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The Relationship Between Irritable Bowel Syndrome , Depression , Anxiety, and Stress among a Sample of Irritable Bowel Patients - Predictive Study

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This study aimed to examine the relationship of irritable bowel syndrome, anxiety, depression and stress among a sample of78 IBS patients (Rome III Diagnostic Criteria for Irritable Bowel Syndrome),anxiety symptoms scale ,Depression symptoms scale ,and stress scale (prepared by the researcher) were used Pearson Correlation Coefficient showed that there are statistically significant relationship between IBS and Anxiety ,Depression and Stress (P≤=0.01).The Regression and Prediction Coefficient (stepwise) was also used and showed that the depression and Stress of predicts to IBS.
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Journal of Psychology and Clinical Psychiatry
The Relationship between Irritable Bowel Syndrome,
Depression, Anxiety, and Stress among Sample of
Irritable Bowel Patients - Predictive Study
Submit Manuscript | http://medcraveonline.com
Volume 5 Issue 4 - 2016
Department of Psychology, Najran University, Saudi Arabia
*Corresponding author: Osama Hasan Gaber, Department
of Psychology, Najran University, Saudi Arabia,
Tel: 00966561380347; Email :
Received: February 04, 2016 | Published: February 24,
2016
Research Article
J Psychol Clin Psychiatry 2016, 5(4): 00290
Abstract
This study aimed to examine the relationship of irritable bowel syndrome,
anxiety, depression and stress among a sample of78 IBS patients (Rome III
Diagnostic Criteria for Irritable Bowel Syndrome), anxiety symptoms scale,
Depression symptoms scale, and stress scale (prepared by the researcher)
were used Pearson Correlation Coefficient showed that there are statistically
significant relationship between IBS and Anxiety, Depression and Stress
   
and showed that the depression and Stress of predicts to IBS.
Keywords: Irritable bowel syndrome; Depression; Anxiety; Stress
Introduction
Researcher believe that the health and disease are two sides
of a single phenomenon, since it was found and humane societies
and continues to the present of the basic concerns of the people
and communities. Therefore man is always trying to look for the
right conditions that will make it on the one hand adapt to external
and internal pressures on the other hand being able to achieve
physiological and psychological balance that cannot be achieved
unless the health of soul and body together. There are also a lot
of physical ailments that are due to psychological reasons, and
Personality aspects study of physical, psychological and mental
is considered important foundation for the understanding of
normal and pathological human behavior and this holistic view
of the human person as a psychological and physical enable us to
understand and diagnose the disease and treatment.
But the most important, psychosomatic disorders, which
became popular after World War II were those diseases that
appear in the form of actual or real defect in the tissue or the wall
of the stomach or large intestine or skin or respiratory function
or other forms of disease, which has become the main concern for
many of the employed cells injuries medicine, because they are
perplexed in the search for its causes, and medical efforts failed to
eradicate them is not surprising because all of these efforts have
been directed towards the offer without searching for reasons [1]
and with the advent of the psychosomatic Medicine book 1943
for (Wise & English) and a “psychosomatic Researches book for
(Jrnkar ) in1953 known psychosomatic right track in each of the
areas of medicine, psychology, becoming conducted hundreds of
studies psychosomatic annually across the world [2].
Since it included the term of psychosomatic used and their
         
theoretical and clinical trends, then mention, for example, that in
1968 used by the American Psychiatric Association to refer him
to the visceral and subjective psycho physiological disorders, and
in the Encyclopedia of psychoanalysis in 1968 (Glover) using the
term psychosomatic refers to its boiling organic those changes
resulting from emotional changes [3].
IBS is considered the famous kinds of psychosomatic disorders,
where IBS is that such a machine which Exceptions to orchestra
music and led to the cacophony of melody. This means that the
work of the colon and his movement is no longer compatible with
the rest of the digestive tract is either faster (leading to diarrhea)
or slow down (leading to constipation) or occasional (leading
to diarrhea and sometimes constipation at other times), but in
all cases, be accompanied severe pain in the abdomen, where
the contractions of the colon and unaccounted which graduated
          
reversing the natural movement in line with the rest of the
digestive tract movement [4].
The irritable bowel syndrome disorders which puzzled by
specialists the complexity of causes where there is unrest organic
as there may be psychological reasons are to be responsible for
it. Irritable bowel syndrome (IBS) has been widely studied in
the western world and pathphysiologic mechanisms have been
available to explain the constellation of symptoms. IBS is a chronic
disorder of unknown etiology clinically consisting of altered bowel
habits, abdominal pain and the absence of any detectable organic
pathologic process. Along with the putative pathophysiologic

intestinal motility and visceral hypersensitivity, there has
been much discussion regarding the brain-gut interaction
        
these symptoms [5] and Several groups have determined that
psychosocial stress alters GI motor function and sensation. In
this way, psychosocial stressors likely exacerbate GI symptoms
in patients who have functional GI disorders. Anxiety disorders,
somatoform disorders, or a history of physical or sexual abuse can

