Q. Does stress cause inflammatory bowel disease?

In the past, it was widely believed that there was a psychological component to IBD. Older studies that showed that stress and psychological problems played a role in the development of IBD have remained unconfirmed. Although the medical community now recognizes that stress does not cause IBD, those early studies have remained in the minds of the general public. As a result, many people still believe the false IBD/stress connection.

In reality, IBD has a physical component that involves significant damage to the mucous layer (in ulcerative colitis) or the entire wall (in Crohn's disease) of the intestinal tract. It is unrealistic to accept that such extensive damage -- the formation of ulcers and granulomas -- could be caused by psychological stress.

Having made the distinction that stress or psychological problems do not cause IBD, it is important to recognize the role of stress in IBD. Having any chronic illness (such as IBD, diabetes, arthritis, or fibromyalgia) brings a significant amount of stress and pressure. No one is happy when they don't feel well, and in the case of chronic illness, people may not feel well much of the time. The symptoms are not going to abate in a few days or a week like with an acute illness such as the flu. The symptoms are going to wax and wane for the rest of the person's life, and that causes considerable physical and emotional stress.

This stress may manifest itself in a variety of ways such as irritability, depression, or panic attacks. IBD itself is causing stress, and in turn, the stress causes the psychological problems. The psychological problems then exacerbate the IBD, creating a vicious circle. The stress did not cause the IBD. It is, however, going to make IBD, or any illness, worse.

It is easy to see why early researchers hypothesized that IBD was psychosomatic: Many of the patients with IBD they saw showed signs of severe stress or other emotional or psychological problems. But those signs may have stemmed from the constant pain, diarrhea, bleeding, and social stigma that the patients endured because of their IBD.

In short, stress or emotional or psychological problems do not cause IBD. However, these problems can make IBD worse.