Psychosocial aspects of functional gastrointestinal disorders

The functional gastrointestinal disorders (FGID) are the most common conditions seen in gastroenterology practice, and also constitute a major portion of primary care practice. Psychosocial factors play a crucial role in the FGID influencing (1) gut physiology, (2) symptom severity, (3) health care seeking, (4) illness behavior, (5) quality of life, and (6) therapeutic approach. Identification of psychologic disturbance or an abuse history and recognizing their impact on the patient's disability are critical and can lead to more effective treatment using biopsychosocial factors, as opposed merely to diagnosing the pattern of the patient's gastrointestinal symptoms. This article reviews the literature on psychosocial aspects of FGID; discusses an approach to the patient encounter (with special emphasis on taking the abuse history); and briefly summarizes both nonpharmacologic and psychopharmacologic therapies for FGID.