoms and illness and maladaptive coping mechanisms can increase the frequency and severity of symptoms.29 30”
From British Society of Gastroenterology guidelines on the management of irritable bowel syndrome (2021) · cites this paper as [29]
Experimental — accuracy not yet measuredIn the citing paper
“and early‐life adverse events, such as physical or sexual abuse, are also prevalent [ 379 , 381 ].”
From European Guideline on Chronic Nausea and Vomiting—A UEG and ESNM Consensus for Clinical Management (2025) · cites this paper as [379]
In the citing paper
“A stressful life and emotional events are associated with symptom exacerbation [ 376 , 379 , 380 ]”
From European Guideline on Chronic Nausea and Vomiting—A UEG and ESNM Consensus for Clinical Management (2025) · cites this paper as [379]
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Self-citationCognitive Behavioral Therapy for IBS: How Useful, How Often, and How Does It Work?
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“It may be related to the brain-gut axis [16–20], through which psycho-social factors can influence gut physiology and trigger gastro-intestinal symptoms [21].”
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“Also, the interplay between psychosocial and physiological factors via the interactions between the central nervous system (CNS) and the enteric nervous system (ENS) is thought to influence IBS expression (11).”
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“Colorectal hypersensitivity is an important pathophysiological mechanism in IBS.(1) It has been associated with overall IBS symptom severity, and pain and bloating in particular.”
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Psychotherapeutic Interventions in Irritable Bowel Syndrome
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“If necessary, this should be incorporated better in the treatment of EDs, as it is likely that FGIDs/FGID symptoms arise due to a complex interplay of biological, psychological and social factors (Van Oudenhove et al., 2016).”
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“Similarly, poor GI health may trigger anxiety and depression in the patients [8,9].”
BackgroundBlakey, S. M., Halverson, T. F., Evans, M. K., Patel, T. A., Hair, L. P., Meyer, E. C., DeBeer, B. B., Beckham, J. C., Pugh, M. J., Calhoun, P. S., et al. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2021.07.033 · Cited by 31
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“However, the relationship between mental status and gastrointestinal symptoms is likely bidirectional: whereas mood disorders may lead to hypervigilance and altered interpretation of symptoms, they may also be a consequence of the disease burden.(31) Finally, while not finding any difference in transit times comparing…”
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“There is some evidence that both anxiety and gastrointestinal (GI) symptom severity are associated with brain regions commonly activated in response to fear, suggesting a potential mechanism by which negative emotions may impact GI symptoms (Drossman, 2005; Van Oudenhove et al., 2016).”
Background
Metadata
- Authors
- Van Oudenhove, L., Levy, R. L., Crowell, M. D., Drossman, D. A., Halpert, A. D., Keefer, L., Lackner, J. M., Murphy, T. B., & Naliboff, B. D.
- Affiliations
- University of Washington (US)
- Mayo Clinic (US)
- University of North Carolina at Chapel Hill (US)
- Boston Medical Center (US)
- Mount Sinai Hospital (US)
- State University of New York (US)
- University of California, Los Angeles (US)
- Corresponding author
- Levy, Rona L.
- ORCID
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2016-05
- Volume
- 150
- Issue
- 6
- Pages
- 1355-1367.e2
- ISSN
- 0016-5085 (ISSN-L)
- PMC
- PMC8809487
- OpenAlex
- W2344812785
- Cited by
- 512
- References
- 110
- Citations by year
- 2026: 49 · 2025: 58 · 2024: 54 · 2023: 52 · 2022: 59 · 2021: 63 · 2020: 51 · 2019: 47 · 2018: 35 · 2017: 38 · 2016: 6
- FWCI
- 45.98
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Allergan
- National Institute of Diabetes and Digestive and Kidney Diseases (U01DK077738)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- functional gastrointestinal disorders, biopsychosocial model, environmental factors, psychological factors, family influence, psychological characteristics, neurophysiological factors, psychological assessment instruments, pharmacotherapy, psychological intervention, treatment options
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