Functional bowel disorders (IBS and non-IBS)
This chapter traces the origins of psychodynamic thinking about somatic symptoms through to contemporary psychodynamic thinking about functional bowel disorders (FBDs). Current thinking about FBDs is influenced by a biopsychosocial model of gastrointestinal illness, in which psychological and social stressors reciprocally influence biological changes to gut motility and visceral sensitivity within the brain-gut axis. Early psychodynamic theories of functional somatic disorders tended to view symptoms as either the symbolic manifestation of repressed psychic content or due to chronic physiological arousal of an organ because of a struggle with repressed unconscious material. Central to psychodynamic therapies are relationships: between the patient and others; the patient, their symptoms and their emotional life; and, importantly, between patient and therapist. Compared to an equal number of 'supportive listening' sessions, psychodynamic psychotherapy led to significant improvements of both psychological and physical symptoms. Psychodynamic psychotherapy can effectively reduce abdominal pain, bowel dysfunction, depression and anxiety in different subsets of patients with irritable bowel syndrome (IBS).