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09-15-2013, 02:02 PM   #1
Ckoenig
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The link between Crohn's disease and Anxiety

My name is Christina and I was recently diagnosed with Crohn's disease. I am also a Licensed Professional Counseling final year graduate student. I am doing a 20 page research proposal on the link between Crohn's disease and anxiety. This is definitely as much personal as it is for research as I have been experienced a long time struggle with both. I had anxiety well before Crohn's disease. I think it is obvious to see why someone with a chronic illness of this nature would develop anxiety, however I believe there is more to it than that. I am here to find out if any has any good resources to share on the topic as well as share my process on this project with you, and my findings eventually.. hopefully.

Thank you,

Christina

p.s. As part of my method I would be interested in hearing from anyone who wants to share their personal experience, or link to where it is already shared.
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Dx'd with Crohn's Disease 8/29/2013 6 inches of diseased terminal illeum. As of December 2014 currently in remission!

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09-15-2013, 04:14 PM   #2
bobisacrohny
 
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Don't have any good articles but would love to see your paper in the future. The way I see it is in times of anxiety our gut reacts which should be good but in periods of extended anxiety it starts to break down. A stressed out machine usually breaks down internally. It is the part of the body that can damage itself the most because of the acids and chemical decomposition process. It also is the core of our system.
09-15-2013, 07:22 PM   #3
wildbill_52280
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yes i have anxiety, and yes before crohns but got much worse after crohn's. in general maybe related to oxidative stress? also, dysbiosis and the interaction between enteric neurons, neurotransmitter production?

many possible scientific reasons, what has your research uncovered?
09-16-2013, 10:44 AM   #4
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this article is pretty good
http://www.scribd.com/doc/98433639/G...tter-Formation
09-16-2013, 08:46 PM   #5
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My Crohn's has flared twice (once when diagnosed in 2006 and present day). Both times it was when I was under serious anxiety/stress - to a level where I had to be medicated because I couldn't cope. I have done no research, but do feel as though that the levels of stress have resulted in my diagnosis and flare. I'm confident that my anxiety was situational-based (not medical-based), as the first time it was when I was going through a divorce of an abusive husband, and this time, it was due to my teen attempting suicide.

I don't know that this helps much, but it's my experience.

Last edited by ruhereyet; 09-16-2013 at 08:46 PM. Reason: typo
09-16-2013, 11:14 PM   #6
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Here is a good article: http://www.scientificamerican.com/ar...t-second-brain
09-16-2013, 11:30 PM   #7
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Nice to know that it is not all in my head. Got diagnosed with Crohns 3 years ago, about a month after having undergone chemo for a bout of cancer. Collapsed at home with failed kidneys (and other organs following suite), and after a long night in hospital, they opted for a laporotomy. Turned out I had a banded adhesion, so they promptly resectioned me. It recured again a few weeks later, so I had a further resection. Very nasty. Unfortunately, medical people being what they are, they never bothered to spell out the implications, other than to top me up on Pentasa and azathioprine. I had no idea I potentially would be looking at a repeat in 5 years, until I started researching on the net (and found this site ... ). Anyway, as for anxiety, yes. Unfortunately for me, I was dealt the genetic double whammy, with suffering from bi polar disorder as well (and I am already taking copious amounts of medication for that too). Tempted to try cannabis to relieve the symptoms, as I have read a lot of positive reports about it, but worried I will fry my mind in the process (paranoia is not much fun. I am aware that Indica is a lot better in that respect, but judging by this countries governments attitude to this, I pretty much have to take what I can get). Anyone else in a similar situation?
09-17-2013, 01:25 AM   #8
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I know someone that lost a long time career job through downsizing because of discriminating management and got blockages, fistulas, weight loss, and etc. during the downsizing and had to have surgery because it got so bad. It all correlated with the stress. You could make a movie or write a book on the antics and injustice!
09-17-2013, 12:23 PM   #9
Ckoenig
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" IBD presents a particular challenge to relationship systems: the tolerance of ambiguity and uncertainty. Boss, Carron, and Horbal (1988) identify the ability to deal with ambiguity as the essential ingredient of successful illness coping. Imagine the challenge for an IBD patient. It is a disease of remarkable unpredictability. Symptom flare-ups strike the patient without warning, akin to Sullivan's (1953) definition of anxiety, as a veritable “blow to the head” (p. 160). Psychic gymnastic agility is required in tolerating uncertainty but remaining focused and organized enough to manage one's medication, lifestyle, and relationships. IBD presents a particular challenge to relationship systems: the tolerance of ambiguity and uncertainty. Boss, Carron, and Horbal (1988) identify the ability to deal with ambiguity as the essential ingredient of successful illness coping. Imagine the challenge for an IBD patient. It is a disease of remarkable unpredictability. Symptom flare-ups strike the patient without warning, akin to Sullivan's (1953) definition of anxiety, as a veritable “blow to the head” (p. 160). Psychic gymnastic agility is required in tolerating uncertainty but remaining focused and organized enough to manage one's medication, lifestyle, and relationships."