IBS in referral practices. In particular, several studies suggested
The Relationship between Irritable Bowel Syndrome, Depression, Anxiety, and Stress
among Sample of Irritable Bowel Patients - Predictive Study 2/9
Copyright:
©2016 Gaber
Citation: Gaber OH (2016) The Relationship between Irritable Bowel Syndrome, Depression, Anxiety, and Stress among Sample of Irritable Bowel
Patients - Predictive Study. J Psychol Clin Psychiatry 5(4): 00290. DOI: 10.15406/jpcpy.2016.05.00290
that the presence of somatization is particularly common and

emotional stress as an etiologic factor in the development of IBS
symptoms also may be inferred from the effects of psychologic
therapies on IBS symptoms [6].
It is clear to the researcher the role of psychological factors and
their relationship to the emergence of irritable bowel syndrome,
because the irritable bowel syndrome is one of psychosomatic
disorders in which shocks the emotional may turn into somatic
symptoms vary depending on the psychological structure of the
people, making the researcher aims to study the irritable bowel
syndrome and its relationship with some psychological variables
such as anxiety, depression and stress psychological.
Objective
Considering the background above, this research aimed to:
a) examine the relationship between irritable bowel syndrome
and depression
b) examine the relationship between irritable bowel syndrome
and anxiety
c) examine the relationship between irritable bowel syndrome
and stress
d) examine the predictive relationship for irritable bowel
syndrome through anxiety, depression and stress.
Literature Review
Irritable bowel syndrome
The talking about psychosomatic disorders leads us to talk
about the history of the relationship between self and the body
and the effect on each other a long and extensive history since
antiquity as the human intellect, since medical and psychological
literature, which extends to 4500 years where the Emperor of
China’s younger, “Huang Ti,” pointed out that frustration causes
for people diseases membership has recommended that we
explore the wishes of the people and their ideas and pursue them
[7].
With the beginning of the twentieth century it has spread the
use of the scientists of the concept of the interrelationship between
the soul and the body, has a number of developments have led
in the areas of psychology, physiology, medicine psychology to
the emergence of the trend psychosomatic disorder talk and
         

of factors research psychological on the physiological functions
of the physiological effects of severe stimuli emotional [8]. The
   
two main thrusts ,First the direction of psychoanalysis, which
revived the concept of psychological origin of the disease organic
psychogenesis and the second direction tends to tangle Holism
concept in human interpretation in cases of health and disease
has the club in this direction (Adolf, Mayer) which stressed the
need for biological psychology to the study of the human as a
whole in cases of health and disease [9].
Researcher believe that the self-improvement as affected by
the body, then there is a high correlation between the soul and
the body from two Cases of psychological and mental processes
lead to bring about certain changes in the body, and some of the
physiological and mental changes affect the self. And Researcher
believe through offer historical relationship between soul and
         
direction, and who believes that mind and body are two things
separate and believes in the principle of duplication or bilateral,
the second direction which emphasizes that the mind and body
is one thing and the two sides of the same coin and can therefore
be say that psychosomatic illnesses are the result of the impact of
psychology on the body which is the result of the close relationship
between soul and body.
Irritable bowel syndrome is one of the famous psychosomatic
disorders because of the complexity of its causes and different
doctors in treatment where there is unrest organic apparent
reason .And We can call irritable bowel disease as a disease age
where the statistics of the World Health Organization reported that

bowel syndrome is a disease that everyone suffers from it rich and
poor, male and female [10]. The irritable bowel syndrome (IBS) is
the most common disorder encountered by gastroenterologists.

