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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
Open accessAbstract
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]
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“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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So, W., Bogucka, E. P., Šćepanović, S., Joglekar, S. P., Zhou, K., & Quercia, D. (2020) · IEEE Transactions on Visualization and Computer Graphics · doi:10.1109/tvcg.2020.3030391 · Cited by 16
“ination are all shown to have important effects on chronic conditions such as obesity, coronary heart disease, and skin disease [21, 53], as well as on functional disorders [51, 61], and medically unexplained symptoms [21, 23].”
(Can’t Get No) Patient Satisfaction
Quigley, B. M., Sova, C. C., Brenner, D. M., Keefer, L., Sitrin, M. D., Radziwon, C. D., Krasner, S. S., & Lackner, J. M. (2017) · Journal of Clinical Gastroenterology · doi:10.1097/mcg.0000000000000906 · Cited by 16
Self-citationImaging Brain Mechanisms of Functional Somatic Syndromes: Potential as a Biomarker?
Kano, M., Oudenhove, L. V., Dupont, P. J., Wager, T. D., & Fukudo, S. (2020) · The Tohoku Journal of Experimental Medicine · doi:10.1620/tjem.250.137 · Cited by 17
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“Together, while a putative reciprocity between pain, stress and sex is widely discussed as key in the tremendous interindividual variability in pain- and stress-related disorders (70–73), including DGBI (10, 74), the exact processes of interaction in this triad and underlying mechanisms remain widely elusive.”
BackgroundThe Association between Functional Dyspepsia and Metabolic Syndrome—The State of the Art
Volarić, M., Šojat, D., Majnarić, L. T., & Vučić, D. (2024) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph21020237 · Cited by 20
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“It is well known that functional gastrointestinal diseases are often accompanied by depression, anxiety, and somatization (47).”
BackgroundThe association of different interoceptive dimensions with functional gastrointestinal symptoms
Gajdos, P., Chrisztó, Z., & Rigó, A. (2020) · Journal of Health Psychology · doi:10.1177/1359105320929426 · Cited by 15
“…approach, focusing on the dynamic interactions between genetic and environmental factors, psychological and central nervous system processes and physiological characteristics, could lead to a better understanding of the mechanisms underlying these conditions (Van Oudenhove et al., 2016).”
BackgroundInfluentialWang, W., Wang, M., Peng, H., Huang, J., & Wu, T. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.10.111 · Cited by 15
The relationship between adverse childhood experiences and disorders of the gut–brain interaction
Fritz, J., Coffey, R., Bloch, J., Cutler, A. J., Gabrielson, S. M. B., DiGiovanni, S., & Faherty, L. J. (2024) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1002/jpn3.12422 · Cited by 14
Brodwall, A., & Brekke, M. (2021) · BMJ Open · doi:10.1136/bmjopen-2021-048949 · Cited by 14
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“Psychological factors also play an important role in functional disorders and might account for overlap as part of a somatic syndrome [1,10,11].”
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Biopsychosocial Model and Perceived Constipation Severity According to the Constipation Phenotype
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“and the brain may be one potential etiology [10].”
BackgroundGlobal patterns of prescription pain medication usage in disorders of gut–brain interactions
Luo, Y., Camey, S. A., Bangdiwala, S. I., Palsson, O. S., Sperber, A. D., & Keefer, L. (2022) · Neurogastroenterology & Motility · doi:10.1111/nmo.14457 · Cited by 14
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Diao, Z., Xu, W., Guo, D., Zhang, J., Zhang, R., Liu, F., Hu, Y., & Ma, Y. (2023) · Medicine · doi:10.1097/md.0000000000034802 · Cited by 13
Woodham, A., David, A. L., Cooper, M. J., & Cordwell, J. (2021) · Clinical Child Psychology and Psychiatry · doi:10.1177/13591045211055077 · Cited by 12
“Whilst this cannot be confirmed by this study, this process is increasingly believed to be critical in modifying both child and parent FGID symptom beliefs (Van Oudenhove et al., 2016; Van Tilburg, 2020).”
BackgroundHealth problems associated with irritable bowel syndrome: analysis of a primary care registry
Clevers, E., Vaes, B., Henrard, S., Goderis, G., Tack, J. F., Törnblom, H., Simrén, M., & Oudenhove, L. V. (2018) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.14612 · Cited by 13
Biopsychosocial Aspects of Adult and Pediatric Disorders of Gut–Brain Interaction
Elsenbruch, S., Ballou, S., Keefer, L., Murphy, T., Oudenhove, L. V., van Tilburg, M. A. L., Vasant, D. H., & Levy, R. L. (2026) · Gastroenterology · doi:10.1053/j.gastro.2026.02.009 · Cited by 18
Self-citationHypnotherapy and IBS: Implicit, long-term stress memory in the ENS?
Császár-Nagy, N., & Bókkon, I. (2022) · Heliyon · doi:10.1016/j.heliyon.2022.e12751 · Cited by 17
“IBS is strongly associated with a high level of somatization and psychosocial morbidities [71,72,119].”
BackgroundŠojat, D., Volarić, M., Keškić, T., Volarić, N., Cerovečki, V., & Majnarić, L. T. (2024) · Biomedicines · doi:10.3390/biomedicines12030702 · Cited by 12
“A view has emerged, including a bio-psycho-social perspective, that provides a comprehensive understanding of FGIDs by trying to explain how a large array of environmental, psychological, and biological factors contribute to the expression of symptoms of these disorders [8].”
BackgroundBiobehavioral approach to distinguishing panic symptoms from medical illness
Tunnell, N. C., Corner, S. E., Roque, A. D., Kroll, J. L., Ritz, T., & Meuret, A. E. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1296569 · Cited by 18
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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