Gerson, M. (2002). Psychosomatics and psychoanalytic theory: The psychology of ulcerative colitis and Crohn's disease. Psychoanalytic Psychology, 19(2), 380-388. doi:10.1037/0736-9735.19.2.380

Came across this today while working on my paper and thought this line was, how shall I put it, very validating?

Thanks everyone for responding and posting. My hypothesis though still in the working stage is something along the lines of that there is a more significant link between anxiety and Crohn's disease than the obvious anxiety DUE to symptoms. I am sure we can all degree it is obvious the nature and frustrations of the illness can CERTAINLY cause anxiety, what is less obvious are the components that may be similar in both issues. So I am most interested by the situations that manifested as an anxiety disorder etc. and THEN the Crohn's came later. Sort of a chicken or the egg question? As I said still in developmental stages. Though my outline and references are DUE on Thursday, ugh!!
09-17-2013, 12:26 PM   #10
Ckoenig
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Nice to know that it is not all in my head. Got diagnosed with Crohns 3 years ago, about a month after having undergone chemo for a bout of cancer. Collapsed at home with failed kidneys (and other organs following suite), and after a long night in hospital, they opted for a laporotomy. Turned out I had a banded adhesion, so they promptly resectioned me. It recured again a few weeks later, so I had a further resection. Very nasty. Unfortunately, medical people being what they are, they never bothered to spell out the implications, other than to top me up on Pentasa and azathioprine. I had no idea I potentially would be looking at a repeat in 5 years, until I started researching on the net (and found this site ... ). Anyway, as for anxiety, yes. Unfortunately for me, I was dealt the genetic double whammy, with suffering from bi polar disorder as well (and I am already taking copious amounts of medication for that too). Tempted to try cannabis to relieve the symptoms, as I have read a lot of positive reports about it, but worried I will fry my mind in the process (paranoia is not much fun. I am aware that Indica is a lot better in that respect, but judging by this countries governments attitude to this, I pretty much have to take what I can get). Anyone else in a similar situation?
Mr. Zippy it is most certainly NOT all in your head by any means. You can take relief in that (I hope) for sure.

So I guess what is interesting to me is what is it IN our genetics that make it that so many of us do have both. Are more people on here having anxiety due to the symptoms or are there MANY who have co-occurring issues with mental health AND anxiety. I personally had anxiety and panic attacks first and now have Crohn's. My mother had SEVERE mental illness of many varieties ( you would think in the field of psychology I could label this better, but I did not know her that well, and her diagnosis etc was not something that was shared with me, so for lack of technical terms she was bat shit crazy period) and SEVERE Crohn's. I seem to have kept my mental illness at a dull roar and seem so far to be having mild/moderate Crohn's (though this is BRAND NEW that I have it at all. So look at that case study for genetics. It is very interesting and I certainly hope to know more.
09-17-2013, 12:45 PM   #11
Ckoenig
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The below excerpt makes me wonder if N0D2 has anything to do with anxiety or any specific mental health disorders... hmmm