pain is associated with defecation or a change in bowel habit with
features of disordered defecation and distension” [11].
The pathophysiology of IBS is still inadequately understood,
but it is most likely due to complex interactions between the
immune, hormonal and nervous systems. Diverse factors,
including psychological stress, food intolerance or allergy,
intestinal infection, injury (e.g., abdominal or pelvic surgery),
      
the intestinal microbiota or bacterial overgrowth, and genetic
transmission, abuse and early life learning, have been found to
contribute to the development of IBS syndrome according to the
research in the last decade [12]. The pathophysiology of IBS is
incompletely understood and thought to be multifactorial, Factors
that may contribute to IBS include genetic, abnormal GI motility,
    
impaired epithelial barrier function and alterations in intestinal
    
[13].
Medicine did not reach to determine the causes of IBS

sensitive to psychological pressure, anxiety, depression or some
types of foods break down his work, causing the so-called IBS.
Some other theory is that the immune system, which protects the
body from germs may have an effect in cases IBS [14].
Researchers have disagreed in determining the apparent cause
of the disorder Irritable Bowel In one classic study was conducted
on a person named “Tom” Tom, a sick employee ulcer and he
      
to the stomach, doctors have that window open as a result of
an injury Palmira where he was Tom, has to deal with the daily
share of the tensions and pressures of work, but in the case of
“Tom” was easy for researchers to observe some of the pressure
The Relationship between Irritable Bowel Syndrome, Depression, Anxiety, and Stress
among Sample of Irritable Bowel Patients - Predictive Study 3/9
Copyright:
©2016 Gaber
Citation: Gaber OH (2016) The Relationship between Irritable Bowel Syndrome, Depression, Anxiety, and Stress among Sample of Irritable Bowel
Patients - Predictive Study. J Psychol Clin Psychiatry 5(4): 00290. DOI: 10.15406/jpcpy.2016.05.00290
responses by watching the stomach mucous membrane of the
window in the abdominal wall researchers have noted that “Tom”
after all The complaint muscles constrict the stomach and cramps
and increases the secretion of hydrochloric acid, and it was the
        
when he feels “Tom” angry and upset, This results indicate to the
role of the mental health of a patient IBS.
Patients with IBS are suffering from a variety of GI complaints,
as well as, associated symptoms like headache, dysuria,
  
Anxiety, depression and somatoform disorders are the most
prevalent psychiatric conditions linked to IBS. It is reported that
at least one of these disorders is present in approximately 40 to 60
percent of IBS patients visited by physicians in gastroenterology
clinics. Results from some studies with population-based design
have reported lower rates of psychiatric symptoms in non-
consulters IBS patients (i.e., individuals who do not consult with
any physician) . While a number of IBS patients feel that their
psychiatric disorders is the result of the intrusive nature of their
IBS [15]. Others think that their psychiatric disorders are related
to the development of their GI symptoms. However, approximately
half of patients with a psychiatric disorder develop the condition
before the onset of GI symptoms, and psychiatric symptoms start

          
research shows that psychological factors that predict for irritable
bowel syndrome, and this is the objective of the current study, they
tested the predictive relationship for irritable bowel syndrome
through anxiety, depression and stress.
Anxiety
        
population as there is overwhelming evidence to suggest that
there is possible biologically basis. This evidence indicates that
stress may play a role in amplifying the disease As is the case in
many diseases, but the biological factors may be more important
role in this disease of the role of stress alone.
Richard Swain indicates that anxiety is the basis of all kinds
of psychopathology which means there is a warning of danger
threatening the safety of man and that there is a relationship
between anxiety and physiological responses to humans [17].
Anxiety according to Jung as a reaction carried out by an
individual when he secreted his mind powers and fantasies
unreasonable issued by the social subconscious ,Anxiety is
the fear of the control the contents of the social unconscious is
reasonable that not a still lingers in which human primitive life,
and Yong believes that man is usually interested in organizing his
life on the basis of reasonable organization and the emergence
of art is reasonable in the social unconscious is a threat to its
existence [18].
Researcher believe that While the human behavior certain, this
behavior results in one complete any personal behavior that is as
a physical and psychological. Mental health and physical situation
affected the opposite is true in the balance under the normal
circumstances of a personal normal adaptive, and the body is
considered as an intermediary between the external environment
and self as an psychological entity, emotional turmoil leads to a
disruption of this balance as the digestive tract affected by anxiety
Recent work suggests that some patients may be biochemically
more sensitive to the development of anxiety symptoms in
the presence of particular diseases. patients with generalized
anxiety disorders have higher plasma catecholamine levels than
normal controls. These patients may down regulate catechol
receptors as a result of these higher plasma concentrations and
thus experience reduced receptor sensitivity in their adrenergic
nervous system [19].
Also According to Harvard Medical School, there may be a
connection between anxiety disorders and the development of
irritable bowel syndrome (IBS) after a bowel infection. IBS can
cause vomiting, diarrhea, or constipation [20].
Depression
Depression expresses about of symptoms complex group
called depressive syndrome concept by scientists, it is clear that
the symptoms of depression may vary from one individual to
another. Some may take their depression form of harsh feelings of
blame and scold self comes when others are mixed with physical
complaints and diseases, physical manner may not know borders
between them [21].

