Thursday, 14 May 2015

Anxiety and depression linked to functional bowel issues: lessons for [some] autism?

Pablo Picasso (1905) @ Wikipedia
IMFAR (International Meeting For Autism Research) 2015 kicks off in earnest today (see here) so in order to keep tabs on the various discussions over the web (#IMFAR2015) alongside the usual workload I'm offering a relatively short blog entry.

The paper served up today is by Maria Ines Pinto-Sánchez and colleagues [1] who reported that: "The prevalence of both anxiety and depression is influenced by gender, presence of organic diseases, and FGIDs [functional gastrointestinal disorders], and it increases with the number of coexistent FGIDs and frequency and severity of GI [gastrointestinal] symptoms."

Based on a participant number in the thousands, outpatients completed "questionnaires evaluating FGIDs and anxiety and depression (Hospital Anxiety and Depression scale)." Responses were analysed focused on those actually meeting "Rome III criteria for FGIDs" and authors came to a few conclusions. "Compared with patients not meeting the criteria, prevalence of anxiety... or depression... was increased in patients with FGIDs." Further: "The prevalence of anxiety and depression increased in a stepwise manner with the number of co-existing FGIDs and frequency and/or severity of gastrointestinal (GI) symptoms."

It's probably not a startlingly new idea that suffering with a FGID can in itself bring about certain psychological/behavioural symptoms. The pain and discomfort that such GI issues can entail is probably a big factor in that relationship although I say that mindful that anxiety and depression are complicated states with lots of potential 'pathways' behind them. More than that however, I'm interested in how these findings might overlay with other labels in mind. Say for example, one looks at the pretty extensive research literature talking about functional bowel disorders being present and over-represented in cases of autism (see here and see here) and all that 'gut-brain' axis chatter that you see these days?

Perhaps also relevant to the autism spectrum disorders (ASDs) is the growing recognition that psychiatric comorbidity/presentation such as anxiety and depression can also be a significant 'disabling' feature for many people on the spectrum (see here and see here respectively). Put these findings together with those described by Pinto-Sánchez et al and I'm hopefully not getting too ahead of myself saying that there may be a possible connection to be had.

Indeed, the possibility of a link between bowel issues and psychological issues such as anxiety with autism in mind is something that has already cropped up in the peer-reviewed literature as per the work from Micah Mazurek and colleagues [2] previously covered on this blog (see here and see here). Without trying to simplify any relationship and again keeping in mind that there may be many reasons for the presentation of anxiety in autism [3], the idea that functional bowel issues might be a key part of anxiety for at least some on the autism spectrum, offers some potentially important lessons including about how one might be able to 'intervene' to improve both physical and psychological health. The focus being on tackling GI symptoms in cases of autism. Y'know, the kinda thing that Tim Buie et al [4] talked about quite a few years back...

Music to close: Florence + The Machine - Ship To Wreck.


[1] Pinto-Sánchez MI. et al. Anxiety and Depression Increase in a Stepwise Manner in Parallel With Multiple FGIDs and Symptom Severity and Frequency. The American Journal of Gastroenterology. 2015. May 12.

[2] Mazurek MO. et al. One-year course and predictors of abdominal pain in children with autism spectrum disorders: The role of anxiety and sensory over-responsivity. Research in Autism Spectrum Disorders. 2014; 8: 1508-1515.

[3] Weiss JA. et al. Bullying Victimization, Parenting Stress, and Anxiety among Adolescents and Young Adults with Autism Spectrum Disorder. Autism Res. 2015 May 11.

[4] Buie T. et al. Evaluation, Diagnosis, and Treatment of Gastrointestinal Disorders in Individuals With ASDs: A Consensus Report. Pediatrics. 2010; 125: S1-S18.

---------- Pinto-Sanchez, M., Ford, A., Avila, C., Verdu, E., Collins, S., Morgan, D., Moayyedi, P., & Bercik, P. (2015). Anxiety and Depression Increase in a Stepwise Manner in Parallel With Multiple FGIDs and Symptom Severity and Frequency The American Journal of Gastroenterology DOI: 10.1038/ajg.2015.128