During the last few years a significant advance has been achieved in the understanding of the pathogenesis of inflammatory bowel disease (IBD). From twin studies it was evident that there is more that 50% concordance of Crohn's disease (CD) in monozygotic twin pairs, however it is only 3.6% among dizygotic twins. These data indicate that the genetic background may be responsible for 50% of the risk or 'susceptibility' to develop CD. Obviously it is not a sufficient condition as otherwise there would be 100% concordance of disease in monozygotic twin pairs. Environmental factors as well must play an important role. This is further supported by the fact that there is only low development in genetic risk factors over ten thousands of years. In contrast, the incidence of CD and ulcerative colitis (UC) has dramatically increased in Western countries in the last 100 years. This further supports the concept of a 'Western lifestyle factor(s)' that triggers chronic intestinal inflammation in a genetically susceptible host. The proof of the concept of a genetic susceptibility was achieved in 2001 with the discovery that NOD2 is the most important susceptibility gene for CD. The function of NOD2 has been investigated in detail. NOD2 is an intracellular 'alarm button', a receptor recognizing invading bacteria that entered the mucosal wall. NOD2 mutants associated with susceptibility to CD seem to be deficient in their recognition of bacterial wall products. In a genome-wide association study a disease association was found in the autophagy-related 16-like 1 gene (ATG16L1). The ATG16L1 gene encodes a protein in the autophagosome pathway that processes intracellular bacteria. Based on these findings, CD is now discussed as an impaired and inadequate immune reaction to the gut bacteria which are a part of our environment (or perhaps 'in-vironment'). In addition to NOD2 and ATG16L1, there are more 'innate' pathways by which commensal and pathogenic bacteria can directly interact with cells of the intestinal mucosa. The 'environment concept' and the 'genetic concept' of IBD pathophysiology are converging. With the finding that most susceptibility genes for CD and UC are involved in innate immune mechanisms and the primary defense against bacteria entering the mucosa, for the first time a unifying concept of the 'genetic pathophysiology hypothesis' and the 'environment pathophysiology hypothesis' of IBD was possible. Bacteria are the link between the environment and mucosal defense system.
(Copyright © 2011 S. Karger AG, Basel.)

Rogler, G. (2011). Interaction between susceptibility and environment: examples from the digestive tract. Digestive Diseases (Basel, Switzerland), 29(2), 136-143. doi:10.1159/000323876
09-17-2013, 02:19 PM   #12
kiny
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NOD2 mutation leads to immunodeficiency, it's a receptor for bacteria and it signals ATG16L1 (ATG = autophagy) to induce autophagy. It has nohting to do with anxiety afaik.

NOD2, ATG16L1 and IL23 mutations is why people with crohn's disease are immunodeficient.

They're all involved in bacterial clearance. If they're defect you won't be able to clear bacteria the right way, which would result in non-stop inflammation and recruitment of leukocytes, because you can't get rid of the pathogen.

.

If you have an immunoCOMPETENT response, and manage to get rid of a bacteria, the inflammation dies down through controlled cell death of immune cells once their job is done. You have homeostasis.
09-17-2013, 02:21 PM   #13
wildbill_52280
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" My hypothesis though still in the working stage is something along the lines of that there is a more significant link between anxiety and Crohn's disease than the obvious anxiety DUE to symptoms.
do you mean the cognitive processing and awareness of the symptoms presence and our interpretation of the meaning/implication to our own personal individual lives as being the "cause" of anxiety? or the presences of physical symptoms regardless of how much we are aware or how we are mentally processing them on influencing an anxious state of mind?



I am sure we can all degree it is obvious the nature and frustrations of the illness can CERTAINLY cause anxiety, what is less obvious are the components that may be similar in both issues. So I am most interested by the situations that manifested as an anxiety disorder etc. and THEN the Crohn's came later. Sort of a chicken or the egg question? As I said still in developmental stages. Though my outline and references are DUE on Thursday, ugh!![/QUOTE]

so are you implying that either the cause of diseases state, or the influence of relapse is due to stress, that is unrelated to mental processing of disease state?
09-17-2013, 02:27 PM   #14
wildbill_52280
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The below excerpt makes me wonder if N0D2 has anything to do with anxiety or any specific mental health disorders... hmmm

