【Health Lecture】Gastrointestinal discomfort is actually caused by anxiety

Recently, we received a patient like this in the outpatient clinic. Aunt Wang, who was in her 60s, had repeated gastrointestinal discomfort, dry heaving every morning, frequent bloating, indigestion, frequent and unformed bowel movements. Aunt Wang went to the gastroenterology department repeatedly for treatment. All the necessary tests were done, but the cause could not be found. There was no improvement after taking medicine. She even worried that she had an incurable disease. She was immersed in the vicious cycle of tension and worry and gastrointestinal discomfort all day long and could not extricate herself.

An experienced gastroenterologist recommended Aunt Wang to see a psychiatric clinic. After a detailed interview with the doctor, Aunt Wang admitted that she often felt lonely because her children were not around. She had been easily irritable in the past two years and often got upset and angry over trivial matters. She also had trouble sleeping. After a mental examination and systematic mental and psychological evaluation, Aunt Wang was diagnosed with anxiety disorder. Under the guidance of the doctor, she began systematic anti-anxiety treatment. After 6 weeks of treatment, Aunt Wang's mood improved, she was no longer upset, and her gastrointestinal discomfort symptoms miraculously improved.

The group of symptoms mentioned above, such as Aunt Wang's, are called "somatization symptoms" in medicine. In layman's terms, there are various discomfort symptoms, but no organic abnormalities can be found in the examination. It is characterized by a mental disorder with a variety of frequently changing physical discomfort as the main complaint. The symptoms may involve various systems and organs of the body. The most common are cardiovascular system symptoms such as palpitations, chest tightness, respiratory distress, and even a sense of impending death. Digestive system symptoms include gastrointestinal discomfort, such as loss of appetite, hiccups, belching, nausea, and a feeling of gas moving in the abdomen. Urinary system symptoms include frequent urination and urgency. Some people also experience abnormal sensations, such as itchy skin, burning sensation, tingling, numbness, headache, chest and back pain, and other unexplained pains.

Somatic symptoms often do not exist independently, but often coexist with mood disorders, especially in the elderly. Unlike adults, anxiety and depression in the elderly often manifest as somatic symptoms, and depression is often masked by other physical discomfort symptoms. Many elderly patients with mood disorders often visit departments related to somatic symptoms rather than psychiatric specialists, so depression in the elderly is easily missed. As the problem of population aging in my country becomes more and more serious, the anxiety and depression disorders of elderly patients with physical diseases are becoming more and more serious. According to statistics, the incidence of depression in my country has been increasing year by year in recent years, and the anxiety and depression rate of elderly patients with physical diseases is as high as 20%~50%.

Why do anxiety and depression in the elderly often manifest as somatic symptoms? It is generally believed that this may be related to cultural background, personality, childhood experiences, and the strengthening of autonomic nervous system symptoms associated with anxiety and depression. If the elderly encounter mental stimulation, they often do not talk about it, but subconsciously express their reactions to the mental stimulation in the form of physical discomfort. For example, negative life events as mental stimulation will lead to increased cortisol levels in the brain. Elevated cortisol can activate the activity of tryptophan pyrrolidase in the liver, promote tryptophan degradation, and lead to insufficient secretion of a neurotransmitter called 5-hydroxytryptamine (5-HT). 5-HT is a neurotransmitter closely related to emotional regulation. 5-HT deficiency can cause anxiety, depression and other symptoms. Therefore, changes in emotions will be reflected in the body, which will lead to various physical discomforts.

Anxiety and depression in the elderly are often difficult to identify. Low mood, loss of interest and pleasure, and fatigue are usually considered the most typical symptoms of depression. Anxiety and depression in the elderly often manifest as somatic symptoms. Therefore, if elderly friends have unexplained physical discomfort and no cause can be found after various examinations, it is recommended to screen for emotional disorders. Early identification of emotional disorders in the elderly can significantly improve their quality of life and reduce the burden of disease.

About the Author:

Chen Min is the attending physician of the Department of Geriatrics at Beijing Longfu Hospital and a member of the Popular Science and Health Education Working Committee of the Chinese Medical Education Association. He has been engaged in clinical diagnosis and treatment of psychiatry for more than 10 years.