disease and affects people in all communities across the world.
Today, depression is estimated to affect 350 million people. The
World Mental Health Survey conducted in 17 countries found that
on average about 1 in 20 people reported having an episode of
depression in the previous year. Depressive disorders often start
at a young age; they reduce people’s functioning and often are
recurring. For these reasons, depression is the leading cause of
disability worldwide in terms of total years lost due to disability.
The demand for curbing depression and other mental health
conditions is on the rise glob- ally. A recent World Health Assembly
called on the World Health Organization and its member states to
take action in this direction [22].
The depression According to [23] at least two of the following
additional symptoms are present; poor appetite or overeating,
trouble sleeping or too much sleeping, low energy or fatigue, low
      
and feelings of hopelessness.
Depression may be related to the emergence of many different

by the enormous diversity regular depression disease, according
to the state of each individual. According to the standards of the
World Health Organization ICD-10 can distinguish depression
stage through injury status of grief and resentment going on for
a time period of two weeks at the very least, with the associated
loss of the ability to feel happy and activity and interest in things
in addition to the loss of the ability to concentrate and the ability
to perform in general. In addition to the appearance of symptoms
such as sleep disorders, loss of appetite, weight loss and limited
thinking on the positions that the patient believes it does not have
a way out. This may lead to the emergence of ideas that relate to
The Relationship between Irritable Bowel Syndrome, Depression, Anxiety, and Stress
among Sample of Irritable Bowel Patients - Predictive Study 4/9
Copyright:
©2016 Gaber
Citation: Gaber OH (2016) The Relationship between Irritable Bowel Syndrome, Depression, Anxiety, and Stress among Sample of Irritable Bowel
Patients - Predictive Study. J Psychol Clin Psychiatry 5(4): 00290. DOI: 10.15406/jpcpy.2016.05.00290
death and actual suicidal intentions. And going slow in thinking
and often tends to think about one subject is often how bad the
situation and the despair of the current situation and the extent to
which the future looks without any hope.(keik.2010) .Also Some
studies results have shown for relation between depression and
symptoms, physical This is the kind of symptoms of the most
common and most deception, such as the speed of fatigue and
weakness of power, back pain, body and digestive disorders and
stomach without that there will be reasons clear membership
justify it [24].
according to the Crohn’s & Colitis Foundation of America
(CCFA). The Patients with depressive symptoms typically have
reported a lower quality of life and may be at an increased risk
for relapses of IBD symptoms. Depression can directly impact the
healing process for IBD because it affects the immune system,

that when patients [with IBD] received mental health care, they
spent fewer days in the hospital and took fewer sick days off from
work.
Researcher believe that the mood disorders of the most
important factors that cause psychosomatic disorder through the
impact of these disturbances on the digestive system because the
mood disorders some of the symptoms, such as eating disorders
and sleeping and that may affect the digestive functions
Stress
The Walter Cannon description 1932 in response to the
 
contributions in the study of early pressure, it was Canon saw that
this response is an adaptive response to it enables the organism to
respond quickly to threats [25].
Canon Researches has revealed the existence of a mechanism
in the human body contribute to retaining a state of equilibrium
Homeostasis any capacity to cope with the changes they face
and return to the case of organic and chemical balance the end
of the situations that cause these changes, and then, any external
demand could be in violation of this balance if the body fails to
deal with, and this is what considered by Canon that stress faced
by the individual, which may lead to membership problems had
also been given and he attention to the role of the sympathetic
device for its important role in creating the body to cope with
stressful situations and enable the body to maintain balance
referred to [26].
     
