Anxiety and depression are prevalent for those who suffer from chronic illness. In fact, one study found that 40% of Inflammatory Bowel Disease (IBD) patients had abnormal anxiety levels and this drastically increases to 80% when the patient is in a flare-up . With chronic illness typically, there is a feeling of loss of control over your own life which can in turn cause stress, anxiety and depression.
Chicken or Egg?
I was diagnosed with IBD 9 years ago and while I have learned to (mostly) manage the symptoms of my disease over time, I have yet to master the feelings of worry and anxiety. After having a bowel resection surgery, I have been in clinical remission but not without its bumps along the way. The fear of the unknown can do a number on one’s mental health. The possibility of a flare-up always lives in the back of my mind. I can remember the countless visits to the hospital, procedures, medications, and extreme pain. I was barely able to take care of myself, and now that I have children, I worry that if I were to have a flare-up, I wouldn’t be able to take care of them or participate in their lives in a meaningful way.
I know that having a chronic illness has increased my anxiety levels, but does stress and anxiety exasperate my symptoms? Research shows that stress can worsen symptoms and cause a relapse of remission. From WebMD “When someone is under stress, the body gears up for a fight-or-flight response by secreting certain hormones, including adrenalin, as well as molecules called cytokines. They stimulate the immune system, which triggers inflammation. In people whose ulcerative colitis is in remission, this sets the stage for the return of their symptoms, known as a flare-up.” This is something I’ve experienced and heard from talking to fellow chronic illness sufferers. Lack of quality sleep and environmental stressors have often caused a revival of symptoms which can be a slippery slope to a full-on flare.
Anxiety definition (from Merriam-Webster):
\ an abnormal and overwhelming sense of apprehension and fear often marked by physical signs (such as tension, sweating, and increased pulse rate), by doubt concerning the reality and nature of the threat, and by self-doubt about one’s capacity to cope with it.
Stress definition (from Merriam-Webster):
\constraining force or influence: such a physical, chemical, or emotional factor that causes bodily or mental tension and may be a factor in disease causation
Anxiety = Fear
When speaking about Generalized Anxiety Disorder it is often associated with people who have irrational fears or worry for no reason. When talking about sufferers from chronic illness, often the anxiety is derived from perceived AND real fears. From my experience, my anxiety stems from a fear of a past trauma reoccurring. Fear of pain, a flare-up, of being out with no access to bathrooms. Fear of foods and eating, procedures, fear of damage caused by long term use of medications (i.e. Remicade can cause an increase in cancer). Fear of missing work, fear that people don’t understand, fear of drug/procedure costs and benefits coverage. This can be scary stuff and can plague your thoughts even when in remission.
From diagnosis to remission the fear still exists, it just changes in size and scope. A newly diagnosed patient can go through stages of grieving and without having the tools to manage the illness it can be very scary. Fast forward to remission, chronic illness has many layers and can be unpredictable. No matter how much you’ve done to manage your illness, there is still a possibility you can have a relapse. The feeling of helplessness can trigger depression, but on the flip-side depression can slow recovery. This begets a vicious cycle which can be hard to get under control.
Coping Physically and Mentally
Patients must cope with not just the disease itself but the mental health side effects of it. While I believe I’ve received excellent care from my Gastroenterologist, he deals with only clinical IBD symptoms so often the mental health aspect of the disease gets overlooked. It is important to bring up your emotional health to your doctor when suffering from a chronic illness despite the perceived stigma. Having that aspect under control could potentially help with physical symptoms. Anxiety and chronic illness can be a chicken and egg scenario where consideration must be given to both to have a holistic treatment plan.
Strategies for Coping With Anxiety:
Find your support: whether that be a close friend, family member, a fellow patient, or support group like Lyfebulb, knowing you aren’t in this alone makes a world of difference.
Don’t assume the worst: challenge those negative thoughts! Remember that you have survived thus far, and all those experiences make you stronger.
Try yoga, meditation, or deep-breathing: Research has shown this to be an effective complementary therapy for patients with IBD.
Seek counseling – an impartial third party can help instill coping techniques
SOURCES: [Sharma P, Poojary G, Dwivedi SN, Deepak KK. Effect of Yoga-Based Intervention in Patients with Inflammatory Bowel Disease. Int J Yoga Therap. 2015;25(1):101-12. doi: 10.17761/1531-2054-25.1.101. ]
Cannabis is an increasingly popular therapy for IBD with cannabidiol (CBD) showing promise as an anti-inflammatory and tetrahydrocannabinol (THC) as a pain reducer and sleep-aid. [Ahmed W, Katz S. Therapeutic Use of Cannabis in Inflammatory Bowel Disease. Gastroenterol Hepatol (N Y). 2016;12(11):668-679.]