During the last few years a significant advance has been achieved in the understanding of the pathogenesis of inflammatory bowel disease (IBD). From twin studies it was evident that there is more that 50% concordance of Crohn's disease (CD) in monozygotic twin pairs, however it is only 3.6% among dizygotic twins. These data indicate that the genetic background may be responsible for 50% of the risk or 'susceptibility' to develop CD. Obviously it is not a sufficient condition as otherwise there would be 100% concordance of disease in monozygotic twin pairs. Environmental factors as well must play an important role. This is further supported by the fact that there is only low development in genetic risk factors over ten thousands of years. In contrast, the incidence of CD and ulcerative colitis (UC) has dramatically increased in Western countries in the last 100 years. This further supports the concept of a 'Western lifestyle factor(s)' that triggers chronic intestinal inflammation in a genetically susceptible host. The proof of the concept of a genetic susceptibility was achieved in 2001 with the discovery that NOD2 is the most important susceptibility gene for CD. The function of NOD2 has been investigated in detail. NOD2 is an intracellular 'alarm button', a receptor recognizing invading bacteria that entered the mucosal wall. NOD2 mutants associated with susceptibility to CD seem to be deficient in their recognition of bacterial wall products. In a genome-wide association study a disease association was found in the autophagy-related 16-like 1 gene (ATG16L1). The ATG16L1 gene encodes a protein in the autophagosome pathway that processes intracellular bacteria. Based on these findings, CD is now discussed as an impaired and inadequate immune reaction to the gut bacteria which are a part of our environment (or perhaps 'in-vironment'). In addition to NOD2 and ATG16L1, there are more 'innate' pathways by which commensal and pathogenic bacteria can directly interact with cells of the intestinal mucosa. The 'environment concept' and the 'genetic concept' of IBD pathophysiology are converging. With the finding that most susceptibility genes for CD and UC are involved in innate immune mechanisms and the primary defense against bacteria entering the mucosa, for the first time a unifying concept of the 'genetic pathophysiology hypothesis' and the 'environment pathophysiology hypothesis' of IBD was possible. Bacteria are the link between the environment and mucosal defense system.
(Copyright © 2011 S. Karger AG, Basel.)

Rogler, G. (2011). Interaction between susceptibility and environment: examples from the digestive tract. Digestive Diseases (Basel, Switzerland), 29(2), 136-143. doi:10.1159/000323876

that's a great article!! im not sure how you came to the suspician from this that nod can predict anxiety or mental health, i didnt see any suggestion of that with the available information.

there have been dietary risks identified in crohns patients/IBD, such as, low fiber, low fruit intake, and high sugar. coudl this explain any findings or reports of anxiety preceding crohns/ibd development? is their any existing findings that linked low fiber or high sugar, or low fruit to high anxiety and mental disorders? if the evidence of this is strong, it would make the theory that simple processing of life events, or the existence of the stressfull life events themselves leading to causation of disease or worsening of disease, much less likely. if we are to try an establish some form of pure mental causation as a variable.

i personally believe it is a variable and does influences intestinal permeability, buts impact on symptoms worsening might not be that strong. there are studies that also well establish stress and intestinal permeability and a pure mental causation on biological functioning, regardless of diet or presence of any disease. but nothing about causing disease, EXCEPT a certain type of monkey that is "reported" to develop spontaneous UC when removed from its environment, not sure of all the details but you may be able to easily find it.I cant remember the kind of monkey and not sure if this is really a stress phenomenon, or the fact that they eat each others poop so much that when it is separated from its natural group, maybe researchers feed it an unnatural diet or something and thats how it develops IBD.

also, ibd patients are low in short chain fatty acids which are produced by intestinal bacteria. low sfca is characteristic of ibd, and influences mineral absorption. magnesium has a powerful role in depression symptoms.

also, magnesium is largely absorbed in the ileum, which is typically inflamed in crohns, this inflammation alone may disrupt absorption of magnesium, b12 and EFAS(like polyunsturated fatty acids omega 3 omega 6), which are also absorbed at the ileum. your brain is made of 60% fat, if you cannot absorb fat very well, something about your brain will not work properly.

id love to provide references, not alot of time, and you can search some of this stuff yourself to back up some of my claims.

Last edited by wildbill_52280; 09-17-2013 at 02:48 PM.
09-17-2013, 02:32 PM   #15
kiny
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09-17-2013, 02:36 PM   #16
mnsun
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Please see here for Neurogastroenterology Studies: http://www.crohnsforum.com/showthread.php?t=47341

Here's a a post I've typed previously:
I would just reiterate that another reason to supplement probiotics (L. Rhamnosus especially, among others) is to correct such emotional complications. The gut bacteria are increasingly being investigated for their role in behavior as well as the mind/gut connection of the vagus nerve and neurotransmitters (GABA).

Probiogenomics is shedding light on gut microbiota and behavioral/emotional states. http://www.pnas.org/content/early/2011/08/26/1102999108 --this link is specifically about L. Rhamnosus.

A poignant excerpt explains: "Importantly, L. rhamnosus (JB-1) reduced stress-induced corticosterone and anxiety- and depression-related behavior."

