the Connection Between Anxiety and Gastrointestinal Symptoms

I'm not sure if it's a psychological factor, but my gastrointestinal function is not good?

Hello, doctor.
I have been a patient with anxiety disorder and obsessive-compulsive disorder for over 10 years.
I have been intermittently taking medication prescribed by a psychiatrist.
My diet is not particularly health-conscious, and I do not smoke or drink alcohol.
My bowel movements are normal.
The core of my anxiety is an intense fear of cancer; whenever I feel something unusual in my body, I immediately think of cancer, which triggers panic and anxiety.
Ten years ago, I experienced a feeling of pressure and pain in my right upper abdomen near the lower edge of my ribs.
I consulted a hepatobiliary and gastroenterology specialist and underwent gastroscopy, colonoscopy, and abdominal ultrasound, all of which showed no significant issues.
Despite this, the symptoms in my right upper abdomen persisted.
The only time the symptoms would temporarily disappear was when I was preoccupied with worrying about other organs potentially having cancer.
When I had no pressing concerns, and my attention returned to the right upper abdomen, the symptoms would reappear.
This cycle continued for four years until one day, the symptoms in my right upper abdomen disappeared on their own.
After a while, I began to experience similar pressure and pain in my left upper abdomen, corresponding to the previous discomfort in my right upper abdomen.
The symptoms were identical, as if they were copied and pasted, just on the opposite side.
For the past six years, the symptoms in my right upper abdomen have not returned, but the symptoms in my left upper abdomen remain.
Again, these symptoms only temporarily vanish when I worry about other organs potentially having cancer.
When I have no significant concerns and my attention shifts back to the left upper abdomen, the symptoms reemerge.
I have been intermittently taking psychiatric medication until last year when I switched doctors and changed to different psychiatric medications.
Unbeknownst to me, the symptoms in my left upper abdomen disappeared for nine months.
However, last week, after seeing some reports about gastrointestinal cancer, I immediately became worried about having cancer.
I looked down at my left upper abdomen, which had been calm for a long time, and focused my attention on it.
Shortly after, the symptoms in my left upper abdomen returned.
Doctor, what should I do? What could be causing my condition? Thank you.

JAMES, 40~49 year old female. Ask Date: 2022/06/22

Dr. Chen Shidian reply Gastroenterology and Hepatology

If it has been over a year, follow-up examinations with ultrasound or blood tests can be performed.
Cancer typically does not remain unchanged for 10 years, so it can be ruled out.
Please rest assured.

Reply Date: 2022/06/22

More Info

The connection between anxiety and gastrointestinal (GI) symptoms is a well-documented phenomenon in the medical field. Your experience illustrates a classic case of how psychological factors can manifest as physical symptoms, particularly in the gastrointestinal system. This interplay is often referred to as the "gut-brain axis," which describes the bidirectional communication between the gut and the brain.

In your case, the recurrent abdominal discomfort you experience seems to correlate closely with your anxiety levels, particularly your fear of cancer. This is not uncommon among individuals with anxiety disorders. When you focus on your health and worry about potential illnesses, your body may respond with physical symptoms, such as the abdominal pain and discomfort you described. This can be attributed to several physiological mechanisms.

Firstly, anxiety triggers the body's "fight or flight" response, which can lead to changes in gut motility and increased sensitivity to pain. Stress hormones like cortisol can affect the digestive system, leading to symptoms such as bloating, cramping, and changes in bowel habits. In your case, the fact that your symptoms seem to disappear when you are preoccupied with other thoughts suggests that your anxiety is a significant factor in your gastrointestinal discomfort.

Moreover, the phenomenon of "somatic symptom disorder" may also be relevant here. This condition involves experiencing physical symptoms that are significantly influenced by psychological factors. In your situation, the persistent focus on your health and fear of cancer may exacerbate your awareness of bodily sensations, leading to a cycle of anxiety and physical discomfort.

It's also important to consider the role of learned behavior in your symptoms. Over the years, you may have conditioned yourself to associate certain bodily sensations with anxiety and fear of illness. This learned response can perpetuate the cycle of anxiety and physical symptoms, making it challenging to break free from this pattern.

To address your concerns, it may be beneficial to explore therapeutic options that focus on managing anxiety. Cognitive-behavioral therapy (CBT) is particularly effective for anxiety disorders and can help you reframe your thoughts about health and illness. Mindfulness and relaxation techniques can also be useful in reducing anxiety and its physical manifestations.

Additionally, it may be worth discussing your symptoms with a healthcare provider who specializes in psychosomatic medicine or a gastroenterologist familiar with the gut-brain connection. They can help rule out any underlying gastrointestinal conditions and provide guidance on managing your symptoms.

In summary, your gastrointestinal symptoms are likely linked to your anxiety, particularly your fear of cancer. By addressing the psychological aspects of your condition, you may find relief from the physical symptoms. It is essential to seek support from mental health professionals and consider therapeutic approaches that can help you manage your anxiety more effectively. Remember, you are not alone in this experience, and there are effective strategies available to help you regain control over both your mental and physical health.

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