 
symptom Group of the general adoption syndrome and although
the “Selye” was originally explores the effects of sex hormones on
the physiological performance, however He became interested in
The effect of stress [27].
And Selye Has been reached, through his researches that the
organism in the case of the face of a stress situation it drives
himself around the act and this act his way adrenergic gland that
increases the secretion of activity sympathetic nervous system,
and this response in itself is not a special quality for a particular
compressor means that the individual, regardless of the reason
for the threat uses the same physiological response pattern, with
time and repeated and prolonged exposure to stress rupture
in the sympathetic device happens. Through this presentation
researcher believes that psychological stress is one of the causes of
psychosomatic symptoms and where turn emotions psychological
to physical symptoms such as irritable bowel disorders or skin
disorders, in which the man through maintaining the balance
sought by the threat caused by the psychological stress.
Bonaz et al. [28] noted that the result in the lack of gastric
emptying and prolong small bowel movement also cause an
increase in bowel movement as well as its impact on the function
of the gastrointestinal tract .And The impact of stress on the
stomach goes far beyond indigestion, however. In recent years,
doctors have uncovered a remarkably complex connection
between the brain and the digestive system. The entire system is
extremely sensitive to our moods. In fact, experts now see stress
as a major player in a wide range of digestive problems, including
irritable bowel syndrome, indigestion, and heartburn .People
with digestive problems often scoff at the idea that stress could be
at the root of their problems [29].
Researcher believes that the relationship between soul and
body all that affected by itself, of course, will affect the body, and
so the case when human psychological stress has exposed some
of the most famous and physical symptoms of irritable bowel
disorder.
Research Issue
This study aimed to examine the relationship between irritable
bowel syndrome and depression, examine the relationship
between irritable bowel syndrome and anxiety, examine the
relationship between irritable bowel syndrome and stress and
examine the predictive relationship for irritable bowel syndrome
through anxiety, depression and stress. The research inquiries
are:
a) What is the relationship between depression and the
irritable bowel syndrome of IBS patients?
b) What is the relationship between anxiety and the irritable
bowel syndrome of IBS patients?
c) What is the relationship between stress and the irritable
bowel syndrome of IBS patients?
d) Can irritable bowel syndrome be predicted by depression,
anxiety or stress?
Methodology & Procedures
Methodology
Descriptive method is used. It enables the researcher to
explore the relationship of irritable bowel syndrome and anxiety,
depression, stress and the predicted relationship irritable bowel
syndrome and those variables.
Study population and sample
The study tools were applied on 78 irritable bowel syndrome
patients.
The Relationship between Irritable Bowel Syndrome, Depression, Anxiety, and Stress
among Sample of Irritable Bowel Patients - Predictive Study 5/9
Copyright:
©2016 Gaber
Citation: Gaber OH (2016) The Relationship between Irritable Bowel Syndrome, Depression, Anxiety, and Stress among Sample of Irritable Bowel
Patients - Predictive Study. J Psychol Clin Psychiatry 5(4): 00290. DOI: 10.15406/jpcpy.2016.05.00290
Study tools
The following tools were used:
a) Anxiety symptoms Scale, prepared by the researcher.
b) Depression symptoms Scale, prepared by the researcher.
c) Psychological stress scale, prepared by the researcher.
d) Rome III Diagnostic Criteria for Irritable Bowel Syndrome.
Results & Discussion
       
Irritable Bowel Syndrome and the Depression for IBS
patients (Table 1)
       
Irritable Bowel Syndrome and depression at 0.01. This result
shows that more depression, more Irritable Bowel Syndrome.
According High rates of depression amongst patients with irritable
bowel syndrome (IBS) have led many researchers to believe there
could be a causal relationship between psychological factors and
IBS symptoms. may also be symptoms of depression. See a doctor
for a medical evaluation to determine the cause of your symptoms
[30].
       
main factors are causing physical disease, and talked about
the premise of the Psychologenic concept which includes the
      
anxiety and depression are believed to play a crucial role in
the incidence of such disorders, because the stress state of the

defensive mechanisms of lead in turn to emotional responses lead
to provoke visceral responses, which in turn caused psychosomatic
disorders [31]. And Often have physical symptoms of depression,
this is kind of the symptoms of the most common and most
insidious symptoms, speed fatigue, poor energy, back pain and
body, without that there will be reasons clear membership justify
It somatic complaints of depression, sleep disorders, headaches,
stomach pains and Digestive disorders [21].
The evidence of relationship depression with irritable bowel
disease research studies have shown that they can also be
effective as analgesics (drugs that reduce pain). Antidepressants
are, therefore, used to treat such chronic painful conditions as
     
