Can abdominal symptoms be “psychological”?

Not in the sense that they are “all in your head”. Abdominal complaints are real and they show up in the body, but a dysregulated nervous system can amplify them or keep them going. This interaction is what psychogastroenterology deals with.

What is psychogastroenterology?

Psychogastroenterology sits where psychology and gastroenterology meet. It studies and treats how the brain, the nervous system and the digestive system affect each other, in other words how the so-called gut–brain axis works. Our nervous system and our digestive system really are very closely linked, but that does not mean the symptoms are imagined.

The gut–brain axis, simply put

The brain and the gut are in constant, two-way communication:

• through the nervous system (the vagus nerve, the enteric nervous system),
• through hormones,
• through the immune system,
• through the gut flora (the microbiome).

Under stress, for example, your stomach “tightens”, and diarrhoea or nausea can appear. If this system becomes oversensitive, even normal body signals can feel painful, frightening or uncontrollable to your nervous system.

Which symptoms is it relevant for?

A psychogastroenterological approach often helps with:

• irritable bowel syndrome (IBS),
• functional abdominal pain (abdominal pain without an organic cause),
• bloating and nausea,
• changes in bowel habits (diarrhoea or constipation),
• anxiety that comes with digestive complaints.

Today these are regarded as disorders of gut–brain interaction, not as “unexplained” symptoms.

What keeps the symptoms going?

Symptoms often persist because of several factors together:

• a nervous system on high alert (stress, anxiety),
• heightened attention to bodily sensations,
• fear of the symptoms (“what if…?”),
• avoidance (steering clear of certain foods or situations).

Avoidance brings relief in the short term, but in the long run it increases the sensitivity of the nervous system.

How can a psychologist help?

The aim of psychogastroenterological work is not to “force the symptoms away”, but:

• to reduce the physiological tension linked to the physical symptoms,
• to make your relationship with the symptoms more flexible,
• to improve your quality of life.

In our work together I use methods such as mindfulness, imagery, techniques based on cognitive behavioural therapy and somatic exercises. You can learn to recognise what makes your symptoms stronger and what you can do when they appear. Psychological support complements, but does not replace, gastroenterological examination and treatment: if you have not yet seen a doctor about your complaints, start there.

You will find how individual online counselling works and what it costs on the Info & prices page. If you would also like to work on this topic in a group, have a look at the Emésszük meg! women’s retreat and the online support group.

This article is general information and does not replace medical examination and treatment.