Is it all in my mind?

No. Neither is it all in your gut or even your body. IBS is a condition that affects both your mind and your body and defined by the Bristish society of Gastroenterology as ' .....a disorder of gut-brain interaction, rather than a functional gastrointestinal disorder.....' . 

But changes in gut immunology or the bacterial content of the colon can affect the way you feel and the symptoms of IBS can make you anxious, depressed and desperate. IBS is a vicious cycle that affects both the mind and body.

Emotional Expression and Symptoms

Resolution of a situation that is causing bodily tension requires the space to think and talk about what has happened – a cognitive buffer. This engages both the emotional and analytical aspects of the brain and creates options for action and resolution by changing the way we see things. Some people with IBS appear to have a much-reduced cognitive space. In them, rational thought is all too easily invaded by emotion. They have a thin skin.

People with such a thin skin may either express their emotion, losing their temper at the slightest provocation, fearing every journey and falling in love at the drop of an eyelid. Rather like Basil Fawlty in Fawlty Towers. Or they can defend themselves behind a tense mask, keeping their emotions under tight control …. until they explode. The symptoms that they suffer from appear to depend on the type of reaction employed.

Diarrhoea, for example, is an expressive symptom and is often associated with uncontained anger or anxiety and an unregulated pattern of binge eating.

Constipation, on the other hand is more defensive and associated with withdrawal and shyness and a suppression of eating behaviour, a situation I have termed ‘the nothing in, nothing out syndrome’.

But sometimes, diarrhoea and constipation can alternate according to whether a person feels in control or chaotic.  They struggle to regulate their feelings. They either feel fragmented and dangerously out of control or they reins themself in too much and has no life. There is no middle ground.  They are like a faulty thermostat, that fails to provide a modulated response to environmental changes and instead creates uncomfortable swings in temperature.

But there are also people who appear to be able to detach and block the emotion. So, disconnected from the context, feelings are rationalised by the more cognitive and analytic aspects of the brain and presented as food allergy and mercury poisoning or any other condition that is in fashion. And the physiological changes, unmodulated by emotion can be particularly profound and are frequently associated with an enhancement of sympathetic nerve activity and a reduction in plasma cortisols.