Similarly, antidepressants are effective in treating symptoms of
IBS and other functional GI disorders. Patients who have taken

improvement in their abdominal pain and reduction in other IBS
symptoms, such as diarrhea, constipation, bloating, nausea or
urgency. The brain is always monitoring and processing all that
goes on in the body [32].
Researcher believe that this result indicates that the
relationship between depression and irritable bowel syndrome
is the relationship suggest that depression and contents of
symptoms is one of the main factors associated with the
emergence of irritable bowel syndrome.
Table 1:      
motivation Irritable Bowel Syndrome and the Anxiety for The study
sample.
Variables Depression 
Irritable Bowel Syndrome 0.379 0.01
 
Irritable Bowel Syndrome and the Anxiety for IBS
patients (Table 2)
       
Irritable Bowel Syndrome and anxiety at 0.01. This result shows
that more anxiety, more Irritable Bowel Syndrome. According
Gournay The causation of irritable bowel syndrome is something
that remains the source of debate and controversy. However, it
seems clear from the physiological point of view, that some people
have particularly sensitive intestinal tracts and muscle activity
is increased [33]. There is also a relationship between anxiety
and digestive disorders as anxiety causes human suffering from
vomiting and diarrhea, swelling of the stomach and digestive
trouble [34]. Much less is known about the impact of anxiety
disorders on function and outcome in persons with chronic
medical illness. There is convincing evidence that anxiety is
associated with high rates of medically unexplained symptoms
and increased utilization of healthcare resources [35].
Researcher believe through as a result of the second question
of the study to the anxiety turns into physical symptoms The
reason for this shift to the unconscious where the cargo emotional
turn into certain physical symptoms with a special meaning for
her patient relationship, including a stock unconscious from
previous experiences.
Table 2:      
Irritable Bowel Syndrome and the Anxiety.
Variables Anxiety 
Irritable Bowel Syndrome 0.337 0.01
       
Irritable Bowel Syndrome and stress for IBS patients
(Table 3)
       
Irritable Bowel Syndrome and stress at 0.01. This result shows
that more stress, more Irritable Bowel Syndrome, The causal
relationship between stress and turmoil psychosomatic, where
the term Psychosomatic suggests a causal psychology behind the
physical symptoms, which are those of causality which alerted
us to it, “Canon”, where different path results agitation among
themselves and this is what is known in medicine psychological
as the hysteria shift, as the shift in the hysteria of the emotional
        
          
a symbolic expression of a compromise between the desire
         
different, Rising, for example, blood pressure in a state of anger
The Relationship between Irritable Bowel Syndrome, Depression, Anxiety, and Stress
among Sample of Irritable Bowel Patients - Predictive Study 6/9
Copyright:
©2016 Gaber
Citation: Gaber OH (2016) The Relationship between Irritable Bowel Syndrome, Depression, Anxiety, and Stress among Sample of Irritable Bowel
Patients - Predictive Study. J Psychol Clin Psychiatry 5(4): 00290. DOI: 10.15406/jpcpy.2016.05.00290
but it is in fact an integral part of the case of the same anger, as
a result of physical mechanics of being in the autonomic nervous
system [36].
There is no doubt that there is a strong bond between man’s
soul and mind and body events and conditions that affect the
psychology or mind in turn affect the body, studies have proven
the continuation of acute stress in a short time can cause the
individual to chronic headaches, high blood pressure and increase
the proportion of Alklorsterol in the blood, In the long-term
functional pressures can lead to heart disease, ulcers, arthritis
and gastrointestinal disorders such as irritable bowel disorder
[37].
          