Here's further elaboration, though this was only a rat study (From Guts To Brains--Eating Probiotics Changes Behaviour in Mice) and it should be noted that L Rhamnosus studies have yet to be carried out on humans: http://blogs.discovermagazine.com/no...cience/?p=5235
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09-17-2013, 05:15 PM   #17
Axelfl3333
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I think stress does play a part along with diet especially in western cultures,stress was a pretty big factor with me working long hours with joe public I knew as soon as I was under major pressure it would usually kick off my backside,by the way for many years I was immune to pressure but the older you get you get tired of it and it you think on the economic woes of the last few years it hasn't,t helped.have ibd cases went up since the financial meltdown?
09-18-2013, 09:01 AM   #18
nogutsnoglory
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This is not Crohn's specific but a fascinating article by ABC news called "Anxiety In Your Head Could Come From Your Gut"

http://abcnews.go.com/m/story?id=20229136
09-19-2013, 08:22 AM   #19
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You all are on the right path and hope and wish you can make a difference in your research, term papers, and counseling Christina!

I believe bad stress and/or anxiety with a combination of bad chemicals in our foods causes our internal vital chemical factory to malfunction from our nervous system overloading the circuits which in turn causes IBD.

Our harmonic human biological system needs to be in balance to run efficiently just like man made mechanical machines do too.
God bless!!!

Can anyone relate???
09-19-2013, 11:24 AM   #20
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Even though this video below isn't about IBD I think there is a correlation that may be of interest: http://www.youtube.com/watch?v=lGglw8eAikY
10-02-2013, 02:40 AM   #21
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I had a quarterlife crisis when I turned 25. Went from being an emotional robot to highly highly volatile. Anxiety attacks, not knowing what was happening in my head. A month into it, I had fully activated my Crohns. Had been symptom free for a good while beforehand. Stress is toxic as hell.
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10-23-2013, 07:21 AM   #22
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Poor you Manimation!!! If it weren't Crohns, you certainly have given a very good description of someone with bipolar hitting a psychotic phase
10-23-2013, 08:25 AM   #23
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I was only officially diagnosed a couple days ago now, but I have had anxiety issues for the most part of my life. I was diagnosed with Anxiety with agoraphobia and emetophobia during my early high school years.

High School was terrible, I developed extreme Agoraphobia which absolutely ruled my life to the point where I would go running out of classrooms that might have had only 8 people in them maximum. I went to a school with 1800 students, and come assembly time I had to find methods of not going one way or another, unless I was able to get a seat right by an open door. Any other seat in that huge hall sent me into a blind panic if there wasn't a clear cut path to an exit point for me to get to. Even a schoolbag lying on the floor between me and my exit terrified me.
I had it under control for around 6 months after I graduated from high school, until I started getting sick again and having actual medical investigations. Then it went crazy again. Every room I walked into, whether it be the library, a shop, the doctors office, or even a friends house, I checked for all my exit points, as well as a place to vomit if need be, not sure why I do that one though.
Let me tell you, October 5th, I went on my first Plane trip, the flight was only an hour long but oh my goodness, it took all my control (and prescription meds) to the point where I was concentrating so hard on breathing and staying seated that I couldn't move, hear, speak or see anything including my bf sitting right beside me. Apparently me and a steel cage 33.5 thousand feet in the air don't do well, funny that since it goes against all my coping mechanisms of being able to get out when I need to.

I also developed emetophobia several years ago, but I kinda had to get over that one, I still struggle with it a lot every day, but it's not like I have much of a choice to not vomit now and again due to the nausea. Though one bout of anxiety due to one phobia will very often trigger the other and it all goes downhill (or down-cliff, might be a more accurate description) from there.
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10-28-2013, 01:34 PM   #24
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Hi Christina, I just happened to notice this thread.

I've known for several years that stress is my major trigger for flares (I have Ulcerative Colitis, not Crohn's). My mother-in-law passing away last year triggered the worst flare I've had in many years.

I would say I am an anxious person (small a), but have never been formally diagnoised with an anxiety disorder, though I have considering seeking professional help for dealing with my anxiety.

I was first diagnosed with UC about 10 years ago, but my GI and I suspect that I've actually had it for a long time, maybe several decades prior to that (I am almost 55). I would love to hear more about your work in the future.
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