Irritable Bowel Syndrome and the Shame of It

Review by Prof. Humphrey O'Connor (Ireland)

Study Summary 

Bowel Disorders of Gut-Brain Interaction (DGBIs), particularly Irritable Bowel Syndrome (IBS), cause difficult symptoms often accompanied by mental health problems, poor quality of life (QOL), and stigma. What may be underestimated in our current concept of DGBIs is the impact of the painful emotion of shame on patient-reported outcomes. Apparently, published research on shame in DGBIs is nonexistent. In a novel study from Sweden, patients with bowel DGBIs (n,537; 70.2% female) and a matched sample without bowel symptoms (n,1881; 60.3% female) completed an online survey to analyze the role of shame in the association between bowel symptom severity and psychosocial outcomes. The patient group had significantly higher levels of shame than the comparative sample and shame acted both as a mediator and an amplifier of the association between bowel symptoms and increased anxiety, depressive symptoms, lower QOL, and increased activity impairment. Within the DGBI group, the most severe symptoms overall, the highest levels of shame, and the most pronounced reductions in QOL and activity impairment were seen in the IBS subgroup. Higher levels of shame were also associated with the female sex. 

Commentary 

These results suggest the severity and stigma of bowel symptoms can trigger heightened feelings of shame which in turn lead to psychological distress and poor QOL in patients with bowel DGBIs, particularly those with IBS. In fairness, the authors acknowledge theirs is a cross-sectional study and a causal relationship cannot therefore be inferred. For individual patients, stigma and shame can also induce unhealthy concealment, social anxiety, delayed diagnosis, and poor treatment compliance. A genuine, kind, non-judgmental, and compassionate approach by clinicians is the perfect antidote to stigma and shame, and the Swedish study shows just how necessary that is. Where possible, an integrated care model is ideal with a gastrointestinal psychologist in clinic where patients, if necessary, can avail compassion-based interventions or acceptance and commitment therapy. We need to be more aware of stigma and shame.

Citation

Trindade IA, Blomsten A, Nybacka S, et al. Implications of shame for patient-reported outcomes in bowel disorders of gut-brain interaction. Gastroenterology 2026;170:353-364.

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