endocrinologist Hans Selye in 1936 as the physiological adaptive
responses to perceived (psychological) or real (physical) threats
(“stressors”) to an organism. An acute (sudden or short-term)
         
defend the stability of the internal environment in order to ensure
the survival of the organism. When the stress passes, a negative
feedback is triggered to terminate the stress response and bring
the body back to a state of homeostasis or eustasis. However, if the
stressor becomes chronic and/ or exceeds the organism’s ability
to maintain the stress response, it becomes harmful because basal
homeostasis cannot be reached. For most humans in modern
societies, psychological stress is more frequent than physical
stress and it may be induced by various social and emotional
triggers, some of which can be unique for an individual [12].
According to Tache [38] a person’s stress response involves a
network of brain regions that interact as they receive information
from inside or outside the body. When stress actives this network,
it triggers two main pathways. One is called the pituitary-adrenal
axis, which acts to increase circulating hormones (glucocorticoids
– particularly cortisol) involved with regulating the body’s
response to stress. The other is the autonomic nervous system,
which regulates involuntary bodily functions such as our blood
pressure, heart rate, and bowel function. Both of these pathways
directly or indirectly affect gut function through the unique
system of nerves within the bowel wall (enteric nervous system).
These pathways, along with the brain and enteric nervous system,
are collectively referred to as the “brain-gut axis.
In the stress-activated pathways, the corticotrophin releasing
factor (CRF) signaling system is a key element in the biochemical
mechanism by which the brain trans- lates a stimulus into an
integrated physical response. This system is composed of the
41 amino acid peptide, three related peptides, namely urocortin
1, urocortin 2 and urocortin 3, as well as the CRF receptors
CRF1 and CRF2 and their variants. When the body experiences
stress, the CRF signaling system plays a primary neuroendocrine
role in stimulating the HPA axis, acting as a neurotransmitter/
neuromodulator to coordinate the immune and visceral efferent
limbs, and activating the locus coeruleus and its noradrenergic
projections. The CRF system can also modulate the forebrain,
hindbrain and spinal sites for regulating the autonomic nervous
system activity, leading to the stimulation of the sym- pathetic
nervous system, release of catecholamine’s and induction of
sacral parasympathetic activity. In addition, stress affects directly
or indirectly the composition and the growth of microbiota, which
helps to maintain bidirectional communication between the
components of the brain and the gut axis. The impact of stress
on the brain-gut axis has been reviewed by Grenham et al. and
O’Malley et al. [12]. Also The stress response causes a number
of detrimental events in the gut, including Decreased nutrient
absorption, decreased oxygenation to your gut, as much as four
          
decreased metabolism and decreased enzymatic output in your
gut – as much as 20,000-fold but that’s not all .
Through this result researcher believes that the psychological
structure of the human being is the determining factor in human’s
reaction to the stress faced by this and that differentiates between
the person and the other person has been exposed to two people
    
affected and the other person not affected by last.
Table 3:      
Irritable Bowel Syndrome and the stress.
Variables Stress 
Irritable Bowel Syndrome 0.360 0.01
      
predicted by depression, anxiety or stress

used. There is two modes predicts the Irritable Bowel Syndrome
by
1. Depression and
2. Depression with stress
The model number one predicts the Irritable Bowel

of the model (Table 4):
 
B for (Depression) x value Depression Example: if it is assumed
that one Irritable Bowel Syndrome patient received a score of
50 on the Depression scale, her/his score of Irritable Bowel



Researcher believe through this result that Irritable Bowel
Syndrome predict by depression, This result can be explained
by the close relationship between the soul and the body where
injury to a particular organ in the body is not due to weakness
formative and bacon may be due to the function of this user-
related frustrating position that the cause of these disorders
Such an these result consistent with the results of a study of
which found Chronic life stress threat was a powerful predictor

on this measure over 16 months. No patient exposed to even
The Relationship between Irritable Bowel Syndrome, Depression, Anxiety, and Stress
among Sample of Irritable Bowel Patients - Predictive Study 7/9
Copyright:
©2016 Gaber
Citation: Gaber OH (2016) The Relationship between Irritable Bowel Syndrome, Depression, Anxiety, and Stress among Sample of Irritable Bowel
Patients - Predictive Study. J Psychol Clin Psychiatry 5(4): 00290. DOI: 10.15406/jpcpy.2016.05.00290
one chronic highly threatening stressor improved clinically (by

absence of such a stressor.
Stress is a ubiquitous condition that affects all people. Stress
can be mental or physical, although in the context of this article
the focus will be mental stress. Mental stress involves challenge,
threat or worry about future adverse events. Such stress activates
the brain’s stress response systems, which in turn affect the
body. Many of the body’s major systems are altered by stress
(cardiovascular, muscular, urinary, gastrointestinal, sweat glands,
etc) often with adverse consequences [39].
Table 4:
Model
 
T Sig
B Std. Error Beta
(Constant) 25.782 8.507 3.031 .000
Depression 0.581 0.172 0.379 3.379 .000
The model number two predicts the Irritable Bowel
Syndrome by depression with stress, Multiple

 
          
stress (Table 5).
Example: if it is assumed that one Irritable Bowel Syndrome
patient received a score of 60 on the Depression scale and
received a score of 54, her/his score of Irritable Bowel Syndrome




This result indicates that stress and depression predict IBS,
Stress and depression were independent risk factors for FD and

consistent with that in several previous studies. This association
is probably derived from mutual and reciprocal interactions
between the brain and the gut. Corticotrophin releasing hormone
(CRH), a major mediator of the stress response in the brain-gut
axis, can increase intestinal permeability and lead to FD and IBS.
In addition, serotonin and the serotonin transporters, which
assist the modulation of feelings and behavior such as anxiety
and depression, can be associated with brain-gut function in
functional GI disorders [40].
The researcher believes that irritable bowel disorder one of
the results of stress and depression is because all of the stress
and depression are considered cases of instability and loss of
balance and therefore man in that case is seeking to make the
process of adaptation in order to maintain psychological balance
and therefore, depression and stress of the predictors of IBS as the
irritable bowel disorder, in fact, is not troubled organically but it is
a case of transforming emotional energy into physical symptoms
The negative affective and emotional states, such as anger, have
been shown to be related to a decrease of antral motor activity
in IBS patients, whereas in controls the same activity increased
in anger-provoking situations. Intestinal motility patterns may
suffer emotional stimulation and, particularly, an exaggerated
      
intestinal transit and small bowel contractions following stressful
events have been documented in IBS patients8.The proposed
rationale for this vulnerability is that IBS patients may have a
lower threshold for coping with stressful events and negative
emotions, however, regarding defensiveness [41-48].
Table 5: 
Mode2
 
T Sig
B Std. Error Beta
(Constant) 11.192 9.485 1.180 .000
Depression Stress
0.515 0.165 0.337 3.132 .000
.397 0.136 0.314 2.927 .000
The Relationship between Irritable Bowel Syndrome, Depression, Anxiety, and Stress
among Sample of Irritable Bowel Patients - Predictive Study 8/9
Copyright:
©2016 Gaber
Citation: Gaber OH (2016) The Relationship between Irritable Bowel Syndrome, Depression, Anxiety, and Stress among Sample of Irritable Bowel
Patients - Predictive Study. J Psychol Clin Psychiatry 5(4): 00290. DOI: 10.15406/jpcpy.2016.05.00290
Acknowledgement
This 
at Najran University (NU/SHED/14/081)
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The Relationship between Irritable Bowel Syndrome, Depression, Anxiety, and Stress
among Sample of Irritable Bowel Patients - Predictive Study 9/9
Copyright:
©2016 Gaber
Citation: Gaber OH (2016) The Relationship between Irritable Bowel Syndrome, Depression, Anxiety, and Stress among Sample of Irritable Bowel
Patients - Predictive Study. J Psychol Clin Psychiatry 5(4): 00290. DOI: 10.15406/jpcpy.2016.05.00290
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... The causal-relationships between IBS symptoms, anxiety, and depression is unfortunately still difficult to be explained clearly. Even Elsenbruch (cited in Gaber, 2016) explained the emergence of the speculation that IBS symptoms are caused by disturbances in psychological aspects and not physiological. The authors do not know whether IBS contributes to anxiety, stress, and depression. ...
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The clinical problems and dilemmas which the busy clinician encounters on a daily basis are the main focus of this publication. Emphasizing a clinical rather than a pathophysiological approach to problems, it facilitates access and helps the practicing clinician to develop an effective and efficient diagnostic and therapeutic strategy. Nevertheless, clinically important aspects of pathophysiology are also dealt with in detail when called for. A variety of scenarios that are especially relevant to modern medical practice, such as the intensive care unit, are taken into account. A group of internationally renowned experts guides the reader through the broad variety of diagnostic options available to assist in the assessment of symptoms originating anywhere along the gastrointestinal tract, from the esophagus to the anus, and, in each instance, every effort is made to critically appraise the technology discussed. Moreover, general overviews of broadly relevant therapeutic approaches are also provided. Pediatric and adult gastroenterologists, gastrointestinal surgeons and hospitalists will find this publication to be a valuable help in their daily practice.
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